Roland Folse

Adenoma weight: A predictor of transient hypocalcemia after parathyroidectomy

To evaluate the relationship of parathyroid adenoma weight to perioperative serum calcium levels, 51 selected patients with pathologically confirmed single adenomas and minimal biopsy at operation were reviewed. Three age- and sex-matched groups were established according to adenoma weight. Compared with Group 1 patients who had adenomas of less than 1 g, Group 3 patients with adenomas of more than 2 g demonstrated significantly higher preoperative serum parathyroid hormone and calcium levels, and significantly lower preoperative serum phosphate levels. Multiple regression analysis revealed a strong correlation between adenoma weight to preoperative parathyroid hormone and calcium levels (r = 0.63, p less than 0.001). These results suggest that larger adenomas may be associated with a more severe form of primary hyperparathyroidism. The incidence of transient postoperative hypocalcemia in the 51 patients who underwent adenoma excision was 37 percent. Permanent hypoparathyroidism did not develop in any of them. Compared with Group 1 patients, Group 3 patients demonstrated a higher incidence of postoperative transient hypocalcemia (69 percent versus 14 percent in Group 1, p less than 0.001) and significantly lower mean serum calcium levels on the third and fourth postoperative days. Increased adenoma weight may be a valuable aid in identifying those patients at risk for transient hypocalcemia after neck exploration.

An evaluation of study habits of third-year medical students in a surgical clerkship

BACKGROUND This study was developed to assess study habits of medical students in a third-year surgical clerkship and to determine the relationship of these study habits to performance outcomes. METHODS A questionnaire designed to assess medical student study habits was administered at the end of five consecutive 10-week multidisciplinary surgical clerkships. The results of questionnaires from 81 students were analyzed in respect to results on the National Board of Medical Education (NBME) surgical subtest and the multiple stations clinical examination (MSCE) given at the end of each clerkship. RESULTS Although only 18 of the total 81 students reported studying in formal but self-directed groups, students who reported studying in a group on average scored 4 points higher on the MSCE than those who did not study in a group (P = 0.001). However, no significant differences or correlations were discovered between any of the study habits and the individual results on the NBME. CONCLUSION Students may benefit from collaborative studying when it comes to clinical experience as demonstrated by improved performance on the MSCE.

The learning needs of first-year surgical residents in the intensive care unit

BACKGROUND Residents are more likely to learn from educational experiences when properly prepared from the start of instruction and expectations are clear and consistent. The purpose of this study was to examine what first year residents need to know and be able to perform before starting their rotation in the intensive care unit (ICU). METHODS The sample included surgical faculty, first through fifth year general surgery residents, and ICU nurses. A survey was developed that listed 110 knowledge and skill items felt to be possible prerequisite learning objectives. Respondents were asked to evaluate the required level of knowledge or skill on a 5-point Likert-type scale. RESULTS Items were divided into knowledge or skill categories and then ranked in descending order by their mean ratings. Four knowledge and 10 skill items were ranked highly by all 3 groups of respondents. Kruskall-Wallis analyses found 58 items with statistically significant differences in mean ratings between groups of respondents. CONCLUSION With this information a self assessment tool was developed to determine the level of performance on these identified learning objectives. A course of instruction can now be developed to assist residents in meeting these objectives before they assume patient care responsibilities in the ICU.

The Effect of Feedback on Students’ Abilities to Write Daily Progress Notes

Previous research has shown that the majority of medical schools do not formally teach medical writing, including writing of progress notes. The purpose of this research was to determine the impact consistently provided objective feedback has on enhancing the quality of student notes. A static group‐comparison design was used to determine the quality of progress notes written by students who received structured written feedback versus those given traditional feedback. Twenty patient names were selected from students’ logbooks from both groups, totaling 40 patient charts. Progress notes were blindly reviewed by 1 faculty member, using a checklist instrument, which was studied for evidence of reliability and validity. Results showed a statistically significant (p = .05) difference between the groups’ abilities to write assessment and plan portions of a progress note, but no differences were noted on student abilities to document subjective data. Findings suggest some students often have an inability to inte...

The preoperative liver scan and surgical decision-making in patients with colorectal cancer

The influence of preoperative liver scans and liver function tests on surgical decision-making was analyzed in 196 patients who underwent surgical therapy for colorectal cancer. One hundred and thirteen patients who had preoperative liver scans were compared with 83 patients who did not. No statistically significant difference existed between the liver scan group and the nonscan group in terms of when surgical decision-making occurred. Likewise, the results of the liver scan did not influence when operative decisions were made. The majority of decision-making occurred intraoperatively when ultimate confirmation of the presence or absence of hepatic metastases was made. Presumptive surgical decisions were made preoperatively, but final decisions occurred intraoperatively when all relevant patient data could be correlated. Liver scanning has limited usefulness in the preoperative evaluation of patients with colon cancer as it does not affect decision-making and is much more costly than liver function testing.

The Way We Teach Information-Seeking Skills

A problem-based approach has been introduced as part of a surgery clerkship, to teach medical students information-seeking skills.Students are given an assignment before an information search seminar, to work independently to resolve one of two patient problems and in the process record each step of their information seeking. Students answer questions about the patients management on a card before the seminar. During the seminar the students report their competence on using medical information sources and are able to assess their own efficacy in comparison to an expert information seeker. Students have responded favourably to the seminars.

Correlates of honor ratings in a clinical clerkship employing a faculty forum evaluation system

5he purpose of this study was to determine whether or not suspected variables affected a surgery clerks chances of being awarded an honor rating. Findings indicated a significant relationship between a student receiving an honor rating and his or her preceptors predetermined level of student advocacy, the number of completed patient interview and physical examination write-ups, and final examination scores. There was no significant relationship found between honor ratings and the preceptors status, the sequence in which the student was discussed or the length of time spent discussing the student at the final evaluation meeting, or the number of clinical faculty present at the meeting. These results lend support to the faculty forum evaluation approach, but suggest a need for further scrutiny of some influencing variables to ensure all students are fairly considered and honor ratings judiciously awarded.