RESUMEN
BACKGROUND: Constructive feedback provides a mechanism for reinforcing learning during the acquisition of surgical skills. Feedback is usually given verbally, and sometimes documented, after direct observation by a trained assessor. The aim was to evaluate video recording as an effective modality for enhancing feedback, in comparison with standard verbal feedback alone. METHODS: This was a prospective, blinded, randomized clinical trial comparing standard verbal feedback plus video with standard verbal feedback alone. Validated pro formas for assessment were used and quality control was performed by independent expert assessors. Trial participants were recorded on video performing the surgical skill, and returned the next day to perform the skill again following video and standard verbal feedback (group 1) or standard verbal feedback alone (group 2). RESULTS: Forty-eight participants were divided equally between the two groups. There was a significant improvement in the mean overall procedure score for group 1 of 2·875 from a maximum achievable score of 20 (P = 0·003), but not for group 2. There were significant improvements in the specific domains of instrument familiarity, needle handling, skin handling and accurate apposition, again all in group 1. The only significant improvement in group 2 was in an organized approach to the task, also observed in group 1. Knot-tying security deteriorated after feedback in group 2 but not in group 1. CONCLUSION: The addition of video feedback can improve the acquisition of surgical skills, and could be incorporated into formal surgical curricula.
Asunto(s)
Competencia Clínica/normas , Educación de Pregrado en Medicina/métodos , Retroalimentación Psicológica , Cirugía General/estadística & datos numéricos , Grabación en Video , Inglaterra , Cirugía General/educación , Humanos , Estudios ProspectivosRESUMEN
In order to determine the effects of the loss or reduced expression of molecules associated with antigen presentation (transporter associated with antigen presentation [TAP]-1, TAP-2, low molecular weight protein [LMP]-2 and LMP-7), we examined the expression of these molecules in primary uveal melanoma lesions. Paraffin-embedded sections from 29 primary uveal melanoma lesions were analysed for expression of TAP-1, TAP-2, LMP-2 and LMP-7 using specific primary antibodies followed by a three-stage immunoperoxidase technique. Microscopic examination was undertaken to determine differences in expression of these molecules on the tumour and the surrounding stroma. Overall, 72% (21 out of 29) of the tumours showed some loss or reduced expression of TAP-1, TAP-2, LMP-2 and/or LMP-7. Statistical analysis of these results showed that progression to metastatic disease was strongly associated with reduced expression of TAP-1 (P < 0.05) and TAP-2 (P < 0.01), taking patient age, tumour site and histology into account. We conclude that the reduced expression of molecules important in eliciting an immune response, such as TAP-1 and TAP-2, may facilitate the metastatic spread of uveal melanoma lesions and may have important implications for prospective immunotherapy.