Background: Although the pre-clinical years are pivotal in career path commitment for medical students, this phase of education is traditionally devoid of surgical exposure. Although peer-assisted learning and simulation are both validated methods of supplementing early exposure to medical specialties, their use in familiarizing students with modern surgical procedures remains minimal. We hypothesize that student-led laparoscopic simulation will result in significantly increased self-perception of surgical clerkship preparedness and confidence in pursuing surgical residency among pre-clinical medical students. Methods: Laparoscopic simulation workshops were organized by student educators who underwent faculty-led leadership training in simulation education. Pre-clinical medical students were invited to participate in weekly 1-hour laparoscopic simulation events that progressed through a series of coordination exercises using box trainers over the course of 8 weeks. Participants completed pre-and post-simulation surveys concerning perceptions toward surgical clerkship and residency. The results of these questionnaires were analyzed using the Wilcoxon Mann-Whitney test. Results: Among the 28 participants, 9 (32%) were first-year pre-clinical medical student and 19 (68%) were second-year medical students. Participants attended an average of 2.8 of the 8 sessions. On a 100point scale, mean student perceptions of surgical clerkship preparedness and confidence pursuing surgical residency scored 44.8 and 50.3, respectively. Upon completion of the post-test, these mean preparedness and confidence scores were significantly increased to 58.6 and 66.6, respectively (P 5 0.001). Conclusion: Peer-assisted laparoscopic simulation learning may be an effective means of enhancing pre-clinical student perceptions toward surgical fields in medical school curricula, however, longitudinal studies are needed to assess the impact on surgical clerkship proficiency and residency matriculation/completion.

Background Treatment of intra-articular distal radius fractures (DRFs) rests on anatomic internal fixation. Fragment-specific fixation (FSF) is applied when fracture pattern is too complex for standard volar plating (SVP), oftentimes with potential increased risk of complications. We hypothesized that patients undergoing FSF would achieve less wrist range of motion (ROM) with higher risk of complications compared with SVP. Methods We conducted a retrospective review of 159 consecutive patients undergoing DRF fixation from 2017 to 2020. Patients < 18 years old, < 8 weeks' follow-up, open fractures, ipsilateral trauma, and fractures requiring dorsal spanning plate were excluded. Patient demographics, specific construct type, AO fracture classification, ROM, and complications were assessed. ROM was calculated using average flexion, extension, supination, and pronation. t-Tests were used to determine differences in ROM among construct types. Results Ninety-two patients met all inclusion criteria: 59 underwent SVP and 33 underwent FSF. Average wrist ROM for patients undergoing SVP was 57 degrees/50 degrees flexion-extension and 87 degrees/88 degrees supination-pronation; average ROM for patients undergoing FSF was 55 degrees/49 degrees flexion-extension and 88 degrees/89 degrees supination-pronation. No significant differences were identified when comparing final wrist flexion (p = 0.08), extension (p = 0.33), supination (p = 0.35), or pronation (p = 0.21). Overall reoperation rate was 5% and higher for FSF (12%) versus SVP (2%). Highest reoperation rate was observed in the double volar hook cohort (80%; N = 4). Conclusion Construct type does not appear to affect final ROM if stable internal fixation is achieved. SVP and FSF had similar complication rates; however, double volar hook constructs resulted in increased reoperations likely from fixation failure and plate prominence. Level of Evidence Level IV, retrospective review.

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