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Arshad SA, Garcia EI, Bell C, Avritscher EBC, Kumar M, Brahmamdam P, Fraser JA, St Peter SD, Aranda A, Hill M, Marquart J, Van Arendonk K, Plumblee L, Streck CJ, Zamora IJ, Ghani MOA, Reichard KW, Sacks K, Kallis M, Hong A, Richards H, Lin S, Gross ER, Kabeer MH, Reyna T, Paton EA, Camp LB, Stephenson K, Dassinger M, Vali K, Filipescu R, DeUgarte DA, Krishna V, Slater B, Islam S, Thompson G, Moore JT, Englum BR, Scholz S, Sharbaugh E, Gander JW, Tsao K. Multicenter Assessment of Cryoanalgesia Use in Minimally Invasive Repair of Pectus Excavatum: A 20-center Retrospective Cohort Study. Ann Surg 2023; 277:e1373-e1379. [PMID: 35797475 DOI: 10.1097/sla.0000000000005440] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the clinical implications of cryoanalgesia for pain management in children undergoing minimally invasive repair of pectus excavatum (MIRPE). BACKGROUND MIRPE entails significant pain management challenges, often requiring high postoperative opioid use. Cryoanalgesia, which blocks pain signals by temporarily ablating intercostal nerves, has been recently utilized as an analgesic adjunct. We hypothesized that the use of cryoanalgesia during MIRPE would decrease postoperative opioid use and length of stay (LOS). MATERIALS AND METHODS A multicenter retrospective cohort study of 20 US children's hospitals was conducted of children (age below 18 years) undergoing MIRPE from January 1, 2014, to August 1, 2019. Differences in total postoperative, inpatient, oral morphine equivalents per kilogram, and 30-day LOS between patients who received cryoanalgesia versus those who did not were assessed using bivariate and multivariable analysis. P value <0.05 is considered significant. RESULTS Of 898 patients, 136 (15%) received cryoanalgesia. Groups were similar by age, sex, body mass index, comorbidities, and Haller index. Receipt of cryoanalgesia was associated with lower oral morphine equivalents per kilogram (risk ratio=0.43, 95% confidence interval: 0.33-0.57) and a shorter LOS (risk ratio=0.66, 95% confidence interval: 0.50-0.87). Complications were similar between groups (29.8% vs 22.1, P =0.07), including a similar rate of emergency department visit, readmission, and/or reoperation. CONCLUSIONS Use of cryoanalgesia during MIRPE appears to be effective in lowering postoperative opioid requirements and LOS without increasing complication rates. With the exception of preoperative gabapentin, other adjuncts appear to increase and/or be ineffective at reducing opioid utilization. Cryoanalgesia should be considered for patients undergoing this surgery.
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Affiliation(s)
- Seyed A Arshad
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Children's Memorial Hermann Hospital, Houston, TX
| | - Elisa I Garcia
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Children's Memorial Hermann Hospital, Houston, TX
| | - Cynthia Bell
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Children's Memorial Hermann Hospital, Houston, TX
| | - Elenir B C Avritscher
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Children's Memorial Hermann Hospital, Houston, TX
| | | | | | | | | | | | | | - John Marquart
- Medical College of Wisconsin/Children's Hospital of Wisconsin
| | | | - Leah Plumblee
- Medical University of South Carolina Shawn Jenkins Children's Hospital
| | | | - Irving J Zamora
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt
| | - Muhammad O A Ghani
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt
| | | | | | | | - Andrew Hong
- Northwell Health/Cohen Children's Medical Center
| | - Holden Richards
- Oregon Health and Science University/Doernbecher Children's Hospital
| | - Saunders Lin
- Oregon Health and Science University/Doernbecher Children's Hospital
| | - Erica R Gross
- Stony Brook Medicine/Stony Brook Children's Hospital
| | | | - Troy Reyna
- The University of California Irvine/CHOC Children's Hospital
| | - Elizabeth A Paton
- The University of Tennessee Health Science Center/Le Bonheur Children's Hospital
| | - Lauren B Camp
- The University of Tennessee Health Science Center/Le Bonheur Children's Hospital
| | - Krista Stephenson
- University of Arkansas for Medical Sciences/Arkansas Children's Hospital
| | - Melvin Dassinger
- University of Arkansas for Medical Sciences/Arkansas Children's Hospital
| | - Kaveh Vali
- University at Buffalo/Oishei Children's Hospital
| | | | | | - Vikram Krishna
- University of California-Los Angeles/Mattel Children's Hospital
| | | | - Saleem Islam
- University of Florida/Shands Children's Hospital
| | | | - James T Moore
- University of Maryland School of Medicine/University of Maryland Children's Hospital
| | - Brian R Englum
- University of Maryland School of Medicine/University of Maryland Children's Hospital
| | - Stefan Scholz
- University of Pittsburgh/UPMC Children's Hospital of Pittsburgh
| | | | - Jeffrey W Gander
- University of Virginia/University of Virginia Children's Hospital. Excluding those from the lead site, authors are listed by alphabetical order of their institution's name
| | - KuoJen Tsao
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
- Children's Memorial Hermann Hospital, Houston, TX
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Jaishankar D, Quinn KM, Sanders J, Plumblee L, Morinelli TA, Nadig SN. Connexins in endothelial cells as a therapeutic target for solid organ transplantation. Am J Transplant 2022; 22:2502-2508. [PMID: 35612993 PMCID: PMC9643625 DOI: 10.1111/ajt.17104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/16/2022] [Accepted: 05/21/2022] [Indexed: 01/25/2023]
Abstract
Connexins are a class of membrane proteins widely distributed throughout the body and have various functions based on their location and levels of expression. More specifically, connexin proteins expressed in endothelial cells (ECs) have unique roles in maintaining EC barrier integrity and function-a highly regulated process that is critical for pro-inflammatory and pro-coagulant reactions. In this minireview, we discuss the regulatory influence connexin proteins have in maintaining EC barrier integrity and their role in ischemia-reperfusion injury as it relates to organ transplantation. It is evident that certain isoforms of the connexin protein family are uniquely positioned to have far-reaching effects on preserving organ function; however, there is still much to be learned of their roles in transplant immunology and the application of this knowledge to the development of targeted therapeutics.
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Affiliation(s)
- Dinesh Jaishankar
- Department of Surgery, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Kristen M. Quinn
- Department of Surgery, Division of TransplantMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Jes Sanders
- Department of Surgery, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Leah Plumblee
- Department of Surgery, Division of TransplantMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Thomas A. Morinelli
- Department of Surgery, Division of TransplantMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Satish N. Nadig
- Department of Surgery, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA,Department of Surgery, Division of TransplantMedical University of South CarolinaCharlestonSouth CarolinaUSA,Department of Microbiology‐Immunology and Pediatrics, Comprehensive Transplant Center, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA,Simpson Querrey InstituteNorthwestern UniversityChicagoIllinoisUSA
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Plumblee L, Atkinson C, Jaishankar D, Scott E, Tietjen GT, Nadig SN. Nanotherapeutics in transplantation: How do we get to clinical implementation? Am J Transplant 2022; 22:1293-1298. [PMID: 35224837 PMCID: PMC9081154 DOI: 10.1111/ajt.17012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 01/25/2023]
Abstract
Patients undergoing organ transplantation transition from one life-altering issue (organ dysfunction) to a lifelong commitment-immunosuppression. Regimens of immunosuppressive agents (ISAs) come with significant side effects and comorbidities. Recently, the use of nanoparticles (NPs) as a solution to the problems associated with the long-term and systemic use of ISAs in transplantation has emerged. This minireview describes the role of NPs in organ transplantation and discusses obstacles to clinical implementation and pathways to clinical translation.
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Affiliation(s)
- Leah Plumblee
- Department of Microbiology and ImmunologyMedical University of South CarolinaCharlestonSouth Carolina
- Department of SurgeryDivision of Transplant SurgeryMedical University of South CarolinaCharlestonSouth Carolina
| | - Carl Atkinson
- Department of Microbiology and ImmunologyMedical University of South CarolinaCharlestonSouth Carolina
- Division of Pulmonary, Critical Care, and Sleep MedicineUniversity of FloridaGainesvilleFlorida
| | - Dinesh Jaishankar
- Department of SurgeryDivision of Transplant SurgeryMedical University of South CarolinaCharlestonSouth Carolina
| | - Evan Scott
- Department of Biomedical EngineeringNorthwestern UniversityEvanstonIllinois
- Department of Microbiology‐ImmunologyFeinberg School of MedicineNorthwestern UniversityChicagoIllinois
- Simpson Querrey InstituteNorthwestern UniversityChicagoIllinois
| | - Gregory T. Tietjen
- Department of SurgeryDepartment of Biomedical EngineeringYale School of MedicineYale UniversityNew HavenConnecticut
| | - Satish N. Nadig
- Department of Microbiology‐ImmunologyFeinberg School of MedicineNorthwestern UniversityChicagoIllinois
- Simpson Querrey InstituteNorthwestern UniversityChicagoIllinois
- Department of SurgeryDepartment of PediatricsComprehensive Transplant CenterFeinberg School of MedicineNorthwestern UniversityChicagoIllinois
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Friendly C, Villacreses C, Mukherjee R, Babilon E, Caraway J, Dieffenbaugher S, Hink A, Mellinger J, Plumblee L, Walters M, Talley C. Leadership skills curriculum development for residents and fellows: A needs-assessment. Am J Surg 2021; 222:1079-1084. [PMID: 34706817 DOI: 10.1016/j.amjsurg.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/11/2021] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Non-technical skills (NTS) curricula have demonstrated success in surgical residencies. The purpose of this study is to examine the need for a structured leadership curriculum at our institution. METHODS A needs-assessment survey analyzing the importance of leadership domains, previously validated by Kazley et al. was delivered to 240 general surgery staff. Respondent groups were broken down into: Attendings, Residents, and Multi-Disciplinary. Statistical analyses were conducted using Cronbach's Alpha (α = 0.9259) and Fisher's exact test (pre-set p-value = 0.05). The importance of each competency was compared among groups and importance was defined as >75% important and very important responses. RESULTS Nineteen of 33 competencies were important for all groups, including 3 with 100% importance: interpersonal communication, team-work, and problem-solving. Several competencies showed statistically significant differences among groups. CONCLUSION A diverse range of surgery staff agreed that 19 leadership domains are important to teach residents, with some variance among respondent groups.
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Affiliation(s)
- Christopher Friendly
- Medical University of South Carolina College of Medicine, 96 Jonathan Lucas St. MSC 623, Charleston, SC, 29425, USA.
| | - Camila Villacreses
- Medical University of South Carolina College of Medicine, 96 Jonathan Lucas St. MSC 623, Charleston, SC, 29425, USA.
| | - Rupak Mukherjee
- Medical University of South Carolina Department of Surgery, 96 Jonathan Lucas St. MSC 613, Charleston, SC, 29425, USA.
| | - Ellen Babilon
- Medical University of South Carolina Department of Surgery, 96 Jonathan Lucas St. MSC 613, Charleston, SC, 29425, USA.
| | - Julie Caraway
- Medical University of South Carolina Department of Surgery, 96 Jonathan Lucas St. MSC 613, Charleston, SC, 29425, USA.
| | - Sean Dieffenbaugher
- Medical University of South Carolina Department of Surgery, 96 Jonathan Lucas St. MSC 613, Charleston, SC, 29425, USA.
| | - Ashley Hink
- Medical University of South Carolina Department of Surgery, 96 Jonathan Lucas St. MSC 613, Charleston, SC, 29425, USA.
| | - John Mellinger
- Southern Illinois University Department of Medicine, 801 North Rutledge St, Springfield, IL, 62702, USA.
| | - Leah Plumblee
- Medical University of South Carolina Department of Surgery, 96 Jonathan Lucas St. MSC 613, Charleston, SC, 29425, USA.
| | - Megan Walters
- Medical University of South Carolina Department of Surgery, 96 Jonathan Lucas St. MSC 613, Charleston, SC, 29425, USA.
| | - Cynthia Talley
- Medical University of South Carolina Department of Surgery, 96 Jonathan Lucas St. MSC 613, Charleston, SC, 29425, USA.
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Evans LL, Williams RF, Jin C, Plumblee L, Naik-Mathuria B, Streck CJ, Jensen AR. Hospital-based intervention is rarely needed for children with low-grade blunt abdominal solid organ injury: An analysis of the Trauma Quality Improvement Program registry. J Trauma Acute Care Surg 2021; 91:590-598. [PMID: 34559162 PMCID: PMC8553177 DOI: 10.1097/ta.0000000000003206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children with low-grade blunt solid organ injury (SOI) have historically been admitted to an inpatient setting for monitoring, but the evidence supporting the necessity of this practice is lacking. The purpose of this study was to quantify the frequency and timing of intervention for hemorrhage and to describe hospital-based resource utilization for low-grade SOI in the absence of other major injuries (OMIs). METHODS A cohort of children (aged <16 years) with blunt American Association for the Surgery of Trauma grade 1 or 2 SOI from the American College of Surgeons Trauma Quality Improvement Program registry (2007-2017) was analyzed. Children were excluded if they had confounding factors associated with intervention for hemorrhage (comorbidities, OMIs, or extra-abdominal surgical procedures). Outcomes included frequency and timing of intervention (laparotomy, angiography, or transfusion) for hemorrhage, as well as hospital-based resource utilization. RESULTS A total of 1,019 children were identified with low-grade blunt SOI and no OMIs. Nine hundred eighty-six (96.8%) of these children were admitted to an inpatient unit. Admitted children with low-grade SOI had a median length-of-stay of 2 days and a 23.9% intensive care unit admission rate. Only 1.7% (n = 17) of patients with low-grade SOI underwent an intervention, with the median time to intervention being the first hospital day. No child who underwent angiography was transfused or had an abnormal initial ED shock index. CONCLUSION Children with low-grade SOI are routinely admitted to the hospital and often to the intensive care unit but rarely undergo hospital-based intervention. The most common intervention was angiography, with questionable indications in this cohort. These data question the need for inpatient admission for low-grade SOI and suggest that discharge from the emergency room may be safe. Prospective investigation into granular risk factors to identify the rare patient needing hospital-based intervention is needed, as is validation of the safety of ambulatory management. LEVEL OF EVIDENCE Prognostic and epidemiological, level III.
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Affiliation(s)
- Lauren L Evans
- Division of Pediatric Surgery, University of California San Francisco Benioff Children’s Hospital Oakland, Oakland, CA 94611
| | - Regan F Williams
- Division of Pediatric Surgery, Le Bonheur Children’s Hospital, The University of Tennessee Health Science Center, Memphis, TN, 38103
| | - Chengshi Jin
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, 94143
| | - Leah Plumblee
- Division of Pediatric Surgery, Children’s Health, Medical University of South Carolina, Charleston, SC, 29425
| | - Bindi Naik-Mathuria
- Division of Pediatric Surgery, Texas Children’s Hospital, Houston, TX, 77030
| | - Christian J Streck
- Division of Pediatric Surgery, Children’s Health, Medical University of South Carolina, Charleston, SC, 29425
| | - Aaron R Jensen
- Division of Pediatric Surgery, University of California San Francisco Benioff Children’s Hospital Oakland, Oakland, CA 94611
- Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA 93721
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Thomas C, Plumblee L, Dieffenbaugher S, Talley C. Teaching on Rounds and in Small Groups. Surg Clin North Am 2021; 101:555-563. [PMID: 34242599 DOI: 10.1016/j.suc.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bedside teaching plays a vital role the training future physicians, allowing for instruction in history taking, physical examination skills, differential diagnosis development, professionalism, teamwork integration, effective communication, and discussions of medical ethics. Due to changes in the health care system, accreditation bodies, and shortened admittance of patients, rates of bedside teaching have declined. Attending surgeons feel increased external pressures to meet performance metrics while resident physicians adhere to duty hour restrictions. This article highlights popular methods, including bedside rounds, near-peer teaching, and resident versus attending preceptors, and discusses how teaching on rounds has an impact on patients.
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Affiliation(s)
- Christopher Thomas
- Medical University of South Carolina, Department of Surgery, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Leah Plumblee
- Medical University of South Carolina, Department of Surgery, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Sean Dieffenbaugher
- Carolinas Medical Center, Atrium Health, Department of Surgery, 1000 Blythe Boulevard, MEB Office 601, Charlotte, NC 28203, USA
| | - Cynthia Talley
- Medical University of South Carolina, Department of Surgery, 96 Jonathan Lucas Street, Charleston, SC 29425, USA.
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Plumblee L, Grey H, Hudspeth M, Nadig S. Undifferentiated embryonal sarcoma and the role of liver transplantation. Journal of Pediatric Surgery Case Reports 2019. [DOI: 10.1016/j.epsc.2019.101284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Plumblee L, Kim D, Pacult M, Pullat R. Successful Treatment of De Garengeot's Hernia Using LaparoscopicTechnique. Am Surg 2019; 85:e508-e510. [PMID: 31638556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Synovec J, Plumblee L, Barfield W, Slone H. Orthopedic In-Training Examination: An Analysis of the Sports Medicine Section-An Update. J Surg Educ 2019; 76:286-293. [PMID: 30097349 DOI: 10.1016/j.jsurg.2018.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Previously published studies have evaluated Orthopedic In-Training Examination sports medicine questions, but none have evaluated whether question difficulty has changed over time. DESIGN Sports medicine subsection questions between 2012 and 2016 were evaluated and compared with previously published data on Orthopedic In-Training Examination from 2004 to 2009. Question categories were classified into 1 of 3 taxonomy levels-basic recall, diagnosis, and advanced problem solving. SETTING Medical University of South Carolina; Charleston, SC, 29425; Institution. PARTICIPANTS Two residents evaluated the Sports Subsection questions separately. Then an attending physician evaluated the questions to resolve discrepancies. A statistician was used for analysis. RESULTS Utilization of imaging modalities averaged 37%, with 28% (11/39) of the questions containing 2 or more imaging modalities. There were increases in utilization of advanced problem-solving questions (45% vs. 27%, p = 0.002) and decreases in basic recall questions (49% vs. 67%, p = 0.008) compared with previously published data. CONCLUSIONS While the percentage of the Orthopedic In-Training Examination represented by sports medicine has remained relatively unchanged, there were fewer questions requiring residents to demonstrate simple recall and diagnosis, and increased demand to perform advanced problem solving while utilizing multiple imaging modalities.
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Affiliation(s)
- John Synovec
- Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia.
| | - Leah Plumblee
- Medical University of South Carolina, Charleston, South Carolina
| | - William Barfield
- Medical University of South Carolina, Charleston, South Carolina
| | - Harris Slone
- Medical University of South Carolina, Charleston, South Carolina
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