An Assessment Rubric for a Resident Training Program in Surgery: A Single-Institution Experience.

Using a Collaborative Action Research model, our research team established a one-month clinical resident training program for first- and second-year clinical residents. We created and implemented an assessment rubric to assess the residents' progress toward independent practice in surgery, and thereby, to evaluate the program itself. The program included training in three areas: basic techniques and procedures in the operating room, surgical ward management, and academic activities. The rubric measured the residents' performance according to three achievement levels: Level 1 (demonstration), Level 2 (active help) and Level 3 (passive help). The program and rubric implementation began in June 2019 and continued until March 2020, when the program outcomes and shortcomings were analyzed. Among nineteen clinical residents, a total of nine clinical residents participated in the study. Most participants reached achievement Level 3 for their performance of basic techniques in the operating room. Finally, we discussed ideas for improvement and drafted plans for an improved rubric to complete the action research cycle. Our research team found the rubric to be a useful tool in evaluating the status of the new clinical resident training program.

Antibiotic literacy among Japanese medical students.

Antimicrobial resistance (AMR) is an urgent global issue. After the AMR action plan was introduced in 2016, a study on antibiotic literacy (i.e., awareness, knowledge, and attitude relating to antimicrobial use) among clinicians and lay people was conducted in Japan. However, no studies have hitherto targeted medical students who are expected to have a high level of antibiotic literacy. The present study was conducted between September 2019 and February 2020, enrolling undergraduate students at Okayama University Medical School. We collected data using a paper-based questionnaire form with 11 questions about antibiotic literacy. The response rate was 93.8% (661/705 students). Overall, 92.6% of the students knew that antibiotics inhibit the growth of bacteria. Student reporting that antibiotics could treat the common cold accounted for 77.0% (Year 1), 50.9% (Year 2), 48.2% (Year 3), 49.1% (Year 4), 23.8% (Year 5), and 26.2% (Year 6). Only 43 (6.5%) had heard about the AMR action plan. The study data suggested that medical students' level of literacy on antimicrobial use should be further enhanced to address AMR and promote antimicrobial stewardship.

A Surgical Instructor Training Course for the Next Generation.

In 2016, Gunma University Hospital's Medical Accident Investigation Committee released a report reiterating the necessity of medical education and the need for surgeons to master non-technical skills. We designed a 17-h training course for surgical instructors, designed to teach participants how to sufficiently educate surgeon trainees and encourage their professional identity formation. A post-training survey showed that participants improved their awareness, and their behavioral changes led to favorable team performances. We then began offering a 3-h workshop focusing on the participants' experiences. We propose that the training course using participant narratives is required and effective to establish surgeons' self-reflection and professional identity as surgeons.

Effects on postgraduate-year-I residents of simulation-based learning compared to traditional lecture-style education led by postgraduate-year-II residents: a pilot study.

BACKGROUND: Simulation-based learning plays an important role in contemporary medical education, although there are problems providing tutors. Peer-assisted learning has begun being formally adopted in medical education. Although it is considered useful for simulation-based learning, its effectiveness remains unclear. This study was designed to compare the effect of simulation-based learning with that of traditional lectures conducted by postgraduate-year (PGY)-II residents on PGY-I residents. METHODS: This study was conducted at Okayama University Hospital over three years, for one week each year, before residents entered clinical practice. The study enrolled 76 PGY-I residents, who were randomized into two groups: simulation and lecture groups. PGY-II residents volunteered to conduct simulations and lectures. Knowledge evaluation was performed using pre- and post-tests, and self-evaluation of competence and behaviour-change and program evaluations were conducted using questionnaires. RESULTS: In both groups, knowledge test scores were found to improve significantly, and the score difference between pre- and post-tests in both the groups was not significant. Self-evaluation of competence and behaviour-change was found to be higher in the simulation group than the lecture group. The trainees in the simulation group valued the program and the PGY-II residents as teaching staff more than those in the lecture group. CONCLUSIONS: The combination of simulation-based learning and peer-assisted learning led by PGY-II residents is potentially more effective in improving the postgraduate education of PGY-I residents than the combination of lecture and peer-assisted learning.

Impact of endoscopic and histological evaluations of two different types of mesh plug for a groin hernia model.

PURPOSE: The biological responses to mesh in vivo have been evaluated in some papers, but the in vivo condition of mesh and plugs have not been sufficiently evaluated. This study evaluated the endoscopic observations and histological assessments of mesh plugs using swine models. METHODS: An artificial abdominal hernia was established in the porcine abdomen, and repaired using three different sizes of two types of plug, Proloop (ATRIUM Medical Corporation, Hudson, NH, USA) or Perfix (BARD Medical Division, Covington, GA, USA). The in vivo conditions of each plug were periodically observed using a laparoscope. Moreover, a histological evaluation of the plugs was performed 3 months after implantation. RESULTS: The laparoscopic observation revealed that inversion of the plugs occurred in 10 out of 18 cases repaired with Perfix, while no case repaired with Proloop inverted. The large and medium sizes of Perfix plugs were inclined by an average of more than 30°. In addition, the triangular shape of Perfix plugs was broken and the vertical/horizontal ratio was enlarged during the observation period, while Proloop plugs shrank both vertically and horizontally. The inflammatory cell count was significantly lower within the Proloop plugs than within Perfix plugs. CONCLUSION: Proloop plugs are apparently superior because they are stable even 3 months after implantation.

A rare primary diaphragmatic hemangioma successfully treated by laparoscopic surgery: report of a case.

This report presents a very rare case of a primary diaphragmatic hemangioma, which was successfully treated by laparoscopic surgery. A 64-year-old man with a left diaphragmatic mass without any significant symptoms was treated by laparoscopic surgery and thus was diagnosed to have a diaphragmatic hemangioma following a pathological examination. Laparoscopic treatment in the deep and narrow abdominal spaces such as the diaphragmatic region is very useful as a less invasive treatment, as well as providing an excellent observation from which to make an accurate diagnosis.

Abnormal fluorine-18-fluorodeoxyglucose uptake in benign esophageal leiomyoma.

A benign esophageal leiomyoma with abnormally increased fluorine-18-fluorodeoxyglucose uptake on positron emission tomography (PET) was resected thoracoscopically. The tumor, of which the maximum standardized uptake value of the lesion was 4.7, was well defined and 38 mm in diameter. Neither mitotic activity nor degeneration was found histologically; and immunoreactivity for CD34, CD117, MIB-1, and glucose transporter-1 was negative immunohistochemically. A diagnosis of gastrointestinal stromal tumor was ruled out by an oncogenic kinase gene mutation study. This case cautions against PET-dependent evaluation for malignant potential of esophageal submucosal tumors.

Antitumor effects and drug interactions of the proteasome inhibitor bortezomib (PS341) in gastric cancer cells.

The proteasome inhibitor bortezomib (PS341) inhibits the function of the 26S proteasome and has been extensively investigated in the clinical setting of hematologic malignancies. Remarkable efficacy has been reported in the treatment of multiple myeloma, but there have been few studies of its use in the treatment of gastrointestinal malignancy, especially gastric cancer. Here, we demonstrate its efficacy, both alone and in combination with other cytotoxic agents, in gastric cancer cell lines. The human gastric cancer cell lines AZ521, MKN45 and NUGC3 were used as experimental models. Bortezomib produced significant growth inhibition in these cells (mean IC50 values: 1.26, 9.44 and 8.63 micromol/l, respectively) and was also observed to decrease the activity of the extracellular signal-regulated kinase 1/2 and Akt signal pathways, increasing the accumulation of p21. Cell-cycle analysis revealed that a low concentration of bortezomib (10-100 nmol/l) increased accumulation in the G1 phase. Moreover, bortezomib showed synergistic growth inhibition in combination with the conventional cytotoxic agents 5-fluorouracil, paclitaxel, doxorubicin and SN-38, and also downregulates the activity of nuclear factor -kappaB, which is induced by these agents. Our results demonstrate that bortezomib could be an effective antitumor agent in the treatment of gastric cancer, both as single-agent therapy and in combination with conventional chemotherapeutic agents.

Successful treatment of a patient with gastric and duodenal metastases from large cell carcinoma of the lung with carboplatin and gemcitabine.

A 62-year-old man with large cell carcinoma of the lung underwent a right upper lobectomy and four months later demonstrated a relapse in the stomach and duodenum. He received systemic chemotherapy consisting of carboplatin and gemcitabine. After the first cycle of chemotherapy, the duodenal lesion disappeared, however, the gastric lesion demonstrated no response. Considering the risk of bleeding or perforation, a partial gastroduodenal resection was therefore performed. Subsequently, he received adjuvant chemotherapy with the same regimen. He has since been doing well for 24 months after the recurrence. Although the prognosis for patients with gastrointestinal metastases from lung cancer tends to be extremely poor, treatment with chemotherapy and a metastasectomy have resulted in this patient, achieving a long survival.

[A case of malignant lymphoma of the stomach in which preoperative chemotherapy provided a complete response].

We have encountered a case of malignant lymphoma of the stomach in which a complete remission was confirmed in a resected specimen after chemotherapy. A 75-year-old woman complained of vomiting blood. A biopsy from gastric endoscopy indicated malignant lymphoma of diffuse large B-cell type. The patient was assumed to be inoperable due to enlargement of the tumor and lymph node metastasis, and THP-COP chemotherapy was carried out. After four courses of the THP-COP regimen, endoscopic examination revealed a significant tumor reduction. Total gastrectomy and splenectomy with lymph node dissection (D2) were performed after chemotherapy. No tumor cells were detected in any sections of the specimen or regional lymph nodes.