Look and learn

published_or_final_versio

Integration of basic and clinical disciplines in medical education

postprin

Patient safety in the undergraduate curriculum: Medical students' perception

Objective Patient safety has emerged as a distinct health care discipline and an undergraduate programme on patient safety is being introduced at the authors' institution. The present study aimed to assess medical students' perceptions and knowledge on patient safety issues. Design A self-administered voluntary questionnaire survey. Setting Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong. Participants A total of 130 fourth-year medical students. Main outcome measures Students' baseline perceptions and knowledge on patient safety issues. Results The majority of students agreed that medical errors were inevitable but over 25% opined that "competent physicians do not make errors". The majority disapproved the practice of nondisclosure of error; whilst 6% would not address 'near-miss' events, and almost 10% did not support an active reporting system. Nearly half of the students were neutral on the notion that uncertainty should not be tolerated in patient care, and over 80% agreed that the most effective strategy to prevent error was "to work harder and be more careful". A knowledge gap in patient safety issues existed. Over 80% of students supported the introduction of our new undergraduate programme. Conclusion Medical students were aware of medical errors being an inevitable barrier between intended 'best care' and what was actually provided to patients. Students appeared to lack the appreciation of non-physician-based causes of errors, and the importance of a multidisciplinary approach to the management of incidents. A formal curriculum on patient safety is urgently needed in this locality, and such an initiative was supported by the medical students who were surveyed.published_or_final_versio

Laparoscopic repair of incisional hernia.

A 75-year-old man developed an incisional hernia over the upper abdomen following a wedge resection of a gastric stromal tumour in 1996. This is the first published report of a successful repair of an incisional hernia via a laparoscopic intraperitoneal on-lay technique using GORE-TEX DualMesh material in Hong Kong. Compared with conventional open repair of incisional hernia, long incisions and wound tension are avoided using the laparoscopic approach. This translates into a reduced risk of wound-related complications and facilitates recovery. In selected cases, minimally invasive surgery is a safe technique for the repair of incisional hernias.published_or_final_versio

A comparative outcome analysis of bilateral versus unilateral endoscopic extraperitoneal inguinal hernioplastics

Background: Bilateral inguinal hernia is an accepted indication for endoscopic totally extraperitoneal inguinal hernioplasty (TEP), but few studies have proved that the outcomes of bilateral TEP are as good as those of unilateral TEP. The objective of the present study was to compare the clinical outcomes of patients who underwent unilateral TEP with those of patients who underwent bilateral TEP. Patients and Methods: From June 1999 to May 2002, 103 patients underwent simultaneous bilateral TEP. The clinical data and outcomes of these patients were compared with those of an age-matched cohort of patients who underwent unilateral TEP during the same period. Results: The demographic features and hernia types were similar for the two groups. The incidence of direct inguinal hernia was significantly higher in the patients with bilateral inguinal hernia. The mean operative time for unilateral TEP was 65 minutes, and for bilateral TEP it was 97 minutes. The mean pain score at rest was significantly lower in the bilateral group than in the unilateral group on postoperative days 2 and 3. Pain scores at rest and during coughing from the day of operation to day 6 were otherwise comparable for the two groups. Comparisons of postoperative morbidity, length of hospital stay, and time to resumption of normal outdoor activities showed no significant differences between the two groups. Conclusions: The postoperative recovery and morbidity of patients who underwent bilateral TEP were equivalent to those who underwent unilateral TEP. Simultaneous bilateral TEP is safe and advantageous in patients with from bilateral inguinal hernias.published_or_final_versio

Does medical student willingness to practise peer physical examination translate into action?

Background: Peer physical examination (PPE) is commonly used in clinical skills teaching to allow students to practice physical examination techniques on each other. Previous studies have demonstrated medical students' generally positive attitudes towards PPE, but the correlation between student attitude and actual practice of PPE has yet to be examined. Aim: To determine if a positive student attitude towards PPE leads to subsequent action. Methods: The target population were MBBS I students (20062007 cohort) admitted to the Li Ka Shing Faculty of Medicine, The University of Hong Kong. Student attitude towards PPE and subsequent practice of PPE were assessed through self-completed written questionnaires before and after the compulsory Clinical Skills Programme (CSP). Results: A total of 100/128 (78%) students completed both questionnaires, of which 83 (65%) could be linked to demographic data. All study participants were ethnically Chinese. A high level of willingness to conduct PPE persisted before and after the CSP for both male and female students. However, more than half of the students did not subsequently examine various non-intimate body regions of a fellow student during the CSP. Female students were more likely to exhibit attitudebehaviour inconsistency. Conclusion: The existing positive attitudes towards PPE need to be harnessed so that more students are encouraged to follow through and actually practise PPE, thus realizing the educational benefits of this activity. This may be done by ensuring that PPE is conducted in a safe setting while being conscientious of gender differences. Scheduled time and the use of a logbook may be useful to facilitate students practising PPE. © 2011 Informa UK Ltd All rights reserved.postprin

Advantages of video trigger in problem-based learning

Conference Theme: Quality Accreditation and Standard in Medical Educationpublished_or_final_versio

Learning needs in a medical curriculum in Hong Kong

Objective To survey medical graduates from the University of Hong Kong on how well they perceived their learning needs had been fulfilled by the old (before 1997) and the new (after 1997) curricula. Design Retrospective questionnaire survey. Setting The University of Hong Kong, Hong Kong. Participants Medical graduates from the University of Hong Kong who graduated between 1997 and 2006 were invited to complete a questionnaire online or in paper form; 1997-2001 graduates were trained under the old curriculum, and 2002-2006 graduates under the new curriculum. Results The response rate was 23%.Thesurvey showed thatthe graduates of both curricula felt that research skills, population health, and ophthalmology were not emphasised enough in the medical programme. In addition, some graduates of the old curriculum mentioned interpersonal skills, ethics and professionalism, and language skills, which were pinpointed in the curriculum reform in 1997. Some graduates of the new curriculum mentioned anatomy, microbiology, and diagnostic radiology. Graduates of both the old and the new curricula perceived the same top five areas as being lacking in their respective curricula, in relationship to their clinical career and personal growth, namely: business administration, law, professional English, life coaching, and humanities. A small percentage of graduates also took courses in these areas after graduation. Conclusions The survey showed that the curriculum reform in 1997 at the University of Hong Kong had correctly pinpointed some of the learning needs. The survey also identified educational needs in the existing curriculum that need to be dealt with in the forthcoming curriculum reform in 2012.published_or_final_versio

Laparoscopic incisional hernioplasty utilising on-lay expanded polytetrafluoroethylene DualMesh: Prospective study

Objective. To evaluate the early outcomes of laparoscopic incisional hernioplasties using on-lay GORE-TEX DualMesh. Design. Prospective study. Setting. Medical centre of a regional hospital, Hong Kong. Subjects and methods. Between June 2000 and October 2001, 11 consecutive patients underwent attempted laparoscopic incisional hernioplasties at the University of Hong Kong Medical Centre. A prospective collection of perioperative data and assessment of postoperative outcomes was performed. Results. Laparoscopic incisional hernioplasty was successfully performed for 10 (91%) patients. One patient was converted to open repair because of extensive adhesions within the peritoneal cavity. The overall mean operative time was 107 minutes. Five (45%) patients were found to have more than one hernial defect after reduction of the hernial contents. Eight (73%) patients were discharged within 2 days after operation. Postoperative morbidities included wound bruising (n=4), seroma (n=2), and prolonged suture site pain (n=l). All postoperative morbidities resolved spontaneously without intervention. With a mean follow-up of 3 months, no early recurrence was detected. Conclusion. Early outcomes of laparoscopic incisional hernioplasty utilising GORE-TEX DualMesh were promising. This technique confers the advantages of minimal access surgery and allows clear identification of multiple hernial defects. Extensive adhesion, which does not allow the establishment of pneumoperitoneum, is a condition that precludes the safe performance of laparoscopic repair.published_or_final_versio

(E)-1-(4-Bromo­phen­yl)-3-(3,4,5-trimethoxy­phen­yl)prop-2-en-1-one1

In the title compound, C18H17BrO4, the dihedral angle between the 4-bromo­phenyl and 3,4,5-trimethoxy­phenyl rings is 44.18 (6)°. In the crystal structure, the mol­ecules are linked by C—H⋯O and C—H⋯π inter­actions