Competency-based Learning: The Impact of Targeted Resident Education and Feedback on Pap Smear Adequacy Rates

Little is known about assessing or improving competency in Papanicolau (Pap) smear sampling among internal medicine residents. We hypothesized that a 3-part targeted resident physician educational program (educational presentation by a knowledgeable instructor, skills workshop, and peer comparison feedback) would be effective in increasing the quality of Pap smears obtained by internal medicine residents. We conducted a randomized, pre-post comparison study over a 16-month period to assess the effect of our educational intervention. We found no difference in baseline adequacy rates. Residents who received the intervention were twice as likely to obtain an adequate Pap smear. Our results suggest that a brief multifaceted intervention designed to improve the frequency with which internal medicine residents obtain endocervical cells while performing Pap smears is effective

Punção aspirativa por agulha fina guiada por ultra-sonografia de nódulos tireoidianos: estudo de 63 casos Ultrasound-guided fine needle aspiration biopsy of thyroid nodules: study of 63 cases

Neste trabalho foi revisada a técnica empregada na execução da punção aspirativa por agulha fina guiada por ultra-sonografia, e são descritos os seus benefícios no diagnóstico de nódulos tireoidianos. Foram realizadas punções aspirativas por agulha fina em 63 pacientes do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro, encaminhados ao Serviço de Radiodiagnóstico, no período de agosto de 2001 a junho de 2002. Dos 63 pacientes estudados, 58 (92%) eram do sexo feminino e cinco (8%) eram do sexo masculino, com uma relação mulher/homem de cerca de 11:1. Trinta e um pacientes (49%) se situaram na quinta e sexta décadas de vida. Oitenta e nove por cento dos pacientes apresentaram-se com nódulos múltiplos ao exame ecográfico; apenas 11% dos pacientes tinham nódulo único. Em relação aos laudos citológicos dos nódulos puncionados, 47% foram benignos, 31%, suspeitos, 17%, inadequados e apenas 5%, malignos. Todos os nódulos malignos (três pacientes) tiveram o diagnóstico citológico de carcinoma papilífero. Dos nódulos benignos, 93% foram diagnosticados como hiperplasia nodular e apenas 7% tiveram diagnóstico de tireoidite. Dos laudos considerados inadequados, 70% foram considerados hemorrágicos, sendo 30% considerados hipocelulares. Os dados encontrados no nosso trabalho estiveram de acordo com os encontrados na literatura médica.<br>In this study we reviewed the technique for ultrasound-guided fine needle aspiration biopsy and its benefits in the diagnosis of thyroid nodules. Ultrasound-guided fine needle aspiration was performed in 63 patients referred to the Department of Radiology of "Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro", Rio de Janeiro, Brazil, between August 2001 and June 2002. Fifty-eight (92%) of the patients were female and five patients (8%) were male; 11:1 female/male ratio. Thirty-one patients (49%) had 50-60 years of age and 89% of the patients showed multiple nodules on ultrasound; only 11% of the patients had single nodules. The cytological reports of the aspirated nodules showed that 47% of the nodules were benign, 31% suspected, 17% inadequate material and only 5% malignant. The cytological diagnosis of all malignant nodules (three patients) was papillary carcinoma. Among the benign nodules, 93% were diagnosed as nodular hyperplasia and only 7% had were diagnosed as thyroiditis. Among the patients with inadequate material, 70% were hemorrhagic, and 30% were hypocellular. The findings observed in this study are concordant with the results in the medical literature