Point: developing a curriculum in clinical pathology.
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Clinical Competence↗
Biomedical subjects
Jason Park
Publications and source records attributed to Jason Park.
Value of debriefing during simulated crisis management: oral versus video-assisted oral feedback.
BACKGROUND: The debriefing process during simulation-based education has been poorly studied despite its educational importance. Videotape feedback is an adjunct that may enhance the impact of the debriefing and in turn maximize learning. The purpose of this study was to investigate the value of the debriefing process during simulation and to compare the educational efficacy of two types of feedback, oral feedback and videotape-assisted oral feedback, against control (no debriefing). METHODS: Forty-two anesthesia residents were enrolled in the study. After completing a pretest scenario, participants were randomly assigned to receive no debriefing, oral feedback, or videotape-assisted oral feedback. The debriefing focused on nontechnical skills performance guided by crisis resource management principles. Participants were then required to manage a posttest scenario. The videotapes of all performances were later reviewed by two blinded independent assessors who rated participants' nontechnical skills using a validated scoring system. RESULTS: Participants' nontechnical skills did not improve in the control group, whereas the provision of oral feedback, either assisted or not assisted with videotape review, resulted in significant improvement (P < 0.005). There was no difference in improvement between oral and video-assisted oral feedback groups. CONCLUSIONS: Exposure to a simulated crisis without constructive debriefing by instructors offers little benefit to trainees. The addition of video review did not offer any advantage over oral feedback alone. Valuable simulation training can therefore be achieved even when video technology is not available.
Adult↗
Quantification of motion characteristics and forces applied to tissues during suturing.
BACKGROUND: The quantification of movement processes describes how a movement is generated. These process measures have been shown to be effective sources of feedback to facilitate motor learning and can thus be applied to teach fundamental technical skills in surgery. The aim of this study was to determine, through detailed analyses, whether specific process measures of hand motions and forces imposed on tissues during suturing were sensitive to (1) practice and (2) levels of surgical expertise. METHODS: Six junior surgical residents (PGY-1) and 7 faculty surgeons were required to perform 20 simulated sutures on an artificial artery model, during which time the performers' hand movements were tracked by electromagnetic markers and the quantity of force they applied was measured by a force platform holding the arterial suturing models. The amount of wrist rotation and peak hand velocity produced during the suturing movement, peak and average forces applied to the tissue, the temporal difference between force and wrist rotation onsets, and the total suturing time were evaluated. RESULTS: Surgeons showed greater wrist rotation, higher average forces, shorter force-rotation initiation times, and shorter suturing times than did junior residents. Only the amount of wrist rotation and the time elapsed between force and wrist rotation onsets improved with practice for the junior group. CONCLUSIONS: Although all 4 variables measured can be used to distinguish between expert and novice performances, only the process measures (wrist rotation and force-rotation initiation time) changed as a result of practice for the junior residents. Thus, these measures can be used to facilitate skills learning by serving as a source of detailed structured feedback to trainees.
Clinical Competence↗
Why are women deterred from general surgery training?
BACKGROUND: This study explored the factors contributing to the low application rates to general surgery (GS) residency by female students and compared perceptions of GS between students and female surgeons. METHODS: We distributed surveys to final-year students at 4 medical schools and nationwide to every female general surgeon in Canada. RESULTS: Of students who were deterred from GS, women were less likely than men to meet a same-sex GS role model and more likely to experience gender-based discrimination during their GS rotation (P < .05). Female students had the perception that GS was incompatible with a rewarding family life, happy marriage, or having children, whereas female surgeons were far more positive about their career choice. CONCLUSIONS: Both real and perceived barriers may deter women from a career in GS. Real barriers include sex-based discrimination and a lack of female role models in GS. There are also clear differences in perception between students and surgeons regarding family and lifestyle in GS that must be addressed.
Career Choice↗
Structural flexibility of laparoscopic instruments: implication for the design of virtual reality simulators.
In accordance with the Practice Specificity Theory, training on models that closely resemble real life scenarios is most beneficial to learning. Research in the virtual reality (VR) simulation, as a potential teaching and evaluation tool, concentrated on the design of trainers to resemble operating room (OR) conditions. The purpose of the present investigation was to determine the structural flexibility of laparoscopic instruments of different materials and diameters under a wide range of stresses. Incorporating the mechanical properties of these instruments into the algorithms can prove to further increase the fidelity of VR simulators. The amount of deviation from pre-stress position in the instruments' shaft was measured with infrared markers and used as the index of structural flexibility. All instruments deviated considerably with the largest deviations observed for the small disposable, and lowest for the large reusable instruments. There was a linear relation between the stress and deviation for all instruments, which varied as a function of diameter. Similar instrument deviations were observed during cholecystectomy performed on porcine liver. Our findings show that laparoscopic instruments are not rigid bodies and are prone to significant deviations during standard laparoscopic procedures. This suggests that the structural flexibility of laparoscopic instruments should be modeled in the design of VR simulators.
Canada↗
A study of career choice patterns among Canadian medical students.
BACKGROUND: The number of students pursuing general surgery (GS) has declined in Canada. The reasons for this, and program directors' (PDs) perception of it, are unclear. METHODS: A survey was distributed to medical students at Queen's University and the University of Manitoba, and to all Canadian GS program directors to explore causes for the trend and identify potential solutions. RESULTS: Students pursuing GS were more likely to feel that GS fit their lifestyle needs (P < 0.05) and to have met positive role models (P < 0.05). Hardship of the training and practice, length of training, need for prestige, income and enjoyment of procedures did not correlate with specialty choice. Half of GS PDs did not perceive a decline in the number of applicants. CONCLUSIONS: Attention to student-raised concerns regarding GS programs and increased awareness of the applicants' trends among PDs can be used to address the current decline in applications to GS.
Adult↗
Ectopic expression of guanylyl cyclase C in adenocarcinomas of the esophagus and stomach.
Guanylyl cyclase C (GC-C), a receptor specifically expressed in cells originating from differentiated intestinal epithelium, is a marker and therapeutic target for colorectal cancer metastases. Intestinal metaplasia, in which epithelial cells assume histological and molecular characteristics of differentiated intestinal enterocytes, is a common precursor to adenocarcinomas of the esophagus and stomach. Thus, those tumors, tissues adjacent to them, and their associated regional lymph nodes were assessed for GC-C expression by reverse transcription coupled with the PCR. GC-C mRNA was detected in five of five and eight of nine esophageal and gastric adenocarcinomas, respectively. Also, GC-C mRNA was detected in three of five and six of seven tissues adjacent to, but not histologically involved in, esophageal and gastric adenocarcinomas, respectively, reflecting molecular changes associated with neoplastic transformation preceding histopathological changes. In contrast, three normal gastric specimens did not express GC-C. Furthermore, GC-C mRNA was detected in 1 of 1 lymph node containing tumor cells by histopathology from a patient with gastric adenocarcinoma and in 3 of 11 lymph nodes, all of which were free of tumor cells by histopathology, from a patient with a gastroesophageal junction tumor. This is the first demonstration that GC-C is ectopically expressed by primary and metastatic adenocarcinomas of the esophagus and stomach and suggests that GC-C may be a sensitive and specific clinical marker and target for adenocarcinomas of the upper gastrointestinal tract.
Adenocarcinoma↗