"Fighting an uphill battle": A mixed methods exploration of surgeon involvement in medical schools' preclinical curricula.

BACKGROUND: Limited exposure to surgeons early on in medical school may adversely impact students' clerkship experiences and professional development. This explanatory sequential mixed methods study investigates a perceived discrepancy between surgical and nonsurgical instructors in our institution's preclinical curriculum. METHODS: The demographics of preclinical faculty were assessed before and after a curricular reform. Semi-structured interviews with 13 surgical faculty explored barriers and facilitators to surgeon involvement. Responses were inductively coded and thematically analyzed. RESULTS: Surgeons' contributions to preclinical instruction fell from 10% to 5% across the curriculum reform. Barriers both leading to and reinforced by surgeons' limited involvement relate to surgeon, medical school, and student factors. Participants proposed three solutions to barriers in each domain. CONCLUSIONS: Surgeons provide a minority of our preclinical instruction and may be disproportionately impacted by reform efforts. Deliberate efforts are necessary to increase opportunities for surgeons to engage with preclinical medical students.

Influence of knee positions and gender on the Ober test for length of the iliotibial band.

OBJECTIVE: Examine the influence of knee positions and gender on the Ober test for the length of the iliotibial band. DESIGN: A cross-sectional comparative repeated measures design. BACKGROUND: The Ober test is in widespread use, yet the influence of knee positions and gender on the test has not been reported. Such information is needed to help clarify test results. METHODS: The Ober test was administered with the knee flexed to 90 degrees and extended to 0 degrees to the right lower limb of 26 women and 23 men. The limb was lowered from abduction and the end point of hip abduction (positive angle) or hip adduction (negative angle) was measured in relation to neutral. RESULTS: The hip adduction movement was restricted more with the knee flexed than with the knee extended for both genders (P<0.009). With the knee flexed the mean hip abduction angle was less for men (+4 degrees) than for women (+6 degrees) (P<0.001), and with the knee extended the mean hip adduction angle was greater for men (-9 degrees) than for women (-4 degrees) (P<0.001). CONCLUSIONS: The Ober test with the knee flexed limited hip adduction more than with the knee extended for both men and women, and women had greater limitations than men. RELEVANCE: The Ober test with the knee flexed and with the knee extended yielded different results and may be considered different tests. Normal Ober test values for the two knee positions should be defined separately for men and women in order to understand how deviations from normal are related to pathologies.