Biomedical subjects

Vijay K Maker

Publications and source records attributed to Vijay K Maker.

6 recordsLinked to original sources

PubMed2006

Transvaginal excision of a large rectal stromal tumor: an alternative.

BACKGROUND: Gastrointestinal stromal tumors (GISTs), the specific kit-positive mesenchymal tumors of the gastrointestinal tract, are rarely found in the anorectum and account for only 0.1% of all colorectal tumors. The main stem of therapy remains surgical excision. The standard surgical approach for anorectal GISTs includes transanal resection or enucleation for smaller and anterior or abdominoperineal resection for larger tumors. METHODS: We present an alternative, transvaginal approach for a local excision of a large rectal GIST. In our case, a 5 x 5 x 8 cm large GIST located 3 cm above the dentate line in the anterior rectal wall was removed through the vagina. RESULTS: In our experience, this approach enables a safe alternative even for larger tumors in the anterior rectal wall with a very low morbidity, sparing the patient from an unnecessary abdominoperineal resection.

Aged↗

PubMed2006

Organs of Zuckerkandl: their surgical significance and a review of a century of literature.

BACKGROUND: Organs of Zuckerkandl (O of Z) harbor the potential for deadly paragangliomas. Paragangliomas are one of the surgical causes of hypertension. Major treatises of medicine offer very little information on this topic. METHODS: PubMed Medline and Google searches were performed to obtain reported cases of paragangliomas of the O of Z. A total of 135 cases of paragangliomas of the O of Z were found. Each case was reviewed and charted. Charts then were analyzed. RESULTS: Seventy-four percent of patients with this neoplasm have hypertension. Eighty percent of patients undergo an operation with more than 30% having an incorrect preoperative diagnosis. These tumors have a 43% mortality when presenting acutely. CONCLUSIONS: Individuals aged < or =50 years with hypertension should be considered for screening for pheochromocytoma/paraganglioma with uring and/or serum catecholamines. Twenty-four-hour collections for urinary metanephrines and vanillylmandelic acid are diagnostic of functional tumors. A high degree of suspicion should follow with radiologic and chemical diagnostic studies. Triple-phase helical computed tomographic scans, metaiodobenzyl-guanidine scans, and magnetic resonance imaging with gadolinium-diethylenetriaminepentaacetic acid infusion are the standard for radiologic diagnosis. Treatment is always surgical excision. Phase II trials are in order for neoadjuvant and adjuvant treatment options.

History, 19th Century↗

PubMedDate not supplied

Are you a surgical role model?

PURPOSE: Multiple papers have examined the recent decline in the number of surgical residency applicants. Many have concluded that a lack of role models in surgery is at least partially responsible for this decline. However, to date, the definition of a surgical role model does not exist. This paper defines a surgical role model based on criteria determined by surgery residents. METHODS: Fourth- and fifth-year surgical residents from 1 residency program were asked to collaboratively define 9 characteristics that make a surgical role model. The 9 criteria as defined by the residents were didactic teaching, teaching rounds, attendance at didactic activities, demonstrates skills and decision making in the operating room with confidence and virtuosity, allows [resident] to do procedures according to ability, allows autonomy to make independent decisions, provides feedback, stimulates critical thinking with use of literature, and assists [resident] to find and complete research for publication. Each resident in the program was then given a questionnaire and asked to evaluate each of the 49 teaching attendings on each of the 9 criteria, on a 3-point scale. Finally, residents evaluated each attending based on professionalism and mutual respect on a scale of I Don't Want To Emulate Him/Her, OK, or Role Model. These categories were also assigned a number (1, 2, and 3, respectively). Pearson correlation and stepwise multiple regression were used to determine the relationship between "Role Model" and the 9 criteria. The unit of analysis was the mean rating given each attending on each of the 10 scales. RESULTS: A total of 847 questionnaires were analyzed. Each of the 9 criteria correlated significantly with the Role Model rating (all p < 0.01). The average correlation was 0.73 (range, 0.64 to 0.78). Of the 9 criteria, 4 correlated best with the Role Model, as shown in. The stepwise regression indicates that 3 of the 9 criteria are uniquely associated with the Role Model variable. These 3 criteria are stimulates critical thinking with use of literature, allows autonomy to make independent decisions, and attendance at didactic activities. CONCLUSIONS: All of the 9 criteria are important factors in residents' perception of the Role Model characteristics of attending faculty. A parsimonious, operational definition of the surgical attending role model is one who stimulates the resident to think, gives the resident the opportunity to think and act independently, and is available to the resident.

Attitude of Health Personnel↗

PubMedDate not supplied

Faculty evaluations: diagnostic and therapeutic.

PURPOSE: An excellent teaching program is one that creates an atmosphere of mentorship, leadership, and professional development. The key to all of these may lie in the faculty evaluation. Currently, favorable faculty evaluations are often rewarded, whereas the more critical evaluations are downplayed and seldom used for faculty development. The purpose of this study is to investigate the efficacy of the faculty evaluation as a diagnostic tool to objectively identify individual strengths and weaknesses. Can such a tool then be used as a therapeutic modality to improve and enhance the faculty as a whole? METHODS: Fourth- and fifth-year surgical residents from 1 residency program were asked to collaboratively define 9 characteristics that make a surgical role model. They then anonymously evaluated each of the 44 teaching attendings on each of the 9 criteria. The results of the evaluations, which consisted of the overall mean scores and SD for each of the 9 criteria, the attending's score and SDs above or below the mean, as well as whether the residents considered them to be a Role Model, were sent to each faculty member as an intervention. Six months after the intervention, the residents evaluated the attendings using the same 9 criteria. Evaluations were collected and analyzed following the same procedure as 6 months prior. T-tests and p-values were calculated to determine any significant differences between the 2 data sets. RESULTS: Based on the results of the pre-intervention evaluations, we were able to delineate faculty members into 3 groups based on their Role Model score. Of the 10 faculty members with the lowest scores (defined as >1 SD below average), 7 improved after the intervention, 3 of them were statistically significant (2 with p < 0.05 and 1 with p < 0.10). In the middle group of 26 faculty members, 1 showed statistically significant improvement (p < 0.05). Interestingly, this was the faculty member with the lowest score in this group. Six faculty originally in the middle group improved to a score greater than 1 SD above average, defining them as a Role Model. The remaining 8 faculty members originally designated as Role Models showed no statistically significant changes in their scores after the intervention. After the intervention, the average score improved for all of the 9 criteria that make a faculty Role Model. Statistically significant improvements were seen in the categories of Provides Feedback (p < 0.05) and Didactic Teaching, Attendance at Didactic activities, and Stimulates Critical Thinking with the Use of Literature (all p < 0.10). CONCLUSIONS: (1) Faculty evaluations are a diagnostic tool with the ability to select out Role Models from the lower scoring groups. (2) After the intervention, the overall average score improved for all of the 9 criteria that make a Role Model, showing improvement of the faculty as a whole. (3) The therapeutic benefits of faculty evaluations were best seen in the faculty with the lowest scores.

Faculty, Medical↗

PubMedDate not supplied

Surgical rotations: the good, the bad, and the ugly.

BACKGROUND: Every surgeon's career begins with a surgical residency. Each residency has dreaded rotations as well as those that seem ideal, but to date, no objective criteria exist to define such rotations. The aim of this study is to establish objective criteria that, when applied to a specific rotation, will define it as a "dream" or a "dreaded" rotation and, in the process, elucidate the good, the bad, and the ugly of surgical rotations in general. METHODS: All 39 residents from a multi-institutional residency program were asked to collaboratively identify the criteria they felt necessary for a dream rotation. Each resident evaluated 16 rotations at 4 hospitals using the identified criteria on a scale of "Inadequate," "Optimal," and "Ideal/Dream Rotation." Residents then gave an overall evaluation of each rotation as a dream rotation on a scale of "No," "For the Most Part," or "Yes." Finally, each resident was asked whether the individual rotations were following ACGME recommendations on duty hours. RESULTS: The best correlations with a dream rotation were: clinical experience - quality and quantity of cases (r = 0.83), operative experience (r = 0.83), patient management responsibilities (r = 0.78), and outpatient office experience (r = 0.77). All p-values were < 0.05. The following correlated less with a dream rotation: conferences (r = 0.56, p < 0.05), medical student experience (r = 0.56, p < 0.05), and hospital facilities (r = 0.28, not significant.). Scut work was the only category for which there was a negative correlation with a dream rotation (r = -0.53, p < 0.05). Eighty-six percent of residents reported compliance with ACGME work hour recommendations, with no apparent correlation with a dream rotation.

Ambulatory Care↗

PubMedDate not supplied

Ongoing faculty evaluations: developmental gain or just more pain?

PURPOSE: We continue to increase the amount of evaluations to improve the outcomes of our residency programs. Although ongoing faculty evaluations clearly are an important part of faculty development, their value in terms of improving the program needs to be evaluated. The questions asked were as follows: (1) Do faculty evaluations continue to improve the faculty over the course of successive evaluation periods? (2) Are there groups of faculty who would benefit the most from faculty evaluation feedback? (3) Are there any specific objective categories within the evaluation that carry more value and may help to shorten this form? METHODS: Forty-two faculty members were evaluated by 40 surgical residents with an assessment form developed by surgical residents that assessed faculty members by 10 different criteria. The initial set of data was collected, and attending surgeons were given an intervention in the form of a letter detailing how they had been assessed in each of the 10 categories. The attending surgeons were evaluated again 6 months later and were given an intervention in the form of verbal feedback regarding their evaluations. The attending faculty members were then assessed 1 year after that. One way analyses of variance and Fisher Protected Least Significant Difference (PLSD) were used to analyze the resulting data to determine if there were significant differences in the faculty evaluations. A part-whole correlation was performed that correlated the 10 evaluation criteria against the mean score on each evaluation, and partial eta-squared analysis was used to determine which criterion had the largest effect on the overall means. RESULTS: The means for the 42 faculty members as a whole continued to improve from the first to the final evaluation period, with 30 faculty members increasing their mean score (18 significantly) and 12 decreasing their mean score (4 significantly). Seven of the 10 evaluation criteria's means improved sequentially by feedback session. These were (1) Didactic Teaching, (2) Teaching Rounds, (3) Attendance at Didactic Activities, (4) Allows [Resident] Autonomy to Make Independent Decisions, (5) Provides Feedback, (6) Stimulates Critical Thinking with Use of Literature, and (7) Encourages and Maintains an Atmosphere of Professional Mutual Respect for All Members of Health Care Team (Role Model). The faculty group with the lowest evaluations improved significantly more than those of both the middle and the role model group, with the middle and the role model groups improving, but not significantly differently from each other. Of the criteria that improved, only Provides Feedback improved significantly from the first to second and the second to third evaluation periods. The three criteria with the highest correlation coefficients were Role Model (0.76), Provides Feedback (0.75), and Stimulates Critical Thinking (0.74). The results from the partial eta-squared test showed that the criterion with the largest effect size was Provides Feedback (0.28). These analyses indicate that the criterion Provides Feedback was both highly correlated with the average score on a faculty member's evaluation and was more responsible than any other criteria for the overall improvement in the mean evaluation score of the faculty members. CONCLUSIONS: (1) Ongoing faculty evaluations indeed are a powerful tool to improve the faculty as a whole. (2) The faculty members with the lowest evaluations showed the largest amount of improvement. (3) Providing feedback to the residents seems to be the most valued factor by the residents for faculty evaluations and perhaps could become the basis of the evaluation for the most accomplished faculty.

Faculty, Medical↗