Does Self-Assessment Improve the Effectiveness of Grand Rounds Lectures in a Community-Based Teaching Hospital?

OBJECTIVE: To determine whether use of self-assessment (SA) questions affects the effectiveness of weekly didactic grand rounds presentations. DESIGN: From 26 consecutive grand rounds presentations from August 2013 to April 2014, a 52-question multiple-choice test was administered based on 2 questions from each presentation. SETTING: Community teaching institution. PARTICIPANTS: General surgery residents, students, and attending physicians. RESULTS: The test was administered to 66 participants. The mean score was 41.8%. There was no difference in test score based on experience with similar scores for junior residents, senior residents, and attending surgeons (43%, 46%, and 44%; p = 0.13). Most participants felt they would be most interested in presentations directly related to their surgical specialty. Participants, however, did not score differently on topics which were the focus of the program (40% vs. 42%; p = 0.85). Journal club presentations (39% vs. others 42%; p = 0.33) also did not affect the score. The Pearson correlation coefficient for attendance was 0.49 (p < 0.0001) demonstrated that attendance was very important. Participation in the weekly SA was significantly associated with improved score as those who participated in SA scored over 20% higher than those who did not (59% vs. 38%; p < 0.0001). Based on multiple linear regression for mean score, SA explained the variation in score more than attendance. CONCLUSIONS: The current study found that without preparation approximately 40% of material presented is retained after 10 months. Participation in weekly SA significantly improved retention of information from grand rounds presentations.

Prevalence and risk factors for development of delirium in burn intensive care unit patients.

Delirium affects 60 to 80% of ventilated patients and is associated with worse clinical outcomes including death. Unfortunately, there are limited data regarding the prevalence and risk factors of delirium in critically ill burn patients. The objectives of this study were to evaluate the prevalence of delirium in ventilated burn patients, using validated instruments, and to identify its risk factors. Adult ventilated burn patients at two tertiary centers were prospectively evaluated for delirium using the Confusion Assessment Method in the Intensive Care Unit (CAM-ICU) for 30 days or until intensive care unit discharge. Patients with neurologic injuries, severe dementia, and those not expected to survive >24 hours were excluded. Markov logistic regression was used to identify the risk factors of delirium, adjusting for clinically relevant covariates. The 82 ventilated burn patients had a median (interquartile range) age of 48 (38-62) years, Acute Physiology and Chronic Health Evaluation II scores 27 (21-30), and percent burns of 20 (7-32). Prevalence of delirium was 77% with a median duration of 3 (1-6) days. Exposure to benzodiazepines was an independent risk factor for the development of delirium (odds ratio: 6.8 [confidence interval: 3.1-15], P < .001), whereas exposure to both intravenous opiates (0.5 [0.4-0.6], P < .001) and methadone (0.7 [0.5-0.9], P = .02) was associated with a lower risk of delirium. In conclusion, delirium occurred at least once in approximately 80% of ventilated burn patients. Exposure to benzodiazepines was an independent risk factor for delirium, whereas opiates and methadone reduced the risk of developing delirium, possibly through reduction of pain in these patients.

Arthroscopic proficiency: a survey of orthopaedic sports medicine fellowship directors and orthopaedic surgery department chairs.

PURPOSE: The goal of this study was to evaluate the opinion of sports medicine fellowship directors and orthopaedic surgery department chairpersons on how many repetitions the average resident needs to become proficient in several common arthroscopic procedures. TYPE OF STUDY: A cross-sectional study. METHODS: A questionnaire was mailed to all fellowship directors on a list maintained by the American Academy of Orthopaedic Surgeons and to all department chairpersons on a list maintained by the American Medical Association. Respondents were asked to estimate the number of operations needed for a trainee to reach minimal proficiency (able to perform procedure skin-to-skin with supervision) and proficiency (capable of performing procedure without supervision) for 5 common arthroscopic procedures: diagnostic knee scope, partial medial meniscectomy, anterior cruciate ligament (ACL) reconstruction, diagnostic shoulder scope, and subacromial decompression. RESULTS: A total of 164 of 230 (71%) people responded to the questionnaire. Department chairpersons who did not perform arthroscopy consistently estimated two thirds the number of operations that department chairpersons who did perform arthroscopy and nearly half the number of operations estimated by fellowship directors. Chairpersons who did perform arthroscopy had responses more similar to fellowship directors than to department heads who did not perform arthroscopy. CONCLUSIONS: These results indicate that, in the opinion of physicians involved in the education of residents and fellows, it may take a substantial number of repetitions to become proficient in arthroscopy. Physicians who perform little or no arthroscopy themselves may underestimate its difficulty. Interestingly, there was substantial variability in the number of repetitions estimated to achieve proficiency in all procedures. The results of this study may be helpful in designing arthroscopic training programs for orthopaedic residents or sports medicine fellows; however, the wide variability in opinions may indicate difficulty in reaching a consensus.