Background During the COVID-19 emergency, medical students were mandated to remain home, creating challenges to providing education remotely for third-year clinical rotations. This study aims to assess student reception and investigate objective outcomes to determine if online learning is a suitable alternative. Methods Medical students enrolled in the third-year surgical clerkship during COVID-19 were asked to participate in a survey. 19 of 27 (70%) students participated. Content, faculty-led lectures, and resident-led problem-based learning (PBL) sessions were assessed using a ten-point Likert scale. National Board of Medical Examiners (NBME) examination, weekly quiz, and oral examination scores were compared to previous years. Student t-tests compared the groups. Results The median age was 25 years. Comparing in-person to electronic sessions, there was no difference in effectiveness of faculty sessions preparing students for NBME (6.2 vs. 6.7, P = .46) or oral examinations (6.4 vs. 6.8, P = .58); there was also no difference in resident-led PBL sessions preparing students for NBME (7.2 vs. 7.2, P = .92) or oral examinations (7.4 vs. 7.6, P = .74). Comparing this group to students from the previous academic year, there was no difference in weekly quiz (85.3 vs. 87.8, P = .13), oral examination (89.8 vs. 93.9, P = .07), or NBME examination (75.3 vs. 77.4, P = .33) scores. Discussion Surgical medical didactic education can effectively be conducted remotely through faculty-led lectures and resident-led PBL sessions. Students did not have a preference between in-person and electronic content in preparation for examinations. As scores did not change, electronic education may be adequate for preparing students for examinations in times of crisis such as COVID-19.

Cribriform-morular variant (CMV) is a rare subtype of papillary thyroid carcinoma (PTC) that is associated with familial adenomatous polyposis (FAP). Given the high likelihood for multi-organ malignancies in FAP patients, this study explores the yield of diagnosing occult FAP among CMV-PTC patients. Institutional database was searched in order to identify patients with pathologically-confirmed CMV-PTC from 2000 to 2012. Medical records were reviewed, and clinical and pathological features were analyzed. Eleven cases of CMV were identified from 6,901 patients with PTC, for a prevalence of 0.16 %. All 11 patients were female. The median age at CMV-PTC diagnosis was 36 years (range 18-46). Two patients had pre-existing FAP at the time of PTC diagnosis. The other nine patients were referred for colonoscopy and/or genetic testing. Six patients underwent colonoscopy and one (17 %) was diagnosed with FAP based on polyposis phenotype and genetic testing. The mean age of patients at the time of CMV-PTC diagnosis was younger in the FAP group (23 years, range 18-34) than in the sporadic group (37 years, range 25-46). All three patients with FAP-associated CMV-PTC had multicentric tumors, while all five sporadic patients did not. Our study found that approximately one-sixth of patients with CMV-PTC may have occult FAP. Patients with FAP-associated CMV-PTC appear to be younger and more likely to have multicentric tumors than those with sporadic CMV-PTC. Due to the increased risk of malignancy in patients with FAP, patients with CMV-PTC should be referred for colonoscopy and/or genetic evaluation for FAP.

No abstract

Minimally invasive or minimal access surgery (MAS) for colon and rectal cancer was introduced in the early 1990s. Although laparoscopic colon surgery is now practiced worldwide, technical barriers, including a steep learning curve, preclude the widespread adoption of MAS techniques for rectal cancer. In addition, although randomized controlled trials have demonstrated that MAS techniques for colon cancer are oncologically equivalent to open surgery, similar confirmatory studies for rectal cancer have yet to be reported. In this Review, current evidence in support of laparoscopic and robotic total mesorectal excision for rectal cancer resection is presented. Other MAS approaches, such as transanal endoscopic microsurgery and natural orifice transluminal endoscopic surgery, are also discussed.

No abstract