Entrustable Professional Activities in Oral Health for Primary Care Providers Based on a Scoping Review.

Despite advances in oral health care, inequalities in oral health outcomes persist due to problems in access. With proper training, primary care providers can mitigate this inequality by providing oral health education, screening, and referral to advanced dental treatment. Diverging sets of oral health competencies and guidelines have been released or endorsed by multiple primary care disciplines. The aim of this study was to transform multiple sets of competencies into Entrustable Professional Activities (EPAs) for oral health integration into primary care training. A scoping review of the literature between January 2000 and December 2016 was conducted according to PRISMA methodology to identify all existing sets of competencies. The following primary care disciplines were included in the search: allopathic/osteopathic medical schools and residency programs in family medicine, internal medicine, and pediatrics; physician assistant programs; and nurse practitioner programs. Competencies were compared using the Health Resources and Services Administration Integration of Oral Health and Primary Care Practice competencies as the foundational set and translated into EPAs. The resulting EPAs were tested with a reactor panel. The scoping review produced 1,466 references, of which 114 were selected for full text review. Fourteen competencies were identified as being central to the integration of oral health into primary care. These were converted to seven EPAs for oral health integration into primary care and were mapped onto Accreditation Council for Graduate Medical Education residency competency domains as well to the Association of American Medical Colleges EPAs for graduating medical students. The resulting EPAs delineate the essential, observable work required of primary care providers to ensure that oral health is treated as a critical determinant of overall health.

Entrustable professional activities in family medicine.

BACKGROUND: The Accreditation Council for Graduate Medical Education Outcome Project intended to move residency education toward assessing and documenting resident competence in 6 dimensions of performance important to the practice of medicine. Although the project defined a set of general attributes of a good physician, it did not define the actual activities that a competent physician performs in practice in the given specialty. These descriptions have been called entrustable professional activities (EPAs). OBJECTIVE: We sought to develop a list of EPAs for ambulatory practice in family medicine to guide curriculum development and resident assessment. METHODS: We developed an initial list of EPAs over the course of 3 years, and we refined it further by obtaining the opinion of experts using a Delphi Process. The experts participating in this study were recruited from 2 groups of family medicine leaders: organizers and participants in the Preparing the Personal Physician for Practice initiative, and members of the Society of Teachers of Family Medicine Task Force on Competency Assessment. The experts participated in 2 rounds of anonymous, Internet-based surveys. RESULTS: A total of 22 experts participated, and 21 experts participated in both rounds of the Delphi Process. The Delphi Process reduced the number of competency areas from 91 to 76 areas, with 3 additional competency areas added in round 1. CONCLUSIONS: This list of EPAs developed through our Delphi process can be used as a starting point for family medicine residency programs interested in moving toward a competency-based approach to resident education and assessment.

Effects of cognitive distraction on performance of laparoscopic surgical tasks.

HYPOTHESIS: To quantify the effects of cognitive distraction on surgical task performance in residents and medical students using a laparoscopic surgical simulator. DESIGN: Within-subjects design. SETTING: A surgical skills laboratory. PARTICIPANTS: Thirteen surgical residents and medical students who volunteered for the study. METHODS AND MATERIALS: Subjects performed six tasks on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR), under two different conditions (distracted and undistracted). Task order remained the same for all subjects, but the order of distraction was counterbalanced. In the distracted condition, distractions consisted of mental arithmetic problems posed sequentially so that subjects were continually distracted. MAIN OUTCOME MEASURES: Time to task completion, surgical errors committed, economy of motion, and overall performance scores were generated by the MIST-VR program software. Arithmetic error was not a factor in the overall performance score. RESULTS: Time to task completion was significantly greater when subjects were distracted for all six tasks performed. Overall score and economy of motion were negatively affected by distraction but the effect did not reach th level of statistical significance. There was no effect of distract on surgical errors. CONCLUSION: Cognitive distraction appears to negatively influence the performance of laparoscopic surgical tasks by increasing task completion time. Further study is required to determine what the effects would be on experienced surgeons and actual surgical outcomes.

A 10-year single-institutional study of the biofragmentable anastomosis ring.

BACKGROUND: The biofragmentable anastomosis ring (BAR) was introduced by Hardy in 1985 as a simple alternative to sutured or stapled intestinal anastomosis. METHODS: The aim of this study was to analyze complications related to the use of the BAR in elective intraperitoneal intestinal anastomosis to identify technical aspects important in the safe use of the device. The BAR was used by a single surgeon over a 10-year period. Three hundred fifty sequential intraperitoneal anastomoses were performed in 346 patients. There were 12 enteroenteric, 2 gastrojejunal, 199 enterocolic, and 137 colocolic anastomoses. RESULTS: There was 1 suture line recurrent carcinoma but no strictures. There were 11 complications that appeared related to construction of the anastomosis, 2 of them resulting in death. The 2 patients who died both had cirrhosis with ascites. Eight patients required re-exploration for suspected anastomotic complications. Six of them recovered and were discharged. CONCLUSION: The BAR appears to be a safe alternative to sutured or stapled bowel anastomosis provided certain precautions are taken in its use.

Rapidly advancing necrotizing fasciitis caused by Photobacterium (Vibrio) damsela: a hyperaggressive variant.

OBJECTIVE: To describe the first case of Vibrio damsela necrotizing fasciitis in New England, emphasizing the importance of very early operative intervention to achieve source control in this extremely aggressive infection. DESIGN: Case report. SETTING: Surgical intensive care unit at Tufts-New England Medical Center in Boston, MA. PATIENT: A 69-yr-old retired fisherman with rapidly progressive necrotizing fasciitis from Photobacterium (Vibrio) damsela infection and ensuing multiple-system organ failure. INTERVENTIONS: Surgical debridement, ventilator support, vasopressors, continuous veno-venous hemofiltration, and blood product transfusions. MEASUREMENTS AND MAIN RESULTS: Death. CONCLUSIONS: A high index of suspicion is necessary for the diagnosis of this specific pathogen and concordant infection. The willingness to surgically debride and amputate without hesitation at a very early point may be the only intervention capable of saving the lives of patients affected by Photobacterium (Vibrio) damsela.