RESUMEN
BACKGROUND: Medical education is evolving to emphasize trainee engagement. The impact of a flipped classroom curriculum and surgical simulation on dermatology resident education has not been evaluated. OBJECTIVE: To assess the impact of video education and surgical simulation on dermatology resident procedural skills. METHODS: We created a curriculum on foundational surgical skills for 31 first- and second-year dermatology residents at 3 institutions. The flipped classroom approach replaces traditional in-person lectures with at-home viewing of instructional videos. After this self-directed learning, trainees had 3 hands-on sessions using simulated skin models. The Objective Structured Assessment of Technical Skills (OSATS) instrument was used to assess residents performing a simulated elliptical excision with intermediate repair before and after the curriculum. Residents completed precurriculum and postcurriculum surveys evaluating operative confidence and perceived value of the curriculum. RESULTS: Residents' total OSATS score increased from a median of 27 (interquartile range, 22-38.5) before the curriculum to 46 (interquartile range, 39.5-51.5) after the curriculum (P < .001). Self-reported confidence in surgical performance significantly improved, and residents were highly satisfied. LIMITATIONS: Limitations include the small sample size and potential influence from concurrent learning on surgical rotations. CONCLUSIONS: Video education and simulation are effective for improving dermatology residents' procedural skills. We hope to serve as a template for other institutions and nondermatology trainees hoping to improve procedural skills.
Asunto(s)
Competencia Clínica , Curriculum , Procedimientos Quirúrgicos Dermatologicos/educación , Entrenamiento Simulado/métodos , Adulto , Educación de Postgrado en Medicina/métodos , Femenino , Humanos , Masculino , Estudios Prospectivos , Estadísticas no Paramétricas , Estados Unidos , Grabación en VideoAsunto(s)
Porocarcinoma Ecrino , Neoplasias Cutáneas , Neoplasias de las Glándulas Sudoríparas , Humanos , Porocarcinoma Ecrino/cirugía , Piel/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/cirugía , Neoplasias Cutáneas/patología , Neoplasias de las Glándulas Sudoríparas/cirugía , Neoplasias de las Glándulas Sudoríparas/patología , Masculino , Anciano de 80 o más AñosAsunto(s)
Procedimientos Quirúrgicos Dermatologicos/efectos adversos , Extremidad Inferior/cirugía , Cirugía de Mohs/efectos adversos , Infección de la Herida Quirúrgica/epidemiología , Técnicas de Cierre de Heridas/efectos adversos , Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Enterobacter/aislamiento & purificación , Escherichia coli/aislamiento & purificación , Humanos , Extremidad Inferior/microbiología , Cirugía de Mohs/estadística & datos numéricos , Proteus/aislamiento & purificación , Pseudomonas/aislamiento & purificación , Estudios Retrospectivos , Factores de Riesgo , Piel/microbiología , Staphylococcus aureus/aislamiento & purificación , Infección de la Herida Quirúrgica/microbiología , Técnicas de Cierre de Heridas/estadística & datos numéricosRESUMEN
INTRODUCTION: 'Syndromic hypermobility' encompasses heritable connective tissue disorders such as hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders which are characterised by excessive joint range of motion and pain. Conservative interventions such as exercise are the cornerstone of management, yet their effectiveness is unclear. AIM: To systematically appraise the effectiveness of conservative management for people with syndromic hypermobility. METHOD: A systematic online database search was conducted (AMED, BND, CINAHL Plus, MEDLINE, PEDro, PsychINFO and SportDiscus). Potential articles were assessed for eligibility by two researchers against the following criteria: adults and children with a hEDS/HSD diagnosis (or equivalent diagnosis using specific criteria); non-pharmacological or non-surgical interventions; outcomes related to pain, physical function, psychological well-being or quality of life. Controlled trials and cohort studies were included. Critical Appraisal Skills Programme checklists were used to assess methodological quality. RESULTS: Eleven studies were included, comprising eight controlled trials and three cohort studies. All studies investigated interventions that had exercise as the primary component. Three small controlled studies demonstrated superior effects of conservative management relative to a control group. However, those studies only focused on a single area of the body, only recruited women, and had no long-term follow-up. All studies reported improvements in a wide range of outcomes over time. CONCLUSION: Controlled trial evidence for the superiority of conservative management over comparators is weak. There is some evidence that people improve over time. Robust randomised controlled trial research of the long-term effectiveness of 'whole-body' (rather than individual joints or body areas) conservative management is required. Key Points ⢠Conservative management is the cornerstone of management of syndromic hypermobility. ⢠The review found that evidence for the effectiveness of conservative management relative to no treatment or other conservative comparators was weak. ⢠However, there was consistent evidence for effectiveness from pre- to post-treatment. ⢠Further robust randomised controlled trial evidence is required.
Asunto(s)
Síndrome de Ehlers-Danlos , Calidad de Vida , Adulto , Niño , Síndrome de Ehlers-Danlos/terapia , Ejercicio Físico , Femenino , Humanos , Rango del Movimiento ArticularAsunto(s)
Dermatomiositis/diagnóstico , Dermatomiositis/tratamiento farmacológico , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biopsia con Aguja , Diagnóstico Diferencial , Quimioterapia Combinada , Femenino , Dermatosis de la Mano/diagnóstico , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Inmunohistoquímica , Lupus Eritematoso Cutáneo/diagnóstico , Pronóstico , Psoriasis/diagnóstico , Medición de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Ulcerative necrobiosis lipoidica (UNL) is an uncommon disease, which is frequently recalcitrant to available therapies. It is characterized by well-defined, ulcerated plaques with indurated borders and atrophic centers. Multiple therapeutic options have been described, with variable success rates. OBJECTIVE: To report the efficacy of using topical tacrolimus in treating UNL. METHOD: Topical tacrolimus was used in the treatment of two patients with UNL. RESULT: Topical tacrolimus is effective in treating UNL. CONCLUSION: Topical tacrolimus is a reasonably effective choice in treating UNL.