Under the knife: medical student perceptions of intimidation and mistreatment.

BACKGROUND: The progression from classroom to clinical setting can be a difficult transition for medical students. Experience in the operating room is anticipated as one of the most challenging environments for a novel medical learner. We sought to identify common concerns before exposure in this learning environment and examine the experience of final-year medical students on their surgical clerkship rotation in an effort to identify areas where improvements can be made. METHODS: A 20-question survey was developed after a focus group met to identify potential issues that medical students encounter during their surgical clerkship. Personal and anecdotal experiences guided the development of the survey. It was distributed to final-year medical students and recent graduates (350 individuals) using SurveyMonkey. A quality improvement ethics application was completed before the commencement of the survey, as were participant consent forms. Responses were grouped and common themes were identified in the experiences reported by 2 investigators. RESULTS: A total of 72 individuals responded to the survey, providing a 21% response rate. Subjects were asked how confident they were in their understanding of what was expected during a surgical rotation. Of them, 52 (72%) responded that they were "unsure" or "very unsure," whereas only 12 and 3 felt "somewhat confident" and "very confident," respectively. Most of the learners felt nervous (96%) and feared appearing incompetent (89%). Common concerns included insufficient knowledge and technical skill, anticipated negative experiences, and feelings of uncertainty regarding medical student expectations. CONCLUSION: We present common themes stemming from medical student experiences during their surgical clerkship. We comment on perception of intimidation and abuse, the rationalization behind such behavior, and perceived lack of guidance. The intention of this analysis was to identify weaknesses in our surgical training so that a quality improvement plan can be implemented.

The epidemiological profile of the Vascular Birthmark Clinic at the Alberta Children's Hospital.

BACKGROUND: The Vascular Birthmark (VBM) Clinic at the Alberta Children's Hospital (Calgary, Alberta) is a multidisciplinary clinic dedicated to the evaluation of children with vascular anomalies. OBJECTIVE: To review the characteristics of patients seen at the VBM Clinic. METHOD: A retrospective data analysis of all pediatric patients presenting to the VBM Clinic between 1998 and 2009 was performed. Data including demographic, referring, diagnostic and treatment information were obtained from the clinic's database. RESULTS: Of 932 patients, 621 with hemangiomas and 311 patients with vascular malformations were found in the database. Hemangiomas were more commonly found in girls (68.5%), and most commonly located on the head and neck (54%), with most patients (72.6%) having only one lesion. Of the patients with hemangiomas, 14.7% underwent diagnostic imaging investigation and 23.7% received treatment including medications, surgery, pulsed-dye laser or dressings. The sex distribution among the 311 patients with vascular malformations was almost equal. Venous malformations accounted for 38.9% of patients, isolated capillary malformations for 31.5%, lymphatic malformations for 11.6%, mixed low-flow malformations for 14.8% and arteriovenous malformations for 2.9%. Overall, 37.9% of patients underwent diagnostic imaging investigation and 42.4% received treatment - either pulsed-dye laser, surgical excision, sclerotherapy or other treatment. CONCLUSIONS: Hemangiomas and vascular malformations can occur at any anatomical site. There is a large variation in clinical presentation necessitating expertise in a variety of diagnostic approaches and treatment modalities. Vascular anomalies are best managed in a multidisciplinary setting.

HISTORIQUE: La clinique des angiomes de l'Alberta Children's Hospital de Calgary, en Alberta, est une clinique multidisciplinaire vouée à l'évaluation des enfants ayant des anomalies vasculaires. OBJECTIF: Analyser les caractéristiques des patients vus à la clinique des angiomes. MÉTHODOLOGIE: Les auteurs ont procédé à une analyse rétrospective des données de tous les patients pédiatriques qui ont consulté à la clinique des angiomes entre 1998 et 2009. Ils ont obtenu des renseignements sur la démographie, l'aiguillage, le diagnostic et le traitement dans la base de données de la clinique. RÉSULTATS: Des 932 patients, 621 ayant des hémangiomes et 311, des malformations vasculaires, faisaient partie de la base de données. Les hémangiomes s'observaient surtout chez les filles (68,5 %), sur la tête et dans le cou (54 %), et la plupart des patients (72,6 %) n'avaient qu'une lésion. Chez les patients présentant des hémangiomes, 14,7 % ont subi une exploration d'imagerie diagnostique et 23,7 % ont subi un traitement, y compris des médicaments, une opération, le laser à colorant pulsé ou des pansements. La distribution selon le sexe chez les 311 patients ayant des malformations vasculaires était presque égale. On observait des malformations veineuses chez 38,9 % des patients, des malformations capillaires isolées chez 31,5 % des patients, des malformations lymphatiques chez 11,6 % d'entre eux, des malformations mixtes à bas débit chez 14,8 % des patients et des malformations artérioveineuses, chez 2,9 % d'entre eux. Dans l'ensemble, 37,9 % des patients ont subi une exploration d'imagerie diagnostique et 42,4 % ont été traités par laser à colorant pulsé, excision chirurgicale, sclérothérapie ou un autre traitement. CONCLUSIONS: Des hémangiomes et des malformations vasculaires peuvent se manifester à n'importe quel foyer anatomique. On observe une vaste variation des présentations cliniques, qui exige des compétences à l'égard de diverses approches diagnostiques et modalités thérapeutiques. Les anomalies vasculaires sont mieux prises en charge en milieu multidisciplinaire.

The opportunities and obstacles in developing a vascular birthmark database for clinical and research use.

INTRODUCTION: Databases are useful tools in clinical settings. The authors review the benefits and challenges associated with the development and implementation of an efficient electronic database for the multidisciplinary Vascular Birthmark Clinic at the Alberta Children's Hospital, Calgary, Alberta. METHODS: The content and structure of the database were designed using the technical expertise of a data analyst from the Calgary Health Region. Relevant clinical and demographic data fields were included with the goal of documenting ongoing care of individual patients, and facilitating future epidemiological studies of this patient population. After completion of this database, 10 challenges encountered during development were retrospectively identified. Practical solutions for these challenges are presented. RESULTS: THE CHALLENGES IDENTIFIED DURING THE DATABASE DEVELOPMENT PROCESS INCLUDED: identification of relevant data fields; balancing simplicity and user-friendliness with complexity and comprehensive data storage; database expertise versus clinical expertise; software platform selection; linkage of data from the previous spreadsheet to a new data management system; ethics approval for the development of the database and its utilization for research studies; ensuring privacy and limited access to the database; integration of digital photographs into the database; adoption of the database by support staff in the clinic; and maintaining up-to-date entries in the database. CONCLUSIONS: There are several challenges involved in the development of a useful and efficient clinical database. Awareness of these potential obstacles, in advance, may simplify the development of clinical databases by others in various surgical settings.