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PubMed2005

[The appreciation of the medical students' knowledge concerning the role and work of medical care funds in Polish health care system].

The aim of the research was verification and comparison of the present state of knowledge among the students (of different departments and years ofstudy), about the role ofMedical Care Funds in the up-to-now healthcare system and the patient's rights as far as the students' future profession as doctors, dentists healthcare managers and medical rescuers is concerned. The research was carried out by means of anonymous questionnaire. A uniform "assessment" method was adopted following the principles of didactic measurement. The following were calculated: range, modal, mediana, arithmetic average, variance, standard deviation, easiness of the task, difficulty of the task, skip fraction, the task's differentiating power, reliability coefficient of the test using the own modification of the Excel programme. No significant differences among the particular groups have been proven as far as the students present state of knowledge is concerned. The research showed different difficulty levels of the particular questions among examined groups. The assessment of the up-to-now work of the Medical Care Funds is negative in the opinion of the respondents, no matter which medical faculty they have represented.

Allied Health Personnel↗
PubMed2006

The duty to follow up.

Case histories are based on actual medical negligence claims, however certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved. Many general practitioners are concerned that the law places all of the responsibility for follow up on to the GP and ask: 'What is the patient's responsibility'? This article explores the duty of GPs and patients to follow up tests and results.

Adenocarcinoma↗
PubMed1994

[The levels of knowledge about nonclinical areas which are characteristic of the new model of primary care].

OBJECTIVE: To evaluate the level of knowledge about the non-clinical areas which characterise the new model of primary care among doctors and nurses who work in primary care teams (PCT); and to identify the most deficient areas of knowledge and the variables associated with these lower levels of knowledge. DESIGN: An observation study of a crossover kind. SETTING: PCTs of Health Area 1 in Madrid. PARTICIPANTS: Doctors and nurses who were working in the 23 PCTs functioning when the study was carried out (321 people). MEASUREMENTS AND MAIN RESULTS: Knowledge was measured by a self-filled, anonymous questionnaire elaborated by a panel of experts. It contained 72 items with correct (C) or false (F) double reply, grouped in 12 basic areas of knowledge relating to the non-clinical aspects which characterise the new model of primary care (PC). A pilot test was done in a PCT in another Area. The data bases were performed on DBASEIII+ and the statistical analysis on SPSS v. 4.0. The required level of knowledge through the questionnaire as a whole was attained by 41.6% of the professionals. An association with the following was noted: Age (p < 0.0001), Profession (p < 0.005), Year that training ended (p < 0.01), Type of contract (p < 0.005), Nature of access to a permanent post (p < 0.0005), postgraduate academic training for doctors (p < 0.001) and Residency in Family and Community Medicine (p < 0.009). The most deficient areas of knowledge were: Evaluation of procedures and programmes (46%), Community Participation (51.6%), the filling-out and standardisation of records (55.2%), and the Evaluation of objectives and quality control mechanisms. CONCLUSIONS: Knowledge of non-clinical areas is low.

Adult↗
PubMed2004

Spectrum and prevalence of cardiac sodium channel variants among black, white, Asian, and Hispanic individuals: implications for arrhythmogenic susceptibility and Brugada/long QT syndrome genetic testing.

OBJECTIVES: The purpose of this study was to determine the prevalence and spectrum of nonsynonymous polymorphisms (amino acid variants) in the cardiac sodium channel among healthy subjects. BACKGROUND: Pathogenic mutations in the cardiac sodium channel gene, SCN5A, cause approximately 15 to 20% of Brugada syndrome (BrS1), 5 to 10% of long QT syndrome (LQT3), and 2 to 5% of sudden infant death syndrome. METHODS: Using single-stranded conformation polymorphism, denaturing high-performance liquid chromatography, and/or direct DNA sequencing, mutational analysis of the protein-encoding exons of SCN5A was performed on 829 unrelated, anonymous healthy subjects: 319 black, 295 white, 112 Asian, and 103 Hispanic. RESULTS: In addition to the four known common polymorphisms (R34C, H558R, S1103Y, and R1193Q), four relatively ethnic-specific polymorphisms were identified: R481W, S524Y, P1090L, and V1951L. Overall, 39 distinct missense variants (28 novel) were elucidated. Nineteen variants (49%) were found only in the black cohort. Only seven variants (18%) localized to transmembrane-spanning domains. Four variants (F1293S, R1512W, and V1951L cited previously as BrS1-causing mutations and S1787N previously published as a possible LQT3-causing mutation) were identified in this healthy cohort. CONCLUSIONS: This study provides the first comprehensive determination of the prevalence and spectrum of cardiac sodium channel variants in healthy subjects from four distinct ethnic groups. This compendium of SCN5A variants is critical for proper interpretation of SCN5A genetic testing and provides an essential hit list of targets for future functional studies to determine whether or not any of these variants mediate genetic susceptibility for arrhythmias in the setting of either drugs or disease.

Bundle-Branch Block↗
PubMed2001

Measuring service-specific performance and educational value within a general surgery residency: the power of a prospective, anonymous, Web-based rotation evaluation system in the optimization of resident satisfaction.

BACKGROUND: We used a Web-based evaluation system to institute specific changes to various clinical teaching services in our integrated residency in an effort to optimize the overall quality of the educational experience and measured the resident satisfaction in these rotations. METHODS: Residents rated 8 categories of experience on a scale of 1 to 5 (maximum summation score, 40 points). Data were analyzed by t-test for equality of means. A probability value of less than.05 was considered significant. RESULTS: Compliance with completion of the evaluations was 100%. The Chronbach's alpha reliability coefficient of the tool was 0.826. Tukey's estimate of power to achieve additivity was 1.5. Six under-performing services were re-engineered with prominent effects on 7 postgraduate year (PGY) rotations. On 2 general surgery services at 1 hospital, the workload was redistributed, and a dedicated team teaching time was instituted (PGY-3 [a]: before, 22 points/after, 31 points; P =.003; PGY-3 [b]: before, 25 points/after, 31 points; P =.004; PGY-1: before, 24 points/after, 29 points; P =.07). A general surgery service at another hospital redistributed coverage of the attending surgeons to create a nonteaching service (PGY-1: before, 22 points/-after, 27 points; P =.01). The transplantation service (PGY-3) was examined, and the role of the point was redefined (before, 24 points/after, 31 points; P =.01). One vascular service (PGY-2) redistributed cases and workload (before, 27 points/after, 22 points; P =.07). The vascular PGY-2 position was eliminated and replaced by a mid-level practitioner. The cardiothoracic service (PGY-1) rotation was converted into a preceptorship (before, 23 points/after, 30 points; P =.015). CONCLUSIONS: A web-based clinical rotation evaluation provides a means for the assessment of the impact of programmatic changes while preserving resident anonymity and maintaining accountability.

General Surgery↗
PubMed2000

Sequence analysis of the mismatch repair gene hMSH6 in the germline of patients with familial and sporadic colorectal cancer.

To evaluate the involvement of hMSH6 in colorectal cancer, the complete coding sequence and flanking intron regions of the gene were analyzed by DNA sequencing in 10 patients fulfilling Bethesda Guidelines for colorectal tumors and 10 patients with sporadic colorectal carcinoma. In addition, 10 mono- and 10 dinucleotide repeat markers were analyzed for microsatellite instability. A protein-truncating T insertion at codon 218 was identified in the index person of a hereditary non-polyposis colorectal cancer (HNPCC)-like kindred and was accompanied by a somatic T deletion in the tumor. The tumor of this patient was positive for mono- but negative for dinucleotide repeat instability and lacked allelic losses at loci frequently affected in colorectal carcinomas. A novel amino acid change, F340S, was found in a patient with sporadic colon and breast cancer and leukemia but was not detected in 246 chromosomes from healthy anonymous blood donors. In addition, we describe 2 silent and 15 intronic sequence variants not previously reported. Although the frequency is low, we present further evidence for hMSH6 germline mutations that predispose patients to HNPCC-like phenotypes and suggest that mono- and dinucleotide repeat instability testing may be useful for distinguishing between individuals harboring an hMSH2 or hMLH1 mutation and a mutation of the hMSH6 gene.

Adaptor Proteins, Signal Transducing↗
PubMed2006

Vitamin and mineral supplement use among US medical students: A longitudinal study.

OBJECTIVE: To provide data on medical students' multivitamin and calcium supplement use during medical school. DESIGN: Medical students were anonymously surveyed at three time points: freshman orientation, orientation to wards, and during senior year. SUBJECTS: Medical students (n = 2,316) at 16 US medical schools (response rate = 80.3%). OUTCOME MEASURES: Prevalence and correlates of multivitamin and calcium supplement use throughout medical school. STATISTICAL ANALYSES: Chi2 tests with associated P values, and logistic regression with associated odds ratios and confidence intervals. RESULTS: Half of medical students surveyed used multivitamins, and 19% used calcium supplements, at least once per week as freshmen. Consumption of calcium, but not multivitamin, supplements increased during subsequent years (P = 0.0001) and both supplements were more commonly used by women (P < 0.0003). Of 970 students tracked across all three time points, 14% of women, compared with only 2% of men (P < 0.0001), took calcium at all three time points. Using multivariate models, we found that medical students were more likely to use multivitamins if they exercised regularly, had children, were underweight, or were women who were not heavy users of alcohol (P < 0.0001 to P < 0.05). Similarly, students who were women, underweight, exercised regularly, or had a personal or family history of osteoporosis were more likely to consume supplemental calcium (P < 0.0001 to P = 0.04). CONCLUSIONS: Medical students of all types used supplements at moderate rates, and women used supplements more commonly and consistently than did men. Medical students, especially nonunderweight and nonexercising students, may be particularly important targets for messages regarding appropriate and adequate vitamin/mineral use.

Adult↗
PubMed2004

Source of bacterial shedding in laminar flow theatres.

In a previous unpublished observation, unacceptably high bacterial counts, presumably due to shedding episodes, occurred in two of 56 (3.57%) slit-air samples during arthroplasty surgery in a laminar flow operating theatre. The isolates matched those cultured from swab samples taken from the skin of one of the surgeons's foreheads on each of the two occasions. These findings occurred despite scrub staff wearing standard occlusive gowns, hats and masks with visors. In order to localize the potential source of such shedding more accurately, 20 members of theatre staff underwent anonymous microbiological swabbing from the facial areas not covered by theatre clothing, namely their foreheads, eyebrows and ears. These swabs were cultured and the growths were compared statistically. Significantly more colonies were cultured from swabs taken from the theatre staff's ears (P = 0.047, Freidman's test) compared with the other two facial areas studied. These data support the use of exhaust helmets in arthroplasty surgery, or at least mandatory coverage of the ears with theatre hats for scrub staff.

Arthroplasty↗
PubMed1987

A required, combined ACLS/ATLS provider course for senior medical students at East Carolina University.

A course that combines advanced cardiac life support (ACLS) training with advanced trauma life support (ATLS) training for senior medical students was evaluated for its ability to integrate concepts of students' prior clinical experience and to stimulate achievement of provider certification. Since initiation of this program in 1982, students have uniformly praised the combined ACLS/ATLS provider course in anonymous, post-course evaluations. The experience was judged to integrate significantly concepts and principles acquired in students' previous 18 months of clinical training. The opportunity to apply these concepts in unique and challenging clinical simulations was noted by students. Evaluation of pretest and post-test data for the class of 1984 (n = 39) using a t test for matched pairs indicates a significant improvement in post-test examination performance (P less than .001). These data are supported by skills stations testing and achievement of provider certification. Ninety-five percent of student participants achieved provider certification in ACLS; 92% achieved provider certification in ATLS.

Certification↗
PubMed1995

Out-patient alcohol detoxification--outcome after 2 months.

We assessed the outcome after 2 months of 28 alcohol-dependent subjects following out-patient detoxification using an uncontrolled follow-up study with data collected at the time of detoxification (T1) and after 2 months (T2). We also determined the cost of out-patient versus in-patient detoxification. The setting was a psychiatric emergency clinic at a South West London University Hospital. Self-reported alcohol consumption in the week before T1 and T2, score on the 'Alcohol Problems Inventory' measuring alcohol-related relational, occupation, legal and medical problems in the 2 months prior to T1 and T2, mean corpuscular volume and gamma-glutamyl transferase at T1 and T2 were used as outcome measures. Eight subjects had a 'good' outcome (seven were abstinent and one only drank four units on one day). Nine subjects were 'improved' by either having their alcohol consumption, or halving their 'Alcohol Problems Inventory' score at T2. 'Good' and 'improved' outcome were confirmed by mean corpuscular volume and gamma-glutamyl transferase results. Eleven subjects were 'not improved'. Engagement following detoxification with voluntary alcohol agencies was associated with a better outcome. In-patient detoxification is calculated to be six times more expensive than out-patient detoxification. Out-patient detoxification is a cost-effective step in the treatment of alcohol-dependent patients.

Adult↗
PubMed2004

Voluntary anonymous reporting of medical errors for neonatal intensive care.

OBJECTIVES: Medical errors cause significant morbidity and mortality in hospitalized patients. Specialty-based, voluntary reporting of medical errors by health care providers is an important strategy that may enhance patient safety. We developed a voluntary, anonymous, Internet-based reporting system for medical errors in neonatal intensive care, evaluated its feasibility, and identified errors that affect high-risk neonates and their families. METHODS: Health professionals (n = 739) from 54 hospitals in the Vermont Oxford Network received access to a secure Internet site for anonymous reporting of errors, near-miss errors, and adverse events. Reports used free-text entry in phase 1 (17 months) and a structured form in phase 2 (10 months). The number and types of reported events and factors that contributed to the events were measured. RESULTS: Of 1230 reports--522 in phase 1 (17 months) and 708 in phase 2 (10 months)--the most frequent event categories were wrong medication, dose, schedule, or infusion rate (including nutritional agents and blood products; 47%); error in administration or method of using a treatment (14%); patient misidentification (11%); other system failure (9%); error or delay in diagnosis (7%); and error in the performance of an operation, procedure, or test (4%). The most frequent contributory factors were failure to follow policy or protocol (47%), inattention (27%), communications problem (22%), error in charting or documentation (13%), distraction (12%), inexperience (10%), labeling error (10%), and poor teamwork (9%). In 24 reports, family members assisted in discovery, contributed to the cause, or themselves were victims of the error. Serious patient harm was reported in 2% and minor harm in 25% of phase 2 events. CONCLUSIONS: Specialty-based, voluntary, anonymous Internet reporting by health care professionals identified a broad range of medical errors in neonatal intensive care and promoted multidisciplinary collaborative learning. Similar specialty-based systems have the potential to enhance patient safety in a variety of clinical settings.

Adverse Drug Reaction Reporting Systems↗
PubMed2003

Field assessment of BAC data to study late-night college drinking.

OBJECTIVE: This field study of late-night college drinking sought to (1) test the ability of the 5+/4+ measure to screen for higher levels of intoxication and (2) examine the relation between estimated and actual blood alcohol concentration (BAC). METHOD: During a 15-week spring semester, college students returning to their residence halls between 10:00 PM and 3:00 AM on Wednesday through Saturday nights were anonymously interviewed to collect BAC and self-report data (n = 1,020). RESULTS: Although 70.9% had not been drinking on Wednesday nights, a majority of the intercepted students had been drinking on the other three nights. Mean BACs on these three nights were in a moderate range (48 to 51 mg/dl), but the 5+/4+ measure classified many students as heavy episodic drinkers at relatively low BACs. For example, 66.3% of those meeting the 5+/4+ criterion for the night had BACs < 100 mg/dl. Students with BACs ranging from 70 to 90 mg/dl exhibited the greatest accuracy in estimating their BAC; those with lower BACs tended to overestimate their level of intoxication; whereas those with higher BACs tended to underestimate it. CONCLUSIONS: Field assessment of student intoxication is an important tool for examining research questions in college drinking. The 5+/4+ measure classifies many college students as heavy episodic drinkers, even though their intoxication level is below conventional thresholds used to define drunkenness. In addition, there is a discernible pattern of BAC estimation in the field that corresponds to intoxication level.

Alcohol Drinking↗
PubMed1991

Direct selection: a method for the isolation of cDNAs encoded by large genomic regions.

We have developed a strategy for the rapid enrichment and identification of cDNAs encoded by large genomic regions. The basis of this "direct selection" scheme is the hybridization of an entire library of cDNAs to an immobilized genomic clone. Nonspecific hybrids are eliminated and selected cDNAs are eluted. These molecules are then amplified and are either cloned or subjected to further selection/amplification cycles. This scheme was tested using a 550-kilobase yeast artificial chromosome clone that contains the EPO gene. Using this clone and a fetal kidney cDNA library, we have achieved a 1000-fold enrichment of EPO cDNAs in one cycle of enrichment. More significantly, we have further investigated one of the "anonymous" cDNAs that was selectively enriched. We confirmed that this cDNA was encoded by the yeast artificial chromosome. Its frequency in the starting library was 1 in 1 x 10(5) cDNAs and after selection comprised 2% of the selected library. DNA sequence analysis of this cDNA and of the yeast artificial chromosome clone revealed that this gene encodes the beta 2 subunit of the human guanine nucleotide-binding regulatory proteins. Restriction mapping and hybridization data position this gene (GNB2) to within 30-70 kilobases of the EPO gene. The selective isolation and mapping of GNB2 confirms the feasibility of this direct selection strategy and suggests that it will be useful for the rapid isolation of cDNAs, including disease-related genes, across extensive portions of the human genome.

Base Sequence↗
PubMed2006

The frequency of smoking, quitting and socio-demographic characteristics of physicians of a medical faculty.

BACKGROUND: The aim of this study was to determine the epidemiology of smoking among physicians and to describe their socio-demographic characteristics. SUBJECTS AND METHODS: All professors, associate professors, assistant professors, lecturers and research assistants working for the Faculty of Medicine of Meram, University of Selçuk, were included in the study. Of the 500 subjects, 363 (72.6%) completed the anonymous questionnaire of the survey satisfactorily. The smoking status, age at smoking initiation, daily cigarette consumption and association between current smoking and socio-demographic variables, family characteristics and body mass index were examined. The SPSS software was used to tabulate the data. The chi-square test was used for statistical analysis. RESULTS: The mean age was 34.2 +/- 9.1 years. The rate of ever-smokers was 28.7% (n = 104). The rates of smoking in females and males were 13.4% (n = 15) and 35.6% (n = 89), respectively (p = 0.000). The rate of ex-smokers was 9.9% (n = 36). The rate of never-smokers was 61.4% (n = 223). The mean age at starting smoking was 21.7 +/- 4.9 years. The quit ratio was 25.7% (36/140) [23.3% (27/116) for men and 37.5% (9/24) for women]. Fagerstrom score was averaged 2.8 +/- 2.7 among all smokers. The rate of smoking in the families (p = 0.003) and among close friends (p = 0.000) of the smoker-group was higher than in non-smokers. CONCLUSION: In Turkey, prevalence of tobacco smoking is high among physicians though lower than the general community. This may compromise their role in tobacco control unless they quit smoking.

Adult↗
PubMed1998

[The epidemiological surveillance of human immunodeficiency virus (HIV) infection in a hospital population of Catalonia. Collaborators in the VIHHOSP project].

BACKGROUND: AIDS is one of the most important problems of public health in our setting. The surveillance of HIV infection in sentinel population is an important alternative to the use of the AIDS cases registries, to obtain a dynamic and updated information about HIV/AIDS epidemic. The objective of this study was to determine the prevalence of HIV infection among the patients from 5 sentinel hospitals in Catalonia, Spain. PATIENTS AND METHODS: Unlinked anonymous screening of serum from patients aged 15-49 from 5 sentinel hospitals in Catalonia, Spain. Samples were broken by age, sex, in-patients or out-patients and clinical specialities related to HIV/AIDS or not related. Samples were analyzed in pools of five and were tested by the OMS strategy II, for the epidemiological surveillance purposes. RESULTS: HIV testing was developed in 9,524 patients, with a prevalence of 1.6% (153 samples). The overall prevalence in men was twice that of women (2.3% vs. 1.1%). Ages between 25 to 34 had the higher prevalence (3.1%). Clinical specialities related with HIV/AIDS had a prevalence twice that of non related (2.3% vs. 1.2%). CONCLUSIONS: The HIV prevalence found in this population is the highest compared to similar studies performed in other western european countries. Our data confirm the pattern of HIV infection for age and sex observed in other studies in Catalonia, Spain. This is the first study of sentinel surveillance in sentinel hospitals in Spain and give us the base line which will serve as a reference to assess the evolution of HIV infection in further studies in sentinel hospital populations in Catalonia.

Adolescent↗
PubMed1996

[Alkaline phosphatase of bone origin in hemodialyzed patients. 110 assays].

OBJECTIVES: To evaluate the value of plasma bone-specific alkaline phosphatase (bAP) in the diagnosis and the prediction of the type of renal osteodystrophy in hemodialysis patients. To examine whether bAP correlated with the two classical biochemical markers of bone turnover in dialysis patients which are total alkaline phosphatases (tAP) and intact PTH (iPTH). METHODS: One hundred adult uremic patients undergoing regular hemodialysis therapy were included in the study. Plasma bAP was determined using a radioimmunometric assay. Intact PTH (1-84) was measured using a radioimmunometric assay, Allegro Intact PTH, Nichols Institute, CA, USA. Other laboratory tests including calcium, phosphorus, and tAP were performed by automated methods. RESULTS: Based on previous biochemical and histological data obtained in the same type of patients, we arbitrarily divided plasma bAP levels in normal (10-20 ng/ml), low (< 10 ng/ml), and high (> 20 ng/ml). We found here that bAP levels were normal in 27 patients, high in 36, and low in 37. In the group with normal bAP, 8/27 patients had iPTH levels higher than 200 pg/ml, the other 19 patients had an iPTH within the normal range. In the 36 patients with high bAP, 10 showed markedly high iPTH and clinical signs of severe hyperparathyroidism leading to the indication of a surgical parathyroidectomy in 7 patients and i.v. calcitriol therapy in the other 3. However, 9 of these 36 patients had an iPTH lower than 200 pg/ml and 17 between 200-500 pg/ml. In the 37 patients with low bAP, iPTH levels were also low in 15 of them, but 12 patients had iPTH levels higher than 200 pg/ml. There was a good correlation between bAP, tAP, and iPTH. However, bAP correlated better with iPTH than tAP. A bAP > 20 ng/ml had a sensitivity of 56%, specificity of 92% and positive predictive value of 80% in the prediction of an PTH higher than > 400 pg/ml and therefore of the biological diagnosis of hyperparathyroidism. A bAP < 10 ng/ml had a sensitivity of 70%, specificity of 56% and a positive predictive value of 48% in predicting a normal-low iPTH (< 100 pg/ml). CONCLUSION: In the absence of bone biopsy, plasma bAP self provides useful information about bone remodeling in hemodialysis patients. The combination of bAP and iPTH measurements further define the type of bone turnover. either elevated plasma bAP or iPTH alone are no always anonymous with secondary hyperparathyroidism.

Adult↗
PubMed2006

Ophthalmology resident surgical competency: a national survey.

PURPOSE: To describe the prevalence, management, and career outcomes of ophthalmology residents who struggle with surgical competency and to explore related educational issues. DESIGN: Fourteen-question written survey. PARTICIPANTS: Fifty-eight program directors at Accreditation Council on Graduate Medical Education-accredited, United States ophthalmology residency programs, representing a total of 2179 resident graduates, between 1991 and 2000. METHODS: Study participants completed a mailed, anonymous survey whose format combined multiple choice and free comment questions. MAIN OUTCOME MEASURES: Number of surgically challenged residents, types of problems identified, types of remediation, final departmental decision at the end of residency, known career outcomes, and residency program use of microsurgical skills laboratories and applicant screening tests. RESULTS: One hundred ninety-nine residents (9% overall; 10% mean per program) were labeled as having trouble mastering surgical skills. All of the programs except 2 had encountered such residents. The most frequently cited problems were poor hand-eye coordination (24%) and poor intraoperative judgment (22%). Most programs were supportive and used educational rather than punitive measures, the most common being extra practice-laboratory time (32%), scheduling cases with the best teaching surgeon (23%), and counseling (21%). Nearly one third (31%) of residents were believed to have overcome their difficulties before graduation. Other residents were encouraged to pursue medical ophthalmology (22%) or to obtain further surgical training through a fellowship (21%) or a supervised practice setting (12%); these residents were granted a departmental statement of satisfactory completion of residency for Board eligibility. Twelve percent were asked to leave residency. Of reported career outcomes, 92% of residents were practicing ophthalmology, 65% as surgical and 27% as medical ophthalmologists. Ninety-eight percent of residency programs had microsurgical practice facilities, 64% had a formal teaching course, and 36% had mandatory practice time. Most programs (76%) did not perform applicant vision or dexterity screening tests; questions existed about the legality and validity of such tests. CONCLUSIONS: The issue of ophthalmology residents who struggle to develop surgical competency appears common. Although many problems appear to be remediable with time, practice, and dedicated, patient teachers, more specific guidelines for a statement of surgical competency are likely necessary to standardize the Board certification process.

Career Choice↗