Background The traditional method of teaching in Surgery is known as “See One, Do One, Teach One.” However, many have argued that this method is no longer applicable mainly because of concerns for patient safety. The purpose of this paper is to show that the basis of the traditional teaching method is still valid in surgical training if it is combined with various adult learning principles. Methods We reviewed literature regarding the history of the formation of the surgical residency program, adult learning principles, mentoring, and medical simulation. We provide examples for how these learning techniques can be incorporated into a surgical resident training program. Results The surgical residency program created by Dr. William Halsted remained virtually unchanged until recently with reductions in resident work hours and changes to a competency-based training system. Such changes have reduced the teaching time between attending physicians and residents. Learning principles such as “Experience, Observation, Thinking and Action” as well as deliberate practice can be used to train residents. Mentoring is also an important aspect in teaching surgical technique. We review the different types of simulators: standardized patients, virtual reality applications, and high-fidelity mannequin simulators and the advantages and disadvantages of using them. Conclusions The traditional teaching method of “see one, do one, teach one” in surgical residency programs is simple but still applicable. It needs to evolve with current changes in the medical system to adequately train surgical residents and also provide patients with safe, evidence-based care.

No abstract

Individuals with diabetes mellitus are at an increased risk of developing a diabetic foot ulcer (DFU). This study evaluated the safety and efficacy of Integra Dermal Regeneration Template (IDRT) for the treatment of nonhealing DFUs. The Foot Ulcer New Dermal Replacement Study was a multicenter, randomized, controlled, parallel group clinical trial conducted under an Investigational Device Exemption. Thirty-two sites enrolled and randomized 307 subjects with at least one DFU. Consented patients were entered into the 14-day run-in phase where they were treated with the standard of care (0.9% sodium chloride gel) plus a secondary dressing and an offloading/protective device. Patients with less than 30% reepithelialization of the study ulcer after the run-in phase were randomized into the treatment phase. The subjects were randomized to the control treatment group (0.9% sodium chloride gel; n 5 153) or the active treatment group (IDRT, n 5 154). The treatment phase was 16 weeks or until confirmation of complete wound closure (100% reepithelialization of the wound surface), whichever occurred first. Following the treatment phase, all subjects were followed for 12 weeks. Complete DFU closure during the treatment phase was significantly greater with IDRT treatment (51%) than control treatment (32%; p 5 0.001) at sixteen weeks. The median time to complete DFU closure was 43 days for IDRT subjects and 78 days for control subjects in wounds that healed. The rate of wound size reduction was 7.2% per week for IDRT subjects vs. 4.8% per week for control subjects (p 5 0.012). For the treatment of chronic DFUs, IDRT treatment decreased the time to complete wound closure, increased the rate of wound closure, improved components of quality of life and had less adverse events compared with the standard of care treatment. IDRT could greatly enhance the treatment of nonhealing DFUs.Currently, there are 387 million individuals worldwide living with diabetes mellitus including 29 million Americans. Diabetics have up to a 25% lifetime risk of developing a diabetic foot ulcer (DFU).1-3 Once an ulcer develops, healing is often slow and challenging even for those with proper treatment. A meta-analysis of studies involving the standard of care for DFUs demonstrated only a 24% healing rate at 12 weeks. 4 A high proportion of DFUs become infected (61%) 5 and approximately 15% of DFUs result in lower extremity amputation. 6,7 However, an estimated 44-85% of these amputations can be prevented with improved foot care programs.8 DFUs are responsible for more hospitalizations than any other complication of diabetes, ranging in costs from $9 to $13 billion in addition to the costs associated with diabetes itself.9 Substantial morbidity rates also adversely impact the physical and mental quality of life of those afflicted.10 Studies using quality of life questionnaires showed that patients with a nonhealing DFU report significantly lower scores compared with diabetic patients without DFUs.11,12 As a result of the complexity to treat these ...

No abstract