Web-Based Education in Systems-Based Practice: A Randomized Trial
Background: All accredited US residency programs are expected to offer curricula and evaluate their residents in 6 general competencies. Medical schools are now adopting similar competency frameworks. We investigated whether a Web-based program could effectively teach and assess elements of systems-based practice.
Methods: We enrolled 276 medical students and 417 residents in the fields of surgery, medicine, obstetrics-gynecology, and emergency medicine in a 9-week randomized, controlled, crossover educational trial. Participants were asked to sequentially complete validated Web-based modules on patient safety and the US health care system. The primary outcome measure was performance on a 26-item validated online test administered before, between, and after the participants completed the modules.
Results: Six hundred forty (92.4%) of the 693 enrollees participated in the study; 512 (80.0%) of the participants completed all 3 tests. Participants' test scores improved significantly after completion of the first module (P < .001). Overall learning from the 9-week Web-based program, as measured by the increase in scores (posttest scores minus pretest scores), was 16 percentage points (95% confidence interval, 14-17 percentage points; P < .001) in public safety topics and 22 percentage points (95% confidence interval, 20-23 percentage points; P < .001) in US health care system topics.
Conclusion: A Web-based educational program on systems-based practice competencies generated significant and durable learning across a broad range of medical students and residents.
Kerfoot BP, Conlin PR, Travison T, McMahon GT
How Surgical Residents Spend Their Training Time: The Effect of a Goal-Oriented Work Style on Efficiency and Work Satisfaction
Hypothesis: When work hours are limited, improving residents' work efficiency allows more time for key training activities, reduces frustration, and improves work satisfaction.
Design: Prospective control study.
Setting: General surgical service with a trauma program.
Participants: Five full-time attending physicians, a resident team of 9 members, and 3 surgical assistants.
Intervention: Reorganization of work habits based on a goal-oriented work style.
Main Outcome Measures: Changes of time spent in key activities; punctuality for operations, clinics, and conferences; residents' work satisfaction, physical fatigue, and mental stress; and attending physician and patient evaluations of residents.
Results: A goal-oriented work style reduced round time and nonpurposeful time and improved punctuality for key education activities. More operative time could be accommodated within the work-hours limits. Residents' work satisfaction improved while mental stress was reduced. Patient satisfaction scores also increased.
Conclusions: Residents' work is generally inefficient. Reduced work hours should be accompanied by work-habit reform to make the best use of residents' training time.
Chung RS, Ahmed N
Effect of Smoking on Aging of Photoprotected Skin: Evidence Gathered Using a New Photonumeric Scale
Objectives: To develop a reproducible photonumeric scale to assess photoprotected skin aging and to determine whether health and lifestyle factors, such as smoking, affect skin aging in photoprotected sites.
Design: Using standard photographs of participants' upper inner arms, we created a 9-point photonumeric scale. Three blinded reviewers used the scale to grade the photographs. Participants answered multiple lifestyle questions.
Setting: Academic outpatient dermatology clinic.
Participants: Eighty-two healthy men and women aged 22 to 91 years.
Interventions: A professional medical photographer took standardized photographs of each participant's upper inner arm. Participants answered standardized health and lifestyle questions.
Main Outcome Measures: (1) Interobserver agreement and reproducibility using the photonumeric scale and (2) health and lifestyle factors most predictive of the degree of aging in photoprotected skin.
Results: There was good blinded interobserver agreement as measured by the maximum range of disagreement scores for each participant (mean, 0.91; 95% confidence interval, 0.76-1.06). Results were reproducible. We developed a multiple regression model showing that the best model for predicting the degree of aging in photoprotected skin includes 2 variables: age and packs of cigarettes smoked per day.
Conclusions: This photonumeric scale demonstrates good interobserver agreement and good reproducibility. Using this scale, the degree of aging in photoprotected skin was significantly correlated with patient age and a history of cigarette smoking. Additional studies are needed to continue garnering information regarding independent risk factors for aging of photoprotected skin.
Helfrich YR, Yu L, Ofori A, Hamilton TA, Lambert J, King A, Voorhees JJ, Kang S
Improvement of Naturally Aged Skin With Vitamin A (Retinol)
Objective: To evaluate the effectiveness of topical retinol (vitamin A) in improving the clinical signs of naturally aged skin.
Design: Randomized, double-blind, vehicle-controlled, left and right arm comparison study.
Setting: Academic referral center.
Patients: The study population comprised 36 elderly subjects (mean age, 87 years), residing in 2 senior citizen facilities.
Intervention: Topical 0.4% retinol lotion or its vehicle was applied at each visit by study personnel to either the right or the left arm, up to 3 times a week for 24 weeks.
Main Outcome Measures: Clinical assessment using a semiquantitative scale (0, none; 9, most severe) and biochemical measurements from skin biopsy specimens obtained from treated areas.
Results: After 24 weeks, an intent-to-treat analysis using the last-observation-carried-forward method revealed that there were significant differences between retinol-treated and vehicle-treated skin for changes in fine wrinkling scores (–1.64 [95% CI, –2.06 to –1.22] vs –0.08 [95% CI, –0.17 to 0.01]; P < .001). As measured in a subgroup, retinol treatment significantly increased glycosaminoglycan expression (P = .02 [n = 6]) and procollagen I immunostaining (P = .049 [n = 4]) compared with vehicle.
Conclusions: Topical retinol improves fine wrinkles associated with natural aging. Significant induction of glycosaminoglycan, which is known to retain substantial water, and increased collagen production are most likely responsible for wrinkle effacement. With greater skin matrix synthesis, retinol-treated aged skin is more likely to withstand skin injury and ulcer formation along with improved appearance.
Trial Registration: clinicaltrials.gov Identifier: NCT00272610
Kafi R, Kwak HSR, Schumacher WE, et al
Abstracts: In Other Archives Journals. Arch Facial Plast Surg. 2007;9(4):302-303. doi: