A technical skills elective program for pre-clerkship medical students reduces levels of high anxiety for performing technical skills.

BACKGROUND: We investigated the effect of a simulation-based technical skills course on rates of high anxiety reported by pre-clerkship medical students for basic and advanced technical skills. METHODS: Twenty-two second year medical students reported levels of anxiety by electronic survey for 21 technical skills before and after the course. A peer group of 75 students were invited to complete the survey for comparison. RESULTS: We received 21 (95.5%) responses before and after the course, and 12 (57.1%) in a three-month follow-up. Rates of high anxiety ranged from 19 to 86% across skills before the course and 0-48% afterward. There was no statistically significant difference in high anxiety reported in a three-month follow-up survey. The rates of high anxiety reported were reduced across all skills for course participants compared to the responding peer group of 32 (42.7%), reaching a statistically significant difference for 15/21 skills (P < 0.05). CONCLUSIONS: Participation in this technical skills course was associated with decreased reports of high anxiety by pre-clerkship medical students regarding the performance of basic and advanced technical skills.

Correction: Endoscopic Removal of Migrated Intrauterine Device: Case Report and Review of Literature and Technique.

[This corrects the article DOI: 10.14309/crj.0000000000000090.].

Endoscopic Removal of Migrated Intrauterine Device: Case Report and Review of Literature and Technique.

Intrauterine devices (IUDs) are commonly used contraceptive methods. Uterine perforation and device migration are rare but have been/are previously described as adverse events. Migration of the perforated IUD into the bowel is rare and generally requires surgical removal. We describe the endoscopic removal of an IUD embedded in the rectal wall in an otherwise healthy patient. Extraction of the IUD was uncomplicated, well tolerated, and followed by same-day hospital discharge. No prophylactic hemostasis or antimicrobial coverage was needed. We also present a comprehensive review of the reported endoscopic IUD removal. We recommend close investigation and follow-up when pregnancy or other potential signs of IUD migration occur. Endoscopic removal appears to be a safe and cost-effective technique for the extraction of IUDs that migrate into the bowel lumen.

Outcomes following Autologous Fat Grafting for Oncologic Head and Neck Reconstruction.

BACKGROUND: The aims of this study were to examine the surgical, oncologic, and aesthetic outcomes of patients undergoing autologous fat grafting for oncologic head and neck reconstruction. METHODS: A review was performed of 119 consecutive patients undergoing autologous fat grafting for oncologic head and neck reconstruction from 2005 to 2014. Aesthetic outcomes were rated by a group of 10 plastic surgeons and 10 laypersons using a five-point Likert scale. RESULTS: A total of 190 fat grafting procedures were performed in 116 patients. Of these, 69 percent had received radiation therapy before their reconstructive surgery. The average number of treatments per patient was 1.6 ± 1 (range, 1 to 6), with a mean injection volume of 24.8 ± 20.2 ml. The mean follow-up time from the first fat grafting procedure was 35.8 ± 23.1 months. Complications occurred in 6 percent, none of which required a return to the operating room or hospital admission. Oncologic recurrence was observed in six patients (three local, one regional, and two distant). Locoregional recurrences were in areas outside of where the fat was grafted. Aesthetic analysis revealed that both plastic surgeons and laypersons thought patients appeared closer to normal following autologous fat grafting. CONCLUSION: This study suggests that autologous fat grafting plays a valuable role in enhancing aesthetic outcomes either by complementing or replacing reconstructive flaps for oncologic head and neck reconstruction while having both low complication rates and no evidence of being associated with cancer recurrence.

The Surgical Skills and Technology Elective Program (SSTEP): A comprehensive simulation-based surgical skills initiative for preclerkship medical students.

BACKGROUND: The Surgical Skills and Technology Elective Program (SSTEP) is a voluntary preclerkship surgical bootcamp that uses simulation learning to build procedural knowledge and technical skills before clerkship. METHODS: Eighteen second year students (n = 18) participated in simulation workshops over the course of 7 days to learn clerkship-level procedural skills. A manual was supplied with the program outline. Assessment of the participants involved: 1) a written exam 2) a single videotaped Objective Structured Assessment of Technical Skill (OSATS) station 3) an exit survey to document changes in career choices. RESULTS: Compared to the mean written pre-test score students scored significantly higher on the written post-test (35.83 ± 6.56 vs. 52.11 ± 5.95 out of 73) (p = 0.01). Technical skill on the OSATS station demonstrated improved performance and confidence following the program (10.10 vs. 17.94 out of 25) (p = 0.05). Most participants (72%) re-considered their choices of surgical electives. CONCLUSIONS: A preclerkship surgical skills program not only stimulates interest in surgery but can also improve surgical knowledge and technical skills prior to clerkship.

Lymphatic drainage in renal cell carcinoma: back to the basics.

Lymphatic drainage in renal cell carcinoma (RCC) is unpredictable, however, basic patterns can be observed in cadaveric and sentinel lymph node mapping studies in patients with RCC. The existence of peripheral lymphovenous communications at the level of the renal vein has been shown in mammals but remains unknown in humans. The sentinel lymph node biopsy technique can be safely applied to map lymphatic drainage patterns in patients with RCC. Further standardisation of sentinel node biopsy techniques is required to improve the clinical significance of mapping studies. Understanding lymphatic drainage in RCC may lead to an evidence-based consensus on the surgical management of retroperitoneal lymph nodes.