Innovative Approach to Severe Esthetic Zone Trauma: Integrating Root Submergence With Guided Bone Regeneration.

OBJECTIVE: Acute traumatic defects in the esthetic zone pose a significant challenge in dental implant rehabilitation, requiring innovative techniques to achieve optimal functional and esthetic outcomes. This article investigates the use of a novel combination of root submergence and guided bone regeneration (GBR) to address these defects. The goal is to evaluate the potential of this integrated approach for achieving predictable bone regeneration and long-term tissue stability. CLINICAL CONSIDERATIONS: Studies have shown significant improvements in soft-tissue contour, papilla preservation, and emergence profile when root submergence is employed. Despite these benefits, the integration of root submergence with GBR remains underexplored in the literature. This combination shows considerable potential for achieving predictable bone regeneration and sustaining tissue stability in the esthetic zone. CONCLUSIONS: The integration of root submergence with GBR offers a promising solution for managing traumatic defects in the esthetic zone by enhancing soft-tissue contours and facilitating predictable bone regeneration. However, additional clinical studies are needed to support the long-term success of this innovative approach in dental implant rehabilitation. CLINICAL SIGNIFICANCE: The combined use of root submergence and GBR for treating acute traumatic defects in the esthetic zone represents a notable advancement in dental implant rehabilitation. This article presents a detailed analysis of the rationale, technique, and clinical outcomes of this approach, underscoring its importance in achieving optimal esthetic and functional outcomes for patients with complex clinical needs.

Assessment of an online open-book examination in postgraduate dentistry.

AIM: To investigate the impact of changing from in-person written assessments to open-book online assessments and assess grade inflation, student preferences and potential cheating. MATERIALS AND METHODS: Data from the Master of Clinical Dentistry in Fixed and Removable Prosthodontics (MClinDent FRP) postgraduate programme in dentistry was analysed. A comparison was made between the results from 3 years of traditional format written examinations (2017-2019) and the same examinations in an open-book online format over 2 years (2020 and 2021). RESULTS: A comparison of assignment grades (all in open-book online format) over the 5 years 2017-2021 showed no significant difference in mean grades, suggesting the academic ability of each cohort was similar. The examination results increased by 2.5% (2020) and 1.9% (2021) compared with the equivalent data from 2017 to 2019. This shows modest grade inflation, which was highly significant (t 4.73, df 937, p < .00001) due to the change in format but suggests that no widespread collusion was taking place to raise the grades. Student feedback strongly endorsed the open-book online format and was of the opinion that it was less stressful. CONCLUSIONS: The move to open-book examinations was supported by student feedback, and the comparison of results, while showing an expected grade inflation, did not provide evidence that cheating was taking place through enhanced examination grades.

Remote online open book examinations: through the lenses of faculty and students in health professions programmes.

BACKGROUND: Open book examinations have been used to assess students' higher order cognitive skills. These examinations can be conducted online remotely with the advancement of technology. However, there are concerns regarding its validity and reliability particularly if the examinations are not proctored. The objective of this study was to explore the perceptions of faculty and students in health professions programmes about remote online open book examinations (ROOBE). METHODS: Semi-structured interviews were conducted among 22 faculty staff who were involved in ROOBE in health professions programmes. All interviews were audio recorded, transcribed verbatim and analysed using a thematic analysis approach. The perceptions of 249 medical students were obtained using an online questionnaire after they completed ROOBE. RESULTS: The faculty agreed that open book examinations could promote students' higher order cognitive skills and reduce students' stress. However, they were concerned about students' academic integrity during non-invigilated ROOBE which could affect recognition by accreditation and professional bodies. The shift from traditional practice of closed-book examinations to ROOBE required change management with the support of guidelines and faculty training.  Majority of the students claimed that the examinations were challenging as they assessed their ability to apply knowledge in real world problems. Nevertheless, they preferred ROOBE due to less anxiety and memorisation, and more emphasis on problem solving skills. The shortcomings were insufficient time for information searching during examinations and uncertainty in preparedness for future practice as they focused less on memorisation of factual knowledge during examination preparation. Cheating among peers and internet instability during non-invigilated ROOBE were the concerns highlighted by some students. CONCLUSIONS: Faculty and students expressed favourable views about ROOBE in promoting higher order cognitive skills. Adequate technological support was essential during ROOBE. While there was a need to address issues related to academic integrity, ROOBE could be included as an authentic assessment within the systems of assessment.

Effects of a blended design of closed-book and open-book examinations on dental students' anxiety and performance.

BACKGROUND: While closed-book examinations (CBEs) have traditionally been implemented in dental education, open-book examinations (OBEs) are being introduced for the purpose of acquiring higher levels of knowledge and promoting long-term memory. This study examines whether it is effective to use a blended assessment of CBEs and OBEs for dental students to reduce test anxiety and enhance academic performance. METHODS: Using a quasi-experimental research method, a blended assessment that combined CBEs in class and OBEs online was designed for a dental course. In 2020, when the pandemic was at its peak, student assessment was ineffective, and the 2020 cohort was omitted for our study; instead, two cohorts of predoctoral dental students (N = 178) enrolled in Restorative Dentistry in the spring semesters of 2019 and 2021 were included in the study. These students were informed about the experimental design, and they provided written consent for data collection, thereby voluntarily participating in the survey. Their self-perceived responses to open-ended survey questions on assessment methods were qualitatively analyzed. RESULTS: There was no significant difference in test anxiety between the CBEs and OBEs at the p-values of 0.001 in all items. Traditional and blended assessment showed a similar trend of lower scores in midterm exams compared to higher scores in final exams, thus discriminating against students' performances. In particular, a low-achieving group was better predicted by a blended assessment. An analysis of the students' self-perceived responses produced highly topical themes, including exam burden, learning effects, and fairness issues. CONCLUSIONS: This study confirmed the feasibility of blended assessment that can be implemented in online and in-person educational environments. Moreover, it can be used as the groundwork to develop new models of assessment in dental education.

Assessment of factual recall and higher-order cognitive domains in an open-book medical school examination.

Open-book examinations (OBEs) will likely become increasingly important assessment tools. We investigated how access to open-book resources affected questions testing factual recall, which might be easy to look-up, versus questions testing higher-order cognitive domains. Few studies have investigated OBEs using modern Internet resources or as summative assessments. We compared performance on an examination conducted as a traditional closed-book exam (CBE) in 2019 (N = 320) and a remote OBE with free access to Internet resources in 2020 (N = 337) due to COVID-19. This summative, end-of-year assessment focused on basic science for second-year medical students. We categorized questions by Bloom's taxonomy ('Remember', versus 'Understand/Apply'). We predicted higher performance on the OBE, driven by higher performance on 'Remember' questions. We used an item-centric analysis by using performance per item over all examinees as the outcome variable in logistic regression, with terms 'Open-Book, 'Bloom Category' and their interaction. Performance was higher on OBE questions than CBE questions (OR 2.2, 95% CI: 2.14-2.39), and higher on 'Remember' than 'Understand/Apply' questions (OR 1.13, 95% CI: 1.09-1.19). The difference in performance between 'Remember' and 'Understand/Apply' questions was greater in the OBE than the CBE ('Open-Book' * 'Bloom Category' interaction: OR 1.2, 95% CI: 1.19-1.37). Access to open-book resources had a greater effect on performance on factual recall questions than higher-order questions, though performance was higher in the OBE overall. OBE design must consider how searching for information affects performance, particularly on questions measuring different domains of knowledge.

Assessment during Covid-19: quality assurance of an online open book formative examination for undergraduate medical students.

BACKGROUND: The spread of COVID-19 pandemic in early 2020 compelled all the educational activities, including medical education to be shifted from face-to-face interaction to a virtual platform. This shift provided opportunities for exploring online assessment modalities. One such assessment method is an online open book exam which is a unique concept in medical education of Pakistan. Limited information is available in literature regarding open book exam for the basic science subjects. Hence, the objective of the study was to determine the quality of the open book exam administered as a pilot project to the first-year medical students. METHODS: It was a cross-sectional analytical study that included 99 students of first year MBBS. The students were administered an online unrestricted type of open book exam as a formative assessment. The exam consisted of 30 open-ended, short answer type questions. The scores of the exam were analyzed for psychometric quality. RESULTS: The mean score was 47.24 ± 15.30 SD %. The reliability of the exam was 0.79. The majority (66.6%) of items were found to be moderately difficult with their difficulty index ranging from 31 to 80%. The majority (86.6%) items were in the range of moderate to high discrimination. There were no questions with negative discrimination. CONCLUSIONS: The exam was found to be reliable and can be implemented with training of faculty and students. Online open book exam provides a good format for remote and formative assessment of students with minimum proctoring during times of constraints such as COVID-19 pandemic.

Medical students' perception of changes in assessments implemented during the COVID-19 pandemic.

BACKGROUND: COVID-19 posed many challenges to medical education in the United Kingdom (UK). This includes implementing assessments during 4 months of national lockdowns within a 2-year period, where in-person education was prohibited. This study aimed to identify medical school assessment formats emerging during COVID-19 restrictions, investigate medical students' perspectives on these and identify influencing factors. METHODS: The study consisted of two phases: a questionnaire asking medical students about assessment changes they experienced, satisfaction with these changes and preference regarding different assessments that emerged. The second phase involved semi-structured interviews with medical students across the UK to provide a deeper contextualized understanding of the complex factors influencing their perspectives. RESULTS: In the questionnaire responses, open-book assessments had the highest satisfaction, and were the preferred option indicated. Furthermore, in the case of assessment cancellation, an increase in weighting of future assessments was preferred over increase in weighting of past assessments. Students were also satisfied with formative or pass-fail assessments. Interview analyses indicate that although cancellation or replacement of summative assessments with formative assessments reduced heightened anxiety from additional COVID-19 stressors, students worried about possible future knowledge gaps resulting from reduced motivation for assessment-related study. Students' satisfaction level was also affected by timeliness of communication from universities regarding changes, and student involvement in the decision-making processes. Perceived fairness and standardisation of test-taking conditions were ranked as the most important factors influencing student satisfaction, followed closely by familiarity with the format. In contrast, technical issues, lack of transparency about changes, perceived unfairness around invigilation, and uncertainty around changes in assessment format and weighting contributed to dissatisfaction. CONCLUSIONS: Online open-book assessments were seen as the most ideal amongst all participants, and students who experienced these were the most satisfied with their assessment change. They were perceived as most fair and authentic compared to real-life medical training. We seek to inform educators about student perceptions of successful assessment strategies under COVID-19 restrictions and provide evidence to allow debate on ongoing assessment reform and innovation. While this work looks specifically at assessment changes during COVID-19, understanding factors affecting student perception of assessment is applicable to examinations beyond COVID-19.

The Impact of an Open-Book Pelvic Ring Injury on Bone Strain: Validation of a Finite Element Model and Analysis Within the Gait Cycle.

The threshold for surgical stabilization for an open-book pelvic fracture is not well defined. The purpose of this research was to validate the biomechanical behavior of a specimen-specific pelvic finite element (FE) model with an open-book fracture with the biomechanical behavior of a cadaveric pelvis in double leg stance configuration under physiologic loading, and to utilize the validated model to compare open book versus intact strain patterns during gait. A cadaveric pelvis was experimentally tested under compressive loading in double leg stance, intact, and with a simulated open-book fracture. An intact FE model of this specimen was reanalyzed with an equivalent simulated open-book fracture. Comparison of the FE generated and experimentally measured strains yielded an R2 value of 0.92 for the open-book fracture configuration. Strain patterns in the intact and fractured models were compared throughout the gait cycle. In double leg stance and heel-strike/heel-off models, tensile strains decreased, especially in the pubic ramus contralateral to the injury, and compressive strains increased in the sacroiliac region of the injured side. In the midstance/midswing gait configuration, higher tensile and compressive FE strains were observed on the midstance side of the fractured versus intact model and decreased along the superior and inferior pubic rami and ischium, with midswing side strains reduced almost to zero in the fractured model. Identified in silico patterns align with clinical understanding of open-book fracture pathology suggesting future potential of FE models to quantify instability and optimize fixation strategies.

Trisections of 4-manifolds with boundary.

Given a handle decomposition of a 4-manifold with boundary and an open book decomposition of the boundary, we show how to produce a trisection diagram of a trisection of the 4-manifold inducing the given open book. We do this by making the original proof of the existence of relative trisections more explicit in terms of handles. Furthermore, we extend this existence result to the case of 4-manifolds with multiple boundary components and show how trisected 4-manifolds with multiple boundary components glue together.

Switching from face-to-face to an online teaching strategy: how anatomy and physiology teaching transformed post-COVID-19 for a university preprofessional program.

The College of Science and Health Professions offers a university preprofessional program. Like most medical schools in Saudi Arabia, the teaching delivery strategy in the university preprofessional program is on campus and face-to-face. During the month of March 2020, teaching activities of the spring semester were proceeding as normal; however, the sudden emergence of COVID-19 disturbed routine activities and compelled authorities to switch all teaching activities from face-to-face to online. Training sessions and workshops for all stakeholders on online delivery methods were arranged. Blackboard and other online facilities were utilized. All teaching materials, including newly made video clips for anatomy and physiology practicals, were uploaded on Blackboard and discussed online with students. Students' anxiety related to the exam was reassured by giving them the option of open book quizzes during summative continuous assessment. All scheduled teaching sessions, lectures, and practicals were conducted proficiently. Revision sessions and assessment quizzes were conducted with students' satisfaction. At the end of the semester, a final exam was conducted online as an open book exam. Students with technical issues while attempting the exam were given an opportunity to make up for it. After a successful final exam, the cumulative block grades showed students secured higher grades in the open book exam. Following that, the King Saud bin Abdulaziz University for Health Sciences has managed to conduct on-campus close book exams that abide by self-distancing and standard operating procedure policies.

Effect of remote online exam delivery on student experience and performance in applied knowledge tests.

BACKGROUND: The use of remote online delivery of summative assessments has been underexplored in medical education. Due to the COVID-19 pandemic, all end of year applied knowledge multiple choice question (MCQ) tests at one UK medical school were switched from on campus to remote assessments. METHODS: We conducted an online survey of student experience with remote exam delivery and compared test performance in remote versus invigilated campus-based forms of similar assessments for Year 4 and 5 students across two academic years. RESULTS: Very few students experienced technical or practical problems in completing their exam remotely. Test anxiety was reduced for some students but increased for others. The majority of students preferred the traditional setting of invigilated exams in a computer lab, feeling this ensured an even playing field for all candidates. Mean score was higher for Year 4 students in the remotely-delivered versus campus-based form of the same exam (76.53% [SD 6.57] vs. 72.81% [6.64]; t438.38 = 5.94, p = 0.001; d = 0.56), whereas candidate performance was equivalent across both forms for Year 5 students. CONCLUSIONS: Remote online MCQ exam delivery is an effective and generally acceptable approach to summative assessment, and could be used again in future without detriment to students if onsite delivery is not possible.

Single stage reconstruction of a neglected open book pelvic injury with bladder herniation into the upper thigh: a case-report.

When open-book injuries are neglected and result into a pelvic malunion or nonunion, long-term problems, such as chronic pain, gait abnormalities, sitting discomfort, neurological symptoms and urogenital symptoms can occur. In this case report, we describe the repair of a neglected pelvic disruption with the dislocation of the urinary bladder in a one-stage procedure. The clinical image with which the patient presented could be split into unique sub-problems, for which separate solutions needed to be chosen: large symphysis diastasis, instability and pain in both SI joints, malunion of the superior and inferior pubic rami fractures; and urinary bladder herniation into the upper thigh. In a single-stage procedure, the pelvic ring was reconstructed and the bladder reduced. The patient was thereafter continent for urine and could walk independently. A complex clinical problem was divided into its sub-problems, for which specific solutions were found.

The effect of concrete supplements on metacognitive regulation during learning and open-book test taking.

BACKGROUND: Previous studies have suggested that when reading texts, lower achievers are more sensitive than their stronger counterparts to surface-level cues, such as graphic illustrations, and that even when uninformative, such concrete supplements tend to raise the text's subjective comprehensibility. AIMS: We examined how being led astray by uninformative concrete supplements in expository texts affects achievement. We focused on the mediating role of metacognitive processes by partialling out the role of cognitive ability, as indicated by SAT scores, in accounting for the found differences between higher and lower achievers. SAMPLE AND METHOD: Undergraduate students studied expository texts in their base versions or in concrete versions, including uninformative supplements, in a within-participant design. The procedure had three phases: Studying, open-book test taking, and reanswering questions of one's choice. RESULTS: Overall, judgements of comprehension (JCOMPs) were higher after participants studied the concrete than the base versions, and the participants benefited from the open-book test and the reanswering opportunity. An in-depth examination of time investment, JCOMP, confidence in test answers, choice of questions to reanswer, and test scores indicated that those whose metacognitive processes were more effective and goal driven achieved higher scores. CONCLUSIONS: The effectiveness of metacognitive processes during learning and test taking constitutes an important factor differentiating between higher and lower achievers when studying texts that include potentially misleading cues.

Introducing Group Open-Book Exams as a Learning and Assessment Strategy in the Clinical Biochemistry Course for Medical Students.

BACKGROUND: Teachers constantly strive to obtain reliable and appropriate teaching and assessment methods to maximize the learning experience. This study aimed to introduce combined modified team-based learning and open-book exams (TBL/OBEs) as learning and assessment strategies in clinical biochemistry for medical students and assess students' perceptions. METHODS: Second-year medical students enrolled in the clinical biochemistry course were included in this study and subjected to TBL/OBE assessment. The assessment included two parts: the open-book format for half of the questions and the closed-book format for the other as a control. Upon completing the combined TBL/OBE session, the students were required to complete a structured survey to evaluate their perception of the experience. The data were gathered and analyzed. Data were presented as mean±standard error of the mean (SEM), and a p-value ≤0.05 was considered statistically significant. RESULTS: A total of 358 students completed the TBL/OBE and closed-book exam (CBE) and responded to the survey. Of these students, 76% preferred the OBE, and 84% thought it was a suitable learning method. On the one hand, the mean difficulty of the OBE format was 92.7±1.5 SEM, while, for the CBE, the mean difficulty was 88.7±1.9 SEM (p=0.015). On the other hand, the mean discrimination factor for OBE was 0.26±0.04 and, for the CBE, 0.41±0.04 SEM (p=0.0016). Males found the OBE questions easier (p=0.025) and less stressful (p=0.01). CONCLUSION: A combined model of modified TBL and OBE is a successful learning and assessment strategy in clinical biochemistry for medical students.

Retroperitoneal abscess associated with closed pelvic ring fracture diagnosed by fine free air on initial trauma pan computed tomography scan.

The patient was a 49-year-old male. He had a closed fracture of the pelvic ring that was treated successfully by avoiding anterior pelvic ring stabilization because of the presence of microscopic free air in the retroperitoneal space behind the pubic bone on initial whole-body trauma computed tomography scan. For his pelvic ring injury, transiliac rod and screw fixation was performed without the need for a pubic symphysis plate by developing the retroperitoneal space. His retroperitoneal abscess was treated by minimally invasive treatment of retroperitoneal abscess with computed tomography-guided percutaneous drainage. At 2 years postoperatively, there was no fever or elevated inflammatory response suspicious of retroperitoneal abscess recurrence. In this case, the presence of microscopic free air influenced the choice of treatment. Even in closed pelvic ring fractures, the presence of free air should be carefully considered when reading images.

Comparative evaluation of open book and conventional assessment methods in medical undergraduate students.

Medical science is a dynamic field of knowledge that is constantly broadening with upcoming clinical research and analysis. Traditional medical education has been focused on textbook-based recall assessments-closed book assessment (CBA). However, the availability of newer technologies has made the accessibility to encyclopedic knowledge expeditious, which demands for a new approach for medical education. As medical professionals, the purpose of learning should be higher cognitive skills such as interpretation and synthesis. So, analyzing students' ability to comprehend the concepts and learning to apply it in a realistic context than merely recalling the facts has come into attention. In this study, we aimed to evaluate and compare the performance of 250 first-year MBBS students at Maulana Azad Medical College, New Delhi, India, between closed book and open book method for biochemistry. Students were divided into two groups, Group A and Group B, based on their average monthly internal assessment marks. CBA was followed by open book assessment (OBA) 1 week apart with similar questionnaire pattern and allotted time. A significant difference in average marks obtained by the two groups was observed in CBA. Group A scored better in CBA, but performance was comparable with Group B in OBA. OBA and CBA can contribute to an assessment program in part because of their complementary pros and cons, and OBA should not be thought of as an alternative to CBA, but their value may be in expanding beyond what is measured by CBA.

Identification of parameters for electronic distance examinations.

Introduction: This study investigates the log data and response behavior from invigilated in-person electronic timed exams at the University of Veterinary Medicine Hannover, Foundation, Germany. The primary focus is on understanding how various factors influence the time needed per exam item, including item format, item difficulty, item discrimination and character count. The aim was to use these results to derive recommendations for designing timed online distance examinations, an examination format that has become increasingly important in recent years. Methods: Data from 216,625 log entries of five electronic exams, taken by a total of 1,241 veterinary medicine students in 2021 and 2022, were analyzed. Various statistical methods were employed to assess the correlations between the recorded parameters. Results: The analysis revealed that different item formats require varying amounts of time. For instance, image-based question formats and Kprim necessitated more than 60 s per item, whereas one-best-answer multiple-choice questions (MCQs) and individual Key Feature items were effectively completed in less than 60 s. Furthermore, there was a positive correlation between character count and response time, suggesting that longer items require more time. A negative correlation could be verified for the parameters "difficulty" and "discrimination index" towards response time, indicating that more challenging items and those that are less able to differentiate between high- and low-performing students take longer to answer. Conclusion: The findings highlight the need for careful consideration of the ratio of item formats when defining time limits for exams. Regarding exam design, the literature mentions that time pressure is a critical factor, since it can negatively impact students' exam performance and some students, such as those with disabilities, are particularly disadvantaged. Therefore, this study emphasizes finding the right time limits to provide sufficient time for answering questions and reducing time pressure. In the context of unsupervised online exams, the findings of this study support previous recommendations that implementation of a stringent time limit might be a useful strategy to reduce cheating.

Transobturator-cable-fixation in pelvic ring injuries with symphyseal disruption - a last resort?

PURPOSE: The role of transobturator-cable-fixation (TOCF) in traumatic symphyseal rupture of the pelvic ring remains unclear. This case series aims to evaluate TOCF in complex and revision cases in pelvic surgery. METHODS: A retrospective analysis of a chronological case series was conducted, studying pelvic fractures stabilized using TOCF between January 2006 and December 2022. The variables considered included age, gender, fracture classification, Injury Severity Score (ISS), Body Mass Index (BMI), trauma mechanism, time to surgery, fixation technique, hospital duration, complications, status on discharge (Glasgow Outcome Scale; GOS), follow-up time and indication for the use of TOCF. RESULTS: All patients (N = 7) were male with a mean age of 64 years and a mean BMI of 29. The mean ISS was 45, with the lowest ISS of 25, indicating that only polytraumatized patients were included. Two anterior-posterior-compression-, four lateral-compression-, and one vertical-shear-pelvic-injury were identified. TOCF was added in six cases to support symphyseal plating and in one case to external fixation. The mean hospital stay was 49 days and the mean follow-up duration was 8.5 months. No complications associated with TOCF were observed during the surgical procedure or follow-up. CONCLUSION: TOCF showed no procedure-associated complications and effectively supported symphyseal healing in all cases. The main indications were obesity, poor bone quality in elderly patients, and revision cases. TOCF could be considered as a last treatment option in open-book pelvic injuries where plating or external fixation is at risk to fail.

Assessing Medical Student Perceptions of Open-Book Exams for Self-Directed Learning.

Introduction  The landscape of medical education is constantly evolving, with innovative assessment methods being integrated to better align with the requirements of modern healthcare education. Among these, open-book exams (OBEs) represent a significant shift from traditional closed-book exams (CBEs), promising to enhance learning outcomes and better evaluate students' understanding of medical concepts. This study aims to explore the multifaceted impact of OBEs on medical students, including their perceptions, study behaviors, stress levels, and the cultivation of critical thinking and self-directed learning skills. Methodology  This is a cross-sectional study, which utilized a mixed-methods approach, conducted at Al Baha University's College of Medicine, to explore the impact of OBEs on self-directed learning among 129 medical students over a 15-day period in October 2023. The research combined quantitative data from online questionnaires, assessing students' experiences, stress, understanding, and study strategies, with qualitative insights from in-depth interviews and open-ended survey questions. Participants were final-year medical students with prior experience in OBEs, selected to minimize bias. Data analysis was performed using Statistical Product and Service Solutions (SPSS, version 25; IBM SPSS Statistics for Windows, Armonk), focusing on descriptive and inferential statistics, while qualitative data underwent thematic analysis to identify patterns in students' perceptions of self-directed learning opportunities. The study was ethically approved, ensuring participant confidentiality and informed consent. Result  Regarding the medical student perspectives on OBEs, the study revealed that the majority of medical students strongly perceive OBEs as less stressful (77, 59.69%) and easier to prepare for (79, 61.24%) compared to traditional exams. A significant proportion also believe OBEs accurately assess their comprehension (106, 82.17%) and prefer them as a mode of assessment (106, 82.17%). Furthermore, most students (87, 67.44%) reported performing better on OBEs compared to CBEs. Regarding the assessment of self-directed learning using the OBE method, students predominantly utilized highlighting important points (70, 54.26%) as a preparation method for OBEs. A large majority (85, 65.89%) considered OBEs as a fair assessment of self-directed learning and believed that they encourage self-directed learning (114, 88.37%). Conclusion  OBEs represent a promising direction for medical education, offering a way to better prepare students for the complexities of real-world medical practice. Future strategies should include not only the refinement of OBE methodologies but also the integration of practice opportunities that enable students to hone their skills in applying knowledge effectively.

Do we need another screw? Sacroiliac screw fixation in open-book pelvic ring injuries (APC type II).

Purpose: To compare anterior plate fixation (SP fixation) both alone and in combination with an additional posterior sacroiliac screw (SP+SIS fixation) as a treatment for pelvic ring injuries with widening of the pubic symphysis and disruption to the anterior sacroiliac ligaments. Methods: To find studies with pelvic ring injuries (APC II; B2.3d) and SP or SP+SIS fixation, a systematic literature review was conducted by searching four databases. A protocol was published a priori at Open Science Framework (https://doi.org/10.17605/OSF.IO/3YHAV). Exclusion criteria included perineal injuries, chronic instability of the symphysis, complete sacroiliac separation, and pediatric patients (age <18 years). Primary outcomes of interest were defined as implant failure, health-related quality of life, and revision rate. Results: Altogether, 1861 studies were screened, and 40 studies qualified for full-text analysis. In total, 14 studies (two surveys, six biomechanical studies, and six retrospective clinical studies) were included. The surveys revealed that surgeons who had more recently begun practicing were more likely to use posterior fixation (SP+ISS). The biomechanical studies were heterogenous and did not yield a uniform pattern. In clinical studies, 117 patients (45%) received SP fixation, and 142 patients (55%) received SP+SIS fixation. Complications occurred in 31 SP patients (30%) and in five SP+SIS patients (3.5%). Conclusion: A high risk of bias was uncovered, and reporting was found to be incomplete. SP+SIS may have the potential to improve outcomes, but the evidence remains too inconclusive to draw reliable recommendations.