How often does computed tomography change the management of acute appendicitis?

Computed tomography (CT) diagnoses appendicitis accurately, but few studies evaluate how often CT changes the management of appendicitis. Consultations for appendicitis were evaluated by surgeons and assigned to groups: high, indeterminate, and low suspicion. After assignment, CT was reviewed if completed or ordered if desired by the surgeon and changes in plans were noted. One hundred patients were evaluated for appendicitis, 70 received appendectomy. Our negative appendectomy rate was 4 of 70 (5.7%). In the high suspicion group, 63 patients had 23 CT scans performed and 2 CT scans were negative, avoiding unnecessary operation and changing management in 2 of 63 (3.2%). The intermediate suspicion group included 27 patients and 26 CT scans performed; 11 were positive resulting in nine positive appendectomies and changing management in 9 of 27 (33%). The low suspicion group had 7 CT scans performed; two were positive leading to two positive appendectomies and changing management in 2 of 10 (20%). CT promoted 10 of 100 patients to the interval appendectomy pathway with no failures in delayed operative management. CT rarely changes management in patients highly suspicious for appendicitis, but may have a role in selecting patients for interval appendectomy. CT frequently changes management if the clinical diagnosis is indeterminate.

Teaching beliefs of medical educators: perspectives on clinical teaching in pediatrics.

BACKGROUND: Most who teach in clinical settings see themselves primarily as clinicians or physicians responsible for patient care and only secondarily as educators. The education literature suggests that teaching predominantly operates at a tacit level, where teachers rely on core beliefs to guide their practice, and actually spend little time in reflective practice. Given the lack of research on how medical educators in clinical settings view their teaching, the purpose of this qualitative study was to explore the teaching beliefs of faculty in a pediatrics department in a college of medicine. METHODS: Using a Teaching Perspectives Inventory, observations and in-depth interviews, a complex picture was revealed about teaching beliefs of medical educators. RESULTS: Due to contextual constraints of the clinical setting (e.g., time, competing stakeholders) that requires primary attention to patient care, they describe 'teaching on the fly'. There is a strong emphasis on: delivering content; encouraging thinking among students; providing questioning and engaging learning experiences; and respecting students as learners. CONCLUSIONS: The implications of these beliefs are significant and indicate that faculty can benefit from opportunities that make their beliefs about teaching more conscious, particularly in determining how best to prepare future physicians to teach in clinical settings.

The quality of surgical resident interpretation of after-hour CT scans of the head and abdomen in trauma.

Computed tomography (CT) is an important diagnostic tool in the evaluation of trauma patients. Accurate interpretation of CT scans remains critical in decision-making and the resultant quality of care. In our study, the records of a consecutive cohort of trauma patients who underwent after-hour CT scans of the head and abdomen between January 23 and June 30, 2004, at Kern Medical Center were reviewed. Three hundred thirty-five CT studies were collected in 211 patients. The accuracy of resident interpretation was 92.8 per cent for abdominal and 97.5 per cent for head CT. Resident readings were 93.2 per cent sensitive and 95.4 per cent specific with a positive predictive value of 85.2 per cent and a negative predictive value of 98.0 per cent. There were 16 (4.8%) instances of interpretation discrepancy between the surgical resident and attending radiologist. Most differences occurred in the evaluation of abdominal CT. In no instance was management or outcome for these patients affected. This data demonstrates a low error rate in resident interpretation of after-hour CT scans of the head and abdomen in trauma, but there remains a need for the continued review of the quality of surgical resident radiologic interpretation in situations when an attending radiologist is not immediately available.

Teaching laboratory rodent research techniques under the tenets of situated learning improves student confidence and promotes collaboration.

A targeted needs assessment at our institution revealed that the online system used to train researchers on performing techniques with animals did not provide opportunities to practice skills, introduce learners to animal care staff, nor satisfactorily support researchers' needs to become comfortable with laboratory animal species. To correct these deficiencies, a series of hands-on training sessions, framed theoretically in situated learning, was developed. This theoretical framework asserts that learning for everyday living (in this case, performing laboratory animal techniques) happens when people interact within the community while using the 'tools at hand' (that is, the instruments and jargon of the field). From this perspective, the students work alongside the instructor as apprentices. The instructor creates increasingly challenging learning opportunities as students work toward independently performing techniques. To test our hypothesis that teaching from this perspective improves comfort levels with laboratory animals and promotes collaborative relationships between animal care and research personnel, a mixed-method design involving online surveys (first survey, n = 45; second survey, n = 35) and semistructured interviews (n = 10) was used. Quantitative results revealed that students became more comfortable with laboratory animals and were more likely to contact animal care personnel due to participating in the training program. The qualitative arm of the study identified specific features of the training program that improved comfort levels for students (seeing then doing, working in small groups, learning within a comfortable environment, and building collegial relationships). These results support teaching rodent research techniques from the practical and theoretical approach of situated learning.

The essential value of projects in faculty development.

Projects--planned activities with specific goals and outcomes--have been used in faculty development programs to enhance participant learning and development. Projects have been employed most extensively in programs designed to develop faculty as educators. The authors review the literature and report the results of their 2008 study of the impact of projects within the Pennsylvania State University College of Medicine Junior Faculty Development Program, a comprehensive faculty development program. Using a mixed-methods approach, the products of project work, the academic productivity of program graduates, and the impact of projects on career development were analyzed. Faculty who achieved the most progress on their projects reported the highest number of academic products related to their project and the highest number of overall academic achievements. Faculty perceived that their project had three major effects on their professional development: production of a tangible outcome, development of a career focus, and development of relationships with mentors and peers. On the basis of these findings and a review of the literature, the authors conclude that projects are an essential element of a faculty development program. Projects provide a foundation for future academic success by enabling junior faculty to develop and hone knowledge and skills, identify a career focus and gain recognition within their community, generate scholarship, allocate time to academic work, and establish supportive relationships and collaborative networks. A list of best practices to successfully incorporate projects within faculty development programs is provided.