Social distancing in pandemic times has prevented physical contact educational activities. Teaching online could help in knowledge acquisition. However, when medical students progress to the clinical clerkships they would have difficulties if they do not acquire yet the basic physical examination (PE) skills. 2 | WHAT WA S TRIED? This online teaching of the basic PE plays a pivotal role in preparing junior medical students to move on to the clinical years. Our pilot 2 | WHAT WA S TRIED? We convened an expert panel to deliver a 90-minute virtual, interactive PPE educational workshop using Zoom software. This included faculty representatives from critical care, infectious disease, and infection control, a nurse manager from an active COVID-19 unit and a moderator with simulation expertise. We developed educational content following guidelines from the Center for Disease Control (CDC) and our local institution (Stanford). From our hospital simulation centre, we broadcasted live narrated demonstrations of PPE donning and doffing and provided guidance surrounding specific clinical scenarios and indications for face mask re-use. We then hosted a Q&A session addressing questions posited by attendees in the chat box. A total of 130 physicians, nursing staff and hospital staff from three departments (Surgery, Medicine, and Radiology) participated in our workshop. Participants (122/130, 94%) responded to a virtual pre-post session poll, describing confidence in safe PPE use. Our general surgery residents were then required to complete a virtual PPE Verification of Proficiency (VOP), demonstrating their knowledge of safe donning and doffing technique. For VOP, we reallocated residents to one of 6 Zoom 'breakout-rooms' where they were required to verbalise and simulate over live video the correct sequence of donning and doffing PPE based upon a checklist. Evaluation was pass/fail, where a pass required articulation of all PPE steps correctly, and trainees were immediately remediated by their exam proctor if unsuccessful.
Introduction and importance Anterior column plate combined with posterior column screws have been effectively used for treatment of displaced transverse acetabular fractures. This article presents the use of 3D-printed technology for customising a guide template to appropriately place posterior column screw. Case presentation A 50-year-old female suffered displaced juxtatectal fracture of the right acetabulum. A personalised guide for antegrade posterior column screw placement was designed based on the data of her pelvic CT-scan. This guide and a prototype of her right acetabulum - created by mirroring the intact left acetabulum - were 3D-printed for preoperative evaluation and pre-contouring of reconstruction plate. Modified Stoppa approach and additional lateral window were used for direct reduction, anterior column plate and posterior column lag screw fixation. Post-operative CT-scan showed good reduction and nearly ideal screw position. Clinical discussion Anterior column plate and antegrade posterior column screw could provide joint stability and early mobilisation for displaced transverse acetabular fractures. However, determination of optimal entry point, direction and length for screw insertion is still technically demanding. The 3-D reconstruction images of hemipelvic specimen allowed us to identify the safe bone corridor, design a drill guide to put the proper guide pin and conduct preoperative trial. All those resulted in appropriate real screw fixation with reduction of soft tissue damage, X-ray exposure and time of operation. Conclusion The use of 3D-printed personalised guide for posterior column screw fixation is a promising alternative option for treatment of displaced transverse acetabular fracture where 3D-navigation system is not available.
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