Persisting autoimmune heparin-induced thrombocytopenia after elective abdominal aortic aneurysm repair: a case report.

Persisting heparin-induced thrombocytopenia (HIT) is characterized by ongoing thrombocytopenia more than 7 days after stopping heparin. It is part of cases referred to as autoimmune HIT (aHIT). In contrast to typical HIT cases, aHIT involves heparin-independent platelet activation mechanism highlighted by a strongly positive functional assay done without heparin. We report the first case of persisting HIT after an elective abdominal aortic aneurysm repair presenting with arterial and venous thrombosis, and describe the potential role of intravenous immunoglobulin in such patients.

Break out of the Classroom: The Use of Escape Rooms as an Alternative Teaching Strategy in Surgical Education.

OBJECTIVE: To implement and assess the impact of a Vascular Surgery-themed Escape Room on medical student motivation, satisfaction, and engagement in CanMEDS roles. DESIGN: The authors designed an Escape Room combining Vascular Surgery objectives, knowledge-based problems and technical skills into Vascular Surgery-themed stations. Groups of 3 to 4 medical students participated in the activity. Data collected included time to escape, CanMEDS roles covered during the activity, debriefing interview session, and satisfaction survey. SETTING: The Escape Room was installed at the University of Ottawa Skills and Simulation Centre at the Ottawa Hospital, a tertiary care center. PARTICIPANTS: Medical students in their preclerkship years of study were invited to participate in the Escape Room. In total, 13 medical students completed the experience, divided into 4 groups. RESULTS: Thirteen medical students divided into 4 groups participated in the Escape Room. Two teams used a collaborative strategy to complete the activity and successfully escaped with an average time of 53.6 minutes, whereas only 1 of the 2 teams completing the experience employing an individualistic strategy successfully escaped. Following the experience, 83% of participants stated that the experience motivated them to prepare beforehand and believed that the experience consolidated the knowledge that they had read. All the participants also reported that the experience encouraged the use of the CanMEDS communicator and collaborator roles. As well, 76.9% of students mentioned that they enjoyed the practical exercises incorporated into the experience and 53.8% stated that they would like to see the Escape Room format included in the medical curriculum. CONCLUSIONS: By combining knowledge-based problems, key learning objectives, technical skills, and CanMEDS themes into the Escape Room, the authors have developed a learning platform that may be more enjoyable and provide an adjunct to traditional didactic lectures.