Academic ability and teamworking in medical students.

BACKGROUND: Teamworking is an essential skill for a doctor to develop in order to work effectively, and is required in the UK as part of the General Medical Council (GMC) Good Medical Practice guidance. Assessment of teamwork may be difficult, however, with medical school assessments being more commonly focused on knowledge and individual skills. We aim to explore the link between academic ability as measured at final medical examinations and teamworking. METHODS: All final-year medical students were asked to attend a simulation session in an immersive 22-bed simulated ward, which used a combination of patient simulators and high-fidelity manikin simulators, with nursing and telephone support. Students were split into separate groups stratified by performance in final-year assessments or in groups with mixed performance. Students were observed in real time by faculty staff and assessed with the individual Teamwork Observation and Feedback Tool (iTOFT), around which the debriefing was centred. Assessment of teamwork may be difficult RESULTS: The performance of 119 students in simulation was assessed, and groups with a mix of academic performance showed significantly greater teamworking ability as measured with the iTOFT as compared with those stratified by performance (p = 0.045). Final assessment at medical school was shown to be a poor predictor of teamworking ability: those who performed best at assessment seemed to underperform in teamworking. DISCUSSION: The simulated-ward learning activity received positive feedback, although the mix of patient simulators and high-fidelity manikins proved a challenge to some students. Medical school assessments appear to be inadequate in the assessment of teamworking ability, with change needed in future to ensure that this and other non-technical skills are assessed.

Lymph node retrieval for colorectal cancer: Estimation of the minimum resection length to achieve at least 12 lymph nodes for the pathological analysis.

INTRODUCTION: Adequate lymph node retrieval is important in colorectal cancer staging for the selection of patients that necessitate adjuvant treatments. The minimum number of 12 lymph nodes is one of the premises and is dependent, among the other factors, from the length of bowel resected. We have reviewed our specimens to identify the high-risk operations for inadequate nodal sampling and estimate the minimum length of bowel needed to resect to achieve this purpose. MATERIALS AND METHODS: A retrospective review of colorectal specimens over 10 years of activity looking at data including location of the tumor, type of operation performed, length of bowel resected and number of lymph nodes retrieved. RESULTS: Abdominoperineal and Hartmann's resections produced significant lower adequate retrievals compared to other colorectal operations, corresponding to 45.4% and 59.1% of cases respectively. The measured average length of bowel was 30 cm and 25 cm respectively, increasing the length to 36 cm and 42 cm would increase the adequacy rate to 90%. CONCLUSIONS: Abdominoperineal and Hartmann's resections are, in our series, high-risk operations that frequently do not produce the minimum number of lymph nodes necessary. These operations may require additional maneuvers such as mobilization of the splenic flexure to achieve the minimum length of bowel to resect.