Assessing the Quality of Online Health Information and Trend Data for Colorectal Malignancies.

INTRODUCTION: Patients often refer to the internet to learn about different health conditions. This study aims to assess the landscape of online health information on malignant colorectal conditions, focusing on the popularity, quantity, and quality of internet resources pertaining to these conditions. This information can be used as a guide for surgeons to supplement patient information at the time of surgical evaluation and to help design optimal online health information. METHODS: The terms "colon cancer," "rectal cancer," "anal cancer," and "colorectal cancer" were searched using the Google search engine. The number of search results or "hits" obtained per search term was recorded and the first 50 websites for each search term were reviewed. Included websites did not have a password requirement, were in English, and were free. Quality assessments were performed using the DISCERN instrument, and mean DISCERN scores were compared using analysis of variance. The popularity of each search term was determined using Google Trends, which generates a relative search volume score. RESULTS: A total of 431 million hits were obtained for the term "colon cancer," 72.5 million for "rectal cancer," 244 million for "anal cancer," and 194 million for "colorectal cancer." Mean DISCERN scores for reviewed websites ranged between 39.7 and 40.6, and were thus within the "fair" category. There were no significant differences in mean DISCERN scores across search terms (P = 0.5). Colon cancer had the highest relative search volume score (61.8), followed by colorectal cancer (43.4/100), rectal cancer (42.5/100), and anal cancer (41.7/100). CONCLUSIONS: Although there is a large amount of online information on malignant colorectal conditions, the quality of the available information is inadequate. Clinician guidance to resources aimed at higher quality from guidance of the DISCERN tool may be of value for patient education.

Impact of the first COVID-19 surge on the outcomes of diverticulitis.

Introduction: During the first surge of the COVID-19 pandemic, healthcare utilization changed. We sought to examine the impact of the first COVID-19 surge on the outcomes of patients whose elective surgeries for diverticulitis were postponed and those who underwent urgent surgery during the surge. Materials and methods: This was a retrospective study from a single tertiary center in the Northeast of the US. Patients whose elective surgeries were delayed, or who underwent urgent surgery for diverticulitis during the first COVID-19 surge (3/16/2020 to 8/1/2020) were included. A cohort from 2019 was used for comparison. Variables were compared between groups including: procedure, death, length of stay, disposition, stoma rate, technique for surgery, and leak rate. Results: Forty-five patients were included in the COVID-19 group and 44 patients in the 2019 group. Twenty-seven patients had elective surgeries delayed during the COVID-19 surge. Ten (37%) required more urgent surgery, 80% with complicated disease. Six (22%) were admitted to the hospital and 13 (48%) required additional antibiotics. Eight (30%) patients postponed their surgeries indefinitely and 7 (26%) had surgery once permitted. There were no observed differences between the two groups in the rate of complicated disease, leaks, technique for surgery or stoma rate. Conclusions: During the first COVID-19 surge, over 1/3 of patients whose elective diverticulitis surgeries were postponed required urgent surgery, a majority of whom had complicated disease. There were no apparent differences in outcomes when compared to a pre-pandemic cohort, highlighting the importance of a triage system with the ability to escalate surgery in a timely manner.

(En)trust me: Validating an assessment rubric for documenting clinical encounters during a surgery clerkship clinical skills exam.

BACKGROUND: The AAMC developed 13 Core Entrustable Professional Activities (EPAs) for graduating medical students. EPA 5 is: Document a clinical encounter in the patient record. Our goal was to develop an assessment rubric and gather evidence to support its validity in measuring progress towards entrustability. METHODS: A rubric was developed for EPA 5. During the 2017 surgery clerkship, 57 students wrote a note for each of two standardized patient (SP) encounters. These notes were prospectively collected and assessed by two physician raters. Messick's validity framework was used to gather validity data. RESULTS: Inter-rater reliability with two raters was excellent, ICC = 0.86 (ICC 95%, confidence interval (CI) 0.80-0.90) for overall note score. Correlation between note items and SP checklists ranged 0.39-0.46 (p < 0.05) and between note items and clinical evaluations 0.28-0.39 (p < 0.05). CONCLUSIONS: There is initial reliability evidence supporting the use of our rubric for assessing progress towards entrustability of EPA 5.

American College of surgeons /Association for Surgical Education Medical Student Simulation-based Surgical Skills Curriculum: Alignment with Entrustable Professional Activities.

BACKGROUND: We hypothesized that medical experts would concur the American College of Surgeons/Association for Surgical Education Medical Student Simulation-based Surgical Skills Curriculum ("ACS/ASE Curriculum") could be used to teach and assess Entrustable Professional Activities (EPAs). METHODS: A "crosswalk" was created between ACS/ASE Curriculum modules and eight EPAs. Medical education experts participated in a Delphi process regarding feasibility of using the modules for teaching and assessing EPAs. RESULTS: Twenty-eight educators from six clinical fields participated. There was consensus that five of the EPAs could be taught and assessed by the ACS/ASE Curriculum. A median of nine hours per month outside the surgical clerkship was recommended for skills training. CONCLUSIONS: The ACS/ASE Curriculum lays the framework for implementing select EPAs into medical student education. Experts recommended increased time for skills training with incorporation of the modules into the first three years of medical education, with assessments planned in the third to fourth years.

Colorectal Cancer Screening.

This article highlights the importance of colorectal cancer screening in the prevention and early detection of colorectal cancer. Early detection of colorectal cancer is associated with reduced mortality. There are a variety of screening procedures for colorectal cancer, which are variable in technique and effectiveness. Engaging patients to participate in a screening regimen with which they will comply is critical to the ultimate success of colorectal cancer screening. Familiarity with risk stratification and screening guidelines is imperative for counseling and appropriate testing.