An electronic portfolio for quantitative assessment of surgical skills in undergraduate medical education.

Journal Article; Research Support, Non-U.S. Gov't;BACKGROUND We evaluated a newly designed electronic portfolio (e-Portfolio) that provided quantitative evaluation of surgical skills. Medical students at the University of Seville used the e-Portfolio on a voluntary basis for evaluation of their performance in undergraduate surgical subjects. METHODS Our new web-based e-Portfolio was designed to evaluate surgical practical knowledge and skills targets. Students recorded each activity on a form, attached evidence, and added their reflections. Students self-assessed their practical knowledge using qualitative criteria (yes/no), and graded their skills according to complexity (basic/advanced) and participation (observer/assistant/independent). A numerical value was assigned to each activity, and the values of all activities were summated to obtain the total score. The application automatically displayed quantitative feedback. We performed qualitative evaluation of the perceived usefulness of the e-Portfolio and quantitative evaluation of the targets achieved. RESULTS Thirty-seven of 112 students (33%) used the e-Portfolio, of which 87% reported that they understood the methodology of the portfolio. All students reported an improved understanding of their learning objectives resulting from the numerical visualization of progress, all students reported that the quantitative feedback encouraged their learning, and 79% of students felt that their teachers were more available because they were using the e-Portfolio. Only 51.3% of students reported that the reflective aspects of learning were useful. Individual students achieved a maximum of 65% of the total targets and 87% of the skills targets. The mean total score was 345 ± 38 points. For basic skills, 92% of students achieved the maximum score for participation as an independent operator, and all achieved the maximum scores for participation as an observer and assistant. For complex skills, 62% of students achieved the maximum score for participation as an independent operator, and 98% achieved the maximum scores for participation as an observer or assistant. CONCLUSIONS Medical students reported that use of an electronic portfolio that provided quantitative feedback on their progress was useful when the number and complexity of targets were appropriate, but not when the portfolio offered only formative evaluations based on reflection. Students felt that use of the e-Portfolio guided their learning process by indicating knowledge gaps to themselves and teachers.The Electronic Portfolio of the Faculty of Medicine was supported by a financial fund from the 2009 Innovation and Teaching Enhancing Programme, University of Seville, Spain. The manuscript processing charges were financed by the Andalusian Association for Medical Education in OtorhinolaryngologyYe

Repercusiones anatomopatológicas de las resecciones hepáticas segmentarias

Se presenta un estudio experimental de las repercusiones anatomopatológicas de resecciones hepáticas segmentarías.han utilizado 60 ratas, que se distribuyeron en cuatro grupos 18 animales cada uno, salvo el grupo I, con seis, de la siguiente forma: l) Anestesia y laparotomía: ll) Resección hepática del 30% ; III) Resección hepática del 50%y IV) Resección hepática del 80%. Los tres grupos de resección se distribuyeron en tres subgrupos, determinando los parámetros estudiados a las veinticuatro horas, setenta y dos horas y diez días respectivamente. Los datos estudiados fueron: l. Inflamatorios: Activación de las células KÜPFFER. estado del lobulillo y de espacios porta. 2.Degenerativos: Esteatosis, focos dc necrosis, infarto y degeneración eosinófila. 3. Regenerativos: Hipertrofia hepatocitaria, mitosis, binucleación y trabeculación. Los resultados confirman que el higado resecado sufre procesos de regeneración que condicionan la adaptación del animal tras la exéresis hepática.We present an experimental study of the anatomopathologic repercussions of segmental liver resection. Sixly rats were used. distributed into 3 groups of 18 animals each one with 6, group L, as follows: I ) anesthesia and laparotomy: 2) 30 % liver resectiom: 3) 5O % liver resection. and 4) 80 % liver resection. The three resection groups were distributed into three subgroups according to parameters studied 24 hours. 72 hours and 1O days, respectively. The data studied were: l. Inflammation: activation of Kupffer cells, state of the lobule and portal spaces. 2. Degeneration: steatosis, necrotic foci, infarction and eosinophilic degeneration. 3. Regeneration: hepatocytic hypertrophy, mitosis, binucleation and trabeculation. The results confirm (hat the resected liver undergoes regenerative processes that condition the adaptation of the animal after hepatic excresis

Experimental Study of Sutureless Colorectal Anastomosis

Background / Aims: The present research project has been made mainly with the idea of comparing the tensile strength values and histological answers of three types of colon anastomosis: sutured with silk 5/0; polyglycolic acid 5/0; sutureless anastomosis with human fibrin gum. Methodology: One hundred and five (105) Wistar breath rata allocated into 3 groups of 35 animals were used to implement this experimental research project: silk, polyglycolic acid and human fibrin gum. Furthermore, each group was subdivided in 5 series respectively to carry out an experimental study on the tensile strength parameter and anatomic-pathological determinations on the 10th, 20th, 30th, 40th and 50th day after the gurgical intevention. The following surgical interventions were practiced on them: A cross section of the colon, followed by: group 1: an end-to-end discontinuous suture anastomosis with Silk; group 2: an end-to-end discontinuous suture anastomosis with polyglycolic acid; group 3: sutureless anastomosis with human fibrin gumu. On the 10th, 20th, 30th, 40th and 50th days we proceeded to measure the anastomosis' tensile strength value for each series. We used a tensile strength apparatus and waited until the break down of the suture sample took place and wrote down the value, in g/cm, given by the voltmeter at that momento. Reslts: The results obtained indicate that anastomosis made in group 1 (silk) lasted longer to the tensile strength apparatus; followed by those practiced in group 2 (polyglycolic acid); and finally anastomosis carried out in group 3 (human fibrin gum). However in the anastomotic carried out with the human fibrin gum the healing started from the 10th day. In the same period of time we carried out the following anatomic-pathological determinations: a)Sharp inflammation; b)edema; c) non-specific chronic inflammatory infiltrate; d) granulomatous inflarnmatory infiltrate to foreign bodies; e) fibrosis. Conclusions: The results show a better answer for anastomosis made with human fibrin gum than those carried out with the two other suture materials. This conclusion is based on the facts that the human fibrin gum used to carry out sutureless anastomosis during this research project generated a Iower sharp inflammation and speediness in its absorption;absence of granular reaction to a foreign body; a minor or non-existent edema at all; as well a good fibrous healing speediness process. Therefore, all these experimental results lead us to conclude that the human fibrin gum used to carry out sutureless anastomosis may be an alternative to the handmade conventional anastomosis. Moreover they are easy to be implemented