RESUMEN
Patient expectations before cubital tunnel release (CuTR), a common procedure that leads to incomplete symptom resolution for many patients, are unclear. Study purposes included (1) describing preoperative patient expectations, and (2) identifying factors affecting expectations. Methods: Included patients underwent isolated unilateral CuTR between 2015 and 2021 at a single tertiary academic medical center. Expectations regarding the level of symptomatic improvement were queried preoperatively. Univariate and multivariable binary logistic regression was performed to determine factors associated with expecting great improvement. Results: Of the 92 included patients, 43 (47%) patients expected great improvement, whereas 27 (29%), four (4%), and five patients (5%) expected some, little, and no improvement, respectively. The remainder (14%) had no expectations. Multivariable modeling demonstrated that retired or unemployed/disabled work status, and commercial insurance status (versus Medicare or Medicaid) were associated with lower expectations independent of the surgeon, surgical technique, revision versus primary CuTR, preoperative atrophy or constant numbness, diabetes, and all studied demographic factors, including social deprivation. Conclusions: Roughly half of the patients expect great relief, and a third expect lesser degrees of relief, following CuTR. Preoperative expectations are significantly higher in patients with Medicaid and Medicare insurance, representing an opportunity for education, given the association between public insurance payer status and worse health outcomes in general. Age, BMI, preoperative atrophy and/or numbness, and the presence of medical comorbidities do not influence expectations but have been shown to yield worse outcomes or influence need for revision CuTR, representing an opportunity for intervention to align patient and surgeon expectations.
RESUMEN
CONTEXT: Many medical students and practicing physicians view biochemistry, especially its metabolic pathways, as a challenging topic given the depth of material. Medical biochemistry educators aim to help prepare future physicians to apply knowledge of metabolism to disease processes. Research confirms that study tools promote critical thinking and help to connect biochemistry concepts to health and disease processes. OBJECTIVES: To explore whether the Pathways of Human Metabolism Map as a study tool helps to connect basic metabolic pathways to clinical applications. METHODS: We provided the Pathways of Human Metabolism Map to our first-year osteopathic medical students and conducted a survey to assess their perceptions. Our survey questions aimed to explore the effectiveness of utilizing the metabolic map for connecting the basic metabolic pathways to clinical applications on their studies. Students were surveyed at the end of the course utilizing a Qualtrics survey encompassing Likert scale questions as well as open-ended responses. RESULTS: The results of our comprehensive survey questions revealed the unique perceptions of students. Analysis of our data implicates that study tools like the metabolic map inspire meaningful learning. CONCLUSIONS: Our data show that students who utilized the metabolic map in their studies reported that utilizing the map improved their understanding of medical biochemistry. Our research results suggest that providing study aids like the metabolic map encourages students to minimize rote memorization and promotes integration with clinical context. Our results provide a support for study strategies that implement meaningful learning in medical education.
