bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatrics Residents' Preparedness for Neonatal Resuscitation Assessed Using High-Fidelity Simulation
Authors: Cordero Leandro , Hart Brandon J. , Hardin Rene , Mahan John D. , Giannone Peter J. , Nankervis Craig A. 
Published: July 2013

Abstract

Background
Pediatrics residents are expected to demonstrate preparedness for neonatal resuscitation, yet research has shown gaps in residents' readiness to perform this skill.

Objective
To evaluate procedural skills and team performance of pediatrics residents during neonatal resuscitation (NR) using a high-fidelity mannequin, and to assess residents' confidence in their NR skills before and after training.

Methods
Two teams of residents (all had completed NR program training) participated in 2 separate, 90-minute sessions (2 to 3 weeks apart) in an off-site delivery room during their neonatal intensive care rotation. Residents' confidence in assisting and leading NR was surveyed before each session. Teams participated in a scenario (adapted from the NR program), which required 5 skills (positive pressure ventilation, chest compressions, endotracheal intubation, umbilical vein catheterization, and epinephrine administration). Video recording was used for debriefing and scoring. Skills were scored for technique and timeliness, and team behaviors were scored for communication, management, and leadership.

Results
Twenty-six residents (11 teams) completed 2 paired sessions. Self-confidence scores increased between the 2 sessions but were not correlated with performance. Gaps in procedural skill performance were observed, and timeliness for most skills did not meet expectations. Significant improvement in team communication was noted.

Conclusions
Important gaps in procedural skill performance, particularly timeliness, were detected by NR simulation training; residents' improvements in self-confidence did not reflect gains in actual performance. Their relative unpreparedness for NR (despite prior certification) highlights the need for deliberate practice and specific team training before and during neonatal intensive care delivery room rotations.
Validation of the Colorado Psychiatry Evidence-Based Medicine Test
Authors: Rothberg Brian , Feinstein Robert E. , Guiton Gretchen 
Published: July 2013

AbstractBackgroundEvidence-based medicine (EBM) has become an important part of residency education, yet many EBM curricula lack a valid and standardized tool to identify learners' prior knowledge and assess progress.ObjectiveWe developed an EBM examination in psychiatry to measure our effectiveness in teaching comprehensive EBM to residents.MethodsWe developed a psychiatry EBM test using the validated EBM Fresno Test of Competence for family medicine. The test consists of case scenarios with open-ended questions. We also developed a scoring rubric and obtained reliability with multiple raters. Fifty-seven residents provided test data after completing 3, 6, 25, or 31 EBM sessions. The number of sessions for each resident was based on their length of training in our program.ResultsThe examination had strong interrater reliability, internal reliability, and item discrimination. Many residents showed significant improvement on their examination scores when data were compared from tests taken before and after a sequence of teaching sessions. Also, a threshold for the level of expert on the examination was established using test data from 5 EBM teacher-experts.ConclusionsWe successfully developed a valid and reliable EBM examination for use with psychiatry residents to measure essential EBM skills as part of a larger project to encourage EBM practice for residents in routine patient care. The test provides information on residents' knowledge in EBM from entry level concepts through expert performance. It can be used to place incoming residents in appropriate levels of an EBM curriculum and to monitor the effectiveness of EBM instruction.
Morning Report: Can an Established Medical Education Tradition Be Validated?
Authors: McNeill Matthew , Ali Sayed K. , Banks Daniel E. , Mansi Ishak A. 
Published: July 2013

Abstract

Background
Morning report is accepted as an essential component of residency education throughout different parts of the world.

Objective
To review the evidence of the educational value, purpose, methods, and outcomes of morning report.

Methods
A literature search of PubMed, Ovid, and the Cochrane Library for English-language studies published between January 1, 1966, and October 31, 2011, was performed. We searched for keywords and Medical Subject Heading terms related to medical education, methods, attitudes, and outcomes in regard to “morning report.” Title and abstract review, followed by a full-text review by 3 authors, was performed to identify all pertinent articles.

Results
We identified 71 citations; 40 articles were original studies and 31 were commentaries, editorials, or review articles; 56 studies (79%) originated from internal medicine residency programs; 6 studies (8%) focused on ambulatory morning report; and 63 (89%) originated from the United States. Identified studies varied in objectives, methods, and outcome measures, and were not suitable for meta-analysis. Main outcome measures were resident satisfaction, faculty satisfaction, preparation for professional examinations, use of evidence-based medicine, clinical effects on patient care, adverse event detection, and utilization of a curriculum in case selection.

Conclusions
Morning report has heterogeneous purposes, methods, and settings. As an educational tool, morning report is challenging to define, its outcome is difficult to measure, and this precludes firm conclusions about its contribution to resident education or patient care. Residency programs should tailor morning report to meet their own unique educational objectives and needs.
The Relationship Between the American Board of Anesthesiology Part 1 Certification Examination and the United States Medical Licensing Examination
Authors: Dillon Gerard F. , Swanson David B. , McClintock Joseph C. , Gravlee Glenn P. 
Published: July 2013

Abstract

Background
The graduate medical education community uses results from the United States Medical Licensing Examination (USMLE) to inform decisions about individuals' readiness for postgraduate training.

Objective
We sought to determine the relationship between performance on the USMLE and the American Board of Anesthesiology (ABA) Part 1 Certification Examination using a national sample of examinees, and we considered the relationship in the context of undergraduate medical education location and examination content.

Methods
Approximately 7800 individuals met inclusion criteria. The relationships between USMLE scores and ABA Part 1 pass rates were examined, and predictions for the strength of the relationship between USMLE content areas and ABA performance were compared with observed relationships.

Results
Pearson correlations between ABA Part 1 scores and USMLE Steps 1, 2 (clinical knowledge), and 3 scores for first-taker US/Canadian graduates were .59, .56, and .53, respectively. A clear relationship was demonstrated between USMLE scores and pass rates on ABA Part 1, and content experts were able to successfully predict the USMLE content categories that would least or most likely relate to ABA Part 1 scores.

Conclusions
The analysis provided evidence on a national scale that results from the USMLE and the ABA Part 1 were correlated and that success on the latter examination was associated with level of USMLE performance. Both testing programs have been successful in conceptualizing many of the knowledge areas of interest and in developing test content to reflect those areas.
PEARLs of Wisdom: Impact of a New Block Conference on Pediatrics Resident Attendance, Satisfaction, and Learning
Authors: Moreno Megan A. , Kota Rajitha , McIntosh Gwen C. , Frohna John G. 
Published: July 2013

Abstract

Background
Resident attendance and participation at didactic conferences is often limited owing to time demands. In 2010, University of Wisconsin-Madison pediatrics residency eliminated all noon conferences and implemented a new block format, PEARL (Pediatric Education and Active Resident Learning).

Objective
The purpose of this study was to assess whether changes in a conference structure improved resident attendance, distractibility, satisfaction, perception of clinical relevance, and connection.

Methods
Pediatrics residents were surveyed to compare experiences in 2 different conference structures: a traditional noon conference and an interactive case-based PEARL conference. Pediatrics residents from the 2008–2010 classes were surveyed about noon conference experiences and 2009–2011 classes were surveyed about PEARL conference experiences.

Results
Participants included 32 residents in the 2010 presurvey and 36 in the 2011 postsurvey. All measures of attendance, distractibility, and satisfaction showed positive changes. For example, the average proportion of conferences attended was 73% with noon conferences and 98% with PEARL (P  =  .001). However, measures of perceived clinical relevance and resident participation did not change significantly. For example, on average 47% of residents reported contributing comments in a noon conference, whereas 56% of residents reported contributing in a block conference (P  =  .199).

Conclusions
PEARL conference significantly improved resident attendance, lowered distractibility, and improved resident satisfaction. However, these structural changes did not lead to changes in perceived clinical relevance of information learned or resident participation. Further content changes or faculty teaching strategies should be considered.
Using a Learning Coach to Develop Family Medicine Residents' Goal-Setting and Reflection Skills
Authors: George Paul , Reis Shmuel , Dobson Margaret , Nothnagle Melissa 
Published: July 2013

AbstractBackgroundSelf-directed learning (SDL) skills, such as self-reflection and goal setting, facilitate learning throughout a physician's career. Yet, residents do not often formally engage in these activities during residency.InterventionTo develop resident SDL skills, we created a learning coach role for a junior faculty member to meet with second-year residents monthly to set learning goals and promote reflection.MethodsThe study was conducted from 2008–2010 at the Brown Family Medicine Residency in Pawtucket, Rhode Island. During individual monthly meetings with the learning coach, residents entered their learning goals and reflections into an electronic portfolio. A mixed-methods evaluation, including coach's ratings of goal setting and reflection, coach's meeting notes, portfolio entries, and resident interviews, was used to assess progress in residents' SDL abilities.ResultsCoach ratings of 25 residents' goal-setting ability increased from a mean of 1.9 to 4.6 (P &lt; .001); ratings of reflective capacity increased from a mean of 2.0 to 4.7 (P &lt; .001) during each year. Resident portfolio entries showed a range of domains for goal setting and reflection. Resident interviews demonstrated progressive independence in setting goals and appreciation of the value of reflection for personal development.ConclusionsIntroducing a learning coach, use of a portfolio, and providing protected time for self-reflected learning allowed residents to develop SDL skills at their own pace. The learning coach model may be applicable to other residency programs in developing resident lifelong learning skills.
Retention of Critical Care Skills After Simulation-Based Mastery Learning
Authors: Moazed Farzad , Cohen Elaine R. , Furiasse Nicholas , Singer Benjamin , Corbridge Thomas C. , McGaghie William C. , Wayne Diane B. 
Published: July 2013

Abstract

Background
Whether cognitive and patient care skills attained during simulation-based mastery learning (SBML) are retained is largely unknown.

Objective
We studied retention of intensive care unit (ICU) clinical skills after an SBML boot camp experience.

Methods
Forty-seven postgraduate year (PGY)-1 residents completed SBML intervention designed to increase procedural, communication, and patient care skills. The intervention included ICU skills such as ventilator and hemodynamic parameter management. Residents were required to meet or exceed a minimum passing score (MPS) on a clinical skills examination before starting actual patient care. Skill retention was assessed in 42 residents who rotated in the medical ICU. Residents received a standardized 15-minute booster teaching session reviewing key concepts during the first week of the rotation. During the fourth week of their rotation, PGY-1 residents completed a clinical skills examination at the bedside of an actual ICU patient. Group mean examination scores and the proportion of subjects who met or exceeded the MPS at each testing occasion were compared.

Results
Residents scored a mean 90% (SD  =  6.5%) on the simulated skills examination immediately after training. Residents retained skills obtained through SBML as the mean score at bedside follow-up testing was 89% (SD  =  8.9%, P  =  .36). Thirty-seven of 42 (88%) PGY-1 residents met or exceeded the MPS at follow-up.

Conclusion
SBML leads to substantial retention of critical care knowledge, and patient care skills PGY-1 boot camp is a highly efficient and effective model that can be administered at the beginning of the academic year.
“Best Practice” for Patient-Centered Communication: A Narrative Review
Authors: King Ann , Hoppe Ruth B. 
Published: July 2013

AbstractBackgroundCommunicating with patients has long been identified as an important physician competency. More recently, there is a growing consensus regarding the components that define physician-patient communication. There continues to be emphasis on both the need to teach and to assess the communication skills of physicians.ObjectiveThis narrative review aims to summarize the work that has been conducted in physician-patient communication that supports the efficacy of good communications skills. This work may also help to define the physician-patient communication skills that need to be taught and assessed.ResultsA review of the literature shows it contains impressive evidence supporting positive associations between physician communication behaviors and positive patient outcomes, such as patient recall, patient understanding, and patient adherence to therapy. There is a consensus about what constitutes “best practice” for physician communication in medical encounters: (1) fostering the relationship, (2) gathering information, (3) providing information, (4) making decisions, (5) responding to emotions, and (6) enabling disease- and treatment-related behavior.ConclusionsEvidence supports the importance of communication skills as a dimension of physician competence. Effort to enhance teaching of communication skills to medical trainees likely will require significant changes in instruction at undergraduate and graduate levels, as well as changes in assessing the developing communication skills of physicians. An added critical dimension is faculty understanding of the importance of communication skills, and their commitment to helping trainees develop those skills.
Polished Cobalt-Chrome vs Titanium Tibial Trays in Total Knee Replacement (a Comparison using the PFC Sigma System)
Authors: Hug Kevin T , Henderson Robert A , Hansen Benjamin J , Wellman Samuel S , Vail Thomas P 
Published: July 2013

ABSTRACTFixed-bearing total knee arthroplasty components can cause wear debris due to fretting micromotion between the polyethylene insert and the metal tibial tray, possibly leading to osteolysis and implant failure. This study compared the effects of either a highly polished cobalt-chrome (CoCr) or titanium tibial tray in patients receiving the PFC. Sigma® posterior stabilized knee system with a moderately cross-linked polyethylene insert. One hundred five patients with titanium tibial trays and 70 patients with CoCr tibial trays were prospectively enrolled at the time of follow-up of at least 4 years from surgery. There were two revisions with implant removal in each group. On blinded radiographic review, osteolysis was observed in three of 105 knees in the titanium group and three of 70 knees in the CoCr group. Radiolucent lines were categorized in accordance with the Knee Society roentgenographic evaluation system. In the titanium group 18% showed no radiolucent lines, 65% scored four or less (nonconcerning), and 17% scored between five and nine (requires observation for progression). In the CoCr group 24% showed no radiolucencies, 61% scored four or less, and 14% scored between five and nine. None of the knees in either group scored greater than 10 (possible or impending failure). Knee society scores and radiographic alignment were statistically similar between groups. These results suggest that there may not be a difference in clinical or radiographic mid-term outcome between titanium and CoCr tibial trays in total knee arthroplasty.Hug KT, Henderson RA, Hansen BJ, Wellman SS, Vail TP, Bolognesi MP. Polished Cobalt-ChromevsTitanium Tibial Trays in Total Knee Replacement (A Comparison using the PFC Sigma System). The Duke Orthop J 2012;2(1):5-11.
Anomalous Thenar Musculature Associated with Aberrant Median Nerve Motor Branch Take-off: An Anatomic and Clinical Study
Authors: Lourie Gary M , Gaston R Glenn , Peljovich Allan E , Marshall Jason J , Patterson Lee 
Published: July 2013

ABSTRACT

Introduction
Iatrogenic laceration of the median nerve motor branch during carpal tunnel release is a devastating complication that has been reported with both open and endoscopic techniques. The purpose of this study is to highlight a previously underreported relationship between an aberrant course of the median nerve motor branch and an anomalous thenar muscle that places the motor branch at high risk.

Materials and methods
This was a two part study. The first part was a retrospective review of over 500 cases of carpal tunnel release over a 7 year period. There were 530 carpal tunnel releases performed and 20/530 cases were found to have a characteristic anomalous thenar muscle associated with a consistent aberrant course of the motor branch of the median nerve. Part two was an anatomic study in which 42 cadaveric wrists were dissected to determine median nerve branching patterns, dimensions of the transverse carpal ligament, and thenar musculature dimensions.

Results
Twenty patients (3.8%) in the clinical arm were found to have anomalous musculature. In each case, the characteristics of the muscle were similar; the muscle was triangular in shape, was distal to the FPB, and had minimal fascial covering. In 100% of the cases the motor branch was found to be more anterior/central or ulnar in its take-off. In the anatomic study, two hands (5%) had aberrant musculature extending distal to the transverse carpal ligament (TCL). Both were associated with an anterior/central or ulnar median motor branch take-off with recurrent course. Larger thenar musculature dimensions and anomalous thenar muscle were associated with more anterior and ulnar motor branch take-off.

Conclusion
There appears to be a high association between anomalous thenar musculature and an aberrant course of the motor branch of the median nerve placing it a greater potential risk for iatrogenic injury.
Lourie GM, Gaston RG, Peljovich AE, Marshall JJ, Patterson L. Anomalous Thenar Musculature Associated with Aberrant Median Nerve Motor Branch Take-off: An Anatomic and Clinical Study. The Duke Orthop J 2012;2(1):18-22.
Free Vascularized Fibular Grafting Preserves Athletic Activity Level in Patients with Osteonecrosis
Authors: Sabesan VJ , Pedrotty DM , Urbaniak JR , Gahreeb G , Aldridge JM 
Published: July 2013

ABSTRACT

Background
Athletic patients with osteonecrosis of the femoral head have few desirable therapeutic options that preserve athletic ability. A total hip arthroplasty for this young and active patient population would be catastrophic for patients’ chances of returning to vigorous athletic endeavors. Therefore, other therapeutic alternatives must be considered prior to enlisting this patient population for a total hip arthroplasty.

Materials and methods
We retrospectively evaluated 15 patients (19 hips) who presented at an average age of 28.5 years (12-46) and stages 2 (6/19), 3 (2/19), 4 (9/19) and 5 (2/19) of osteonecrosis of the femoral head (ONFG). All patients were participating in strenuous athletic activity and were treated with free vascularized fibular autografting (FVFG) to the femoral head.

Results
Postoperative evaluation of pain symptoms and functional activity showed improvements in all patients. The average follow-up time was 8 years. Harris hip scores significantly increased from an average preoperative score of 72.5 to an average postoperative score of 94. Seventy-five percent of patients were able to return to their sport after recovery and all patients reported being satisfied with the procedure and would repeat their decision to have surgery. Three patients’ hips were converted to arthroplasty at 3, 11 and 17 years post-FVFG.

Conclusion
Our results demonstrate FVFG as a successful treatment in athletes with osteonecrosis of the femoral head. This procedure has the potential to reduce pain, increase activity and allow most to return to their sport, an achievement often not possible with other treatment options.
Sabesan VJ, Pedrotty DM, Urbaniak JR, Gahreeb G, Aldridge III JM. Free Vascularized Fibular Grafting Preserves Athletic Activity Level in Patients with Osteonecrosis. The Duke Orthop J 2012;2(1):40-43.