Internship Preparatory Clinical Course: A Timed-Station Approach to Bridging the Theory-to-Practice Gap.

BACKGROUND: Medical students' transition to internship has a discernible gap in structured preparation, particularly in practical skill application. We introduced the internship preparatory clinical course (IPCC) to address this gap.  Methods: The course was conducted at the clinical skills and simulation center at King Saud University Medical City and included a total of eight skills distributed across four stations. It employs a timed-station methodology, inspired by the Observed Structured Clinical Examination, but innovatively adapted as a teaching method. Participants were exposed to various stations, such as suturing techniques, interactive mannequins for anatomical structure demonstration, real ultrasound machines on simulated patients, IV cannulation, and urinary catheterization. To facilitate active learning, participants received course materials a day prior, equipped with QR codes for quick reference. Instructors emphasized on-the-spot review, fostering an environment where learners actively engage. Toward the end of the course, after internship a follow-up survey was administered to obtain feedback, achieving a response rate of 83% (n=45/54). RESULTS: Feedback from the course was overwhelmingly positive, with 91.1% (n=41/45) rating the course as 7 and above out of 10. Participants expressed a higher degree of confidence in providing wound care (Median: 8, IQR: 2) and inserting or removing a Foley catheter (Median: 8, IQR: 4). Lower confidence was observed in stoma examination and care (Median: 5, IQR: 4). During their internships, participants reported that 100% (n=45/45) utilized suturing skills, 48.9% (n=22/45) performed focused assessment with sonography in trauma (FAST) examinations, and 62.2% (n=28/45) attempted nasogastric tube insertions. Additionally, 88.9% (n=40/45) performed wound examinations, 77.8% (n=35/45) provided wound care and dressing, 37.8% (n=17/45) performed abscess drainage, 51.1% (n=23/45) removed and 37.8% (n=17/45) inserted a Foley catheter, and 20% (n=9/45) provided stoma care. CONCLUSION: The IPCC effectively addresses the existing gap in medical education, bridging the theory-to-practice divide. The innovative use of the timed-station approach emphasizes the importance of active learning. Our results signify the importance of simulation training, as most interns acknowledge the positive impact of the course on their internship. We recommend preparing pre-interns for internships by giving special consideration to the procedural aspects as most associated with medical errors. The timed-station approach can improve cost-effectiveness and enhance responsibility-driven learning.

Penetrating Neck Injury: Double Jeopardy of a Complex Aerodigestive Dilemma.

The neck is a critical region containing many essential structures. Before surgical intervention, it is crucial to assess the adequacy of the airway and circulation, as well as the presence of any skeletal or neurological damage. Here, we present a case of a 33-year-old male with a background of amphetamine abuse who presented to our emergency department with a penetrating neck injury just below the mandible at the hypopharynx level, resulting in an upper zone II neck injury with complete separation of the airway. The patient was taken immediately to the operating room for exploration. Airways were managed by direct intubation, hemostasis was maintained, and the open laryngeal injury was repaired. After the surgery, this patient was transferred to the intensive care unit for two days and discharged after a satisfactory full recovery. Penetrating neck injuries are rare but often fatal. Advanced trauma life support guidelines emphasize the importance of managing the airway as the first action. Providing multidisciplinary care before, during, and after trauma can help prevent and treat such incidents.

An Emergency Adaptation of Anterolateral and Clamshell Thoracotomy for Blunt Traumatic Right Atrial Rupture: A Case Report.

The high mortality rate of blunt cardiac injuries is primarily due to the condition's severity and the challenges associated with pre-hospital survival. The absence of definitive diagnostic modalities necessitates prompt and adaptable surgical intervention. We present an 18-year-old male who sustained a right atrial blunt traumatic cardiac rupture following a motor vehicle collision. Despite initial stabilization with blood products and vasopressors and the necessitated emergent surgical exploration, the case required various surgical techniques, including anterolateral followed by an extension to a clamshell thoracotomy and laparotomy to manage the complex cardiac rupture and associated injuries. Furthermore, it underscores the critical nature of surgical incision in such patients and its impact on the overall prognosis. The successful outcome, highlighted by intraoperative decision-making and proper postoperative care, demonstrates that with timely and adaptable surgical approaches, even the most severe cases of traumatic blunt cardiac ruptures can be managed effectively.

Impact of Osteoporosis in Postmenopausal Women With Primary Knee Osteoarthritis.

BACKGROUND: Although knee osteoarthritis (OA) and osteoporosis (OP) are common age-related bone disorders, the association between the two conditions remains indefinable. The aim of the present study is to investigate a possible relationship between the two conditions in post-menopausal women. METHODOLOGY: A cross-sectional study was conducted at King Khalid University Hospital, Riyadh, Saudi Arabia, after obtaining IRB approval. The study included all post-menopausal female patients above 50 years of age, who underwent dual-energy X-ray absorptiometry (DXA) scans between January 2019 and July 2021 and have clear radiological data regarding knee OA. For our study, 487 ladies satisfied our inclusion criteria with an age range of 50-94 years (mean 64.67 ±8.4). The severity of knee OA was determined according to the Kellgren and Lawrence (KL) grading system. RESULTS: The mean age and weight of all patients showed a significant association with knee OA. There was no significant association between bone quality and all parameters of bone mineral density (BMD) and T-score with the presence of knee OA. The mean age, height, weight, and BMI have a significant relationship with OP. Grade 3 of the KL classification system for knee OA is the only grade that showed a significant relationship with the presence of OP. The status of bone quality, BMD, and T-score parameters have no significant relationship with the severity subgrouping of knee OA. The BMD and the T-score of the right femoral neck have a significant correlation with BMI, which is linked to the presence of knee OA. CONCLUSION: We didn't find a clear relationship between OP or BMD and the presence of knee OA. However, our findings demonstrated that BMD, T-score of the right femoral neck, and BMI can all be utilized as predictors for the development and progression of knee OA. We recommend considering the many potential confounding variations when describing a relationship between OP and OA.

Surgical outcomes and stoma-related complications in inflammatory bowel disease in Saudi Arabia: a retrospective study.

BACKGROUND: The prevalence of inflammatory bowel diseases (IBD), Crohn's (C) and ulcerative colitis (UC) has increased in Saudi Arabia during the past decade. Even though medical treatment is first-line therapy, most patients require surgery during the course of the disease. Stoma creation complications in IBD are underreported in the literature of the Middle East and especially in Saudi Arabia. OBJECTIVES: Report the postoperative, stoma and peristomal complications following stoma creation in (C) versus UC. DESIGN: Retrospective cohort study. SETTINGS: Tertiary care center. PATIENTS AND METHODS: Patients with IBD who underwent stoma creation for either UC or CD between August 2015 and July 2020 were included. The diseases were compared to assess their characteristics and association to postoperative, stoma and peristomal complications. All complications were reported over a 90-day duration from the surgery. Patients younger than 14 years of age were excluded. MAIN OUTCOME MEASURES: Postoperative complications, stoma and peristomal complications in IBD patients who underwent stoma creation. SAMPLE SIZE: 50. RESULTS: Of 50 IBD patients underwent stoma creation, 32 patients (64%) were diagnosed with CD and 18 patients (36%) with UC. Most of the procedures in both groups were laparoscopic and elective. Low BMI and serum albumin were more prevalent in the CD group. Postoperative complications were higher in the CD patients compared to the UC patients (CD 40.6% vs UC 11.1%, P=.028) with the most common complication being abdominal collection[a]. Stoma complications were comparable between the two groups (UC 16.7% vs CD 15.6%). However, peristomal complications were higher clinically in UC patients in comparison with the CD patients (UC 61.1% vs CD 37.5% P=.095) with the most common complication being skin excoriation (UC 44.4% vs CD 37.5%). CONCLUSIONS: CD has significantly higher postoperative complications compared to UC. Peristomal complications were high in both groups and had a negative impact on quality of life. Therefore, comprehensive stoma education and regular outpatient follow ups are recommended to improve the overall outcomes. LIMITATIONS: Retrospective and conducted in one academic institution with a small sample size.