The American surgeon
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The American surgeon · Jun 2007
How residents think and make medical decisions: implications for education and patient safety.
Medical errors are a major cause of morbidity and mortality, and cognitive errors account for many of these events. This study examined the basic science of the cognitive performance of trainees. We created a low-intensity medical simulator to perform a preliminary study of the ability of residents to recall and process patient information presented verbally. ⋯ More importantly, the reasoning process (forward hypothesis based) of the more experienced residents differed from novices. This preliminary study demonstrates that the cognitive processes used by residents experienced in critical care are quantitatively and qualitatively different from those used by novices. These processes were also associated with far fewer cognitive errors in clinical decision making.
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Chest wall fractures, including injuries to the ribs and sternum, usually heal spontaneously without specific treatment. However, a small subset of patients have fractures that produce overlying bone fragments that may produce severe pain, respiratory compromise, and, if untreated mechanically, result in nonunion. We performed open reduction and internal fixation on seven patients with multiple rib fractures-five in the initial hospitalization and two delayed--as well as 35 sternal fractures (19 immediate fixation and 16 delayed). ⋯ Three patients had their plates removed after boney union was achieved. No evidence of infection or nonunion occurred. The excellent results achieved in the subset of patients with severe chest wall deformities treated initially at our institution and those referred from outside suggest that operative fixation is a useful modality that is likely underused.