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Abstract Objective This study aimed to compare two methods of feedback: verbal face-to-face feedback after direct observation (F2F-feedback) versus electronic-written feedback after observation of recorded-VDO of student’s performance (VDO-feedback), in terms of effectiveness in improving skill, effects on motivation and satisfaction. Background Medical schools are responsible for teaching and ensuring proficiency of basic surgical skills. Feedback is effective in developing psychomotor skills; by providing information of learner’s current performance, how to improve, and enhancing motivation. Materials and method Fifty-eight medical students (3rd– 4th year) were trained to perform vertical mattress suture in small groups. Then, during 6-week period of self-directed practice, students were randomized into group1 VDO-feedback (male:female = 21:8) and group 2 F2F-feedback (male:female = 20:9). Feedbacks were provided once every 2 weeks (Week2, Week4). End-of-rotation OSCE was at Week6, and retention tested was at Week8. Performance checklist (Cronbach’s Alpha 0.72) was used to assess skill at 4 timepoints; pre- and post- small group learning, OSCE, and retention phase. Questionnaire was used to assess motivation, learning strategies and satisfaction (Cronbach’s Alpha 0.83). Result After in-class learning, further significant improvement of skills could be gained by both F2F- and VDO- feedbacks (p

Objective: The assimilating and converging Kolb learning style were reported to have positive correlation with critical thinking ability in Orthopedic resident. However, the relationship between Kolb learning styles and academic performance remained controversy. The objective of this study is to report the relationship between Kolb learning style and academic performance in Orthopedic residents. Materials and Methods: The causal comparative cross-sectional study on 48 Orthopedic residents of academic year 2020 was conducted. The demographic characteristics of the participants were reviewed. The scores from the multiple choices question (MCQ) in-training examination, the objective structured clinical examination (OSCE) and the global performance rating scale were collected to represent academic performances of each Miller’s pyramid of assessment level. The Kolb learning style inventory were allocated. The statistical analysis was performed and p < 0.05 was considered statistically significant difference. Results: The response rate was 100%. There was no statistically significant difference of MCQ in-training examination, OSCE and global performance rating scale among each learning style as p=0.789, 0.493 and 0.407, respectively. The assimilating and converging styles were the 2 learning styles which had the academic performance scores above the average scores in all assessments. Conclusion: This study could not demonstrate the significant difference of academic performances among Kolb learning style in Orthopedic residents. However, the assimilating and converging style had the consistent scores above average scores in all domains. The Orthopedic learning experience should focus on the development of reflective observation, abstract conceptualization and active experimentation to facilitate effective improvement in academic performance of the residents.

Objective: The present study has been aimed at constructing a causal model to determine factors affecting healthrelated quality of life (HRQoL) in postoperative patients with colorectal cancer (CRC) following discharge. Materials and Methods: A cross-sectional study was conducted with 396 postoperative CRC cancer patients from ten tertiary hospitals representing each of the four Regions of Thailand. Data was collected through a standard questionnaire. Structure equation modeling (SEM) was applied to analyze data. Results: The findings revealed that the majority of patients with CRC surgery had a moderate HRQoL. One hundred and twenty-three patients (31.1%) had complications. SEM showed a good fit with ƛ2=40.347, df=28, p=0.062, GFI=0.980, CFI=0.959 and RMSEA=0.033. The final model showed that age, stage of cancer and healthcare service being received following CRC surgery had direct effects on HRQoL. Nutritional status and follow-up outpatient clinic had indirect effects on HRQoL during postoperative complications. Moreover, social support and primary family caregiver support had indirect effects on HRQoL through self-management capacity. Conclusion: The findings of this study emphasized the importance of implementing effective strategies to improve quality of life among postoperative patients with CRC after discharge and indicated these strategies should focus on quality of healthcare service following CRC surgery, self-management capacity and prevention of postoperative complications. Postoperative complications can be reduced by providing effective follow-up in outpatient clinics and nutritional status management, consequently improving quality of life among this population.

Background: Multiple-choice question (MCQ) item writer training is an important step towards the production of high quality tests. Educators generally suggested faculty development programs of long duration, which are not practical for many clinical teachers. This study explored an alternative approach, using a series of short workshops. Objective: This study examined (1) the perception of clinical teachers on item writer training workshops, and (2) the impact of training on item difficulty and discrimination. Methods: A series of three short workshops on MCQ item development and item analysis were administered. Participating clinical teachers were asked to provide satisfactory ratings of the workshops. Items developed for comprehensive examina- tions of fifth-year medical students were analyzed, comparing item difficulty and item discrimination between those written by workshop participants and non-participants, both before and after the workshops. Results: Participants were very satisfied with the workshops. The items developed by participants before the workshop tended to be inappropriately too easy or difficult than those developed by non-participants, but showed similar discriminating power with items of non-participants. After the workshops, participants developed test items that were similarly appropriate in the difficulty level as compared with items of non-participants. Post-workshop items of participants had higher discriminating power than those of non-participants. Conclusion: A series of three short workshops on item writer training is an effective and acceptable program for clinical teachers. It has a positive impact on test statistics, improving item quality both in their difficulty and discrimination.

Background: Postoperative ileus (POI) usually delays the postoperative recovery after open colectomy. Gum chewing may facilitate bowel motility through cephalic-vagal stimulation. Bowel sounds, the time to first postoperative flatus and defecation, the common nursing outcomes of bowel motility, has not been investigated in Thai patients. This study examines the effect of gum chewing on bowel motility in colorectal cancer patients after open colectomy. Methods: A single blind randomized controlled trial was conducted with 32 patients in experimental and 32 patients in control groups. The experimental group chewed a piece of sugar-free gum with a fruity flavor for 20 minutes each time, three times a day starting from the first postoperative day till the date of first oral liquid received, while the control group receive routine care. Results: The bowel sounds of the experimental group after chewing gum significantly increased more than those of the control group (p = 0.00). The time to the first postoperative flatus in the experimental group was significantly shorter than that in the control group; likewise the first postoperative defecation was also shorter (p = 0.04, p = 0.02, respectively). Conclusion: Gum chewing is helpful in stimulating bowel motility measured by an increase in bowel sounds and in reduced times to first postoperative flatus and defecation. This nursing intervention may be used for stimulating bowel motility in patients with colorectal cancer after an open colectomy.

BackgroundChest radiography is not routinely recommended before elective endoscopies. A high incidence of perioperative chest radiography requests was observed at our institution. This study aims to investigate factors influencing preoperative chest radiography request for patients undergoing elective gastrointestinal (GI) endoscopies.MethodsThis cross-sectional clinical study recruited 264 participants from different medical specialties who were responsible for preoperative endoscopic chest x-ray (CXR) ordering including anesthesiologists, surgeons and gastroenterologists. They completed questionnaires exploring their general knowledge and attitudes about preoperative chest radiography. Demographic characteristic of the participants affecting the knowledge on preoperative chest radiography was determined. A Structural Equation Model (SEM) was constructed from validated conceptual framework to find causal relationships between hypothesized factors and intention for preoperative endoscopic chest radiography request. Statistical analyses were performed using the SPSS software version 18.0 and Analysis of Moment Structures (AMOS) version 18.0.ResultsThe questionnaire response rate was 53.79%. Baseline general knowledge on preoperative chest radiography of the participants was comparable. The SEM results showed unsupported relationship between hypothesized factors and the intention for preprocedural GI endoscopic CXR request (p < 0.1).ConclusionsGeneral knowledge of medical personnel on tuberculosis needs improvement. To rectify the unnecessary chest radiography request before elective GI endoscopic procedures, awareness of the patients' health conditions, adherence to the hospital's policy and realizing of possible patient-related mishaps are not the determinants for preprocedural endoscopic chest radiography request. Future works are required to explore other alternative factors involved for reducing chest radiography requests which are not indicated.

Background: The first step in cultivating the culture of safety in the operating room is the assessment of safety culture among operating room personnel. Objective: To assess the patient safety culture of operating room personnel at the Department of Surgery, Faculty of Medicine Siriraj Hospital, and compare attitudes among different groups of personnel, and compare them with the international standards. Methods: We conducted a cross-sectional survey of safety attitudes among 396 operating room personnel, using a short form of the Safety Attitudes Questionnaire (SAQ). The SAQ employed 30 items to assess safety culture in six dimensions: teamwork climate, safety climate, stress recognition, perception of hospital management, working conditions, and job satisfaction. The subscore of each dimension was calculated and converted to a scale score with a full score of 100, where higher scores indicated better safety attitudes. Results: The response rate was 66.4%. The overall safety culture score of the operating room personnel was 65.02, higher than an international average (61.80). Operating room personnel at Siriraj Hospital had safety attitudes in teamwork climate, safety climate, and stress recognition lower than the international average, but had safety attitudes in the perception of hospital management, working conditions, and job satisfaction higher than the international average. Conclusion: The safety culture attitudes of operating room personnel at the Department of Surgery, Siriraj Hospital were comparable to international standards. The safety dimensions that Siriraj Hospital operating room should try to improve were teamwork climate, safety climate, and stress recognition.

Background: Postoperative ileus (POI) usually delays the postoperative recovery after open colectomy. Gum chewing may facilitate bowel motility through cephalic-vagal stimulation. Bowel sounds, the time to first postoperative flatus and defecation, the common nursing outcomes of bowel motility, has not been investigated in Thai patients. This study examines the effect of gum chewing on bowel motility in colorectal cancer patients after open colectomy. Methods: A single blind randomized controlled trial was conducted with 32 patients in experimental and 32 patients in control groups. The experimental group chewed a piece of sugar-free gum with a fruity flavor for 20 minutes each time, three times a day starting from the first postoperative day till the date of first oral liquid received, while the control group receive routine care. Results: The bowel sounds of the experimental group after chewing gum significantly increased more than those of the control group (p = 0.00). The time to the first postoperative flatus in the experimental group was significantly shorter than that in the control group; likewise the first postoperative defecation was also shorter (p = 0.04, p = 0.02, respectively). Conclusion: Gum chewing is helpful in stimulating bowel motility measured by an increase in bowel sounds and in reduced times to first postoperative flatus and defecation. This nursing intervention may be used for stimulating bowel motility in patients with colorectal cancer after an open colectomy.

Background: Medical ethics has been accepted as part of every accredited medical curriculum for the past 40 years. Medical students’ attitudes have an important role for development and improvement of the curriculum. Faculty of Medicine Siriraj Hospital is the oldest and largest medical school in Thailand, and has been teaching medical ethics since 1907. Objective: To determine attitudes among medical students and interns toward medical ethics education and understand the factors influencing their attitudes. Methods: Mixed quantitative and qualitative research was conducted with early 6th year medical students and interns. A questionnaire was adapted from previous studies and included some original items. Results: Of the 550 questionnaires distributed, 386 were returned (70.2% response rate). Males (n=180) made up 46.63 % of the sample. Interns (n=219, 56.74 %) tended to have more positive attitudes toward ethics learning than did medical students (n = 167, 43.26 %). Male participants tended to agree more with negative statements about ethics learning than did females. There was no statistically significant effect of hometown (Bangkok versus elsewhere) or grade point average on attitudes. The main problem cited with medical ethics education was lack of engaging methods. Conclusion: Because clinical experience has an effect on learners’ attitudes towards ethics education, medical ethics should be taught at the appropriate time and with proper techniques, such as drawing explicit ties between ethical principles and real-life situations. Attention to the more detailed aspects of these data should also facilitate improvements to curriculum content, thereby ensuring better educational outcomes.

A retrospective study of clinical performance assessment of residents in the general surgery residency program at the Department of Surgery, Faculty of Medicine Siriraj Hospital, during the 200-2001 and 2001-2002 academic years was done to evaluate the inter-rater reliability, internal structure, and ducational discriminant validity of the assessment. The inter-rater reliabilities were determined by using the intraclass correlation. Correlations between individual performance ratings were checked to determine how well faculty members differentiate their ratings with individual clinical skills. Finally, the percentage of marginal or unsatisfactory ratings was checked to demonstrate how sensitive the ratings were in identifying performance deficiencies among residents. Â Â Â From the evaluation of 42 residents in the 2000-2001 academic year, inter-rater reliability coefficients of individual ratings ranged from 0.06 to 0.93 with an average of 0.51. From the evaluation of 47 residents in the 2001-2002 academic year, inter-rater reliability coefficients ranged from 0.04 to 0.85 with an average of 0.49. Inter-rater reliabilities of performance ratings of third-year residents were at an acceptable standard for a medium-stake assessment. However, those of first and second-year residents should need some improvement. Tasks performed by first and second-year residents seem to have been inadequate for faculty members to evaluate their performance reliably. The correlation study between individual performance ratings demonstrated the lack of discrimination between many clinical skills in faculty ratings. Faculty members need some guidelines to differentiate between many items including relationship with patients, relationship with other doctors, and relationship with other workers; knowledge and judgment; work concentration and work effectiveness; and punctuality and responsibility. About ten percent of ratings were marginal or unsatisfactory which indicated that these ratings were sensitive enough to identify performance deficiencies among residents.

A retrospective study of clinical performance assessment of residents in the general surgery residency program at the Department of Surgery, Faculty of Medicine Siriraj Hospital, during the 200-2001 and 2001-2002 academic years was done to evaluate the inter-rater reliability, internal structure, and ducational discriminant validity of the assessment. The inter-rater reliabilities were determined by using the intraclass correlation. Correlations between individual performance ratings were checked to determine how well faculty members differentiate their ratings with individual clinical skills. Finally, the percentage of marginal or unsatisfactory ratings was checked to demonstrate how sensitive the ratings were in identifying performance deficiencies among residents. Â Â Â From the evaluation of 42 residents in the 2000-2001 academic year, inter-rater reliability coefficients of individual ratings ranged from 0.06 to 0.93 with an average of 0.51. From the evaluation of 47 residents in the 2001-2002 academic year, inter-rater reliability coefficients ranged from 0.04 to 0.85 with an average of 0.49. Inter-rater reliabilities of performance ratings of third-year residents were at an acceptable standard for a medium-stake assessment. However, those of first and second-year residents should need some improvement. Tasks performed by first and second-year residents seem to have been inadequate for faculty members to evaluate their performance reliably. The correlation study between individual performance ratings demonstrated the lack of discrimination between many clinical skills in faculty ratings. Faculty members need some guidelines to differentiate between many items including relationship with patients, relationship with other doctors, and relationship with other workers; knowledge and judgment; work concentration and work effectiveness; and punctuality and responsibility. About ten percent of ratings were marginal or unsatisfactory which indicated that these ratings were sensitive enough to identify performance deficiencies among residents.

To evaluate the ability of the resident selection criteria to predict clinical performance of general surgery residents, the application files and resident evaluations of 35 general surgery residents who were in the residency program of the Department of Surgery, Faculty of Medicine Siriraj Hospital during the 2000 - 2001 and 2001 - 2002 academic years were reviewed. A correlation study was done using scores from three selection criteria (medical school grades, letters of recommendation, and interview) predictors and clinical performance ratings as outcomes. The interview scores were the best predictor for overall performance of residents in the first and second years. The GPA scores were the best predictor for overall third-year performance. Each selection criterion contributed unique predictive ability for resident performance. The combination of interview scores, scores from letters of recommendation, GPA scores, and ages at admission could predict 60.5% of the total variance in the overall first-year performance scores (R=0.778, p=0.012). The combination of interview scores and score from letters of recommendation could predict 31.4% of the total variance in the overall performance score in the second year (R=0.56, p=0.049). None of the multiple regression models demonstrated statistically significant prediction for the third-year overall performance.

A case report of left paraduoenal hernia in an 18-year-old man presenting with complete small intestinal obstruction. This patient suffered from intermittent colicky abdominal pain for 10 days. The pain worsened over the 2 days before admission. He also had bilous vomiting and obstipation. He was diagnosed with complete small intestinal obstruction and sent for an emergency exploratory laparotomy. At operation, he was found to have a left paraduodenal hernia. The small bowel could be reduced manually into the normal position and the neck of the hernial sac was closed. He made an uneventful recovery after the operation and was discharged from hospital 4 days later. Although paraduodenal hernia is a rare cause of small intestinal obstruction, it should be taken into account in the differential diagnosis of small intestinal obstruction especially in a patient with no previous abdominal exploration. Early surgical intervention could prevent the possible complication of gangrenous bowel.

A 27 year old Thai male presented with progressive abdominal distension without leg edema, low grade fever and 10 Kgs weight loss over 2 months. Physical examination revealed cachexia,a markedly distended abdomen, with a fluid thrill, but no hepatosplenomegaly. An abdominal tap produced serosanguinous fluid. Analysis of the ascitic fluid demonstrated white blood cell 300 /mm3, red blood cell 270,000 /mm3, SAAG 0.9 gm/dl, ascites protein 3 gm/dl, AFB stain no organisms seen. Cytology showed a few mesothelial cells but no malignant cells. A chest X-ray was normal. The patient underwent laparoscopy. The peritoneum was studded with whitish miliary nodules and fibrin plaques. Peritoneal biopsy revealed chronic inflammation with fibrosis, no granuloma or specific organism. Abdominal CT images demonstrated a large multiseptated cystic mass with a thick wall, occupying almost the entire abdominal cavity. Abdominal exploration demonstrated a huge intraabdominal cystic mass, with multiple discrete white nodules on the surface of the cystic wall and the liver. Histology demonstrated most of tumor cells were deeply embedded in collagenous tissue with a biphasic pattern and high mitotic figure. Immunoperoxidase staining demonstrated tumor markers as follow vimentin, cytokeratin (AE1/AE3), epithelial membrane antigen (EMA) and neurospecific enolase (NSE). The final diagnosis was biphasic malignant mesothelioma. Up to now, no standard treatment is available. Surgery for localized tumors has been reported. Other treaments, such as external radiation, intraperitoneal instillation of radioactive gold and chemotherapy have generally failed to improve overall survival. The median survival is 2 to 12 months after diagnosis with a total duration of about 1 year from the onset of symptoms.

Background: Lung is a common metastasis site of rectal cancer. Metastatic site, size of tumor, lymph node involvement effect survival in rectal cancer. Isolated lung metastasis has better prognosis than other organ. Identification of rectal cancer cases with isolated lung metastasis would improve management of patients. Objectives: To study the prevalence and predictors of synchronous lung metastasis in Thai rectal cancer patients. Materials and Methods: Investigators retrospectively reviewed medical records of patients whom was first diagnosed with rectal cancer with pathologic confirmation at Siriraj hospital, Thailand between 2012 and 2017 and had computed tomography (CT) of chest and abdomen. The data included gender, age, weight, smoking, diabetes mellitus, hypertension, lymph node, tumor size, tumor location, histopathology, CEA level, history of prior cancer, history of cancer in family, and synchronous liver and lung metastasis. Results: We analyzed data from 427 patients. Two hundred and forty-one patients (56.4%) were male. Mean age and weight were 61 years and 61 kg, respectively. Mean tumor size was 31.5 mm. Most of tumor located at upper rectum (30.8 %). Mean CEA level was 12 ng/mL. The prevalence of lung metastasis in rectal cancer was 25%. A univariable analysis revealed that CEA level, tumor size and lymph node metastasis were statistically significant predictors of synchronous lung metastasis. A multivariable analysis found that tumor size > 30 mm (Odds ratio 1.9, p = 0.006) and lymph node metastasis (Odds ratio 2.3, p < 0.001) were statistically significant predictors of synchronous lung metastasis in rectal cancer. Conclusion: The prevalence of synchronous lung metastasis in rectal cancer was 25 % and factors that predicted synchronous lung metastasis in rectal cancer were tumor size > 30 mm and lymph node metastasis. [ABSTRACT FROM AUTHOR]