Search

Background: Mastery learning is an effective educational tool to assess basic procedural skill proficiency and may also be beneficial for more complex skills along the continuum of surgical training. In addition, anxiety and confidence have effects on cognitive and decision-making performance, both in educational and clinical settings. This study evaluates anxiety and confidence in a skills-level-appropriate mastery learning module for chest tube insertion in graduating medical students., Methods: A 2-week intern preparatory course was held 2 consecutive years, with 10 and 14 students, respectively. Learners completed a pretest on day 1, didactic session and supervised deliberate practice followed by a Posttest on day 4, and a retention test on day 10. Year one used a traditional educational methodology, and year two provided for remediation as per mastery learning methodology. The chest tube scoring checklist was validated by faculty trauma surgeons to reflect an intern-appropriate skills level. Before and after each test, learners reported state anxiety. Immediately after each test, learners also completed a confidence scale., Results: No learners in either year achieved mastery on the pretest. A total of 40% of the learners achieved the mastery standard on the posttest in year one. All (100%) of the learners achieved the mastery standard after the posttest in year two. Overall, after state anxiety decreased significantly in both years, confidence increased significantly in year two., Conclusion: A skills-level-appropriate mastery learning module resulted in higher performance and increased confidence compared with a traditional education model for chest tube placement for incoming surgical interns., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: There have been conflicting reports regarding whether the number of rib fractures sustained in blunt trauma is associated independently with worse patient outcomes. We sought to investigate this risk-adjusted relationship among the lesser-studied population of older adults., Methods: A retrospective review of the National Trauma Data Bank was performed for patients with blunt trauma who were ≥65 years old and had rib fractures between 2009 and 2012 (N = 67,695). Control data were collected for age, sex, injury severity score, injury mechanism, 24 comorbidities, and number of rib fractures. Outcome data included hospital mortality, hospital and intensive care unit durations of stay, duration of mechanical ventilation, and the occurrence of pneumonia. Multiple logistic and linear regression analyses were performed., Results: Sustaining ≥5 rib fractures was associated with increased intensive care unit admission (odds ratio: 1.14, P < .001) and hospital duration of stay (relative duration: 105%, P < .001). Sustaining ≥7 rib fractures was associated with an increased incidence of pneumonia (odds ratio: 1.32, P < .001) and intensive care unit duration of stay (relative duration: 122%, P < .001). Sustaining ≥8 rib fractures was associated with increased mortality (odds ratio: 1.51, P < .001) and duration of mechanical ventilation (relative duration: 117%, P < .001)., Conclusion: In older patients with trauma, sustaining at least 5 rib fractures is a significant predictor of worse outcomes independent of patient characteristics, comorbidities, and trauma burden., (Copyright © 2016 Elsevier Inc. All rights reserved.)