Psychologic assessment in patients undergoing bariatric surgery

BACKGROUND

Psychological Clearance level (PCL) for patients undergoing metabolic and bariatric surgery (MBS) is a critical step for successful postoperative outcomes. This study aims to assess the relationship between the level of psychologic fitness and postoperative outcomes in patients undergoing MBS.

METHODS

We retrospectively analyzed the data of patients who underwent MBS (laparoscopic sleeve gastrectomy [LSG] and laparoscopic Roux-en-Y Gastric Bypass [LRYGB]) and completed two years follow-up, between 2012 and 2019, in a single medical center. The patients were divided into four groups based on PCL, suggesting level of readiness for surgery: Group A (PCL-0: guarded), group B (PCL-1: Fair/reasonable), group C (PCL-2: Good/appropriate), and group D (PCL-3: Strong/excellent). Primary outcome was the percent of total body weight loss (%TWL), and the absolute change in BMI units. Secondary outcomes were missed postoperative visits and patient compliance. Differences between the groups were analyzed using a generalized linear model (GLM), chi-squared and exact Fisher tests, as appropriate.

RESULTS

Of 1411 total patients, 607 (43.20%) had complete data at two years follow-up. 512 (84.34%) were females. LSG was performed in 361 (59.5%). No difference was found in %TWL between the four groups (22.14% vs. 28.0% vs. 26.0% vs. 24.8%, p = 0.118). We found a small difference in the mean (SD) of absolute change in BMI between the groups, and on post-hoc analysis it was found between groups B (PCL-1) and D (PCL-3). Overall, no difference between the groups in number of follow-up visits, or compliance issues. However, patients who attended more follow-up visits had less compliance issues (p < 0.001). PCL is inversely correlated with number of psychologic diagnoses (r = - 0.41, p < 0.001) and medical comorbidities (r = - 0.20, p < 0.001).

CONCLUSION

We found no difference in the percent of TWL in patients who underwent MBS based on PCL at two -years follow-up. Medical comorbidities and psychiatric diagnoses impact the PCL.

History of surgical training in Kalamazoo

This narrative reviews the history and evolution of surgical training in Southwest Michigan, particularly Kalamazoo, over the past 100 years. During this time, the de novo growth of medical treatment and the gradual and progressive establishment of medical and surgical training, paralleled with innovation, have shaped the clinical practices in Southwest Michigan. The surgical expertise that exists in Kalamazoo has made it one of the most important headquarters for surgical innovation, not only in the United States, but in the world. The surgical training program in Kalamazoo began in the 1960s, and this accredited general surgery residency program has graduated numerous successful surgeons. Currently this program is one of several training programs at Western Michigan University Homer Stryker M.D. School of Medicine (WMed), the only medical school in Southwest Michigan. Under the leadership of Dean Surgeon Dr. Paula Termuhlen and Chair Dr. Robert Sawyer, a bright future in surgical education, research, and innovation is highly anticipated. Expectations of future growth in this program will provide a significant pipeline for graduating physicians and surgeons for decades to come.

The Effects of Pre-medical Anatomy and Clinical Experiences on Medical School Anatomy-Related Academic Performance

PURPOSE

The objective of this study was to examine the effects that pre-medical patient care clinical experiences and anatomical education had on undergraduate medical course grades and anatomy practical exam scores. This study provides a unique perspective to this line of inquiry in that it included data from 9 class year cohorts between academic years 2010-2011 and 2018-2019, all from a single institution.

METHODS

A survey to assess pre-medical clinical and anatomical experiences was completed by each new matriculate. Results were compared to each student's course grades and anatomy practical exam scores. The effects of pre-medical experiences on practical scores and final grades were evaluated using generalized linear mixed models.

RESULTS

Several positive and negative associations were identified. The most obvious effect revealed by data analysis was the class year cohort effect, seen as variation in the academic performance of each cohort from year-to-year. Other significant results included a positive association between pre-medical comparative anatomy coursework and anatomy assessment performance over the entire year's anatomy curriculum. Counterintuitively, some pre-medical clinical experiences, such as nursing experience, had a negative effect on course grades and practical exam performance.

CONCLUSIONS

Pre-medical students can use this information to decide whether to enroll in undergraduate anatomy courses or engage in extra pre-medical clinical work. It may also be valuable to medical school admissions departments in regard to determining the anatomy coursework and clinical experience requirements for their applicants.

Effect of Grading and Class Rank on Performance in a Surgical Simulation Course

OBJECTIVE

This study seeks to evaluate the psychological and academic effects of grading a medical school simulation course. This study also seeks to evaluate whether a student's class rank affects these results and whether the academic effects of a simulation course persist long-term.

DESIGN

Two separate medical school classes were evaluated. The first class participated in an ungraded surgery simulation course with only formative feedback. The second class participated in a tier-graded course. Qualitative assessment of both courses included daily standardized and self-reported stress surveys, student feedback surveys at the end of the course, and student feedback surveys at the end of the surgery clerkship. Quantitative assessment included pre and postcourse examinations, NBME Surgery Subject Assessment percentile ranks, and COMLEX 2 surgery subscores. Qualitative and quantitative assessments were compared between classes as a whole and between students in the upper and lower half of each class. Results were analyzed using a Student two-tailed t test.

SETTING

Rocky Vista University College of Osteopathic Medicine Institute of Simulation, Parker, Colorado.

PARTICIPANTS

One hundred forty-eight students from the Rocky Vista University College of Osteopathic Medicine Class of 2017 and one hundred fifty-one students from the Rocky Vista University College of Osteopathic Medicine Class of 2018.

RESULTS

Daily standardized stress surveys indicated some increase in stress for students in the graded course, especially for students in the upper half of the graded class. All students adapted to stress significantly by the end of each course, but upper-half students adapted more significantly. Students' self-reported stress levels demonstrated a significant decrease during the ungraded course, but a slight increase during the graded course. Students' self-reported confidence levels rose significantly during the ungraded course, but less significantly during the graded course. Student feedback surveys demonstrated a positive student perception of both courses, but, when stratified, some responses were significantly different between students in the upper and lower half of each class, with upper-half students generally giving a higher rating to the graded course. Clinical knowledge examination scores and improvement in scores within the course were significantly higher for the graded course, with no significant differences between students in the upper and lower half of each class. Students' mean NBME Surgery Subject Assessment percentile rank did not differ significantly between the two classes, but were significantly higher than for previous classes who had not participated in a simulation course. Mean NBME Surgery Subject Assessment percentile rank and COMLEX 2 mean surgery subscore were significantly higher for students in the upper half than for students in the lower half of each class. COMLEX 2 mean surgery subscore did not differ significantly between classes who had participated in a simulation course and previous classes who had not. Students in the upper half of each class in this study performed significantly better than students in the lower half of each class on the mean COMLEX 2 surgery subscore.

CONCLUSIONS

This study reaches the following conclusions: (1) objective stress level measurements did not correlate with students' self-reported stress levels; (2) grading a simulation course raises objective stress levels in higher-performing students more than in lower-performing students, but higher-performing students demonstrate the ability to effectively adapt to the increased levels of stress and achieve significant increases in confidence; (3) higher performing students generally demonstrate a greater sense of satisfaction with the simulation course experience when the course is graded; (4) higher-performing and lower-performing students within a class perform in a similar fashion on examinations within the intensely structured environment of a simulation course, whether the course is graded or not; (5) grading a course stimulates all students to perform better on examinations within the course; (6) this higher level of performance and similarity of performance between higher and lower-performing students does not continue when students are not in a structured environment, and students stratify into disparate performance groups in accordance with their class rank; and (7) students exposed to a surgical simulation course perform better on NBME surgery subject examinations than students who have not participated in a simulation course, but this increased level of performance does not extend long-term to national board exams.