Tridimensional models and radiographic study of dorsal laminectomy and thoracolumbar hemilaminectomy in dogs

PURPOSE

To create three-dimensional anatomical models of the thoracic and lumbar portions of the canine spine that reproduce the vertebral surgical approaches of dorsal laminectomy and hemilaminectomy, and to perform the respective radiographic evaluations of each approach.

METHODS

In a digital archive of the canine spine, digitally replicate the dorsal laminectomy and hemilaminectomy in the thoracic and lumbar portions and, then, make tridimensional prints of the vertebral models and obtain radiographs in three dorsoventral, ventrodorsal and laterolateral projections.

RESULTS

The anatomical models of the surgical spinal canal accesses of the thoracic and lumbar portions showed great fidelity to the natural bones. The created accesses have the proper shape, location and size, and their radiographic images showed similar radiodensities.

CONCLUSIONS

The replicas of the dorsal laminectomy and hemilaminectomy developed in the anatomical models in the thoracic and lumbar portions are able to represent the technical recommendations of the specialized literature, as well as their respective radiographic images, which have certain radiological properties that allow to make a deep radiological study. Therefore, the models are useful for neurosurgical training.

A 9-Step Theory- and Evidence-Based Postgraduate Medical Digital Education Development Model: Empirical Development and Validation

BACKGROUND

Digital education tools (e-learning, technology-enhanced learning) can be defined as any educational intervention that is electronically mediated. Decveloping and applying such tools and interventions for postgraduate medical professionals who work and learn after graduation can be called postgraduate medical digital education (PGMDE), which is increasingly being used and evaluated. However, evaluation has focused mainly on reaching the learning goals and little on the design. Design models for digital education (instructional design models) help educators create a digital education curriculum, but none have been aimed at PGMDE. Studies show the need for efficient, motivating, useful, and satisfactory digital education.

OBJECTIVE

Our objective was (1) to create an empirical instructional design model for PGMDE founded in evidence and theory, with postgraduate medical professionals who work and learn after graduation as the target audience, and (2) to compare our model with existing models used to evaluate and create PGMDE.

METHODS

Previously we performed an integrative literature review, focus group discussions, and a Delphi procedure to determine which building blocks for such a model would be relevant according to experts and users. This resulted in 37 relevant items. We then used those 37 items and arranged them into chronological steps. After we created the initial 9-step plan, we compared these steps with other models reported in the literature.

RESULTS

The final 9 steps were (1) describe who, why, what, (2) select educational strategies, (3) translate to the real world, (4) choose the technology, (5) complete the team, (6) plan the budget, (7) plan the timing and timeline, (8) implement the project, and (9) evaluate continuously. On comparing this 9-step model with other models, we found that no other was as complete, nor were any of the other models aimed at PGMDE.

CONCLUSIONS

Our 9-step model is the first, to our knowledge, to be based on evidence and theory building blocks aimed at PGMDE. We have described a complete set of evidence-based steps, expanding a 3-domain model (motivate, learn, and apply) to an instructional design model that can help every educator in creating efficient, motivating, useful, and satisfactory PGMDE. Although certain steps are more robust and have a deeper theoretical background in current research (such as education), others (such as budget) have been barely touched upon and should be investigated more thoroughly in order that proper guidelines may also be provided for them.

Log In to Experiential Learning Theory: Supporting Web-Based Faculty Development

BACKGROUND

For an increasingly busy and geographically dispersed faculty, the Faculty of Medicine at the University of Southampton, United Kingdom, developed a range of Web-based faculty development modules, based on Kolb's experiential learning cycle, to complement the faculty's face-to-face workshops.

OBJECTIVE

The objective of this study was to assess users' views and perceptions of the effectiveness of Web-based faculty development modules based on Kolb's experiential learning cycle. We explored (1) users' satisfaction with the modules, (2) whether Kolb's design framework supported users' learning, and (3) whether the design principle impacts their work as educators.

METHODS

We gathered data from users over a 3-year period using evaluation surveys built into each of the seven modules. Quantitative data were analyzed using descriptive statistics, and responses to open-ended questions were analyzed using content analysis.

RESULTS

Out of the 409 module users, 283 completed the survey (69.1% response rate). Over 80% of the users reported being satisfied or very satisfied with seven individual aspects of the modules. The findings suggest a strong synergy between the design features that users rated most highly and the key stages of Kolb's learning cycle. The use of simulations and videos to give the users an initial experience as well as the opportunity to "Have a go" and receive feedback in a safe environment were both considered particularly useful. In addition to providing an opportunity for reflection, many participants considered that the modules would enhance their roles as educators through: increasing their knowledge on various education topics and the required standards for medical training, and improving their skills in teaching and assessing students through practice and feedback and ultimately increasing their confidence.

CONCLUSIONS

Kolb's theory-based design principle used for Web-based faculty development can support faculty to improve their skills and has impact on their role as educators. Grounding Web-based training in learning theory offers an effective and flexible approach for faculty development.

Breaking bad news: doctors' skills in communicating with patients

CONTEXT AND OBJECTIVE:

Breaking bad news is one of doctors' duties and it requires them to have some skills, given that this situation is difficult and distressful for patients and their families. Moreover, it is also an uncomfortable condition for doctors. The aim of this study was to evaluate doctors' capacity to break bad news, ascertain which specialties are best prepared for doing this and assess the importance of including this topic within undergraduate courses.

DESIGN AND SETTING:

Observational cross-sectional quantitative study conducted at a university hospital in Belo Horizonte (MG), Brazil.

METHODS:

This study used a questionnaire based on the SPIKES protocol, which was answered by 121 doctors at this university hospital. This questionnaire investigated their attitudes, posture, behavior and fears relating to breaking bad news.

RESULTS:

The majority of the doctors did not have problems regarding the concept of bad news. Nevertheless, their abilities diverged depending on the stage of the protocol and on their specialty and length of time since graduation. Generally, doctors who had graduated more than ten years before this survey felt more comfortable and confident, and thus transmitted the bad news in a better conducted manner.

CONCLUSION:

Much needs to be improved regarding this technique. Therefore, inclusion of this topic in undergraduate courses is necessary and proposals should be put forward and verified.

The Current State of Urological Residency Education

INTRODUCTION

We reviewed literature pertaining to the current state of urological education for residents in the United States.

METHODS

A literature review was performed to identify relevant manuscripts using a key word search of the PubMed® and MEDLINE® databases. Central themes of the literature were identified and summarized for the purpose of this review.

RESULTS

A literature search identified 23 articles related to urological residency education. Key themes identified in the available literature included surgical simulation, decreasing open experience, and improving the efficiency and quality of resident education and evaluation. With increasing limitations in available resident training hours as well as increasing utilization of minimally invasive approaches in the field of urology it is important to critically assess how urological residents are trained.

CONCLUSIONS

As the scope and complexity of medical knowledge and surgical approaches evolve in the field of urology it is imperative to critically evaluate how urological residents are trained to ensure that graduating residents are prepared to provide outstanding patient care as independent surgeons.