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A study of undergraduate medical students' abilities to identify salient information in reviewing patient charts was conducted by members of the Department of Surgery at Southern Illinois University School of Medicine. Specific goals of the two-year study were to develop and test a method for assessing chart skills and to test the following hypotheses: (a) knowledge base is a component of chart review skill; (b) chart skills are related to basic observational skills; (c) performance on one chart is positively correlated with performance on other charts; (d) chart performance is affected by distraction and time pressure; and (e) chart performance improves with clinical experience. Evaluation instruments and methodology are described. Hypotheses a, b, and e and the time effect hypothesized in d were supported; hypothesis c was not supported. Results of the study provide a foundation for further research exploring the effect of instruction on chart performance and investigating the relationships between chart performance and other measures of clinical competence.

In the early days of periacetabular osteotomy (PAO), surgical approaches were characterized by extensive soft-tissue dissection. The Smith-Petersen approach (and iliofemoral modifications) and the ilioinguinal approach have traditionally been used for PAO. The optimal surgical approach for PAO, or any surgical procedure, should be characterized by few complications, minimized surgical trauma, and no compromise of long-term surgical results. A minimally invasive transsartorial approach using fluoroscopy and an approximately 7-cm skin incision has been developed for performing PAO. No muscles are detached, and the femoral nerve and vessels are protected by the iliopsoas and sartorius muscles. This approach is safe, minimizes blood loss and transfusion requirements, is associated with a short duration of surgery, and allows for optimal correction of the acetabular fragment. Follow-ups (range, 3.9 to 8.1 years) of 209 PAOs performed using this approach have shown Kaplan-Meier survivorship rates of 94.7% at 5 years and 88.6% at 8.1 years, with conversion to total hip arthroplasty as the end point. Perioperative management includes a patient education program, optimized pain treatment strategies (local infiltration analgesia), and a progressive mobilization and exercise program. The transsartorial approach coupled with a specific perioperative management program has proved successful for PAO surgery.

Summary Skills in reviewing medical charts have been demonstrated components of clinical competence related to knowledge base, level of clinical experience, and basic observational skills. A study of the generalizability of performance on chart review exercises, which controlled for knowledge in the content area, was undertaken to determine their potential in evaluating students' problem-solving ability. Results of the study indicate that the case specificity which has characterized simulated problem-solving tasks is largely case, rather than content, specificity: correlations between scores on single charts demonstrated no consistent relationships for measures of proficiency, efficiency, and diagnostic accuracy. However, averaging the scores on two charts and then computing correlations resulted in significant positive measures for both proficiency and efficiency. The effects of length and difficulty level on the generalizability of tests of problem-solving ability are areas suggested for future research.

To examine the effect of contralateral carotid artery stenosis on postoperative events, a retrospective review was made of 451 patients undergoing 510 carotid endarterectomies during a 6-year period. Three degrees of contralateral carotid stenosis were identified radiologically: 0% to 49%, 50% to 99%, and totally occluded. Each group was further separated into two categories according to preoperative symptoms. "Low risk" included asymptomatic lesions, transient ischemic attacks, and nonhemispheric symptoms; "high risk" described poststroke patients and urgent operations. The results show the incidence of stroke or death was not increased in patients with severely stenosed or occluded contralateral vessels in either low- or high-risk patients (p = 0.741 and p = 0.561, respectively). Patients in the high-risk category, however, had a significantly higher risk of postoperative complications than patients in the low-risk category (p less than 0.001). The study reaffirms that preoperative indications have a major influence on surgical outcome and suggests that the status of the contralateral artery has little bearing on postoperative events.

A study of undergraduate medical students' abilities to identify salient information in reviewing patient charts was conducted by members of the Department of Surgery at Southern Illinois University School of Medicine. Specific goals of the two-year study were to develop and test a method for assessing chart skills and to test the following hypotheses: (a) knowledge base is a component of chart review skill; (b) chart skills are related to basic observational skills; (c) performance on one chart is positively correlated with performance on other charts; (d) chart performance is affected by distraction and time pressure; and (e) chart performance improves with clinical experience. Evaluation instruments and methodology are described. Hypotheses a, b, and e and the time effect hypothesized in d were supported; hypothesis c was not supported. Results of the study provide a foundation for further research exploring the effect of instruction on chart performance and investigating the relationships between chart performance and other measures of clinical competence.