Is it time for integration of surgical skills simulation into the United Kingdom undergraduate medical curriculum? A perspective from King’s College London School of Medicine

PURPOSE: Changes in undergraduate medical curricula, combined with reforms in postgraduate education, have training implications for surgical skills acquisition in a climate of reduced clinical exposure. Confidence and prior experience influences the educational impact of learning. Currently there is no basic surgical skills (BSS) programme integrated into undergraduate curricula in the United Kingdom. We explored the role of a dedicated BSS programme for undergraduates in improving confidence and influencing careers in King's College London School of Medicine, and the programme was evaluated. METHODS: A programme was designed in-line with the established Royal College of Surgeons course. Undergraduates were taught four key skills over four weeks: knot-tying, basic-suturing, tying-at-depth and chest-drain insertion, using low-fidelity bench-top models. A Likert-style questionnaire was designed to determine educational value and influence on career choice. Qualitative data was collected. RESULTS: Only 29% and 42% of students had undertaken previous practice in knot-tying and basic suturing, respectively. 96% agreed that skills exposure prior to starting surgical rotations was essential and felt a dedicated course would augment undergraduate training. There was a significant increase in confidence in the practice and knowledge of all skills taught (p<0.01), with a greater motivation to be actively involved in the surgical firm and theatres. CONCLUSION: A simple, structured BSS programme can increase the confidence and motivation of students. Early surgical skills targeting is valuable for students entering surgical, related allied, and even traditionally non-surgical specialties such as general practice. Such experience can increase the confidence of future junior doctors and trainees. We advocate the introduction of a BSS programme into United Kingdom undergraduate curricula

A Review of the Biology, Ecology and Behavior of Velvety Tree Ants of North America

Ants belonging to the genus Liometopum are regionally distributed across North America, Europe and Asia. L. apiculatum Mayr, L. luctuosum Wheeler, and L. occidentale Emery are found in western North America and are referred to as velvety tree ants. Very little is known about the biology of these species, but they are similar. They are typically associated with trees and shrubs and are frequently found tending hemipterans. All three species are are easily disturbed and and resort to highly aggressive behaviors including the use of strong alarm odors. The following review is intended to summarize the literature regarding the biology and control of these species. Special emphasis has been given to factors that might be important in their control and gaps in our current knowledge.</span

A Review of the Biology, Ecology and Behavior of Velvety Tree Ants of North America

Ants belonging to the genus Liometopum are regionally distributed across North America, Europe and Asia. L. apiculatum Mayr, L. luctuosum Wheeler, and L. occidentale Emery are found in western North America and are referred to as velvety tree ants. Very little is known about the biology of these species, but they are similar. They are typically associated with trees and shrubs and are frequently found tending hemipterans. All three species are are easily disturbed and and resort to highly aggressive behaviors including the use of strong alarm odors. The following review is intended to summarize the literature regarding the biology and control of these species. Special emphasis has been given to factors that might be important in their control and gaps in our current knowledge

Preparation and Use of Preconstructed Orders, Order Sets, and Order Menus in a Computerized Provider Order Entry System

Objective: To describe the configuration and use of the computerized provider order entry (CPOE) system used for inpatient and outpatient care at the authors' facility. Design: Description of order configuration entities, use patterns, and configuration changes in a production CPOE system. Measurements: The authors extracted and analyzed the content of order configuration entities (order dialogs, preconfigured [quick] orders, order sets, and order menus) and determined the number of orders entered in their production order entry system over the previous three years. The authors measured use of these order configuration entities over a six-month period. They repeated the extract two years later to measure changes in these entities. Results: CPOE system configuration, conducted before and after first production use, consisted of preparing 667 order dialogs, 5,982 preconfigured (quick) orders, and 513 order sets organized in 703 order menus for particular contexts, such as admission for a particular diagnosis. Fifty percent of the order dialogs, 57% of the quick orders, and 13% of the order sets were used within a six-month period. Over the subsequent two years, the volume of order configuration entities increased by 26%. Conclusions: These order configuration steps were time-consuming, but the authors believe they were important to increase the ordering speed and acceptability of the order entry software. Lessons learned in the process of configuring the CPOE ordering system are given. Better understanding of ordering patterns may make order configuration more efficient because many of the order configuration entities that were created were not used by clinician