Plastic surgery in the Norwegian undergraduate medical curriculum: students’ knowledge and attitudes. A nationwide case-control study

Delphi survey of intercontinental experts to identify areas of consensus on the use of indocyanine green angiography for tissue perfusion assessment during plastic and reconstructive surgery

BACKGROUND

In recent years, indocyanine green angiography (ICG-A) has been used increasingly to assist tissue perfusion assessments during plastic and reconstructive surgery procedures, but no guidelines exist regarding its use. We sought to identify areas of consensus and non-consensus among international experts on the use of ICG-A for tissue-perfusion assessments during plastic and reconstructive surgery.

METHODS

A two-round, online Delphi survey was conducted of 22 international experts from four continents asking them to vote on 79 statements divided into five modules: module 1 = patient preparation and contraindications (n = 11 statements); module 2 = ICG administration and camera settings (n = 17); module 3 = other factors impacting perfusion assessments (n = 10); module 4 = specific indications, including trauma debridement (n = 9), mastectomy skin flaps (n = 6), and free flap reconstruction (n = 8); and module 5 = general advantages and disadvantages, training, insurance coverage issues, and future directions (n = 18). Consensus was defined as ≥70% inter-voter agreement.

RESULTS

Consensus was reached on 73/79 statements, including the overall value, advantages, and limitations of ICG-A in numerous surgical settings; also, on the dose (0.05 mg/kg) and timing of ICG administration (∼20-60 seconds preassessment) and best camera angle (61-90^o) and target-to-tissue distance (20-30 cm). However, consensus also was reached that camera angle and distance can vary, depending on the make of camera, and that further research is necessary to technically optimize this imaging tool. The experts also agreed that ambient light, patient body temperature, and vasopressor use impact perfusion assessments.

CONCLUSION

ICG-A aids perfusion assessments during plastic and reconstructive surgery and should no longer be considered experimental. It has become an important surgical tool.

Demographic and Cultural Differences in the Acceptance and Pursuit of Cosmetic Surgery: A Systematic Literature Review

Worldwide, the numbers of cosmetic procedures continue to climb. However, cosmetic surgery (CS) continues to be plagued by negative stigmatization. This study reviews the literature to identify how attitudes toward CS vary by sex, age, race, culture, and nationality, and aims to determine how other factors like media exposure interact with demographics to influence how well CS is accepted.

Methods

A PRISMA-guided systematic review of the literature was conducted to identify all English-language papers reporting on CS or plastic surgery acceptance, attitudes, or stigmatization, specifically examining for data on age, sex, race/ethnicity, culture, and media influence.

Results

In total, 1515 abstracts were reviewed, of which 94 were deemed pertinent enough to warrant a full-text review. Among the potential demographic predictors of CS acceptance, the one with the most supportive data is sex, with women comprising roughly 90% of all CS patients in virtually all populations studied and consistently exhibiting greater CS knowledge and acceptance. Culturally, the pursuit of beauty through CS is a universal phenomenon, although different countries, races, and cultures differ in how willingly CS is embraced, and in the aesthetic goals of those choosing to have it. In countries with culturally diverse societies like the United States, non-Hispanic Whites continue to predominate among CS patients, but the number of CS patients of other races is rising disproportionately. In this trend, social media is playing a major role.

Conclusion

Healthcare practitioners performing cosmetic procedures need to consider demographic and cultural differences of the patients in order to enhance their understanding of their patients' aesthetic goals and expectations.

Knowledge and Attitude of Medical Students toward Plastic Surgery

Introduction Inadequate professional and medical exposure and misconceptions about plastic surgery have not only been linked to students’ poor knowledge and attitude toward it, but also bias against the selection of plastic surgery as a specialty. This assertion is yet to be tested and confirmed in our setting. This study therefore aimed to determine the knowledge and attitude of medical students toward plastic surgery.

Methods One hundred and eight (108) students between their 3rd and 4th year of study were randomly recruited and handed structured questionnaires on knowledge and attitude toward plastic surgery. Data were then analyzed using SPSS and represented in percentages, medians, and means. Mann-Whitney and Kruskal–Wallis tests were done to assess for significant statistical differences based on gender grouping and year of study, respectively. A p-value ≤ 0.05 was considered significant at a 95% confidence interval.

Results Majority of the students had some awareness about plastic surgery since, a majority (88%) identified plastic surgery with cosmetics and identified trauma as the main condition handled by plastic surgeons. Sixty-four percent (64%) acknowledged the risks associated with plastic surgery and 79.6% noted the presence of the procedures in Kenya. When assessing attitude, 62% reported that they did not want to pursue plastic surgery in the future, 75% would not consider plastic surgery done on them and 77% of the respondents felt embarrassed to undergo the surgery if their family knew while another 77% felt embarrassed if their friends knew. It is worth noting that 55% had their initial exposure to plastic surgery through information from the media sources. Mann-Whitney test done to assess for gender differences only revealed significant difference (p-value = 0.009) on assessing for the availability of plastic surgery procedures in Kenya. Kruskal–Wallis test did not reveal any significant differences based on year of study.

Conclusion Data from our study suggest that students have some awareness about plastic surgery but have a poor attitude toward it.

The effect of microsurgical training on novice medical students’ basic surgical skills—a randomized controlled trial

Background

It has been demonstrated that medical students are capable of learning microsurgical techniques. We hypothesize that microsurgical training might give insight into the importance of delicate tissue handling and correct knot tying that could have a positive influence on macrosurgical skills. The primary aim of this study was to evaluate the effect of microsurgical training on macrosurgical suturing skills in novice medical students.

Subjects and methods

In 2018, 46 novice medical students were enrolled and randomized into two groups. The intervention group received both macro- and microsurgical training and the control group received only microsurgical training. Both groups underwent an assessment test that consisted of macrosurgical tasks of three simple interrupted sutures with a square knot and continuous three-stitch long over-and-over sutures. These tests were individually filmed and assessed using the University of Bergen suturing skills assessment tool (UBAT) and the Objective Structured Assessment of Technical Skill global rating scale (OSATS). Questionnaires regarding future career ambitions and attitudes towards plastic surgery were also completed both prior to and following the tests.

Results

The intervention group needed a longer time to complete the tasks than the control group (12.2 min vs. 9.6 min,p > 0.001), and scored lower on both the UBAT (5.6 vs. 9.0,p > 0.001) and the OSATS (11.1 vs. 13.1,p > 0.001) assessments. The microsurgery course tended to positively influence the students’ attitudes towards a career in plastic surgery (p = 0.002). This study demonstrates poorer macrosurgical skills in the medical students group exposed to microsurgical training. The true effect of microsurgical training warrants further investigation.

Level of evidence: Level I, diagnostic study.

Validating curricular competencies in innovation and entrepreneurship for biomedical research trainees: A modified Delphi approach

INTRODUCTION

Biomedical researchers need skills in innovation and entrepreneurship (I&E) to efficiently translate scientific discoveries into products and services to be used to improve health.

METHODS

In 2016, the European Union identified and published 15 entrepreneurial competencies (EntreComp) for the general population. To validate the appropriateness of these competencies for I&E training for biomedical researchers and to identify program content, we conducted six modified Delphi panels of 45 experts (6-9 per panel). Participating experts had diverse experience, representing such fields as entrepreneurship, academic research, venture capital, and industry.

RESULTS

The experts agreed that all 15 EntreComp competencies were important for biomedical research trainees and no additional competencies were identified. In a two-round Delphi process, the experts identified 120 topics to be included in a training curriculum. They rated the importance of each topic using a 5-point scale from not at all important (1) to extremely important (5) for two student groups: entrepreneurs (those interested in starting their own ventures) and intrapreneurs (those wanting to be innovative and strategic within academia or industry). Consensus (mean importance score >4) was reached that 85 (71%) topics were of high importance for the curriculum. Four topics were identified by multiple panels for both student groups: resiliency, goal setting, team management, and communication skills.

CONCLUSIONS

I&E training for biomedical trainees should address all 15 EntreComp competencies, including "soft skills," and be flexible to accommodate the needs of trainees on different career trajectories.