Qualities of a Teacher: A Trainee's Perspective.

OBJECTIVE: To determine the qualities of a good medical teacher from a trainee's perspective, to evaluate the best teaching method, and to explore the association of specialty and level of training with teaching methods and qualities of a medical teacher. METHODS: The questionnaire-based cross-sectional survey was conducted in two tertiary care teaching hospitals in Lahore, Pakistan, from July 2019 to December 2020, and comprised all house officers and postgraduate residents. Data was collected using a self-administered questionnaire that had three sections: demographics, best method of teaching, and the characteristics of a good medical teacher. Data was analysed using SPSS 20. RESULTS: Of the 135 subjects, 56(41.5%) were males; 79(58.5%) were females; 76(56%) were junior trainees; and 77(57%) belonged to surgical specialties. The overall mean age was 27.6±2.4 years. Best teaching method identified by the trainees was 'asking of problem-based questions' 46(33.6%). Good communication skills 61(44.5%), and calm and non-humiliating demeanour 61(44.5%) were the most frequently identified qualities. More surgical trainees considered the generation of competition among learners as the best teaching method than the trainees from other specialties (p=0.001). House officers reported 'unbiased' (p=0.001) and 'moral and ethical' (p=0.001) significantly more frequently as a good trait in their teachers compared to the residents. CONCLUSIONS: The most important qualities in a medial teacher, as identified by the learners, were good communication skills and calm and polite attitude.

Does prior percutaneous endoscopic gastrostomy alter post-operative outcome after esophagectomy.

BACKGROUND: With the introduction of neoadjuvant chemoradiotherapy in patients with esophageal carcinoma, nutritional access has become essential to counter deleterious effects of dysphagia. Current NCCN guidelines do not recommend PEG prior to esophagectomy in these patients, but there is little evidence for this recommendation. The objective of this study was to compare outcomes in patients who underwent esophagectomy with or without prior PEG placement. METHODS: We retrospectively reviewed 96 patients who underwent esophagectomy between 2005 and 2012 for esophageal carcinoma. Patients were divided into two groups; Group I (PEG +ve) and Group II (PEG -ve). Patient characteristics, operative variables, and post-operative complications were compared. χ (2) and Fisher's test were used for categorical, while t test was used for interval variables. RESULTS: Median age was 51(18-70) years. Lower thoracic tumors were more common in Group I (69 vs. 63 %) (P = 0.04) and more patients underwent minimally invasive surgery in this group (50 vs. 2.6 %) (P < 0.0001). Mean blood loss (326 vs. 465 ml) (P = 0.02) and ICU stay (1.6 vs. 4.3 days) (P = 0.01) were significantly lower in Group I. There was no 30-day mortality in Group I versus 10.5 % in Group II (P = 0.01). No significant difference in anastomotic leak and stricture rate was observed. Gastric conduit was used in all patients for reconstruction. One patient had malignancy in PEG site biopsy. CONCLUSION: Percutaneous endoscopic gastrostomy before esophagectomy is safe and does not adversely impact post-operative outcomes.

Minimally invasive esophagectomy for esophageal cancer: the first experience from Pakistan.

BACKGROUND: Two common procedures for esophageal resection are Ivor Lewis esophagectomy and transhiatal esophagectomy. Both procedures have high morbidity rates of 20-46%. Minimally invasive esophagectomy has been introduced to decrease morbidity. We report initial experience of MIE to determine the morbidity and mortality associated with this procedure during learning phase. MATERIAL AND METHODS: Patients undergoing MIE at our institute from January 2011 to May 2013 were reviewed. Record was kept for any morbidity and mortality. Descriptive statistics were presented as frequencies and continuous variables were presented as median. Survival analysis was performed using Kaplan Meier curves. RESULTS: We performed 51 minimally invasive esophagectomies. Perioperative morbidity was in 16 (31.37%) patients. There were 3 (5.88%) anastomotic leaks. We encountered 1 respiratory complication. Reexploration was required in 3 (5.88%) patients. Median operative time was 375 minutes. Median hospital stay was 10 days. The most frequent long-term morbidity was anastomotic narrowing observed in 5 (9.88%) patients. There were no perioperative mortalities. Our mean overall survival was 37.66 months (95% confidence interval 33.75 to 41.56 months). Mean disease-free survival was 24.43 months (95% CI 21.26 to 27.60 months). CONCLUSION: Minimally invasive esophagectomy, when performed in the learning phase, has acceptable morbidity and mortality.

Complete pathological response after neoadjuvant treatment in locally advanced esophageal cancer predicts long term survival: a retrospective cohort study.

BACKGROUND AND OBJECTIVES: Esophageal cancer incidence is gradually increasing worldwide. Studies have looked at the pathological stage rather than clinical stage as predictor of survival. We looked at patients with complete pathological response to compare their survival outcomes to those who had residual disease after neoadjuvant treatment. MATERIALS AND METHODS: All patients with esophageal cancer who underwent neoadjuvant treatment followed by resection at our institute were retrospectively reviewed. Overall survival and disease free survival were calculated for patients with complete pathological response and compared to those with residual disease using log rank test. RESULTS: Mean age of our patients was 51.08 years with standard deviation of 10.17 years. 39% belong to stage IIa while 5% belong to Stage IIb. 56% were Stage III. Final histopathological stage was recorded and both disease free and overall survival were calculated. 45% of our patients had complete pathological response. Patients with complete pathological response had mean survival of 62.73 months ± 17.02 compared to 41.42 months for patients who had residual disease. 5 year disease free survival was 58%. CONCLUSION: Complete Pathological response significantly improves overall and disease free survival. It is also the predictor of long term survival.