Hand It to Dr Google: The Quality of Online Information on Ganglion Cysts.

Background: The internet is becoming a common source of health information for hand surgery patients. This study evaluates the quality of web-based resources on ganglion cysts of the hand. Methods: We completed a search for "ganglion cyst" on 3 search engines (Google, Dogpile, and Yippy). The quality of the top-100 patient education websites was assessed using a validated internet rating tool. Websites were evaluated based on affiliation, accountability, currency, interactivity, website organization, readability, coverage, and accuracy. Results: Of the 100 websites, the majority (74%) had commercial affiliations. Only 34% of websites identified an author, and even fewer identified the authors' credentials (27%) or affiliations (26%). A third of the websites cited references, and less than half provided an update date. The average readability based on Flesch-Kincaid grade level was 9.2, and only 3% could be read at or below 6th grade reading level. Prevention was the most poorly covered topic at 13% due to omission. In all, 66% of the websites were completely accurate in terms of global accuracy. Websites were most likely to present inaccurate information on treatment, often failing to mention conservative treatment (watch-and-wait approach) or promoting the use of natural health products. We also found 5% of websites presented closed rupture of the ganglion cyst as a legitimate home remedy. Conclusions: The overall quality of online information on ganglion cysts is highly variable and may occasionally be harmful for patients. It is increasingly important for physicians to prompt patients about their internet use.

The Teacher-Learner Contract (TLC): An Objectives-Based Checklist for Surgical Shadowing.

OBJECTIVE: A lack of structure and communication in physician shadowing experiences may prevent medical students from accruing its potential benefits. In this study, we evaluated the use of an objectives-based surgical shadowing teacher-learner contract (TLC) on the outcomes of shadowing experiences. DESIGN: Cross-sectional study with 30 unique student-surgeon pairs who participated in a 1-time shadowing experience between December 2016 and May 2017. SETTING: Eight hospitals and clinics in Metro Vancouver, British Columbia, Canada. PARTICIPANTS: A convenience sample of preclinical medical students attending University of British Columbia and local surgeons from a variety of specialties were recruited by email. A random sample of 30 students was selected from a pool of interested students. RESULTS: Twenty-eight students and 18 surgeons completed the study. In general, students and surgeons reported that the TLC focused learning and improved communication between teachers and learners. Students also commented that using the TLC prompted them to reflect on their goals and consider how the shadowing experience might contribute to their overall medical education. Both students and surgeons found benefit in using the checklist (mean 3.5 ± 0.75 and mean 3.8 ± 1.1, respectively, where 1 was not useful and 5 was very useful). All participants rated the TLC as easy to use (mean 1.429 ± 1.271 and mean 1.333 ± 0.686, respectively, where 1 was not difficult and 5 was very difficult), and 80% of respondents said they would use the tool again. Participants who benefited the most were students with limited surgical shadowing experience and surgeons with less experience teaching preclerkship students. CONCLUSIONS: This study demonstrates that an objectives-based learning contract like the TLC can facilitate meaningful shadowing experiences for teachers and learners and may have longitudinal educational benefits. However, widespread implementation will require institutional support of this concept.

Evidence-based Sterility: The Evolving Role of Field Sterility in Skin and Minor Hand Surgery.

Field sterility is commonly used for skin and minor hand surgery performed in the ambulatory setting. Surgical site infection (SSI) rates are similar for these same procedures when performed in the main operating room (OR). In this paper, we aim to look at both current evidence and common sense logic supporting the use of some of the techniques and apparel designed to prevent SSI. This is a literature review of the evidence behind the ability of gloves, masks, gowns, drapes, head covers, footwear, and ventilation systems to prevent SSIs. We used MEDLINE, EMBASE, and PubMed and included literature from the inception of each database up to March 2019. We could not find substantial evidence to support the use of main OR sterility practices such as head covers, gowns, full patient draping, laminar airflow, and footwear to reduce SSIs in skin and minor hand surgery. Field sterility in ambulatory minor procedure rooms outside the main OR is appropriate for most skin and minor hand surgery procedures. SSIs in these procedures are easily treatable with minimal patient morbidity and do not justify the cost and waste associated with the use of main OR sterility.