Assessment of Anatomy Education Teaching Modalities before and during COVID-19 in US Medical Schools

Medical schools in the United States, as well as across the world, have undergone curriculum reform in the delivery of anatomy courses, which recently required social distancing during the COVID-19 pandemic. The aim of this study was to compare total teaching time across three major types of anatomy curricular formats in preclerkship and clerkship phases of US medical education, and quantitatively describe which tools/teaching modalities are used within different curricula structures across preclinical and clinical anatomy courses as well as evaluate the relative percent of the curricular time their use comprised prior to and during the pandemic. An optional survey instrument (with skip patterns), developed using Qualtrics Software and approved by the author’s home Institutional Review Board, was sent to anatomy course directors at 152 allopathic medical schools, from all four geographic and size categories delineated by the Association of American Medical Colleges. Data were analyzed using Qualtrics XM Stats iQ software. Thirty allopathic US medical institutions were represented in this survey, among which there existed an even distribution across the three integration formats with the majority of instruction occurring in the first-year curriculum. Total anatomy teaching time varied widely, but cadaveric dissection and lectures were the predominant teaching modalities, even during the pandemic. Traditional dissection comprised the majority of contact time compared to alternative modalities, but less than half of respondents currently incorporate new modalities. Approximately half of the schools changed to an all-virtual format for 2020–2021. Among those that were fully virtual, time using 3D anatomy significantly increased. Our results demonstrate that traditional anatomic educational practices remain the mainstay of medical education. Surprisingly, total contact hours in anatomic education varied widely, but there were striking similarities in the use of traditional tools

Pectoralis major turnover versus advancement technique for sternal wound reconstruction

We compared the efficacy of pectoralis turnover versus advancement technique for sternal wound reconstruction. A retrospective chart review was performed, December 1989 to December 2010, to compare postoperative complication rates between pectoralis major turnover versus pectoralis major advancement reconstruction techniques. Complications included hematomas, wound infections, tissue necrosis, dehiscence, and need for reoperation. Pearson χ and logistic regression were used and significance was P < 0.05. Sixty-seven patients received 91 tissue flaps. Eleven patients (16%) required reoperation due to complications, including recurrent wound infection, tissue necrosis, wound dehiscence, mediastinitis, and hematoma formation. Four patients (6%) were treated conservatively for minor complications. Overall, complication rates were significantly higher after pectoralis major advancement reconstruction (32.5% vs. 3.7%, P = 0.004). When feasible, pectoralis major turnover flap offers a superior reconstructive technique for complex sternal wounds, with diminished complications compared with the pectoralis advancement flap

Employment search, initial employment experience, and career preferences of recent pediatric surgical fellowship graduates: An APSA survey, part of the right child/right surgeon initiative

Background APSA's Right Child/Right Surgeon Initiative addresses issues concerning patient access to appropriate pediatric surgical care and workforce distribution. The APSA Workforce Committee sought to understand the experiences and motivations of recent graduates of Pediatric Surgery Training Programs entering the workforce. Methods Using APSA membership databases, we identified members who completed fellowship training from 2010 to 2019. An online survey was created using Survey Monkey, and invitations to participate were sent via email. Results 144 of 447 invited participants responded (32% response rate). 91% of respondents participated in dedicated research prior to fellowship, but only 64% perform research during their employment. 23% completed an additional clinical fellowship, but only 54% currently practice within the second field. When asked to identify the top three factors used to choose a position, the most common responses were “location or geography” (71%), “available mentorship” (53%), and “compensation and benefits” (37%). Describing their first position, 77% reported working in an academic institution, 78% reported working in a metropolitan/urban area, and 55% reported working in a free-standing children's hospital. 94% participate in General Surgery resident education, and 49% are faculty within a Pediatric Surgery fellowship. Overall, 92% of respondents were able to find the type of employment position that they had wanted. Conclusion In our survey the overwhelming majority of young pediatric surgeons found the type of job they desired. Most report beginning their practice in more populated, urban areas within academic institutions. Geographic location and work environment played heavily into their employment decisions. These preferences could contribute to continued disparity in access to pediatric surgeons between urban and rural America and to dilution of experience for urban surgeons. Possible solutions include alternative incentive programs for employment in less populated areas or new training models for general surgeons in rural areas to train in fundamentals of Pediatric Surgery

Surgical management of early-stage hepatocellular carcinoma: resection or transplantation?

BACKGROUND: The surgical management of hepatocellular carcinoma in patients with well-compensated cirrhosis is controversial. The purpose of the current study was to compare the outcome of patients with well-compensated cirrhosis and early stage hepatocellular carcinoma treated with initial hepatic resection versus transplantation. METHODS: Between 1985 and 2008, 245 patients underwent hepatic resection, and 134 patients underwent liver transplantation for early stage hepatocellular carcinoma. All patients had well-compensated cirrhosis. Prognostic factors were evaluated using univariate and multivariate analyses; survival was calculated using the Kaplan-Meier method. RESULTS: Compared with transplantation, patients undergoing resection had larger tumors and a higher incidence of microscopic vascular invasion. Transplantation was associated with better 5-year disease-free and overall survival compared with resection. Hepatitis status, presence of microscopic vascular invasion, and tumor size were predictors for recurrence, while the presence of microscopic vascular invasion and tumor size conferred an increased risk of death. The disease-free survival advantage with transplantation was more pronounced in hepatitis C patients compared with non-hepatitis and hepatitis B patients. The overall survival advantage with transplantation persisted in cases of solitary lesions < or = 3 cm, but was attenuated in patients with a MELD score < or = 8. CONCLUSION: In well-compensated cirrhotic patients with early stage hepatocellular carcinoma, transplantation was associated with longer disease-free and overall survival. Patients undergoing resection did, however, have tumors with more advanced pathologic features. Patients best suited for initial resection as the treatment of hepatocellular carcinoma were those with a MELD score </= 8 without evidence of hepatitis