Surgery
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Comparative Study
Patients with poor baseline walking capacity are most likely to improve their functional status with multimodal prehabilitation.
Evidence suggests that multimodal prehabilitation programs comprising interventions directed at physical activity, nutrition, and anxiety coping can improve functional recovery after colorectal cancer operations; however, such programs may be more clinically meaningful and cost-effective if targeted to specific subgroups. This study aimed to estimate the extent to which patients with poor baseline functional capacity improve their functional capacity. ⋯ Patients with lower baseline walking capacity are more likely to experience meaningful improvement in physical function from prehabilitation before and after a colorectal cancer operation.
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Comparative Study
Preoperative antiplatelet use does not increase incidence of bleeding after major operations.
This study examined the outcomes of patients holding or continuing clopidogrel during the preoperative period. ⋯ We did not identify significantly increased adverse patient outcomes in those patients who received preoperative clopidogrel within this population. We assert that it appears to be reasonable and safe to continue antiplatelet therapy with clopidogrel in this population in elective situations and that preoperative clopidogrel use does not increase the risk of bleeding in emergency circumstances.
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Ventriculostomy is a common neurosurgical procedure with a relatively steep learning curve. A low-cost, high-fidelity simulator paired with procedure-specific performance measures would provide a safe environment to teach ventriculostomy procedural skills. The same validated simulation model could also allow for assessment of trainees' proficiencies with measures that align with Accreditation Council for Graduate Medical Education milestones. This study extends previous work to evaluate validity evidence from the simulator, its newly developed performance assessment, the Ventricolostomy Procedural Assessment Tool, and the Objective Structured Assessment for Technical Skills. ⋯ Despite a small sample, favorable evidence using current Standards supports the use of the novel simulator and both tools combined for skills training and performance assessment, but challenges (potential threats to validity) should be considered prior to implementation.
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The flipped classroom, a blended learning paradigm that uses pre-session online videos reinforced with interactive sessions, has been proposed as an alternative to traditional lectures. This article investigates medical students' perceptions of a simulation-based, flipped classroom for the surgery clerkship and suggests best practices for implementation in this setting. ⋯ Medical students' perceptions of a simulation-based, flipped classroom in the surgery clerkship were overwhelmingly positive. The flipped classroom approach can be applied successfully in a surgery clerkship setting and may offer additional benefits compared with traditional lecture-based curricula.
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The American College of Surgeons-Accredited Education Institutes (ACS-AEI) Consortium aims to enhance patient safety and advance surgical education through the use of cutting-edge simulation-based training and assessment methods. The annual ACS-AEI Consortium meeting provides a forum to discuss the latest simulation-based training and assessment methods and includes special panel presentations on key topics. ⋯ The focus of this report is on the basis for and advances in simulation-based summative assessments, the current practices employed across various surgical disciplines, and future directions that may be pursued by the ACS-AEI Consortium.