Measuring service-specific performance and educational value within a general surgery residency: the power of a prospective, anonymous, Web-based rotation evaluation system in the optimization of resident satisfaction.

BACKGROUND: We used a Web-based evaluation system to institute specific changes to various clinical teaching services in our integrated residency in an effort to optimize the overall quality of the educational experience and measured the resident satisfaction in these rotations. METHODS: Residents rated 8 categories of experience on a scale of 1 to 5 (maximum summation score, 40 points). Data were analyzed by t-test for equality of means. A probability value of less than.05 was considered significant. RESULTS: Compliance with completion of the evaluations was 100%. The Chronbach's alpha reliability coefficient of the tool was 0.826. Tukey's estimate of power to achieve additivity was 1.5. Six under-performing services were re-engineered with prominent effects on 7 postgraduate year (PGY) rotations. On 2 general surgery services at 1 hospital, the workload was redistributed, and a dedicated team teaching time was instituted (PGY-3 [a]: before, 22 points/after, 31 points; P =.003; PGY-3 [b]: before, 25 points/after, 31 points; P =.004; PGY-1: before, 24 points/after, 29 points; P =.07). A general surgery service at another hospital redistributed coverage of the attending surgeons to create a nonteaching service (PGY-1: before, 22 points/-after, 27 points; P =.01). The transplantation service (PGY-3) was examined, and the role of the point was redefined (before, 24 points/after, 31 points; P =.01). One vascular service (PGY-2) redistributed cases and workload (before, 27 points/after, 22 points; P =.07). The vascular PGY-2 position was eliminated and replaced by a mid-level practitioner. The cardiothoracic service (PGY-1) rotation was converted into a preceptorship (before, 23 points/after, 30 points; P =.015). CONCLUSIONS: A web-based clinical rotation evaluation provides a means for the assessment of the impact of programmatic changes while preserving resident anonymity and maintaining accountability.

Beyond requirements: residency management through the Internet.

HYPOTHESIS: An Internet application could collect information to satisfy documentation required by the Residency Review Committee. Beyond replacing a difficult and inefficient paper system, it would collect, process, and distribute information to administration, faculty, and residents. DESIGN: Descriptive study. SETTING: An integrated residency of 18 services at a university teaching hospital with 4 affiliated institutions. PARTICIPANTS: Residency administrators, faculty, and residents. INTERVENTIONS: The application included a procedure recorder, resident evaluation of faculty and rotations, goals and objectives (stratified by service and resident level), and matching faculty evaluation of residents with these goals as competencies. Policies, schedules, research opportunities, clinical site information, and curriculum support were created. MAIN OUTCOME MEASURES: Degree of compliance with Residency Review Committee standards, number of deficiencies corrected, and quantity and quality of information available to administration, faculty, and residents. RESULTS: The Internet system increased resident compliance for faculty and rotation evaluations from 20% and 34%, respectively, to 100%, which was maintained for 22 months. These evaluations can be displayed individually, in summary grids, and as postgraduate year-specific averages. Faculty evaluations of residents can be reviewed throughout the system. The defined category report for procedures, which had deficiencies in the preceding 6 years, had none for the last 2 years. The Internet application provides Accreditation Council for Graduate Medical Education-validated operative logs to regulatory agencies. CONCLUSIONS: A Web-based system can satisfy requirements and provide processed data that are of better quality and more complete than our paper system. We are now able to use scarce time and personnel to nurture developing surgical residents instead of shuffling paper.

[Characteristics of the secretory activity of the respiratory cells of mouse lungs after partial chemical sympathectomy]. / Osobennosti sekretornoi aktivnosti kletok respiratornogo otdela legkikh myshei posle chastichnoi "khimicheskoi simpatéktomii".

Partial "sympathectomy" in the neonatal BALB mice was achieved by the treatment with guanethidine. The number of neurons in the stellate ganglion decreased to 20% of the control values and remained constant throughout the subsequent period of 1 month. Partial "chemical sympathectomy" did not affect the postnatal growth and development of the lungs. Partial "chemical sympathectomy" significantly increased the number of secreting cells in bronchiolar and alveolar regions. Secretory activity of the alveolocyte population, type two, synthetizing and secreting surfactant also increased. It has been concluded that the partial "chemical sympathectomy" stimulated the alveolar surfactant secretion.

[Respiratory portion of the lungs of intact BALB strain mice]. / Respiratornyi otdel legkikh intaktnykh myshei linii BALB.

Four male mice (1-month-old) of BALB strain have been studied. Three types of cells participate in formation of cellular lining of the terminal branchioles: ciliated, Clara cells and villose cells which are included in the neuroepithelial bodies composition. Clara cells are numerous and they are similar in their ultrastructural organization, they contain a great number of polymorphous secretory granules, single mitochondria and a poorly developed endoplasmic reticulum. A comparatively large number of pores of Khone are revealed: there are 4-8 pores per one alveole, and one pore is situated on 197.4 mcm2 of the alveolar surface. Alveolocytes of the second type of make the main actively secreting cell population of the alveolar passages and alveoles. Simultaneously, at the state of secretion there are 76% of the cells. The secretion of alveolar surfactant is realized by means of merocrine exocytosis. Relative volumetric fraction of mitochondria in alveolocytes of the II type comprises 12% and that of "cytophospholiposomes" (osmiophilic laminar bodies)--11%.