Background: In the face of the COVID-19 pandemic and a country-wide lockdown, the University of the Philippines College of Medicine halted face-to-face teaching in exchange for online learning for its students. For the Learning Unit VI students, clinical rotations shifted to hybrid activities to continue learning activities while minimizing exposure risk. The Philippine General Hospital Department of Orthopedics introduced the following hybrid activities in its curriculum for Learning Unit VI students: 1) Online Lectures, 2) Online Departmental Conference, 3) Online Division Rounds, 4) Online SGDs, 5) Written Case, 6) Online Exams, 7) Preceptorship, Demo, Return Demo, and 8) Online OSCE. The department used a variety of platforms including synchronous sessions, asynchronous pre-recorded lectures, and face-to-face teaching, as appropriate. Objectives: The study compared the faculty and student course evaluations of activities in the hybrid ORTHO 251 course. Methodology: Faculty and students were asked to evaluate each activity according to the Course Evaluation By Students (CEBS), the standard questionnaire used by the college, to determine the overall rating of each activity as well as any differences between the two groups. Results: The hybrid activities conducted in the ORTHO 251 course were rated as good or excellent by the faculty and students, with differences in a few activities. Consultants rated online exams as being less effectively integrated and that there was inadequate time allotment for online SGDs, written cases, and online exams. Meanwhile, students rated all activities higher in terms of stimulating self-directed learning. Conclusion With good to excellent outcomes, this study found that it has at least satisfactorily matched the learning platform to the learning component. While knowledge may be taught via asynchronous recorded lectures or reading materials, attitude and thinking processes are better formed through synchronous discussion. Skills in medical education, including Orthopedics, are still best taught via face-to-face demoreturn demo. With this information, the department can investigate the causes of these differences and improve on the identified weaknesses.
Orthopedics ; Education, Distance ; Education, Medical

BACKGROUND: Red blood cell (RBC) transfusion is an essential practice during surgery to accommodate for bleeding. As such, there are efforts being made to allow for a safe and appropriate transfusion due to shortages of blood components and to minimize transfusion-related adverse reactions. However, a conventional transfusion decision with relatively high hemoglobin (Hb) threshold is still performed in clinical setting. In this study, we investigated the threshold of Hblevel and appropriateness of RBC transfusion in patients receiving perioperative RBC transfusion in surgical departments. METHODS: We investigated the pre-transfusion Hb level of 1,379 patients (2,170 episodes) receiving perioperative RBC transfusion in five surgical departments, including cardiothoracic surgery (CS), general surgery (GS), neurosurgery (NS), obstetrics and gynecology (OBGY), and orthopedics (OS), between June 2017 and March 2018. The appropriateness of transfusion was evaluated with two criteria: 1) pretransfusion Hb level ≤10 g/dL and 2) posttransfusion Hb level ≤10 g/dL. RESULTS: The median pretransfusion Hb level was 8.5 g/dL (interquartile range 7.7~9.4); that of each department was as follows: 8.6 g/dL (7.9~9.2) in CS, 7.9 g/dL (7.3~8.6) in GS, 9.1 g/dL (8.5~9.8) in NS, 8.5 g/dL (7.7~9.8) in OBGY, and 8.7 g/dL (7.9~9.7) in OS. With a criteria of pretransfusion of Hb level ≤10 g/dL, 85.4% of total episodes were appropriate. With criteria of post-transfusion of Hb level ≤10 g/dL, 44.7% were appropriate. CONCLUSION: This study presents a fundamental data observing the trend of RBC transfusion in a single institution. A significant proportion of inappropriate RBC transfusion are still being conducted in surgical setting. Continuous and effective education of clinicians and implementation of monitoring systems to assess the appropriateness of RBC transfusion may be necessary.
Education ; Erythrocyte Transfusion ; Erythrocytes ; Gynecology ; Hemorrhage ; Humans ; Neurosurgery ; Obstetrics ; Orthopedics

There is a paucity of available research on knowledge of orthopaedic implant costs and healthcare schemes among orthopaedic residents. With the rising healthcare costs in Singapore, it is imperative for residents, who are the future surgeons, to understand these issues in order to provide proper counselling and cost-effective management. This study aimed to quantify how accurately they understood these issues and determine if senior residents had better knowledge given their increased experience. An online survey was administered to all orthopaedic residents within a residency programme. There was poor knowledge of implant costs and healthcare schemes among residents. Junior residents fared better at healthcare schemes, while senior residents fared better at estimation of implant costs. Education on these issues should be incorporated into the residency programme to bring about more holistic and cost-conscious clinicians.
Attitude of Health Personnel ; Clinical Competence ; Cross-Sectional Studies ; Education, Medical, Graduate ; Health Care Costs ; Health Knowledge, Attitudes, Practice ; Humans ; Internship and Residency ; Orthopedics ; economics ; education ; Physicians ; Prostheses and Implants ; economics ; Singapore ; Surveys and Questionnaires ; Workload

BACKGROUND: Red blood cell (RBC) transfusion is one of the major treatments for correcting anemia, but its use should be carefully considered because of adverse transfusion reactions and inappropriate usage. Therefore, individual health care facilities have self evaluated their use of transfusion in an attempt to decrease unnecessary procedures. In this study, we evaluated the differences in the minimum hemoglobin (Hb) trigger for RBC transfusion among clinical departments in Severance Hospital. METHODS: We analyzed the electronic medical records of RBC transfusion episodes that were conducted at a Hb level above 8 g/dL from July 2014 to September 2015. We classified these data by clinical department, and considered the overall medical conditions of the patients. The minimum Hb trigger level in this study was defined as the lowest Hb level within 24 hours prior to RBC transfusion. RESULTS: A total of 4,953 RBC transfusion episodes that were conducted at Hb levels above 8 g/dL were analyzed over that period. In general, the minimum Hb trigger level was higher in the operation group than the hemorrhage group. When compared among clinical departments, the department of orthopedic surgery, neurosurgery, rehabilitation medicine, and anesthesiology showed high levels of minimum Hb trigger equal to or greater than 10 g/dL. CONCLUSION: The minimum Hb trigger level differed among clinical departments, with the operation group showing a much higher level of minimum Hb trigger. We hope that these data will be practically applied to establish plans and strategies for managing the appropriateness of RBC transfusions in Korea. In addition, continuous evaluation and transfusion education for clinical departments should be performed.
Anemia ; Anesthesiology ; Delivery of Health Care ; Education ; Electronic Health Records ; Erythrocyte Transfusion* ; Erythrocytes* ; Hemorrhage ; Hope ; Humans ; Korea ; Neurosurgery ; Orthopedics ; Rehabilitation ; Transfusion Reaction ; Unnecessary Procedures

PURPOSE: The purpose of this study was to evaluate the questions pertaining to the foot and ankle on the Korean Orthopedic In-Training Examination (KOITE) between 2012 and 2016. MATERIALS AND METHODS: Questions regarding the foot and ankle on KOITE during the five-year period (2012∼2016) were analyzed. Number of foot and ankle questions, topics, taxonomic classification, imaging modalities, and cited references related to each question were analyzed. RESULTS: The average number of foot and ankle questions was 35, accounting for 7.0% (35/500) of all KOITE questions. All questions were categorized into three topic areas: disease (51.4%, 18/35), trauma (31.4%, 11/35), and basics (17.1%, 6/35). Taxonomy 3 (decision-making type questions) was the most common (42.9%, 15/35). References that are commonly used for each question were Campbell's Operative Orthopedics (100%, 35/35) and the textbook of The Korean Orthopaedic Association (74.3%, 26/35). CONCLUSION: This analysis can be valuable to not only orthopaedic surgery residents to improve their knowledge of orthopedics, but also to instructors for optimizing their education programs.
Ankle ; Classification ; Education ; Foot* ; Orthopedics*

PURPOSE: The purpose of this study was to develop a smartphone app for use in patient controlled analgesia (PCA) education and to identify PCA knowledge and pain management following lower extremity orthopaedic surgery under spinal anesthesia in patients who received smartphone app education. METHODS: Participants were 150 patients in an orthopaedic hospital located in Busan. The measurement variables used in this study were PCA knowledge, pain management and pain level. For data analysis, SPSS/WIN 21.0 program was used in the analysis of the relation of frequencies. In addition, percentage, mean and standard deviation, t-test, ANOVA, Duncan, Pearson's correlation coefficients were also assessed. RESULTS: The score for knowledge regarding PCA was 4.27±1.64. The correlations between knowledge and pain management (button push times education on PCA using a smartphone app is an effective method for pain management in patients after surgery. Development and active use of smartphone apps to manage pain for patients in a variety of other surgical departments is recommended.
Analgesia ; Analgesia, Patient-Controlled* ; Anesthesia, Spinal* ; Busan ; Education* ; Humans ; Lower Extremity* ; Methods ; Mobile Applications ; Orthopedics* ; Pain Management* ; Passive Cutaneous Anaphylaxis ; Smartphone* ; Statistics as Topic

PURPOSE: To evaluate the questions of hand and wrist section of Korean orthopedic in-training examination (KOITE). METHODS: We analyzed questions of hand and wrist section of KOITE between 2010 and 2014. The weight of hand and wrist section was calculated and topics were thoroughly analyzed. The construct of questions were evaluated and taxonomic classifications were also performed. The frequency of presentations of physical examinations and radiologic evaluations in diagnosis and treatment related questions were analyzed. The coverage of available references which were recommended by Korean Orthopedic Association (KOA) were analyzed. RESULTS: Sixty one out of 500 questions (weight: 12.2%) were related with hand and wrist section. Disease (30/61, 48.2%) was more commonly asked than trauma, however most frequently asked topic with a broad classification was fractures and dislocations (19/61, 31.1%). The description only questions (46/61, 75.4%) were most commonly asked construct of question. According to taxonomic classification, taxonomy B (diagnosis; 27/61, 44.3%) was most frequently asked. The Campbell's operative orthopedics (54/61, 88.5%) and textbook of KOA (53/61, 86.9%) were representative references covering questions most widely. CONCLUSION: This analysis of hand and wrist section of KOITE could be used as the check-up tools for resident training programs of each training hospitals.
Classification ; Diagnosis ; Dislocations ; Education ; Hand* ; Korea ; Orthopedics* ; Physical Examination ; Wrist*

PURPOSE: The purpose of this study was to analyze the questions in the hip and pelvis section of the Korean Orthopaedic In-Training Examination (KOITE). MATERIALS AND METHODS: We analyzed all KOITE questions pertaining to hip and pelvis surgery between 2010 and 2014. A thorough analysis of the contents was performed after categorizing as tested topics, imaging modalities used, taxonomic classification, and recommended references. We also analyzed the scores of the hip and pelvis section of the KOITE. RESULTS: Seventy-five of five-hundred questions (weight, 15.0%) were related to the hip and pelvis. Trauma including fracture and dislocation (26/75, 34.7%) was asked more commonly than disease and basics. The description-only questions (65/75, 86.7%) were the most frequently asked. According to taxonomic classification, taxonomy 3 (decision; 39/75, 52.0%) was most frequently asked. Campbell's Operative Orthopedics (52/75, 69.3%) was the reference that covered most of the questions. CONCLUSION: This analysis of the hip and pelvis section of KOITE could be used for resident training programs in teaching hospitals.
Classification ; Dislocations ; Education ; Hip* ; Hospitals, Teaching ; Orthopedics* ; Pelvis*

STUDY DESIGN: The study was conducted on patients who received autologous conditioned serum (ACS) as a line of treatment at the Orthopedics outpatient department of Post Graduate Institute of Medical Education and Research (PGIMER, Chandigarh) from January 2011 to June 2012. Of the 1,224 patients, 20 males or females were included in the study based on the inclusion and exclusion criteria. The institutional board of PGIMER approved the study before it was initiated. PURPOSE: To study the efficacy of ACS in the treatment of unilateral lumbar radiculopathy. OVERVIEW OF LITERATURE: Interleukin (IL)-1 appears to be of special importance among the cytokines identified in orthopedic diseases. ACS contains high concentrations of IL-1 receptor antagonist, antagonist to IL-1 in that is a biochemical 'sensitizer' of nerve roots in radiculopathy. METHODS: We included 20 patients with unilateral lumbar radiculopathy after obtaining informed consent. We prepared ACS as described by Meijer et al. Under bi-planar fluoroscopic imaging in anterior-posterior and lateral views, ACS was administered via epidural perineural technique. Patients in both groups were evaluated by quadruple visual analogue scale, straight leg raising test, revised Oswestry disability index, and 12-Item Short Form of Health Survey before and after epidural injections at 3 weeks, 3 months, and 6 months. RESULTS: There was a statistically significant change in all parameters from pre-injection to first, second, and third follow-up (p<0.001). CONCLUSIONS: ACS can modify the disease course in addition to reducing pain, disability and improving general health.
Cytokines ; Education, Medical ; Female ; Follow-Up Studies ; Health Surveys ; Humans ; Informed Consent ; Injections, Epidural ; Interleukin-1 ; Interleukins ; Leg ; Male ; Orthopedics ; Outpatients ; Prospective Studies* ; Radiculopathy*

PURPOSE: The purpose of this study was to determine whether the multiple mini-interview (MMI) predicts academic achievement for subjects in a medical school curriculum. METHODS: Of 49 students who were admitted in 2008, 46 students finished the entire medical education curriculum within 4 years. We calculated the Pearson correlation coefficients between the total MMI score of the 46 graduates and their academic achievements in all subjects of the curriculum. RESULTS: The correlation coefficients between total MMI score and academic achievement in Medical Interview and History Taking, Problem-Based Learning, Doctoring I, and Clinical Practice of Surgery ranged from 0.4 to 0.7, indicating that they were moderately related. The values between total MMI score and achievement in Research Overview, Technical and Procedural Skills, Clinical Performance Examinations 1 and 3, Clinical Practice of Laboratory Medicine and Psychiatry, Neurology, and Orthopedics ranged from 0.2 to 0.4, which meant that they were weakly related. CONCLUSION: MMI score can predict medical student' academic achievement in subjects in the medical humanities and clinical practice.
Clinical Competence ; Curriculum ; Education, Medical ; Humanities ; Humans ; Neurology ; Orthopedics ; Problem-Based Learning ; Schools, Medical*