Recent Publications by CFE Educators

Lentigo formation has been described in adults after the resolution of psoriatic plaques treated with various standard psoriasis treatments. We describe three cases of lentigines developing in areas of resolving psoriatic plaques: two in patients treated with etanercept and one before starting etanercept. A possible pathomechanism is proposed.

PURPOSE

Learning in the clinical workplace can appear to rely on opportunistic teaching. The cognitive apprenticeship model describes assigning tasks based on learner rather than just workplace needs. This study aimed to determine how excellent clinical teachers select clinical learning experiences to support the workplace participation and development of different level learners.

METHODS

Using a constructivist grounded theory approach, we conducted semi-structured interviews with medical school faculty identified as excellent clinical teachers teaching multiple levels of learners. We explored their approach to teach different level learners and their perceived role in promoting learner development. We performed thematic analysis of the interview transcripts using open and axial coding.

RESULTS

We interviewed 19 clinical teachers and identified three themes related to their teaching approach: sequencing of learning experiences, selection of learning activities and teacher responsibilities. All teachers used sequencing as a teaching strategy by varying content, complexity and expectations by learner level. The teachers initially selected learning activities based on learner level and adjusted for individual competencies over time. They identified teacher responsibilities for learner education and patient safety, and used sequencing to promote both.

CONCLUSIONS

Excellent clinical teachers described strategies for matching available learning opportunities to learners' developmental levels to safely engage learners and improve learning in the clinical workplace.

BACKGROUND AND STUDY AIMS

The real-time optical diagnosis of colorectal polyps with high confidence predictions can achieve high levels of accuracy. Increasing the rates of high confidence optical diagnosis can improve the clinical application of real-time optical diagnosis in routine practice. The primary aim of this prospective study was to evaluate whether high magnifying endoscopy improves the rates of high confidence narrow-band imaging (NBI) - based optical diagnosis for differentiating between neoplastic and non-neoplastic colorectal lesions according to the NBI international colorectal endoscopic (NICE) classification.

PATIENTS AND METHODS

Consecutive adult patients undergoing colonoscopy with a high magnifying (maximum, × 80) colonoscope between April and August 2012 were recruited. The optical diagnosis for each polyp was evaluated during colonoscopy in two consecutive stages by the same endoscopist, who first used NBI with non-magnifying endoscopy (NBI-NME), then NBI with magnifying endoscopy (NBI-ME). A level of confidence was assigned to each prediction.

RESULTS

The analysis included 124 patients (mean age, 56.4 years; male-to-female ratio, 72:52) with 248 polyps smaller than 10 mm. Of the 248 polyps, 210 were 1 to 5 mm in size and 38 were 6 to 9 mm in size; 77 polyps were hyperplastic, 4 were sessile serrated adenomas/polyps, 160 were low grade adenomas, 5 were high grade adenomas, and 2 were deep submucosal invasive carcinomas. The rate of high confidence optical diagnosis when NBI-ME was used was significantly higher than the rate when NBI-NME was used for diminutive (1 - 5 mm) polyps (92.9 % vs 79.5 %, P  0.001) and for small (6 - 9 mm) polyps (94.7 % vs 84.2 %, P = 0.048).

CONCLUSION

High magnifying endoscopy significantly improved the rates of high confidence NBI-based optical diagnosis of diminutive and small colorectal polyps.

STUDY REGISTRATION

UMIN 000007608.

Over the course of their nearly 30-year history, the ABCD(E) criteria have been used globally in medical education and in the lay press to provide simple parameters for assessment of pigmented lesions that need to be further evaluated by a dermatologist. In this article, the efficacy and limitations of the ABCDE criteria as both a clinical tool and a public message will be reviewed.

OBJECTIVE

To determine if a knot-tying checklist can provide a valid score and if the checklist can be used by novice surgeons in a reliable manner.

METHODS

This study was conducted at the Surgical Skills Center at the University of California, San Francisco. A knot-tying checklist was developed from a kinesthetic knot-tying curriculum. Novice (67 first-year medical students) and experienced surgeons (8 residents postgraduate year 3 and higher and 2 attending physicians) were videotaped performing 4 knot-tying tasks, and the videotapes were rated with a global score and a checklist by interns (n = 3) and experienced (n = 3) surgeons.

RESULTS

Both interns and experienced surgeons can use the knot-tying checklist with acceptable reliabilities (>0.8 with 3 raters). The checklist is able to differentiate between novice and experienced surgeons, when used by both interns and experienced raters. The expert knot-tying score correlated with the global score overall (r = 0.88) and for each task (r was 0.82 for task 1, 0.85 for task 2, 0.80 for task 3, and 0.81 for task 4).

CONCLUSIONS

The knot-tying checklist provides a valid score for basic surgical knot-tying and can be used by novice and experienced raters. Its use supports peer assessment of performance in a surgical skills laboratory setting.

OBJECTIVE

The objective of this study was to assess whether HIV programming in southern Botswana could be leveraged to provide care for patients with noncommunicable diseases (NCDs).

METHODS

A retrospective analysis was performed to determine the spectrum and complexity of NCDs seen by HIV-focused outreach programming delivered between July 2011 and December 2013, to 9 facilities in southern Botswana. The association of HIV status and specific International Classification of Disease codes was examined using bivariate analysis.

RESULTS

Outreach HIV physicians recorded 926 outpatient consults involving 835 patients during the studied period. While 25% (n=209) of patients seen were HIV infected, most patients were either HIV negative (49%, n=410) or had an unknown HIV status (26%, n=216). Noncommunicable disease referrals were as common at primary- and district-level facilities (90% [n=459] versus 93% [n=301]; P=.22).

CONCLUSION

This study demonstrates how HIV programming in Botswana can be leveraged to improve access to specialist medical services for patients with NCDs.

OBJECTIVES/HYPOTHESIS

To compare voice outcomes after vocal fold augmentation using a trial (temporary) vocal fold injection (VFI) versus long-term augmentation in patients diagnosed with vocal fold atrophy.

STUDY DESIGN

Retrospective, single-blinded study.

METHODS

Nineteen patients diagnosed with vocal fold atrophy underwent trial VFI and subsequent long-term augmentation. Voice Handicap Index-10, acoustic, and aerodynamic measures were analyzed following trial and long-term augmentation procedures.

RESULTS

Forty-two percent (8/19) of patients had a good response to trial VFI (P  .0001); 58% (11/19) had a poor response to trial VFI (P = .95). Of the patients with good response to trial VFI, 75% (6/8) also had good response to long-term augmentation (P = .006), but 25% (2/8) reported a poor response to long-term treatment. Of the patients who had a poor response to trial VFI, 55% (6/11) also had a poor response to long-term treatment, but 45% (5/11) of patients reported good response after long-term augmentation.

CONCLUSIONS

This is the first study to provide comparative voice outcomes using both trial VFI and long-term augmentation for vocal fold atrophy. Additional critical evaluation of the value of trial VFI for vocal fold atrophy patients is suggested.