The Mount Sinai journal of medicine, New York
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Comparative Study
Comprehensive educational performance improvement (CEPI): an innovative competency-based assessment tool.
The focus of competency-based training is on outcomes, specifically well-trained residents. Our goal is to help move resident assessment away from content- and process-based factors and towards measures of mastery of practice. Doing so requires reorganizing and reprioritizing elements of the training program. We describe our attempt to shift the priorities of our program (the primary care internal medicine residency of the Mount Sinai School of Medicine [Elmhurst] Program) towards the desired outcomes of the medical resident, faculty, institution, and program as a whole. These outcomes are based on the six core competencies of graduate medical education (medical knowledge, patient care, interpersonal and communication skills, professionalism, systems-based practice, and practice-based learning and improvement). We call this process "comprehensive educational performance improvement" (CEPI). ⋯ The CEPI process has a number of strengths. It allows for the concurrent assessment of each learning element with its intended outcomes, enabling us to simultaneously assess its outcome and its programmatic value. It effectively integrates the cognitive aspects of a program element with its clinical aspects, along with the input of evaluators at various levels. Finally, it helps train faculty members in an evidence-based approach to the curriculum.
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The increasing use of organophosphorus insecticides in agriculture and inside homes and schools, as well as its widespread existence in the environment, poses a potential health hazard. As the use of these agents increases, acute and chronic exposure has become more common. ⋯ There are few reports about fetal toxicity of organophosphates in the literature because of the relatively few cases reported. In this paper we report a case of intoxication from chlorpyrifos, an organophosphorus compound, during pregnancy, causing fetal death.
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Residents play a pivotal role in the education of medical students and junior house staff but are rarely provided with the tools to help them teach effectively. Residents value their roles as teachers and desire training programs in teaching skills. Teaching skills courses for residents have been shown to improve residents' self-confidence and self-assessed use of effective teaching behaviors. ⋯ This adaptable, seven-hour curriculum has been well received by residents and faculty. We are currently evaluating the effects of the program on residents' confidence and use of learned skills. And we are working to expand this program to every department and to create innovative means of measuring resident competency in teaching and its ultimate effect on student learning.
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Recurrences of inguinal hernias are a not infrequent problem seen by the surgeon. Usually, repair of these hernias is technically more demanding than the original repairs, with potential for a new recurrence, and a higher risk of complications. Open preperitoneal placement of prosthetic mesh is an effective method of repair for such recurrences. ⋯ We present our experience with this technique in 27 patients during a 7-year period. Mean follow-up was 45 months. The procedure was safe (no significant early and late morbidity) and achieved a safe repair (no recurrence during the follow-up period).