Alamanda Vignesh K, Crosby Samuel N, Mathis Shannon L, Archer Kristin R, Terhune Kyla P, Holt Ginger E
Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232-8774, USA.
Sarcoma. 2013;2013:679323. doi: 10.1155/2013/679323. Epub 2013 Apr 18.
Background. One-third of all extremity soft tissue sarcomas are misdiagnosed and inappropriately excised without proper preoperative diagnosis and planning. This study aimed at examining the clinical judgment of residents in both general and orthopaedic surgery and at determining whether resident education plays a role in appropriately managing unknown soft tissue masses. Methods. A case-based survey was used to assess clinical decisions, practice patterns, and demographics. Aggregate response for all of the clinical cases by each respondent was correlated with the selections made for practice patterns and demographic data. Results. A total of 381 responses were returned. A higher percentage of respondents from the orthopaedic group (84.2%) noted having a dedicated STS rotation as compared to the general surgery group (35.8%) P < 0.001. Depth, size, and location of the mass, rate of growth, and imaging characteristics were considered to be important factors. Each additional year of training resulted in 10% increased odds of selecting the correct clinical decision for both groups. Conclusion. Our study showed that current residents in both orthopaedic surgery and general surgery are able to appropriately identify patients with suspicious masses. Continuing education in sarcoma care should be implemented beyond the years of residency training.
背景。所有肢体软组织肉瘤中有三分之一在未进行适当的术前诊断和规划的情况下被误诊并被不恰当地切除。本研究旨在检验普通外科和骨科住院医师的临床判断能力,并确定住院医师培训在妥善处理不明软组织肿块方面是否发挥作用。方法。采用基于病例的调查来评估临床决策、实践模式和人口统计学特征。每位受访者对所有临床病例的总体回答与针对实践模式和人口统计学数据所做的选择相关联。结果。共收到381份回复。与普通外科组(35.8%)相比,骨科组中更高比例的受访者(84.2%)指出有专门的软组织肉瘤轮转经历(P < 0.001)。肿块的深度、大小和位置、生长速度以及影像学特征被认为是重要因素。两组中,每增加一年培训,做出正确临床决策的几率就增加10%。结论。我们的研究表明,目前普通外科和骨科的住院医师能够恰当地识别患有可疑肿块的患者。肉瘤护理方面的继续教育应在住院医师培训年限之后继续开展。