Surgery News - February 2008 - (Page 4)

NEWS SURGERY NEWS • F E B R U A RY 2 0 0 8 Surgical Skills Course Gets Med Students Up to Speed B Y J E F F E VA N S Else vier Global Medical Ne ws H O T S P R I N G S , VA . — A surgical skills course appears to improve proficiency and confidence in senior medical students who match in a surgical specialty, and could accelerate the learning process in residency training programs, Dr. L. Michael Brunt reported at the annual meeting of the Southern Surgical Association. Students who participated in the 7-week course in their senior year attained skills on some assessments similar to those of second-year surgical residents, said Dr. Brunt, an ACS Fellow and professor of surgery at Washington University, St. Louis. The nearly 100-year-old model for training surgical skills in the operating room is “no longer tenable” because of the 80-hour work week restrictions, the need for increased operating room efficiency, societal pressures, and the increasing complexity of patients and surgical techniques. “For these reasons, the importance of surgical skills training outside the operating room is increasingly recognized,” Dr. Brunt said. “There are few skills programs that exist nationwide for senior medical students who are planning a surgical career, and therefore, the current generation of students may be at a disadvantage when thrust into the briskly moving pace of He and his associates found that those internship and the operating room.” who enrolled in the course significantly imDr. Brunt discussed the results of the proved their speed on four of five suturing first 2 years of the course at Washington and knot-tying skills (simple interrupted University. Thirty-one students who took and running subcuticular suturing and one2- to 3-hour sessions each week received handed and restricted-space knot tying). instruction in these areas: Prior to the start of the course, students were signifiBasic suturing and knot-tycantly slower on all of the suing skills and an overview of turing and knot-tying skills (exsurgical instruments, with cept for two-handed knot practice equipment. tying) than were second-year Emergent procedural techsurgical residents. By the end niques, such as central line of the course, students were placement, intubation, chest still slower than residents on all tube insertion, and intravenous skills, but residents were sigand arterial line placement. nificantly faster on only oneBasic laparoscopic skills and Students attained handed and restricted-space drills using the SAGES Fundaskills on some knot tying. Students and resimentals of Laparoscopic assessments Surgery (FLS) skills training similar to those of dents also spent a similar total amount of time on all five system. second-year Common on-call manage- surgical residents. tasks at the end of the course (677 seconds vs. 564 seconds). ment problems in postoperaDR. BRUNT Of 13 students who took the tive patients. Use of energy sources and surgical sta- FLS test and were matching in either general or urologic surgery, 5 passed all five plers. Implementation of techniques by prac- components of the test and 3 passed four of the five components. Their mean FLS ticing in a live pig lab. Students were expected to practice score of 67 was higher than the test’s minabout 15-30 minutes each day, but the in- imum passing score of 54. On pre- and postcourse surveys, stuvestigators did not measure the actual amount of practice time. The instruments dents reported having significantly more and suturing pads cost about $100 per confidence in managing acute patient problems and performing basic procestudent, Dr. Brunt said. dures after the course than before it. In particular, 29% of students entered the course with low confidence (a mean score of 2.5 or less on a 1-5 Likert scale), but none reported low confidence afterward. In fact, no answers to survey questions were given a rating below 2.5 after the course. The percentage of students who rated themselves as having high confidence (mean score of at least 4) rose from 27% before to 49% after the course. The students reported significant improvement on 28 of the 45 questions in the survey. “In all of the discussions that have gone on in the last few years about accelerated surgical training and shortened training and making it more efficient, this approach is one of the few [really practical] things that [has] been shown to have value,” said Dr. Frank R. Lewis Jr., an ACS Fellow and executive director of the American Board of Surgery, who commented on the study at the meeting. Much of the course material “would be easily exportable and transferable into other institutions,” Dr. Brunt said, adding that such training will be a part of the curriculum for fourth-year medical students. Stryker Endoscopy provided an educational grant for the course, and the materials were supplied by Ethicon EndoSurgery Inc. Dr. Brunt reported that he has no financial conflicts of interest with either company. ■ Facial Expression Gradually Returns Rapid MRSA Blood Test Gets Green Light From FDA Following First Face Transplant B Y M A RY A N N M O O N ©DENIS CHARLET/AFP/GETTY IMAGES Else vier Global Medical Ne ws Administration has recently approved the first rapid blood The Food and Drugtest for methicillin-resistant Staphylococcus aureus. The test, called the BD GeneOhm Staph SR, can detect both methicillin-resistant S. aureus (MRSA) and more common and less dangerous strains of the staph bacterium in just 2 hours. Manufactured by BD Diagnostics, a subsidiary of BD of Franklin Lakes, N.J., the test uses polymerase chain reaction techniques to detect a gene sequence unique to the drug-resistant strain of S. aureus. In 2005, BD received approval for a similar test, the BD GeneOhm MRSA Assay, which detects MRSA in nasal specimens. That test is used primarily to screen patients about to enter the hospital for the presence of asymptomatic MRSA so preventive measures can be taken. The new blood test will be used primarily to select a treatment option for patients suspected of having an invasive staph infection. According to BD spokesperson Barbara Kalavik, the company plans to begin marketing the BD GeneOhm Staph SR as soon as February in the United States. Marketing began in Europe in late December 2007. Both versions of the test require the use of a specialized instrument, called a PCR-thermocycler, which costs about $35,000. Not counting the capital cost of this equipment, the new blood test is expected to cost about $35 per patient. The approval was based on a multicenter clinical trial that showed that the test correctly identified 100% of the MRSA-positive specimens and more than 98% of other staph infections. According to the FDA, “In order to preserve the integrity of positive test results, this test should be used only in patients suspected of a staph infection. The test should not be used to monitor treatment for staph infections because it cannot quantify a patient’s response to treatment.” In addition, the FDA warned that test results should not be used as the sole basis for diagnosis, since positive results may reflect the bacteria’s presence in patients who have already been successfully treated for staph infections. —Robert Finn fter 18 months, the functional and aesthetic outcomes of the first human face transplantation are satisfactory and “encouraging,” according to the physicians who performed the surgery. Dr. Jean-Michel Dubernard of the University of Lyons, France, and his associates previously published the initial results of the transplant, which they performed in a 38-year-old woman in November 2005. The longer term outcome suggests that face transplantation “can offer hope” to selected patients who have severe disfigurement, they said in the New England Journal of Medicine. The woman had been mauled by a dog in May 2005, with her distal nose, upper and lower lips, her entire chin, and the adjacent areas of both cheeks amputated. She received a graft of the lower face from a 46-year-old donor who had the same blood type and all but one of the same HLA antigens. The recipient’s sensory discrimination recovered quickly in the entire skin surface and the oral mucosa, although it remains subnormal. Heat and cold sensation was nearly normal at 4 months and normal at 6 months over the entire graft. She was unable to close her mouth completely until 6 months post transplant. Her smile became normal by 18 months. Two episodes of acute graft rejection occurred: one 18 days after transplant and the other 7 months later. Initial treatment with a standard regimen of oral prednisone, tacrolimus, and mycophenolate mofetil were ineffective, but IV methylprednisolone reversed both episodes of rejection. Extracorporeal photochemotherapy to reduce the risk of further graft rejection has been well tolerated. Isabelle Dinoire, 39, is shown a few months after her transplant (left), and a year later. The woman also developed type 1 herpes simplex virus of the lips, which responded to oral valacyclovir and topical acyclovir, and molluscum contagiosum on the cheeks, which was treated by curettage. Her initial immunosuppressive regimen impaired her renal function. This dysfunction was attributed to tacrolimus, which was replaced by sirolimus. Renal function has gradually improved since the switch. The patient has gradually resumed a normal social life. The return of facial expressiveness “correlated well with psychological acceptance of the foreign graft,” Dr. Dubernard and his associates said (N. Engl. J. Med. 2007;357:2451-60). “I would like to see an evaluation of the results by someone other than the surgeons who performed the surgery,” Dr. Linda Phillips, an ACS Fellow, told this newspaper. “However, this procedure holds much hope for those disfigured by facial injury or disease,” said Dr. Phillips, division chief of plastic surgery at the University of Texas Medical Branch, Galveston. ■

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Surgery News - February 2008 Contents IOM Committee Looks Into Safety Of Work Schedules Expertise Can Extend Liver Resectability Report Faults Specialty Hospitals' EDs Meeting Expectations Silver Lining HOD on Health Longer Liver Life?

Surgery News - February 2008

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