Medicine Residents Research Articles

Targeted obstetric haemorrhage programme improves incoming resident confidence and knowledge

Postpartum haemorrhage is an infrequent but potentially life-threatening obstetrical emergency amenable to simulation. An educational programme consisting of a lecture and high-fidelity simulation exercise was given to incoming obstetrics and gynaecology (OB) and family medicine (FM) residents. Residents reported pre- and post-intervention confidence scores on a 1–5 Likert scale and a subset completed a postpartum haemorrhage knowledge assessment. Residents reported significant improvements in confidence in parameters involved in diagnosis and management of postpartum haemorrhage. The postpartum haemorrhage test mean scores significantly increased (57.4 ± 9.6% vs 77.1 ± 7.9%, p < 0.01) and were significantly correlated to confidence scores (Spearman's coefficient of 0.651, p < 0.001). In conclusion, an education programme that incorporates high-fidelity simulation of postpartum haemorrhage improves the confidence and knowledge of incoming residents and appears to be an effective educational approach.

Effect of Modest Pay-for-Performance Financial Incentive on Time-to-Discharge Summary Dictation Among Medical Residents

Evaluate the effect of a modest financial incentive on time-to-discharge summary dictation among medicine residents. Pay-for-performance incentives are used in a number of health care settings. Studies are lacking on their use with medical residents and other trainees. Timely completion of discharge summaries is necessary for effective follow-up after hospitalization, and residents perform the majority of discharge summary dictations in academic medical centers. Medicine residents with the lowest average discharge-to-dictation time during their 1-month inpatient medicine ward rotation were rewarded with a $50 gift card. Discharge data were captured using an autopopulating electronic database. The average discharge-to-dictation time was reduced from 7.44 to 1.84 days, representing a 75.3% decrease. Almost 90% of discharge summary dictations were performed on the day of discharge. A modest financial incentive resulted in a marked improvement in the time-to-discharge summary dictation by medicine residents. Pay-for-performance programs may be an effective strategy for improving the quality and efficiency of patient care in academic medical centers.

The Forgotten Educational Needs of the House Staff: Training Internal Medicine Residents to Address End-of-Life Issues

An intervention was conducted, aimed at providing residents in internal medicine with communication skills to address end-of-life issues with patients. Residents participated in two 1-hour educational sessions designed to teach a communication protocol, enhance listening skills, and to provide practice in effective communication in a safe, small-group format. An anonymous on-line survey assessed the effectiveness of the intervention. Twenty-five residents completed the intervention. There was a trend toward increased comfort level in addressing end-of-life issues among residents who completed the intervention, versus a comparison group. Residents who completed the intervention reported that using the words "death" and "dying" with patients and families was an important teaching point.

Frequent inaccuracies in ABCD2 scoring in non-stroke specialists' referrals to a daily Rapid Access Stroke Prevention service

The ‘accuracy’ of age, blood pressure, clinical features, duration and diabetes (ABCD2) scoring by non-stroke specialists referring patients to a daily Rapid Access Stroke Prevention (RASP) service is unclear, as is the accuracy of ABCD2 scoring by trainee residents.In this prospective study, referrals were classified as ‘confirmed TIAs’ if the stroke specialist confirmed a clinical diagnosis of possible, probable or definite TIA, and ‘non-TIAs’ if patients had a TIA mimic or completed stroke. ABCD2 scores from referring physicians were compared with scores by experienced stroke specialists and neurology/geriatric medicine residents at a daily RASP clinic; inter-observer agreement was examined.Data from 101 referrals were analysed (mean age=60.0years, 58% male). The median interval between referral and clinic assessment was 1day. Of 101 referrals, 52 (52%) were ‘non-TIAs’: 45 (86%) of 52 were ‘TIA mimics’ and 7 (14%) of 52 were completed strokes. There was only ‘fair’ agreement in total ABCD2 scoring between referring physicians and stroke specialists (κ=0.37). Agreement was ‘excellent’ between residents and stroke specialists (κ=0.91). Twenty of 29 patients scored as ‘moderate to high risk’ (score 4–6) by stroke specialists were scored ‘low risk’ (score 0–3) by referring physicians.ABCD2 scoring by referring doctors is frequently inaccurate, with a tendency to underestimate stroke risk. These findings emphasise the importance of urgent specialist assessment of suspected TIA patients, and that ABCD2 scores by non-stroke specialists cannot be relied upon in isolation to risk-stratify patients. Inter-observer agreement in ABCD2 scoring was ‘excellent’ between residents and stroke specialists, indicating short-term training may improve accuracy.

Burton E. Sobel: 1937–2013

Dr Burton (Burt) E. Sobel was born in New York City on October 21, 1937 and died in Colchester, Vermont on May 3, 2013. At the time of his death, he was the Distinguished University Professor at the University of Vermont, and Director of the University’s Cardiovascular Research Institute. Burt received his undergraduate training at Cornell University, and attended Harvard Medical School, from which he received his medical degree magna cum laude in 1962. After his residency in Medicine at the (then) Peter Bent Brigham Hospital he had fellowship training in cardiology and pharmacology in the intramural program of the National Heart, Lung, and Blood Institute. In 1968, he assumed his first faculty position in the Department of Medicine at the University of California, San Diego, where he was director of the Coronary Care Unit and then also of the Myocardial Research Unit. In 1973, he became Director of the Cardiovascular Division at Washington University, St. Louis, and, in 1985, he was named the Lewin Distinguished Professor in Cardiovascular Disease and Director of the Center for Cardiovascular Research at that University. From 1994 to 2005, he served as the Amidon Professor and Chair of the Department of Medicine at the University of Vermont. Burt was the quintessential physician–scientist–leader. From my close contact with him during his years at the National Institutes of Health and at the University of California, San Diego, it was clear that …

Interview: Aging: the next frontier

Rosanne M Leipzig speaks to Michael Mansbridge, Assistant Commissioning Editor: Rosanne M Leipzig is the Gerald and May Ellen Ritter Professor (tenured) and the Vice Chair for Education of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai in New York (USA). She graduated from the University of Rochester, attended the University of Michigan Medical School (USA) where she received her MD and PhD (in Human Genetics), completed her residency in Internal Medicine at the University of Rochester (NY, USA), and a Fellowship in Clinical Pharmacology at New York Hospital/Cornell University Medical Center. Dr Leipzig is an internationally recognized leader in geriatrics and evidence-based medicine, and has received numerous awards for her work, including the American College of Physicians Richard and Hinda Rosenthal Foundation Award, a Joy McCann Scholar award recognizing her expertise in mentoring and medical education, the 2008 Dennis W Jahnigen Memorial ...

Financial Evaluation of Clinic After Emergency Medicine Specialists and Residents

Objective: The financial evaluation of Turkish clinics and hospitals was initiated after the establishment of Government Hospital Associations following changes to the health system. The number and quality of studies on the subject is inadequate and in this retrospective study the aim was to evaluate the economic changes affecting emergency clinics after emergency medicine specialists and residents took up office. Material and Methods: Depending on the annual patient number and income of the emergency clinics between 2004 and 2011, different parameters were evaluated and an efficiency point established. Results: The efficiency point increased from 0.15 in 2004 to 35 in 2011. Mean annual patient registration was more than 400.000. The annual income of the clinics increased from 2.7 million TL in 2004 to 17 million TL in 2011. Although annual patient numbers did not change clinic income showed a sixfold increase. Not only has income changed but also the quality of the patient population, as evidenced by the fact that the annual death rate was zero before 2004 but in 2011 rose to 154 per year. Conclusion: Employment of emergency medicine specialists and residents in emergency departments results in high income for clinics and hospitals. (JAEM 2013; 12: 89-92)

Exploring educational gaps in myelodysplastic syndromes in medical students and internal medicine residents: A dual-institution survey.

7118 Background: Myelodysplastic syndromes (MDS) are a heterogeneous and poorly understood group of disorders. Prior studies have focused on patient and provider understanding of these disorders; however, no study to our knowledge has been conducted to explore educational gaps of medical students and medicine residents. The hypothesis of this work is that MDS are poorly understood by trainees, but this could be improved after education. Methods: A nine question survey pertaining to definition, diagnosis, risk assessment and survival in MDS was sent to medical students and medicine residents a week prior to a lecture on MDS. At Duke, the lecture was a senior resident talk; at Rush, it was a medicine grand rounds by a hematology attending. The survey was resent to the initial groups 15 days after the lectures, but only those who attended the lecture were invited to take it. Results: At Duke, the response rate was 141 out of 255 (55%); at Rush, it was 65 out of 414 (16%). Responses for the questions were similar at both institutions with no statistical difference in the percent of correct responses by institution. 83.7% said that anemia was not a normal consequence of aging. 82.4% acknowledged that a bone marrow biopsy is required to diagnose MDS. 57.6% said anemia was the most common hematologic manifestation of MDS. 40.4% said that a hemoglobin of &lt;10 should be referred to hematology. 36.1% said the bone marrow in MDS is hypercellular. 17.6% said MDS transforms to AML in 30% of cases. 11.2% identified MDS as a cause of macrocytic anemia. Only 11.1% identified MDS as a malignancy, and 5.5% identified the average survival of high-risk IPSS stage MDS as 0.4 years. In post-lecture surveys (n= 23), knowledge largely improved. However, given low number of responses, this reached statistical significance in only four of nine questions. Conclusions: MDS are poorly understood by both medical students and residents, especially in regard to the definition as a malignancy, prognosis, and risk of AML evolution. We propose that educational efforts aimed at early trainees would improve these knowledge deficits, in addition to the medical care of patients with MDS. The study is limited by the post-survey completion rate.

High-Fidelity Simulations for Orthopaedic Residents

Surgical training requires acquisition of procedural skills as well as competency in medical management. Changes in training and practice patterns have decreased the operative and nonoperative experiences of trainees. With the introduction of new technologies, more complex procedures, and a host of external constraints, the doctrine of learning primarily through supervised patient-care experiences has been superseded by efforts to teach in nonclinical environments1. Increasingly, simulation is being used to help learners develop essential operative technical skills to compensate for the loss of experience that historically has been obtained through exposure to cases. Hip fixation, osteotomy and fusion, and arthroscopy are some of the orthopaedic procedures that are taught through simulation2-4. Despite the attempts to compensate for decreased opportunities for procedural competency training, to our knowledge no one has developed an alternate method to teach clinical skills needed by orthopaedic residents to manage patients in the postoperative period. Residents develop the ability to manage emergency medical situations through exposure to patient problems, just as motor memory is developed through repetitive performance of a procedure. Feedback from more experienced physicians is another important component of learning proper medical management of patients. Whereas operative skill is supervised, thereby providing opportunities for immediate feedback and improvement, postoperative care receives less scrutiny. The simulated setting is an ideal place to practice handling medical emergencies in a standardized manner. Simulation-based medical education is recognized as a method of boosting medical professional performance while enhancing patient safety5. It is being used at a rapidly expanding rate for training of health-care providers, including pediatrics, internal medicine, and anesthesia residents, and for medical students, but we believe that this is the first description of a simulation-based medical education course focusing on postoperative care by orthopaedic residents. Our hypothesis was that simulation-based …

Examining changes in certification/licensure requirements and the international medical graduate examinee pool

Changes in certification requirements and examinee characteristics are likely to influence the validity of the evidence associated with interpretations made based on test data. We examined whether changes in Educational Commission for Foreign Medical Graduates (ECFMG) certification requirements over time were associated with changes in internal medicine (IM) residency program director ratings and certification examination scores. Comparisons were made between physicians who were ECFMG-certified before and after the Clinical Skills Assessment (CSA) requirement. A multivariate analysis of covariance was conducted to examine the differences in program director ratings based on CSA cohort and whether the examinees emigrated for undergraduate medical education (national vs. international students). A univariate analysis of covariance was conducted to examine differences in scores from the American Board of Internal Medicine (ABIM) Internal Medicine Certification Examination. For both analyses, United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores were used as covariates. Results indicate that, of those certified by ECFMG between 1993 and 1997, 17% (n=1,775) left their country of citizenship for undergraduate medical education. In contrast, 38% (n=1,874) of those certified between 1999 and 2003 were international students. After adjustment by covariates, the main effect of cohort membership on the program director ratings was statistically significant (Wilks' λ=0.99, F 5, 15391=19.9, P<0.001). However, the strength of the relationship between cohort group and the ratings was weak (η=0.01). The main effect of migration status was statistically significant and weak (Wilks' λ=0.98, F 5,15391=45.3, P<0.01; η=0.02). Differences in ABIM Internal Medicine Certification Examination scores based on whether or not CSA were required was statistically significant, although the magnitude of the association between these variables was very small. The findings suggest that the implementation of an additional evaluation of skills (e.g., history-taking, physical examination) as a prerequisite to postgraduate medical education (residency) provides some additional, relevant data to those who select ECFMG-certified residents.

Melanoma: is immunotherapy the future?

Interview by Jenaid Rees, Commissioning EditorJeffrey S Weber, MD, PhD, is the current Director of the Donald A Adam Comprehensive Melanoma Research Center of Excellence and is a senior member at the Moffitt Cancer Center (Tampa, FL, USA). After achieving his PhD in molecular cell biology from Rockefeller University (NY, USA) and then a medical degree from New York University Medical Center (NY, USA), Dr Weber went on to complete a residency in internal medicine for the University of California, San Diego (CA, USA) before undertaking his fellowships at the National Cancer Institute (MD, USA). His main clinical interest involves immunotherapy for melanoma and other malignancies, and he has been working in the field of melanoma therapeutics for over 20 years. In this time, he has published more than 120 articles in peer reviewed journals and has served on several scientific boards including the Melanoma Research Foundation Scientific Advisory Committee and the scientific advisory board of the Melanoma Thera...

To determine the accuracy of focused assessment with sonography for trauma done by nonradiologists and its comparative analysis with radiologists in emergency department of a level 1 trauma center of India

Background:Focused assessment with sonography for trauma (FAST) is an important skill during trauma resuscitation. Use of point of care ultrasound among the trauma team working in emergency care settings is lacking in India.Objective:To determine the accuracy of FAST done by nonradiologists (NR) when compared to radiologists during primary survey of trauma victims in the emergency department of a level 1 trauma center in India.Materials and Methods:A prospective study was done during primary survey of resuscitation of nonconsecutive patients in the resuscitation bay. The study subjects included NR such as one consultant emergency medicine, two medicine residents, one orthopedic resident and one surgery resident working as trauma team. These subjects underwent training at 3-day workshop on emergency sonography and performed 20 supervised positive and negative scans for free fluid. The FAST scans were first performed by NR and then by radiology residents (RR). The performers were blinded to each other's sonography findings. Computed tomography (CT) and laparotomy findings were used as gold standard whichever was feasible. Results were compared between both the groups. Intraobserver variability among NR and RR were noted.Results:Out of 150 scans 144 scans were analyzed. Mean age of the patients was 28 [1-70] years. Out of 24 true positive patients 18 underwent CT scan and exploratory laparotomies were done in six patients. Sensitivity of FAST done by NR and RR were 100% and 95.6% and specificity was 97.5% in both groups. Positive predictive value among NR and RR were 88.8%, 88.46% and negative predictive value were 97.5% and 99.15%. Intraobserver performance variation ranged from 87 to 97%.Conclusion:FAST performed by NRs is accurate during initial trauma resuscitation in the emergency department of a level 1 trauma center in India.

Evaluating the effect of preventive medicine for residents living around mosquito breeding water during rest period of malaria

To evaluate the effect of preventive medicine for residents living around mosquito breeding water during rest period of malaria by delimiting a certain range. The study adopted the stratified cluster random sampling method to select subjects from 6 counties in the high epidemic area along and north of the Huai River since March 2007. Then the villages of 6 counties were stratified into five levels according to the case reported in year 2006, and one village was randomly selected from each level, thereby 30 villages were selected in total.300-500 subjects were interviewed in each village, and in total 12 860 subjects were recruited in the study. The five selected villages in each county were allocated to three intervention groups according to the block randomization method. The first intervention group included 9 villages, 4362 people; the second intervention group was consisted of 12 villages, 4471 people; the non-intervention group had 9 villages, 4027 people. The basic information of the subjects were collected by questionnaire to analyze the relation between malaria cases and the distribution of the mosquito breeding water, then accordingly delimited the range for preventive medicine. Group 1 received the delimiting preventive medicine treatment, group 2 received routine medicine treatment, while non-treatment group received no treatment. The morbidity, standardized morbidity, net change of morbidity (the D-value of the standardized morbidity before and after the intervention), age-specified incidence, and the protective rate (PR), effectiveness index (IE) and the capture rate of the delimited method group were then calculated. Group 1 had 1219 (27.9%) people taking medicine and Group 2 had 219 (4.9%) people. In 2006, before the prevention conducting, the high incidence aging group in the first, second and nonintervention group was separately people aging 50 - 59, 60 - 69 and ≥ 70 years old; whose incidence was 36.22‰ (18/497), 40.11‰ (15/374) and 34.88‰ (9/258) respectively. After the intervention, the high incidence aging groups in the first and second intervention group changed to the population over 70 years old, with incidence at 9.17‰ (3/327) and 22.01‰ (7/318) respectively; while the high incidence aging groups in the nonintervention group changed to people aging between 30-39 years old, with the rate at 24.88‰ (10/402). In 2006, the morbidity of malaria in the first, second intervention group and nonintervention group was separately 18.78‰ (83/4420), 20.27‰ (93/4587) and 14.61‰ (53/3627); while the standardized incidence was separately 18.85‰, 20.72‰ and 14.89‰. In 2007, after the prevention conducting, the morbidity in the three groups was 2.75‰ (12/4362), 11.63‰ (52/4471) and 12.17‰ (49/4027), respectively; while the standardized incidences was 2.81‰, 12.75‰ and 12.35‰, respectively. The net value of changes of morbidity in the three groups was separately 16.04%, 7.97% and 2.54%. The difference in net values of changes of morbidity between intervention group 1 and 2 had statistical significance (χ(2) = 7.74, P < 0.05). Comparing with the nonintervention group, the PR and IE in intervention group 1 was separately 84.2% and 6.31; while the capture rate was 69.2% (9/13). The delimiting preventive medicine treatment during rest period of malaria was very effective for eliminating the potential infection source of malaria and reducing the morbidity of malaria.

A goal programming model for scheduling residents in an anesthesia and reanimation department

Medicine residency is three to seven years of challenging graduate medical training that puts a lot of mental and physiological burden over the residents. Like other surgical branches, anesthesia and reanimation departments provide 24h continuous service and the residents are the main providers of this service. The residents are assigned for on-call shifts during their training, as well as working during the regular day shifts. These schedules must address several considerations like preferences of the residents and coverage requirements of two different locations: the intensive care unit (ICU) and the surgery room (SR). In this study we develop a goal programming (GP) model for scheduling the shifts of the residents in the Anesthesia and Reanimation Department of Bezmialem Vakif University Medical School (BUMS). The rules that must be strictly met, like the number of on-duty shifts or preventing block shifts, are formulated as hard constraints. The preferences of the residents like increasing the number of weekends without shifts and assigning duties on the same night to the same social groups are formulated as soft constraints. The penalties for the deviation from the soft constraints are determined by the analytical hierarchy process (AHP). We are able to solve problems of realistic size to optimality in a few seconds. We showed that the proposed formulation, which the department uses currently, has yielded substantial improvements and much better schedules are created with less effort.

Mujeres en sanidad: entre la igualdad y la desigualdad

This paper aims to analyze the obstacles that female doctors should fight along their career. We affirm that the process of feminization of professions like Medicine does not result in an improvement for women professional careers. We also affirm that leadership positions are not distributed proportionately between men and women. The increase of women among Medicine students, residents and doctors is not accompanied by a proportional growth of women in management and leadership positions in hospitals, but there is a low representation of women in top positions. We also point that medical practice is not unrelated to gender discrimination existing in our society but, unlike the widespread view, is a reflection

Editorial introductions

Editorial introductions

The Utah Center for Clinical and Translational Science: Transformation through Collaboration

The Intermountain West encompasses a 400,000 square mile area that includes the states of Utah, Idaho, Wyoming, and Montana. Within the region the University of Utah Health Sciences Center (UUHSC) is the only academic health center and Intermountain Healthcare (Intermountain), a not-for profit corporation, is the largest healthcare provider. The UUHSC and Intermountain are competitors for clinical market share in most service lines. Both UUHSC and Intermountain have significant research enterprises and each has different strengths. The University of Utah developed the first Biomedical Informatics Department in the nation, is internationally recognized for research in human genetics, and has robust programs in molecular medicine and other laboratory-based sciences. Intermountain is internationally recognized for health services research and programs in quality improvement. The impetus for collaboration in the research enterprise was however, limited before the national initiative to establish a consortium of academic health centers supported through the National Institutes of Health (NIH) clinical and translational science awards (CTSA). Here we describe the transformation of the clinical research environment in the Intermountain West as a result of the collaborative relationships developed between UUHSC and Intermountain following the establishment of the Utah Center for Clinical and Translational Science (CCTS) through the CTSA consortium. Founded in 1905, the University of Utah School of Medicine, located in Salt Lake City, houses 16 clinical and 6 basic science departments. In collaboration with UUHSC, the faculty and staff of the University of Utah educate and train healthcare professionals, conduct research, and provide medical care for adults and children in Utah and the surrounding Intermountain states. Intermountain Healthcare (Intermountain), founded in 1975, is a not-for-profit, integrated healthcare delivery system based in Salt Lake City, UT. Intermountain is the largest healthcare provider in the Intermountain West, providing healthcare services in southeastern Idaho plus the entire state of Utah and operating 23 inpatient facilities including one tertiary children’s hospital, Primary Children’s Medical Center [PCMC] in Salt Lake City, UT. Over 500 multi-specialty physicians are employed through the Intermountain Medical Group and hundreds of other affiliated providers practice in Intermountain hospitals and clinics. Within the region, competition related to clinical market share decreased the ability of institutions to collaborate. Exceptions included 1) the delivery of inpatient pediatric care at PCMC which is owned and operated by Intermountain and staffed by both UUHSC and Intermountain physicians and 2) the training of physicians to serve several western states in both urban and rural locations which resulted in a well-developed Affiliation Agreement defining teaching programs operated in several Intermountain hospitals for UUHSC trainees. Intermountain and UUHSC operate integrated residency and fellowship programs in medicine, obstetrics and gynecology, pediatrics, radiation therapy, and surgery. In contrast, the collaboration in the research enterprise for the past three decades had been limited to the efforts of individual investigators and there were no institutional policies or infrastructure to systematically support the research efforts across institutions or to share resources. The national competition to join the CTSA consortium provided an opportunity to re-evaluate the research relationship and to and develop and support research collaboration between both institutions. UUHSC and Intermountain joined forces in order to apply for a CTSA and to represent the Intermountain West in the consortium. The Utah Center for Clinical and Translational Science (CCTS) became part of the national CTSA consortium in 2008. Linkages created through the CCTS across both organizations have served to create productive and trusting work relationships, allowing us to provide a shared research infrastructure that takes advantage of our innovative systems and shared intellectual capital of personnel. These linkages have increased collaboration and resulted in significant benefits for both instituions.

Necessidades educacionais dos profissionais da Estratégia Saúde da Família (ESF): possibilidades de Educação em Saúde no município de Fortaleza (CE)

As reformas curriculares e a mudança do perfil na formação de profissionais da saúde apresentam muitos desafios. O objetivo deste estudo foi caracterizar as necessidades educacionais em saúde percebidas e representadas pelos profissionais de nível superior que atuam na Estratégia Saúde da Família (ESF) do município de Fortaleza/CE, recém-aprovados em concurso de âmbito municipal. Trata-se de um estudo descritivo com duas etapas. Um estudo transversal em 2006 com aplicação de inquérito para aferição das necessidades de Educação em Saúde, e a segunda etapa em 2011 com a análise documental sobre as ações realizadas para educação permanente dos profissionais da rede municipal de saúde pela Secretaria Municipal de Saúde de Fortaleza. O instrumento utilizado para coleta dos dados foi um questionário semiestruturado, aplicado a profissionais médicos, enfermeiros e odontólogos. Do universo de 900 profissionais recém-concursados, nossa amostra de conveniência contou com 375 respondentes. Observou-se, no estudo, que, quanto ao desejo de realização de pós-graduação, o mestrado profissional, a residência em medicina de família e comunidade, a residência multiprofissional em saúde da família, que são modalidades de pós-graduação que ocorrem em serviço, são necessidades manifestadas por significativa parte dos profissionais. Por outro lado, profissionais também assinalaram a necessidade de cursos de 40 horas de forma pontual. A educação permanente é apontada pela literatura e pelo atual estudo como um caminho para melhoria na qualidade da ESF, por centrar nos processos de trabalho a construção do processo educativo. Para a educação em Saúde gerar efetivos processos de reflexão-ação-reflexão no cotidiano de trabalho, deve-se promover a ligação política com a mudança da formação de perfil profissional e, para isso, colocar em evidência as necessidades educacionais dos profissionais é fundamental.

Recent therapeutic advances in the treatment of systemic lupus erythematosus

William Stohl received a BS from the Massachusetts Institute of Technology in 1973, a MD from the University of Pennsylvania in 1977 and a PhD from the University of Pennsylvania in 1979. After completing his internship and residency in internal medicine, he joined the laboratory of the late Henry Kunkel at the Rockefeller University in 1982. It was there that Dr Stohl began his investigative career focused on B cells, with an emphasis on their dysfunction in systemic lupus erythematosus (SLE). In 1986, Dr Stohl joined the faculty in the Division of Rheumatology (Department of Medicine, University of Southern California, Los Angeles, CA, USA) where he has remained throughout his professional career, rising to the Chief of the Division in 2007. For the past 11 years, the major focus of Dr Stohl’s investigations has been B lymphocyte stimulator (BLyS, also known as BAFF), its role in SLE pathogenesis and its therapeutic neutralization. Dr Stohl maintains an active laboratory that studies BLyS in SLE mice an...

Regional Dissection of the Human Female Pelvis

OPEN ACCESSMarch 20, 2012Regional Dissection of the Human Female Pelvis Alan J. Detton, MS, Eric J. Kenz, MS, Lisa M.J. Lee, PhD Alan J. Detton, MS Ohio State University College of Medicine Google Scholar More articles by this author , Eric J. Kenz, MS The Ohio State University Google Scholar More articles by this author , Lisa M.J. Lee, PhD The Ohio State University Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9122 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractThis resource is a concise supplementary laboratory dissection guide and review for regional gross anatomy of the human female pelvis. The resource is intended primarily for undergraduate and graduate medical students and residents who are performing pelvic dissections, preparing for their board examinations, or simply reviewing the gross anatomy of the female pelvis. The resource contains a cogent, 25-page PDF file on regional dissection of the human female pelvis created for use by faculty, students, and residents in medicine and allied health professions, with students and faculty in anatomy courses in mind. The PDF features images with and without labels to point out hard-to-dissect, complex, three-dimensional regions and structures of the human female pelvis. These structures are challenging to dissect in gross labs and are commonly observed in sagittal sections, making it difficult to evaluate three-dimensional anatomical structure and relationships. The framework provides a concise review of these challenging-to-identify structures for users during or after pelvic dissection and as a supplement to currently available atlases. Additionally, all original images and labels provided in the presentation may be adapted for use in a variety of educational settings to increase discussion and instructional efficiency and to foster a comprehensive review. Educational Objectives By the end of this resource, learners should be able to: Apply an alternative approach to pelvic dissection.Identify and describe gross structures and regions of the female pelvis.Determine three-dimensional relationships of female pelvic structures and their relationship to each other.Test their knowledge of a three-dimensional pelvis through a practical test. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Female Pelvis Instructor's Guide.pdf Female Pelvis Prosections.pdf To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationDetton AJ, Kenz EJ, Lee LMJ. Regional Dissection of the Human Female Pelvis. MedEdPORTAL. 2012;8:9122. https://doi.org/10.15766/mep_2374-8265.9122 Copyright & Permissions© 2012 Detton et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivatives license.KeywordsFemale PelvisDissectionPerineum Disclosures None to report. Funding/Support None to report. Loading ...