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http://www.webmedcentral.com/images/Header_Logo.giftext/html2012-08-01T21:42:09+01:00http://www.webmedcentral.com/Prof. Sunil Kumar JoshiColostrum Feeding: Knowledge, Attitude and Practice in Pregnant Women in a Teaching Hospital in Nepal
http://www.webmedcentral.com/article_view/3601
Background: The role of colostrum in promoting growth and development of the newborn as well as fighting with the infection is widely acknowledged. In Nepal, there are differences in cultures in the acceptability of colostrum and the prevalence of colostrum feeding. Although, breastfeeding is a common practice in Nepal, importance of colostrum feeding is still poorly understood.
Objectives of the study: To assess the awareness of the importance of colostrum feeding in pregnant women.
Methods: Data collection was done through semi structured questionnaire regarding colostrum feeding among pregnant women attending Gynaecology and Obstetrics Outpatient Department (OPD) and Antenatal Ward of Kathmandu Medical College Teaching Hospital (KMCTH). The study was conducted during the months of December 2011and January 2012.
Results: The study shows that 74% of women had heard about colostrum, 69% knew that it is nutritious milk to be fed to the new born babies. Nine percent (9%) women were aware about its protective effect and 41 % had knowledge that it helps in proper growth of children and fight against infections. There were still many women (26%) who lacked knowledge about colostrum, majority being uneducated and who came from the rural areas. Those women who knew about it, received the information about colostrum via various media (30%), followed by family and friends (16%) and antenatal advice (12%) which contributes the reason of improved practice of colostrum feeding in urban areas.
Conclusion: Many women were aware about the importance of colostrum but the data still indicates that further efforts are necessary to improve the Knowledge, Attitude and Practice of colostrum feeding.
text/html2010-09-13T19:05:17+01:00http://www.webmedcentral.com/Dr. P Ravi ShankarPromoting integrated learning and open-book examinations in South Asian medical schools
http://www.webmedcentral.com/article_view/608
South Asia has a good proportion of the world’s medical schools and creates a large percentage of the world’s health manpower. The examination pattern remains largely traditional and emphasizes factual knowledge and mastery of information. Rote learning is emphasized throughout school in South Asia.
Educational objectives are becoming important in many countries. Sessions are planned to achieve the objectives and evaluation provides the means to know whether or not the objectives have been achieved [1]. Evaluation can also serve as feedback on the effectiveness of the teaching-learning process. Formative assessment gives feedback to students about their learning process and steps to be taken to further improve it.
Assessment in Basic Sciences in Nepal:
It has been said that whoever controls the examination, controls the curriculum and controls the way students learn. The world over, many medical schools are adapting an integrated curriculum where various subjects serve as tools for solving a patient problem. In Nepal, the seven basic science subjects (Anatomy, Physiology, Biochemistry, Pharmacology, Pathology, Microbiology and Community Medicine) are taught in an integrated organ-system based manner during the first four semesters with regular clinical contact. The Kathmandu University emphasizes integrated problem-based learning but the students are still assessed subject wise [2]. In Tribhuvan University, there are integrated system-wise papers but each subject still sets its own questions and students do not bring together knowledge of various basic science subjects to solve a clinical problem [3].
Assessment in basic sciences in India:
In India the subjects of Anatomy, Physiology and Biochemistry are taught and examined at the end of the first year of the undergraduate medical (MBBS) course and the subjects of Pathology, Microbiology and Pharmacology are taught and examined during the next eighteen months.
Promoting integrated learning:
Kathmandu University (KU) recommends that the different academic departments should identify in an integrated manner the educational objectives which are to be achieved and that teaching of the various subjects should take place synchronously [2]. However, I personally feel that integration is best achieved using clinical cases or case scenarios.
When a doctor practices and sees a patient he/she will have to bring together and integrate various subjects and use his/her knowledge and skill to treat the patient. If subjects are taught individually then knowledge often stays compartmentalized. Over years of practice many doctors achieve the skill of integrating subjects and focusing the knowledge towards patient care. If the student learns this skill right from the first day of medical school then he/she would be much better equipped to handle patient problems.
Sequential didactic lectures which are used for integrated learning in many schools is not very effective in integrating subjects and teaching the student to orient the knowledge towards patient care. Student seminars emphasizing a particular disease are found to be an effective means of integration. Manipal College of Medical Sciences (MCOMS) conducts student seminars every fortnight and these seminars have been effective in integrating basic science subjects [4]. At KIST Medical College, Lalitpur correlation seminars are held at the end of each organ system. The topic/s for the seminar/s and the objectives to be covered from each department/subject are discussed in detail.
Small group problem-solving sessions:
A set of common clinical problems should be identified and students should work in small groups towards solving the problem. The facilitator should identify learning issues and create a conducive environment for study. Each small group should contain not more than ten students. Lectures should be reduced to the minimum and should be only for topics which cannot be covered through problems. For specific practical skills resource sessions can be organized. Faculty members can help students better understand their subject through the perspective of the patient problem. In addition to horizontal integration among basic science subjects and Community Medicine vertical integration with clinical subjects should also be done. This will create greater interest among students for learning the basic sciences. In my institution objectives from the clinical sciences are also given to students during the correlation seminar and a clinical faculty member is also associated with seminar preparation and assessment. During the clinical years basic science subjects should also be included in student seminars. This will help students revise these subjects and further underline their importance in treating patients.
Integrated learning sessions using clinical problems have been tried in some South Asian medical schools. At the Ziauddin Medical University in Pakistan vertical and horizontal integration among subjects has been achieved using problem-based learning [5].
Assessments:
Formative assessment during the learning sessions should be done. Group dynamics, participation in group activities and ability to approach the clinical problems in a correct manner are various parameters which can be assessed. Formative assessment of students during pharmacology practical sessions are carried out at KISTMC and student performance in formative assessments is considered during the final pharmacology practical exams [6].
The summative assessment should at least partly be integrated and open book examinbations can be considered. In Singapore the curriculum of Community, Occupational and Family Medicine (COFM) aims to produce graduates with the skills to critically appraise evidence, prevent and manage diseases and promote health in the community and in primary healthcare [7]. Innovative assessment methods such as open book examinations (OBEs), objective structured communication stations and evaluation of student participation in group work are used.
Open book exams:
With the information overload in medicine, the emphasis is shifting from knowing something to knowing where to find the information. Core basic knowledge is important but many other things can be looked up. OBEs strongly favor this shift in emphasis. I believe students should be assessed through a clinical problem which they try to answer in an integrated fashion using textbooks and other sources. I am ambivalent about allowing internet sources of information in the examination as the information retrieval is very quick and does not need any effort on the part of the student. Doctors in practice can however use the net for quick information once they have mastered ‘retrieval’ skills during the course of study.
The department of Pharmacology at MCOMS teaches students to select a personal or P-drug for a disease condition on the basis of efficacy, safety, cost and convenience. During the practical examinations students choose a P-drug for a given disease condition, verify the suitability of the selected P-drug and write a prescription. They are allowed to refer to textbooks and other sources [8]. The students learn to retrieve information, critically appraise it and make informed choices. They were in favour of the OBE [8]. OBE is also used in the P-drug selection exercise during Pharmacology practical examinations at KISTMC. Thus at least a part of the assessment of students should stress OBEs, information retrieval skills rather than only rote learning and factual recall.text/html2010-09-14T22:37:26+01:00http://www.webmedcentral.com/Dr. Sajita Setia21st Century Teaching For Students Of Medical Laboratory Technology: A Problem-Based Learning Approach
http://www.webmedcentral.com/article_view/619
Introduction: The expected knowledge base required for newly qualified laboratory technicians in practice setting is immense. However it is almost impossible to include all the information required at entry into professional practice into the teaching curricula. Problem based learning (PBL) is intended to develop lifelong and self-directed learning. The aim of this study was to analyze students’ opinion about a new model of PBL and to evaluate its effect on the students’ conceptual understanding.
Methods: We developed a teaching and learning quality improvement (QI) model for final year medical laboratory technology (MLT) students based on PBL. After finishing an introductory teaching module, students were given a pre-test assessing both reasoning skills and facts at beginning of next class. Students were then randomly divided into four groups in the next session. This was followed by small group PBL discussions on pre-test questions. A similar surprise post-test was then conducted after 2 weeks and each student’s view on PBL was assessed.
Results: A total of three PBL sessions were conducted. The overall mean post-test scores were significantly higher than the mean pre-test scores (p value<0.05). The PBL model was rated as ‘an excellent way in understanding concepts’ by majority of the students and 86.7% of students gave overall positive remarks.
Conclusion: The QI model based on PBL sessions improved the students’ conceptual understanding of the topic. This model may lead to the development of self-directed learning skills and enhance student-centered learning outcomes beyond knowledge acquisition.text/html2010-10-02T19:38:34+01:00http://www.webmedcentral.com/Mr. Zaher ToumiThe Knowledge And Skills Of Surgical Foundation Year One Doctors In A Teaching Hospital A Review And Results Of A Survey
http://www.webmedcentral.com/article_view/875
Introduction:
Junior doctors had acquired knowledge and skills in the past using weekly specialty based teaching sessions and on the job learning. They currently learn on the job as before (with the restraints of less working hours). However, generic hospital wide teaching programmes have replaced the specialty teaching programmes. We aim to assess the effects of these changes on the surgical foundation year one doctors’ knowledge of common surgical conditions and on their basic surgical skills.
Methods:
We carried out a survey of foundation year one doctors towards the end of their first surgical placements in the largest teaching trust in Manchester. We surveyed the foundation year one doctors’ perception of their abilities to manage common surgical conditions and to carry out basic surgical procedures.
Results:
Response rate was 100% with 24 doctors participating in the survey (n=24). Only 9 out of 24 FY1s (38%) agreed that the generic teaching programme provided teaching which is relevant to their surgical placement. The FY1s’ perceived knowledge and ability to deal with common surgical conditions was 3/5. Doctors in GI surgery placements fared better on average (mean 3.20 vs. 2.78, p<0.05) than non-GI placement trainees.
Conclusions:
Foundation year one doctors needs specialty teaching as they rotate through their rotations apart from the generic teaching programme. It could be useful if all those who cover surgical on call shift to go through a GI placement to improve their skills and knowledge in common surgical conditions.text/html2011-02-11T18:06:22+01:00http://www.webmedcentral.com/Mr. Mohamed M NajimudeenLearning Via Just - In- Time (JiTT) Education: A Must For All Medical Schools In The Global Information Age.
http://www.webmedcentral.com/article_view/1555
LEARNING VIA JUST- IN- TIME (JiTT) EDUCATION: A MUST FOR ALL MEDICAL SCHOOLS IN THE GLOBAL INFORMATION AGE. What is Just –In –Time Teaching?The conventional lecture has only 5% retention. Whereas the discussion has 50% and teaching to others has 90% retention. Lecture is an art of transferring information from the notes of the Lecturer to the notes of the students without passing through "the minds of either" .Therefore the learning method should be shifted to teaching by students and discussion among students under the supervision of a teacher. Just-in-Time Teaching (JiTT) is a way of learning where the students take a major role.Gregor Novak ,a physics teacher from Purdue University Indianapolis campus in 1964 developed JiTT after the culmination of thirty years of experience and research is a Web-based, classroom-linked strategy termed "JiTT" or Just-in-Time Teaching.JiTT improves the efficacy of the class room by the interaction between the teacher and student. There is a team spirit. The teacher and students work as a team. This will help to maximise the retainable knowledgeAs Alexander Astin mentioned the JiTT increased amounts and quality of student-student interaction, student-faculty interaction and student study outside of classAs Novak points out , much of the dialogue whether student-student or student teacher, can occur outside the classroom, thanks to the maturation of electronic technologies. Interaction is not simply electronic, but also occurs in the classroom with fellow students and with instructors. Student feedback shows the approach meets itsprimary goal: engaging students by allowing them to control the learning process "Novak believes that the core element of JiTT is the interactive lecture. Instructors in the interactive lecture then adjust and organize lessons based on those student responses. The students largely determine the way the lecture is presented in the classroom. The student input is "Just in Time" for the lesson, hence the name. With knowledge of those responses to the subject matter, instructors engage the students at their level of background knowledge and use their answers as input for class discussion. Most importantly, students find the JiTT approach helps learning. Of those surveyed after two semesters of JiTT courses, 92 percent preferred the approach to a standard course. How is Just-In-Time different from the traditional education model?According to Jerry Wind and David Rubenstein, the traditional lecture model delivers standardized content in a discrete time and place, usually in passive setting. In other words, a teacher in a lecture room imparts knowledge to a large number of students. The students may be briefly engage in discussions but remain mostly passive. Apparently this model has worked well for centuries, because it is efficient for teachers. It focuses on teaching rather on learning. The newer model however focuses on learning rather on teaching and passing some controls of the learning process over to the students.The newer model pursues three major goals and objectives;First and foremost it maximizes the efficacy of the classroom sessions. The teacher discusses a prelearned chapter interactively with the students and difficulties in comprehending the subject are further clarified.Secondly to structure the out of the class time for maximum benefit. The third objective is to create and sustain a team spirit. Here students and instructors work as a team towards the same objective to help students pass the course with the maximum amount of retainable knowledge.Our Experience with JiTT.Since the beginning of the last semester, the traditional lectures for semester 6 7 and 8 have been replaced with JiTT in the Department of Obstetrics and gynaecology. The faculties from the respective semester post a power point slides of the respective topic to be discussed on the web accompanied with twenty questions based on the lecture ,a week prior to the scheduled lecture. The students are expected to study the slides and subsequently seek answers for the posted questions from all available resources.On the day of the scheduled lecture the doubts are discussed followed by the students answering the questions posted on the web. Marks are given according to their answer. These marks are included in their continuous assessment. Evaluation of this current model of teaching is ongoing in the department. However preliminary reports suggest that the students are overwhelmed by this new method as they have to seek answers from various sources. This method help them to be critique and comprehensive. It helps them to improve their retention of knowledge of the topic discussed ,thus performing well in the subsequent exams.Active learning will certainly yield a better results. It also make the student to search and learn more. There is increased time for student to study. There will be more interaction with the teachers. However it involves more work to the students and the teacher than the conventional lecture method. Learning technologies should be designed to increase, and not to reduce, the amount of personal contact between students and faculty on intellectual issues.
text/html2011-10-18T10:42:22+01:00http://www.webmedcentral.com/Dr. P Ravi ShankarHINARI: Providing Access to Scientific Literature in Resource Constrained Settings
http://www.webmedcentral.com/article_view/2332
In resource constrained settings like Nepal access to scientific literature is often difficult. Most institutional libraries provide access to only a very limited number of journals. Also problems of the postal system and other issues result in delay in receipt of biomedical journals and access to recent information. Many libraries are not well organized and access to different materials available in the library can be a problem. In Nepal, the program, Nepal Journals Online (www.nepjol.info) provides free online access to 63 Nepalese journals in the field of medicine and other areas.A major initiative undertaken by the World Health Organization (WHO) along with major publishers to provide researchers in resource constrained settings access to scientific literature is the Health InterNetwork Access to Research Initiative (HINARI). In 2007, I had written about the HINARI program for the Journal of the Institute of Medicine (Shankar PR. Health InterNetwork Access to Research Initiative (HINARI). Journal of the Institute of Medicine 2007;29:58-9.). In the last five years major developments have taken place in the program and I feel that WebmedCentral as an open access publisher will be an appropriate forum to share with readers in developing nations the advantages and salient features of the HINARI program. I frequently use HINARI and want institutions and researchers in eligible countries to be aware about the program and use it in their academic and other activities. The HINARI website is www.hinari-gw.who.int. The program provides access to over 8000 information resources to researchers in 105 countries in 30 different languages. HINARI was developed within the framework of the Health InterNetwork, introduced by the United Nations' Secretary General Kofi Annan at the United Nations (UN) Millennium Summit in the year 2000. The program was started in January 2002 with about 1500 journals from six major publishers. The HINARI program has defined two groups of countries for access (group A and group B). The lists have been created based on three factors: Gross national income (GNI) per capita (World Bank figures), United Nations Least Developed Country (LDCs) List and Human Development Index (HDI). National universities, research institutes, professional schools (medicine, nursing, pharmacy, public health, dentistry), teaching hospitals, government offices and national medical libraries are entitled to access HINARI. In professional schools students can also access the information resources. In our institution interested students often use HINARI to access biomedical literature.The list of countries with free or low cost access (US$1000 per institution per calendar year) is available on the HINARI website (http://hinari-gw.who.int/whalecomwww.who.int/whalecom0/hinari/eligibility/en/index.html). Members of institutions in eligible countries can register for HINARI by completing an online application form. Registered institutions within a country or a geographical area are available from the website. After completing the registration process a common user name and password is made available for all staff in the institution. The librarian of the institution is the preferred contact point. Online training programs for using HINARI and the associated AGORA and OARE programs are available and interested persons can contact the ITOCA staff at moodle@itoca.org to register for the training program. Training videos have been developed and instructions on using the freely downloadable reference management software, Zotero are provided.Journals in HINARI can be searched by title where journals are arranged alphabetically, or can be accessed by subject category, language of publication or by publisher. There is also an option to search HINARI through Pubmed. Detailed instructions on searching HINARI through Pubmed have been compiled by Vimbai M. Hungwe – Outreach and Training Office and are available at http://hinari-gw.who.int/whalecomwww.who.int/whalecom0/hinari/training/HINARI%20Guide%20to%20Using%20PubMed.pdf. Full access to different databases like IMEMR (Index Medicus for the Eastern Mediterranean Region) and IMSEAR (Index Medicus for the Southeast Asian Region), SCOPUS is available. This link to and access to different databases makes HINARI a very powerful tool. HINARI also provides access to different reference sources like the British National Formulary, Cochrane library, One source among others. Links are also provided to free collections like free books for doctors, PLoS series, Pubmed Central and others.The listings under each alphabet also includes a growing collection of + books which provides full access to various books on different subjects. Helpful hints for using HINARI is available at http://hinari-gw.who.int/whalecomwww.who.int/whalecom0/hinari/usinghinari/en/ . Promotional posters about HINARI can be downloaded from the website. The world map showing the breakdown of institutions registered with HINARI in different countries will be of interest (http://hinari-gw.who.int/whalecomwww.who.int/whalecom0/hinari/eligibility/Global_HINARI_registered_2011.png). The feedback from users section underscores the usefulness of HINARI. The HINARI website can be accessed in six different languages (English, Arabic, Chinese, Spanish, French and Portuguese). Frequently asked questions section answers many queries which users may have.The HINARI website is well designed and supports easy navigation. The multiple steps required to access a particular article makes good internet speed necessary otherwise there can be a long delay. The site recommends a minimum speed of 56 kbps which now becoming available in most locations however higher speeds may be beneficial. The organization can be contacted at hinari@who.int.text/html2012-01-31T15:38:44+01:00http://www.webmedcentral.com/Dr. Mahdi EsmaeilzadehThe Role of Fuzzy Biology and Matematical Science in Research and Education in Health System
http://www.webmedcentral.com/article_view/2946
According to the importance of understanding modern biology, powerful countries in the world have done substantial planning and investment for education and research in health systems in the next decade. In this regard, fuzzy biology and matematical science for this research, is crucial.This cross sectional analytical study was done randomly on 137 people from Shirvan (North Khorasan, Iran) with normal face patterns. Facial and cranial ratios was estimated and compared. Data analyzed by SPSS software. The regression line and the growth coefficient were determined for each Parameter. Finally, the mean values of these parameters were determined. Student-t test was used for comparing the measured values.Iranian population at birth have hypereuryprosopic Face and hypercephalic Cranium form. While getting older, the midface height increases, face becomes more prominent, chin becomes shorter and Face and Cranium change to Eurycephalic and hyperleptoprosopic form respectively.text/html2013-01-08T09:30:10+01:00http://www.webmedcentral.com/Dr. Burhan W ImamwerdiThe Effects of Early Clinical Exposure On Medical Laboratory Technology Students: Its effect on Internship Period and their professional Carrier
http://www.webmedcentral.com/article_view/3926
Objective: With the development of the field of medicine, the diagnostic and applied techniques of medical sciences are having a more proactive role in helping this development. In order to address this need, this research proposes Early Clinical Education (ECE) as an innovative learning style that will encourage the strength and depth of learning, develop intellectual skills and enhance integration of theory and practice by extending learning environment from class rooms towards hospital setup.Method: An 18 question questionnaire was implemented on 55 interns and 36 graduates of medical laboratory technology program exposed to ECE in the hospital laboratory setup during the academic years of 2008 to 2012. An additional questionnaire was implemented on 58 hospital lab staff for the same period.Results: 95.1% of participants stated that ECE period was a crucial preparatory stage for their internship period with 93.9% of the students expressing significantly higher level of confidence during their internship due to their prior ECE training. 98.8% indicating that ECE had great effect on their professional performance and 90.3% indicating that they would have never performed at the same level without the ECE they experienced in the hospital setup.This outcome was strongly echoed by the professional hospital staff who has been directly involved in the training of our medical laboratory program students test group.Conclusion: Early Clinical Education learning methodology is proposed as an additional innovative learning style to be utilized as part of a structured curriculum or as an additional learning style to any existing curriculum.
Advances in Knowledge:1. Implementing Early Clinical Education (ECE) as an innovative learning style methodology in Medical Laboratory Technology.2. ECE role in deepening of the knowledge learning, developing technical skills and enhancing the integration of theory and practice.3. Extending the learning environment from classroom to its realistic professional setup in hospitals.4. Utilize hospital clinical environment in motivating and fostering student’s professional attitude.Application to Patient Care:1. ECE role in enhancing student's understanding of medical conditions and enabling them to better retain the knowledge and skills involved for best approaches to lab diagnosis.2. Exposing students to a wider range of patient’s conditions and assist them to acquire, practice and refine skills involved in a supportive environment that fosters an appreciation of their important role as active lab technologists in a patient healthcare system.text/html2013-01-07T22:41:10+01:00http://www.webmedcentral.com/Mr. Mohamed M NajimudeenLearning Via Just-In-Time(jitt) Education: A Must For All Medical Schools In The Global Information Age
http://www.webmedcentral.com/article_view/1553
What is Just –In –Time Teaching?The conventional lecture has only 5% retention. Whereas the discussion has 50% and teaching to others has 90% retention. Lecture is an art of transferring information from the notes of the Lecturer to the notes of the students without passing through "the minds of either".Therefore the learning method should be shifted to teaching by students and discussion among students under the supervision of a teacher. Just-in-Time Teaching (JiTT) is a way of learning where the students take a major role.Gregor Novak, a physics teacher from Purdue University Indianapolis campus in 1964 developed JiTT after the culmination of thirty years of experience and research is a Web-based, classroom-linked strategy termed "JiTT" or Just-in-Time Teaching.JiTT improves the efficacy of the class room by the interaction between the teacher and student. There is a team spirit. The teacher and students work as a team. This will help to maximise the retainable knowledgeAs Alexander Astin mentioned the JiTT increased amounts and quality of student-student interaction, student-faculty interaction and student study outside of classAs Novak points out, much of the dialogue whether student-student or student teacher, can occur outside the classroom, thanks to the maturation of electronic technologies. Interaction is not simply electronic, but also occurs in the classroom with fellow students and with instructors. Student feedback shows the approach meets itsprimary goal: engaging students by allowing them to control the learning process "Novak believes that the core element of JiTT is the interactive lecture. Instructors in the interactive lecture then adjust and organize lessons based on those student responses. The students largely determine the way the lecture is presented in the classroom. The student input is "Just in Time" for the lesson, hence the name. With knowledge of those responses to the subject matter, instructors engage the students at their level of background knowledge and use their answers as input for class discussion. Most importantly, students find the JiTT approach helps learning. Of those surveyed after two semesters of JiTT courses, 92 percent preferred the approach to a standard course. How is Just-In-Time different from the traditional education model?According to Jerry Wind and David Rubenstein, the traditional lecture model delivers standardized content in a discrete time and place, usually in passive setting. In other words, a teacher in a lecture room imparts knowledge to a large number of students. The students may be briefly engage in discussions but remain mostly passive. Apparently this model has worked well for centuries, because it is efficient for teachers. It focuses on teaching rather on learning. The newer model however focuses on learning rather on teaching and passing some controls of the learning process over to the students.The newer model pursues three major goals and objectives;First and foremost it maximizes the efficacy of the classroom sessions. The teacher discusses a prelearned chapter interactively with the students and difficulties in comprehending the subject are further clarified.Secondly to structure the out of the class time for maximum benefit. The third objective is to create and sustain a team spirit. Here students and instructors work as a team towards the same objective to help students pass the course with the maximum amount of retainable knowledge.Our Experience with JiTT.Since the beginning of the last semester, the traditional lectures for semester 6,7 and 8 have been replaced with JiTT in the Department of Obstetrics and gynaecology. The faculties from the respective semester post a power point slides of the respective topic to be discussed on the web accompanied with twenty questions based on the lecture ,a week prior to the scheduled lecture. The students are expected to study the slides and subsequently seek answers for the posted questions from all available resources.On the day of the scheduled lecture the doubts are discussed followed by the students answering the questions posted on the web. Marks are given according to their answer. These marks are included in their continuous assessment. Evaluation of this current model of teaching is ongoing in the department. However preliminary reports suggest that the students are overwhelmed by this new method as they have to seek answers from various sources. This method help them to be critique and comprehensive. It helps them to improve their retention of knowledge of the topic discussed, thus performing well in the subsequent exams.Active learning will certainly yield a better results. It also make the student to search and learn more. There is increased time for student to study. There will be more interaction with the teachers. However it involves more work to the students and the teacher than the conventional lecture method. Learning technologies should be designed to increase, and not to reduce, the amount of personal contact between students and faculty on intellectual issues.text/html2013-03-20T06:50:18+01:00http://www.webmedcentral.com/Dr. P Ravi ShankarConducting Small Group Learning Sessions in a Cost-Effective Manner: Our Experiences
http://www.webmedcentral.com/article_view/4154
In recent years there has been a lot of emphasis on ‘active’ learning strategies carried out in small groups. While many medical school faculties are interested in adopting small group learning strategies, doubts and concerns remain especially in developing countries. Among these are fitting these activities into a crowded curriculum with emphasis on didactic lectures as the teaching strategy and short answer questions as the major assessment method. Another major concern among teachers is that small group teaching-learning is a resource intensive and high-tech learning strategy not suitable for developing countries. Many faculty members may not be comfortable with small group teaching-learning which employs a different set of teaching strategies and the teachers may have to relinquish a certain amount of control over the learning process.1 The authors have been conducting small group, activity-based learning sessions in medical schools in Nepal for over seven years. Recently they have also introduced small group sessions in a medical school in the Caribbean. They have been using small group learning strategies with minimal investment, utilizing resources already available in medical schools. Small group sessions are as the name suggests sessions where students work together in small groups to achieve specified learning objectives using available resources.
Pharmacology small group sessions at MCOMS, Pokhara: Dr. Shankar and Dr. Subish first took up the challenge of conducting pharmacology small group sessions at the Manipal College of Medical Sciences (MCOMS), Pokhara where the pharmacology laboratory had a traditional setting of benches and desks. Various practical exercises like P-drug selection, dealing with pharmaceutical promotion, pharmacovigilance, designing an adverse drug reaction (ADR) reporting form and communicating drug and non-drug information to a simulated patient were carried out.2,3
Pharmacology small group sessions: The first author had taken up the challenge of conducting small group, problem-based sessions in pharmacology at KIST Medical College (KISTMC) in Nepal. The room where the sessions were to be conducted was around 18 meters by 8 meters. The college admits about 100 students to the undergraduate medical (MBBS) course each year and the batches for the pharmacology sessions consisted of 50 students each. These students were divided into five small groups of 10 students. The academic leadership was supportive of our endeavors but being a newly established medical school resources were limited and we were instructed to develop the sessions using existing resources wherever possible and only purchase new materials when absolutely required. We purchased five tables with a dimension of three by two meters around which students could work. We also purchased sixty plastic armless chairs on which students could be comfortably seated while doing their group work. Flip charts, marker pens and two flip boards were also procured. We had a computer for the room to which an LCD projector could be attached. Different learning resources were loaded on this computer. Three small tables for doing role plays and other activities completed the room set up. Charts, medicines and other resources were also procured. Using these resources we have been conducting small group sessions in pharmacology for over six years in the institution. The sessions have been highly appreciated by the students and their performance in university exams has been good.4 Interesting details of how the faculty members of the department of pharmacology at KISTMC worked towards creating a creative and safe learning environment have been shared in a recent article.5
Medical humanities sessions: We were keen that students at KISTMC should have a degree of exposure to the medical humanities. After discussion with the academic leadership we decided to conduct sessions for first year students. In 2008, the year the first batch of students were admitted our challenge was where to conduct the sessions and how. The college had an empty room on the top floor of the hospital measuring about 25 meters by 15 meters with a white board and plenty of windows but was otherwise empty. The college had purchased student chairs with an attached writing surface for the classrooms but did not finally use them preferring the traditional arrangement of benches and desks. We decided to use these for the module. These chairs arranged in a circle formed a feasible and effective arrangement for small groups. A computer and an LCD projector were procured and two flip boards used for small group presentations. We invested in five microphones and a public address system for the hall. Medical Humanities has been conducted in the institution for nearly six years6 and while students did mention logistics and resources can be improved, their feedback about the module was positive.7 The same room has been used for conducting various workshops and training programs. An integrated OSCE as a method of assessing students at the end of early clinical exposure has also been conducted in the large room since the last four years.
Module on medication safety for students: Dr. P. Subish wanted to conduct a module on medication safety for interested students at the College of Medical Sciences (CMS), Bharatpur as a curriculum innovation project for a FAIMER fellowship in health professions education. The challenge was finding a suitable room and resources for the session as the institution was mainly geared towards traditional, lecture-based teaching. There was a room available above the reading room in the basic science campus. LCD projector and a traditional black board were the resources present. Microphones and public address system were not available. The set up of chairs or stools around a table was used and while flip charts were available they were pasted on the wall using cello tapes in the absence of a flip board. Despite various logistic problems and other challenges including frequent ‘bandhs’ (shutdowns) the authors managed to successfully complete the module. The authors have also conducted workshops and other faculty development programs at CMS using available resources
Small group sessions at the Xavier University School of Medicine: The institution situated in Aruba in the Dutch Caribbean admits students mainly from the United States and Canada for the undergraduate medical (MD) program. Recently driven by a variety of factors there has been a lot of emphasis on small group activity-based learning in the institution. Among the sessions conducted at present is a medical humanities module for first semester (MD1) students, a small group module in pharmacology for fourth semester (MD4) students and a faculty development program for the faculty. The lecture hall of the MD4 students is being used as the venue for the small group sessions. The class room chairs with their writing surfaces arranged together provide comfortable seating for group members. Computers and internet access are available along with a LCD projector. A flip board was purchased and microphones and public address system are available. The small group size of 20 to 30 participants makes it easier in terms of logistics and requirements. Space for role plays, counseling sessions with table and chairs which can be rearranged as per requirements are provided. These sessions are ongoing and initial feedback obtained has been positive.
Learning small group facilitation skills: Perhaps the most important skill to be developed to conduct small group sessions are facilitation skills. We feel the fellowship in health sciences education being offered by the Foundation for the Advancement of International Medical Education and Research (FAIMER) is a wonderful opportunity to learn and develop these skills.8,9 There are three regional FAIMER institutes in India and also institutes in China, Brazil and South Africa in addition to the one at Philadelphia, United States of America which offer a two year fellowship in health professions education. The program is offered at minimal cost to health professions educators from developing nations. Learning from other institutions where small group learning strategies are being used and beginning to conduct sessions in your institution are good methods to further develop and refine your skills.text/html2010-09-09T23:28:39+01:00http://www.webmedcentral.com/Dr. Muhamad Saiful Bahri YusoffThe Reliability And Validity Of The Postgraduate Stressor Questionnaire (psq) Among Postgraduate Medical Trainees
http://www.webmedcentral.com/article_view/558
Objective: To determine the construct validity and the internal consistency of the Postgraduate Stressor Questionnaire (PSQ) among postgraduate medical trainees hence in the future it could be used as a valid and reliable instrument to identify stressors among them.
Methods: Items of the PSQ were derived from a review of literature on the subject and a discussion with experts in the field. It comprised of 28 items with seven hypothetical groups. The content and face validity was established through discussion with experts from field of Medical Education and Psychiatry. It was administered to all participants (N = 34) of postgraduate personal and professional development programme in a Malaysian university. Data was analysed using Statistical Package Social Sciences (SPSS) version 18. Factor analysis was applied to test construct validity whereas reliability analysis (Cronbach’s alpha) was applied to test internal consistency of the PSQ.
Results: Thirty three postgraduate medical trainees participated in this study. Factor analysis found that the 28 items of the PSQ were loaded nicely into the seven pre-determined groups as their factor loading values were more than 0.3. The reliability analysis showed that the Cronbach’s alpha value for The PSQ was 0.95. Whereas, The Cronbach’s alpha values for academic, poor relationship with superior, bureaucratic constraints, work-family conflicts, poor relationship with colleagues, performance pressure, and poor job prospect domains were 0.63, 0.84, 0.81, 0.65, 0.73, 0.78, and 0.70 respectively.
Conclusion: This study showed that the PSQ had good psychometric values. It is a promising instrument that can be used in the future to identify stressors among postgraduate medical trainees.text/html2010-09-12T12:47:33+01:00http://www.webmedcentral.com/Prof. Sunil Kumar JoshiUse Of Information Technology In Medical Education
http://www.webmedcentral.com/article_view/607
Background
The Information Technology Association of America (ITAA) defines Information Technology (IT) as "the study, design, development, implementation, support or management of computer-based information systems, particularly software applications and computer hardware."1 Today, these two terms – computers and IT - are almost synonymous and together, they have webbed the whole globe in such a way that there is not a single part in the world or a single incident that we cannot know of and the amazing part is that we don’t even need to leave our room. In a way, IT has brought the world to our fingertips and it won’t be an exaggeration to say so.
When I collected two sacks full of medical text books from the library of a state owned Soviet medical university two decades back, I had never thought that a day would come soon when no medical student would be doing such an exercise. It was a cumbersome job to stand in the queue for almost few hours, get the books on your back to your hostel. The same process has to be repeated at end of the year to submit these back. Nowadays I hardly believe that a medical student in any part of the world has to do that.
With the development in IT, there has been a significant change in medical education all over the world. The changes is that majority of the medical students are computer literate these days. Instead of heavy books, the students rather carry CD-ROMs, or small drives in their pockets and these can be used anywhere and anytime. New information on medical topics is readily accessible via the Internet and handheld computers such as palmtops, personal digital assistants (PDA).
Use of IT in Medical Education
Information Technology can assist medical education in various ways such as in college networks and internet. Computer-assisted learning, Virtual reality, Human patient simulators are some options. With the help of college networks and Internet, the medical students as well as the teachers may stay in contact even when they are off college. Rapid communication can be established with the help of e-mails and course details, handouts, and feedbacks can be circulated easily. Many medical schools these days use online programmes such as “Blackboard” or “studentcentral” to underline and coordinate their courses. Such programmes allow speedy access to information and quick turnaround of evaluation and messaging, and allow all tutors, assessors, and students at any site to look at the curricular context of their own particular contribution. Similarly, the Internet provides opportunities to gain up-to-date information on different aspects of health and disease and to discuss with colleagues in different continents via net conferencing. Free access to Medline, various medical journals, online textbooks and the latest information on new development in medicine also encourages learning and research.
As computer assisted learning (CAL) is gaining more popularity, these days many medical schools encourage the students to purchase computers, and others are making strategies for integrating medical informatics into the curriculum.2,3 CAL is considered as an enjoyable medium of learning and very suitable for conceptually difficult topics. Interactive digital materials for study of histopathology, anatomy and heart sounds are used widely. Development of anatomical three dimensional atlases of various internal organs using computed tomography and magnetic resonance imaging are very illustrative and help the students to understand the subject matter clearly.
There are real time visualization of surface based anatomy on any personal computer featured with advanced ”speed up” techniques. The data are visible human body and students can build and deconstruct a 3-D model of brain and head etc. Similarly, Advanced Life Support (ACLS) simulators and Haptics ”the science of touch” simulators are used in medical education to develop various clinical skills such as ECG interpretation, appropriate intervention such as ABC, drugs, injections, defibrillation without working on a real patient. These days, highly sophisticated simulators”virtual reality” with highly adanced medical simulation technologies and medical databases are avaialable in the advanced medical schools that expose the medical students to the vast range of complex medical situations. It can emulate various clinical procedures such as catheterisation, laparoscopy, brochoscopy etc. With new technology, the students can virtually go inside each and every organ and see how they actually look like from outside as well as from inside. We now have proofs that we can have virtual trainings that improves the surgical skills of young surgeons.4,5 Is that not a wonderful gift of IT? Yes, there is no doubt.
Not only that, these days, we can also have web based learning.6 The learning materials are uploaded in the Internet, so that anyone in any corner of the world can read them. I appreciate this system very much not only because we can learn more things but also because it sends a message across the world that education and knowledge are basic human rights and we should rise above the national and political barriers and share knowledge with all.
In more organised forms, we can even have formal online medical courses and trainings which are checked and certified by particular medical councils. The courses are designed by medical experts, then peer reviewed and edited by doctors. Students or doctors can attend those courses like any other course in a medical college. At the end of the course, one can also get an evaluation and grades or credits accordingly.7 This system is a perfect one because one does not have to move from one place to the other to join the courses, in which case he would have had to take a break from his present job and also spend a lot of money on travel and accomodation besides the regular fees for the course. And when one has to manage so many things before he could join a course, he would probably think not to join it at all. So, these courses will have less participation which is detrimental to the medical education system. But with online courses, none of such problems seem to arise. In addition, I am sure a lot more doctors would take the course which will raise the standards of health care delivery system. The same applies to medical seminars and conferences. Many doctors can’t attend them just because he can not afford the high expenses. This is specially true for the doctors in developing countries. But with video conferencing and live lectures, IT has provided a perfect solution.
Information technology and medicine
Like any other field, medical system has also updated itself with information technology. IT is widely used in all medical and surgical disciplines. Let me pick an example to see how IT could improve the patient care in a hospital. In Sweden, every person has his personal identity number8 and his every personal details including his health records are digitalised and uploaded in a network system. So, as soon as he enters any health centre, with his identification number, the doctor can get detail information on his medical history including the past surgeries, major events and any on going treatment details. Not only this, doctors from different specialities can review the patient at the same time though they are working in different corners of the hospital. This means that a patient with abdominal pain would not have to go from his general practitioner (GP) to the radiologist, then to the pathologist, then to a surgeon and back to his GP after a long day of painful trip inside the hospital to finally get his prescription for the simple pain. Is it not a better service to the patient that he does not have to take such pain anymore? The bottom line is we need inter speciality cooperation which we call an integrated approach to a patient. And this is very important because only with such co operation can we deliver quailty health service. And thanks to IT, which has made it possible.
Information technology for the developing countries
We all agree that there is a huge difference between the education system and quality of the education between the developing countries and the developed ones. With limited resources, the developing countries cannot afford big researches, big conferences and scientific gatherings. As I mentioned above, even mere participitation in such events becomes difficult. The colleges have poor infrastructures, they don’t have enough trained faculties. Sometimes, due to small number of faculty members and learning resources, colleges have to cut down on the number of students they enroll in a year. In such cases, as far as I can see, only IT can provide a rescue. We can design the courses that every students can take at home, we can have discussion forums where the teachers and students can have interactive sessions. It does not sound ethical to allow many students in the operation theatre considering the increased risk of contamination and unnecessary crowd. But we can record all the surgical procedures and let the students watch and learn which I guess would be equally informative and effective as going to the operation theatre itself.
The other problem medical education system faces in developing countries is the access to journals. Due to limited resources, they can not subscribe all the renowned international journals, which make a very essential part of medical education. Infact, reading journals keeps the doctors and students updated with every new therapies and concepts and it’s what makes the doctors smart. So, what do we do now? Yes, we can definitely turn to IT for help. Its the IT that has made it possible to have online databases like HINARI, PUBMED, Cochrane etc and online journals like BMJ, Nature, Annals, and a lot others. Is that not a privilege we get through IT?
IT has also helped a lot to promote research activities in developing countries. First, it gives access to many previous research articles on the topic, so that people could learn about the methodology previously designed. Next, they could design their own methodology so that the results could be comparable with the previous ones because non comparable findings are not much worth. Besides, unless and until, the findings of a research are published and reach out to numerous people, it does not carry any significance. And, only with IT can we have huge number of readers because very few countries and associations subscribe journals where most of our research articles are published. So, IT has helped to put our national journals in an international arena. Had they not had an online version, no one would have been aware of our journals.
Problem based learning and evidence based medicine are supposed to be the pillars of modern medicine and education system. The essence of these systems lie in the study of researches, literatures and experiments and it requires access to vast amount of information which only Internet can provide. So, IT has become indispensible in the present day medical education system.
Besides these, there are many benefits of e-learnings, which encourages their use9:1. Self paced courses2. Available anytime, anywhere3. Guaranteed consistency4. Personalised and relevant5. Easily updated6. Easy tracking and reporting7. Reduces logistical costs (travel, space, materials)
Difficulties ahead
IT seems to have a solution to everything but then, have we been able to implement all our ideas about IT in medical education? Perhaps NOT! There are many hurdles infront of us and the path is not easy.
First major problem is the technology. Computers and internet services are still a matter of luxury in many places of our country and even in cities, the services are not satisfactory. Slow Internet connections and non-reliability of Internet services are simply enough to discourage the use of IT in education. On the top of these, the daily powercut is a heavy blow. Usually, PDAs are supposed to be very useful and handy to use in wards. But, their high prices simply make them unaccessible.
What ever is said about free access to information should be taken with caution because, at times it proves to be an exaggerated statement. Many big medical researches are conducted and many new things discovered. A lot of new theories are proposed and they are published as well. It would have been very nice to know of all those and implement them in health care system. But, we, specially the developing nations get hiccups on the very first step – we don’t get access to those information at all. We are forced to subscribe to those online versions as well which we cannot afford. So, IT doesn’t seem to help in such conditions.
Another hurdle in proper use of IT in medical system is that not everyone know how to use computers and IT. Most people of the older generation don’t have much idea of it. So, in such condition, how can we expect to computerise our education system. It does not seem easy. The other problem could be quality control. If we see the online study materials, there are millions of websites and materials. So, how do we rate them, how do we filter them? It’s a big challenge in itself. If the students get the wrong information instead of the right ones, it would be the biggest backfire we can ever expect.
One more difficulty in integrating IT and medicine could be the fact that students have to learn both of the specialities. Often, there are reports and discussions that medical students are already unnecessarily burdened with loads of studies. On the top of that if they have to learn computers and also many other application programs in order to be able to use IT efficiently, won’t that be an extra burden to the students? Won’t it affect their studies.text/html2010-09-16T23:08:36+01:00http://www.webmedcentral.com/Dr. Muhamad Saiful Bahri YusoffThe Learning Approach Inventory (LA-i): Its Reliability and Validity Among Medical Students
http://www.webmedcentral.com/article_view/647
Objective: To determine the internal consistency and construct validity of the Learning Approach Inventory (LA-i) among first year medical students.Methods: Cross sectional study was done on 196 first year medical students in Universiti Sains Malaysia (USM). The items of the LA-i were framed based on characteristics of three learning approaches. The Cronbach’s alpha reliability analysis and factor analysis were applied to measure internal consistency and construct validity respectively. The analysis was done using Statistical Package for Social Science (SPPS) version 18.Result: A total of 196 medical student responded to this study. The Cronbach’s alpha value of the LA-i was 0.867. The Cronbach’s alpha values of surface, strategic and deep domains were 0.69, 0.81 and 0.89 respectively. Factor analysis showed all 12 items were loaded into 3 constructs and their factor loading values were more than 0.3. Each domain of the final version LA-i has 4 items.Conclusion: The LA-i has shown good psychometric values. It is a valid and reliability tool to identify learning approach of medical students. It is a promising inventory that can be used to identify learning approach among students in future.text/html2010-09-16T23:10:38+01:00http://www.webmedcentral.com/Dr. Muhamad Saiful Bahri YusoffThe Construct Validity and Internal Consistency of the Adult Learning Inventory (AL-i) among Medical Students
http://www.webmedcentral.com/article_view/648
Objective: To determine the internal consistency and construct validity of the AL-i among first year medical students.
Methods: Cross sectional study was done on 196 first year medical student in Universiti Sains Malaysia (USM). The items of AL-i were framed based on the adult learning principles. The Cronbach’s alpha reliability analysis and factor analysis were applied to measure internal consistency and construct validity respectively. The analysis was done using Statistical Package for Social Science (SPPS) version 18.
Result: A total of 196 medical students responded to this study. The Cronbach’s alpha value of the AL-i was 0.798. The Cronbach’s alpha values of adult learner and child learner domains were 0.85 and 0.81 respectively. Factor analysis showed that on 10 items were nicely loaded into two constructs as their factor loading values were more than 0.3. Approximately 2 out of 12 items were removed from the inventory because they did not fit into the intended domain. Each domain of the final version AL-i has 5 items.
Conclusion: The AL-i has shown good psychometric values. It is a valid and reliability tool to determine adult leaner status among medical students. It is a promising psychometric instrument that can be used to determine types of learner among students in future.text/html2010-10-04T19:31:27+01:00http://www.webmedcentral.com/Mr. Zaher ToumiThe Knowledge And Skills Of Surgical Foundation Year One Doctors In A Teaching Hospital In The UK: A Review And Results Of A Survey
http://www.webmedcentral.com/article_view/887
Introduction:Junior doctors had acquired knowledge and skills in the past using weekly specialty based teaching sessions and on the job learning.They currently learn on the job as before (with the restraints of less working hours). However, generic hospital wide teaching programmes have replaced the specialty teaching programmes. We aim to assess the effects of these changes on the surgical foundation year one doctors’ knowledge of common surgical conditions and on their basic surgical skills.Methods:We carried out a survey of foundation year one doctors towards the end of their first surgical placements in the largest teaching trust in Manchester. We surveyed the foundation year one doctors’ perception of their abilities to manage common surgical conditions and to carry out basic surgical procedures.Results:Response rate was 100% with 24 doctors participating in the survey (n=24). Only 9 out of 24 FY1s (38%) agreed that the generic teaching programme provided teaching which is relevant to their surgical placement. The FY1s’ perceived knowledge and ability to deal with common surgical conditions was 3/5. Doctors in GI surgery placements fared better on average (mean 3.20 vs. 2.78, pConclusions:Foundation year one doctors needs specialty teaching as they rotate through their rotations apart from the generic teaching programme. It could be useful if all those who cover surgical on call shift to go through a GI placement to improve their skills and knowledge in common surgical conditions.
text/html2010-12-13T15:04:26+01:00http://www.webmedcentral.com/Ms. Ashley BrissetteMotivation In Medical Education: A Systematic Review
http://www.webmedcentral.com/article_view/1261
The purpose of this study was to systematically review the literature on motivation in medical education, with the intention of providing a framework for educators to consider this important dimension of curriculum development. Motivation is the translation of a person’s basic psychological needs and drives, filtered through their view of the world, toward an action with an anticipated result. There is a range of motivational states from intrinsically motivated to immotivated; the types of motivation are not dichotomous, and the model itself is fluid (i.e.: a person can move between different types of motivation depending on the situation). Educators can foster intrinsic motivation by addressing learner’s needs for competence, autonomy, and relatedness. Each need fulfilled on its own promotes intrinsic motivation, however, fulfilling all three needs at once creates a synergistic effect. The need for competence is fulfilled by providing optimal challenge and positive performance feedback, the need for autonomy by providing choice and opportunity for self-direction, and the need for relatedness by providing a sense of belongingness and connection to the medical profession. Motivating the learner may be one of the most important things that an educator does.text/html2010-12-23T15:32:52+01:00http://www.webmedcentral.com/Dr. P Ravi ShankarPromoting Integrated Learning And Open-book Examinations In South Asian Medical Schools
http://www.webmedcentral.com/article_view/1427
Abstract:South Asia has a large proportion of the world’s population and medical schools. The examination pattern is traditional and emphasizes factual recall of information. Evaluation can serve a number of purposes in medical education. In Nepal the six basic science subjects and Community Medicine are taught in an integrated manner during the first two years of the course. Assessment however continues to be on the basis of individual subjects. In India different basic science subjects are taught at different periods of the course.In Nepal basic science education is structured in the form of organ systems. Different subjects teach the particular system in the allotted time period using didactic lectures. Clinical problems, self-directed learning and problem solving sessions will be more effective in integrating subjects. In addition to horizontal integration vertical integration with clinical subjects is also important. Formative assessment has an important role in learning. Assessments should ideally be integrated. Open book exams (OBEs) can be used as one of the methods to assess the ability to retrieve information. Assessment should emphasize concepts and understanding rather than stressing factual recall of information.South Asia has a good proportion of the world’s medical schools and creates a large percentage of the world’s health manpower. The examination pattern remains largely traditional and emphasizes factual knowledge and mastery of information. Rote learning is emphasized throughout school in South Asia.Educational objectives are becoming important in many countries. Sessions are planned to achieve the objectives and evaluation provides the means to know whether or not the objectives have been achieved [1]. Evaluation can also serve as feedback on the effectiveness of the teaching-learning process. Formative assessment gives feedback to students about their learning process and steps to be taken to further improve it.Assessment in Basic Sciences in Nepal:It has been said that whoever controls the examination, controls the curriculum and controls the way students learn. The world over, many medical schools are adapting an integrated curriculum where various subjects serve as tools for solving a patient problem. In Nepal, the seven basic science subjects (Anatomy, Physiology, Biochemistry, Pharmacology, Pathology, Microbiology and Community Medicine) are taught in an integrated organ-system based manner during the first four semesters with regular clinical contact. The Kathmandu University emphasizes integrated problem-based learning but the students are still assessed subject wise [2]. In Tribhuvan University, there are integrated system-wise papers but each subject still sets its own questions and students do not bring together knowledge of various basic science subjects to solve a clinical problem [3]. Assessment in basic sciences in India:In India the subjects of Anatomy, Physiology and Biochemistry are taught and examined at the end of the first year of the undergraduate medical (MBBS) course and the subjects of Pathology, Microbiology and Pharmacology are taught and examined during the next eighteen months. To the best of my knowledge assessment is on a subject basis and integrated assessment is not carried out. Animal experiments are still being used in Physiology and Pharmacology in a few universities. No reports of open book assessment in medical education in India were obtained on doing a Pubmed and Google Scholar literature search. Promoting integrated learning:Kathmandu University (KU) recommends that the different academic departments should identify in an integrated manner the educational objectives which are to be achieved and that teaching of the various subjects should take place synchronously [2]. However, I personally feel that integration is best achieved using clinical cases or case scenarios.When a doctor practices and sees a patient he/she will have to bring together and integrate various subjects and use his/her knowledge and skill to treat the patient. If subjects are taught individually then knowledge often stays compartmentalized. Over years of practice many doctors achieve the skill of integrating subjects and focusing the knowledge towards patient care. If the student learns this skill right from the first day of medical school then he/she would be much better equipped to handle patient problems.Sequential didactic lectures which are used for integrated learning in many schools is not very effective in integrating subjects and teaching the student to orient the knowledge towards patient care. Student seminars emphasizing a particular disease are found to be an effective means of integration. Manipal College of Medical Sciences (MCOMS) conducts student seminars every fortnight and these seminars have been effective in integrating basic science subjects [4]. At KIST Medical College, Lalitpur correlation seminars are held at the end of each organ system. The topic/s for the seminar/s and the objectives to be covered from each department/subject are discussed in detail. Basic science curricula have been studied at Chiropractic colleges in a recent article [5]. At most chiropractic colleges basic sciences eg. general anatomy, physiology, biochemistry, etc are taught as stand-alone content domains. The lack of integration creates difficulties for students who need to understand how the parts function together as an integrated whole and apply this understanding to solving clinical problems. More horizontally integrated basic science curricula could be achieved by several means: according to the author. Integrated Part I National Board of Chiropractic Examiners questions, a broader education for future professors, an increased emphasis on integration within the current model, linked courses, and an integrated, thematic basic science curriculum. "Anatomizing" is a new verb used to describe the breaking apart of a complex entity such as the human body, into isolated pieces of information for study [6]. The problem is the parts can never equal the complex, integrated whole. This practice does not prepare medical students for the inevitable task of dealing with the integrated structure-function of the human body, both normal and diseased, as patient managers. Assessment questions focusing on recall of previously memorized information fosters the learning behavior of only memorization. Examination questions that assess student understanding and integration of the content will foster high-quality learning producing better practitioners and lifelong learners. These articles stress the importance of integrated learning of the Basic Sciences with clinical relevance of assessment questions in promoting integrated learning among students.Small group problem-solving sessions:A set of common clinical problems should be identified and students should work in small groups towards solving the problem. The facilitator should identify learning issues and create a conducive environment for study. Each small group should contain not more than ten students. Lectures should be reduced to the minimum and should be only for topics which cannot be covered through problems. For specific practical skills resource sessions can be organized. Faculty members can help students better understand their subject through the perspective of the patient problem. In addition to horizontal integration among basic science subjects and Community Medicine vertical integration with clinical subjects should also be done. This will create greater interest among students for learning the basic sciences. In my institution objectives from the clinical sciences are also given to students during the correlation seminar and a clinical faculty member is also associated with seminar preparation and assessment. During the clinical years basic science subjects should also be included in student seminars. This will help students revise these subjects and further underline their importance in treating patients.Integrated learning sessions using clinical problems have been tried in some South Asian medical schools. At the Ziauddin Medical University in Pakistan vertical and horizontal integration among subjects has been achieved using problem-based learning [7]. Formative and summative assessments:Formative assessment during the learning sessions should be done. Group dynamics, participation in group activities and ability to approach the clinical problems in a correct manner are various parameters which can be assessed. Formative assessment of students during pharmacology practical sessions are carried out at KISTMC and student performance in formative assessments is considered during the final pharmacology practical exams [8].The summative assessment should at least partly be integrated and open book examinbations can be considered. In Singapore the curriculum of Community, Occupational and Family Medicine (COFM) aims to produce graduates with the skills to critically appraise evidence, prevent and manage diseases and promote health in the community and in primary healthcare [9]. Innovative assessment methods such as open book examinations (OBEs), objective structured communication stations and evaluation of student participation in group work are used.Open book exams:With the information overload in medicine, the emphasis is shifting from knowing something to knowing where to find the information. Core basic knowledge is important but many other things can be looked up. OBEs strongly favor this shift in emphasis. I believe students should be assessed through a clinical problem which they try to answer in an integrated fashion using textbooks and other sources. I am ambivalent about allowing internet sources of information in the examination as the information retrieval is very quick and does not need any effort on the part of the student. Doctors in practice can however use the net for quick information once they have mastered ‘retrieval’ skills during the course of study.The department of Pharmacology at MCOMS teaches students to select a personal or P-drug for a disease condition on the basis of efficacy, safety, cost and convenience. During the practical examinations students choose a P-drug for a given disease condition, verify the suitability of the selected P-drug and write a prescription. They are allowed to refer to textbooks and other sources [10]. The students learn to retrieve information, critically appraise it and make informed choices. They were in favour of the OBE [10]. OBE is also used in the P-drug selection exercise during Pharmacology practical examinations at KISTMC. Thus at least a part of the assessment of students should stress OBEs, information retrieval skills rather than only rote learning and factual recall.Student perspective about integrated curricula and open book exams:In 2001 the University of New South Wales Faculty of Medicine in Australia started designing a curriculum-management system to support the development and delivery of its new, fully integrated, outcome-based, six-year undergraduate medicine program [11]. The Web-enabled curriculum-management system is known as eMed, and comprises a suite of integrated tools used for managing graduate outcomes, content, activities, and assessment in the new program. The eMed functions were determined by organizational and curricular needs, and a business management perspective guided its development. Evaluation results indicated a high level of user acceptance and approval. Integrated online formative assessments were introduced in an Australian medical school [12]. The assessments were administered to students enrolled I the first two years of the undergraduate medical program. Participation in formative assessments was associated with a higher end of course score. I could not come across studies dealing with student perspective towards OBEs in the literature.
text/html2011-01-18T20:31:46+01:00http://www.webmedcentral.com/Dr. Shobha KLInitial Experiences Of Developing An Assessment Scheme For Problem Based Learning Module In An Undergraduate Preclinical Curriculum
http://www.webmedcentral.com/article_view/1477
Background:Problem based learning (PBL ) is an instructional method which utilised clinical cases or problems as a context for students learning in basic and clinical medicine. Melaka Manipal medical College has incorpoarted PBL into its undergraduate medical curriculum. During the process we developed a system to assess the students’ performance during the PBL process. The study was aimed to understand the correlation of this method with other existing assessment methods and its reliability.Method: The study reports the data generated during the PBL process of september 2006 batch. Students’ performance was assessed using the new assessment method. The marks obtained during the three PBL sessions were analysed for its correlation with other assessment methods. Faculty feedback regarding the assessment system was also taken.Results: Percentages of students’ who scored above ≥ 4/6 in the brain storming scores increased from the first to the third PBL session (80.4% to 90%) , tutors were satisfied with the students’ performance. PBL evaluation provided a documented feedback to the students on their knowledge, skills (e.g. use of resources, problem analysis and solving) group work skills and attitudes.text/html2011-01-27T22:45:52+01:00http://www.webmedcentral.com/Dr. Patrick M FoyePhysical Medicine & Rehabilitation Residents Teaching Clinical Anatomy In The Gross Anatomy Lab: Enhanced Student Performance
http://www.webmedcentral.com/article_view/1483
Background: Preclinical curricula in medical schools are moving away from teacher-centered and discipline-based curriculum to an integrated clinical model. Our medical school's Physical Medicine and Rehabilitation (PM&R) resident physicians taught clinical correlations in the gross anatomy lab for first-year medical students. This study assesses, via subjective and objective measures, whether these sessions improved student understanding of musculoskeletal and neuromuscular clinical anatomy.Design and Methods: PM&R residents taught clinical correlation sessions in the cadaver lab for two afternoons: once at the end of the dissection of the thorax, back and upper extremities, and then again after dissection of the abdomen, pelvis and lower extremities. The sessions were in small group to facilitate interaction. Students' performance on musculoskeletal questions in the National Board of Medical Examiners (NBME) anatomy subject examination was evaluated to assess the effectiveness of this teaching approach. Also, surveys were completed by 288 medical students (out of 351) and also by the residents themselves.Results: Results indicate that teaching sessions by residents enhanced students’ understanding of human anatomy and, importantly, its clinical application. These educational benefits for students were found via both subjective evaluations by the students themselves as well as being corroborated objectively via external, standardized, national testing (markedly improved scores on the musculoskeletal components of the NBME, p=0.0048). It was also a positive experience for the residents, who learned the material at greater depth and gained valuable teaching skills.Conclusion: The PM&R residents teaching clinical anatomy to medical students within the cadaver lab educationally benefited both the students and the residents.
text/html2011-03-11T22:26:56+01:00http://www.webmedcentral.com/Dr. Mohsen Adib-HajbagheryTraditional Lectures, Socratic Method and Student Lectures: Which One do the Students Prefer?
http://www.webmedcentral.com/article_view/1746
Background: Traditional lectures are still the most popular instructional method in the universities. This paper aimed to report the effects of traditional lectures, Socratic Method and students' lectures on the students? anxiety, learning satisfaction and exam score.Methods: A quasi-experimental study was conducted on 40 nursing students to assess the effects of three methods. The course content was divided into three sections and each section was taught using a different method. The students? anxiety was assessed at start and at the end of sections. The students? satisfaction and their exam score were evaluated at the end of sections.Results: Mean exam score of the students was 12.62 for traditional lecture, 14.80 for Socratic Method and 15.10 for the students' lectures. The students learning satisfaction was higher at the end of Socratic Method and students' lectures method. Traditional lectures induced the least anxiety while the Socratic Method induced the most.Conclusions: Socratic Method and students' lectures are more preferred by the students. Level of the students' anxiety could be diminished through more preparations.
text/html2011-03-28T13:04:45+01:00http://www.webmedcentral.com/Dr. Srinivas R DeshpandeThe Original Sin we All Did
http://www.webmedcentral.com/article_view/1806
The original sinThe original sin we all did - and allowed the medical council to doWas to get the first phase reduced to 8-9monthsThe original sin we all did -allowed the medical council to doMade our kiddos less proficient in anatomical physiochemistryAnd feed the hard kebab to a milk fed infantAllowed the original sin long enough-Made the medical toddler to learn anatomy fast and soonAnd vomit, fully-as told, state councils never asked why such hurryWe never protested, did our biddingFor this, the heavens will never bless us all,Committing crime by knowledge excess-all at onceOur council never understood as nowAnd inflicted faculty reduction to please its paid customer collegesEven now-When we cry bout the reduction in faculty, by half-we getBulldozed -told shut up, and frowned, get dictates toHurriedly teach them all anatomy, thru all orifices, it hurtsPhysiology and biochem as the nails in their coffinsThere died medicine as you thought ours was a nonmedical subject.There died there interest in medicine, as we just hurried thru-Hence the preterm babies, our MBBS and BDS kiddosDon't know anything -when they exitWe all know.This is but a way to destroy-the breed of doctors, and create a clan of quacksWho know not much of anything?Anatomy or physiological chemistryOr medicineFor T'is said-the best way to destroy a race is to destroy its intelligentsia-and the way a doctor can thinkAnd behaveMake this guy deficient-in basicsAnd he shall get destroyedWe forgot-Virchow, Pasteur, Metchnikov and ventured into venture capital medicineAnd merchandised medicine, fully for our marasmic children.But our clinician brothers who got genetically divergedEvolutionarily in race for seat selectionsDictated to the council-bloody useless subjects!!!Said-Wretched-kill these Preclinical and paraclinicals-shi#!! Sheer Waste!!Send the kiddos to clinical-we teach them all the good stuff in clinicalLet the non clinical rubbish be over in a year-said our luminary clinicos;And we now have maladjusted medicos; yes sir, yes sir,Whatever happened to your integration?Vertical and horizontalMoney integrated in your subjectsWe just degenerated-No complaint again-we said, digested the injuries, weakenedAs our strength got reducedSubject matter curricula remained sameUniversities remained as dumb-the universitiesSurmised MBBS is an undergraduate courseAnd applied for auto destructionAnd allowed Msc to be called postgraduate courseAllowed them to teach MBBSThese Kids of Mudaliar-who knew not an ounce of medicine by the bed side,Were let loose on our infants by our own medical council-these idiotsTaught our MBBS kiddos medicineThe subject they learnt hands-on; inappropriateNon efficient non relevant teaching we allowed- The original sinWas thus to have reduced the first phase to 8monthsAnd to allow inappropriate teachers to exist, to dominate.The original sin we all did -allowed the medical council to doMade our kiddos less proficient in anatomical physiochemistryVery intelligent, we can gauge-yet we continued our original sin,And now we venture to increase the teacher strengths to 250And increased the strain on the hapless teacherWho has been already teaching less?As teaching colleagues' have got fewer and work has buried him,His profession has been a pain-cause of his penuryStrained by dental, mental and accidental teachingAnd yet think 250 student strength will be fineThe original sin we all did, again and again-allowed the medical council to doMade our kiddos less proficient in anatomical physiochemistryWhile we hire truckload patients to our empty private college hospitalsAnd spill blood in new labor theatres to simulate a used placeDress up clerks as technicians,O gods of medicine devour us-this will go on how longOne day show,One day instrumentsOne day teachers, technicians, and tutorsEven one day patientsWe have seen it allHow many sins more-we don't knowAs we are very intelligent, being IndiansTo beat the laws, beat the constitutionWe create birth and death records,We cheat MCI inspectors as they know very wellAll game-well fixed, routine.How many sins more-we don't knowAs we are very intelligent, being IndiansThe original sin we all did -allowed the medical council to doMade our kiddos less proficient in anatomical physiochemistryAnd be born intelligent in this landYet not migrate, for betterYet not migrate to avoid this double standards game.text/html2011-05-28T15:16:41+01:00http://www.webmedcentral.com/Dr. Walter ChenBridging Medical Student Stress and ACGME General Competencies: A Pilot Study of the Problem-Solving Conference
http://www.webmedcentral.com/article_view/1948
Background: Medical students encounter a number of problematic issues during transition periods in the clinical training. The Problem-Solving Conference (PSC) was developed to provide a platform for students to disclose these issues and to explore whether the Accreditation Council for Graduate Medical Education (ACGME) General Competencies might provide solutions. This pilot study aimed to evaluate the feasibility and applicability of PSC program.Methods: All of the 15 students from the Department of Chinese Medicine participated in the conference bi-weekly from June 2006 to May 2007. For each PSC session, students completed a form describing problems they had encountered and associating them with the ACGME General Competencies. The program director and clinical teachers of the PSC reviewed these forms before initiating the conference. Finally, the students completed a satisfaction survey by the end of the one-year program.Results: Based on a total of 250 forms completed, clinical problems linked with: systems-based practice (21.2%), practice-based learning (13.3%), interpersonal communication (13%), and professionalism (12.8%). Furthermore, 29.9% of the problems had a negative impact on future practice. The most frequent coping strategies were: using instrumental support, acceptance and active coping. Most participants were satisfied with the PSC format and instructors’ feedback. While students recognized the educational value of the PSC, they suggested that it should be held less frequently.Conclusions: The PSC is an innovative, learner-centered and competency-oriented program. The program creates opportunities for face-to-face communication and helps students to cope with problems related to the ACGME General Competencies. Thus, the PSC appears to be a useful clinical teaching method.
text/html2011-06-13T21:13:55+01:00http://www.webmedcentral.com/Dr. Sajita SetiaCase Based Learning Versus Problem Based Learning: A Direct Comparison from First Year Medical Students Perspective
http://www.webmedcentral.com/article_view/1976
Background: Case-based learning (CBL) is an educational paradigm closely related to the problem based learning (PBL) that uses a guided inquiry method and provides structure during small-group discussions. To date, no studies have directly compared PBL and CBL from medical students’ perspective in developing countries.Aim: To compare first year medical students’ attitudes to CBL versus PBL after alternating the teaching methods during several teaching sessions.Methods: After conducting several PBL sessions, students were introduced to CBL where the facilitator played an important role during the small group discussion sessions. At the end of all the CBL sessions, students filled a questionnaire form that sought opinions on (i) rating of CBL model as a tool in understanding concepts’ compared with regular teaching sessions and PBL (ii) global analysis of CBL on 4-point likert scale (iii) overall remarks about CBL. Gender differences in the level of attitudes and perceptions towards the CBL program were evaluated by logistic regression (enter method).Results: A total of 88 first year medical students took part in the questionnaire. Majority of the students’ rated CBL in understanding concepts as “good” compared with both regular teaching sessions as well as PBL. Majority of the students’ rated ‘‘agree’’ on a 4-point likert scale for ‘‘motivation by CBL to work more in this subject’’, ‘‘improvement of problem-solving skills using CBL”, “CBL as a worthwhile progression from PBL”, etc. Female students responded more positively towards CBL than male students. Conclusion: Students viewed the constructs of CBL better than PBL.
text/html2011-07-06T19:48:23+01:00http://www.webmedcentral.com/Dr. Henry TulganThe Challenges of Providing Continuing Medical Education at a Non-Teaching Community Hospital
http://www.webmedcentral.com/article_view/2005
A necessary step leading to improvements in the health of individuals, communities and populations is the recognition of the critical role of Continuing Medical Education (CME) for practicing physicians. CME, a lifetime commitment, rightfully has taken its place as a full time partner with undergraduate and graduate medical education. A pressing issue at this time is to respond to the need for and implementation of accredited programs for physicians with busy practice schedules in non-teaching community hospitals. Shrinking resources have caused a number of these small institutions to cease their roles as accredited CME providers to the detriment of their staff members. However, recognition of the preservation of CME for its staff because of increasing emphasis in maintenance of certification and maintenance of licensure has led the leadership of WMHMC to take the opposite position. This will facilitate regular learning internally obviating the necessity for travel to academic centers, dependency on distance learning formats while allowing needed person to person interchange.WMHMC is a 71 bed hospital based in Palmer, MA with 4 additional regional practice sites. 68 dedicated physicians consider it their primary affiliation. Although there is a fiscal relationship with the University of Massachusetts Memorial Health Center (UMMHC), the institution is not one of its medical school’s designated teaching affiliates. Nevertheless, at WMHMC, the continued provision of CME for the staff and other health care providers is recognized as a vital component of its mission. It is also one means of reducing a potential source of stress for its practitioners. WMHMC maintains its CME program in full accord with the definition of CME by the Accreditation Council for Continuing Medical Education (ACCME). The definition includes identification, development and promotion for physician maintenance, competence and incorporation of new knowledge to improve quality care for patients and their communities. (1) This definition serves the needs of the staff of WMHMC and contributes to the care of its patient population. In addition to those members of WMHMC’s medical staff who dedicate time and effort to providing teaching for their peers, the existing fiscal relationship with UMMHC and its geographic closeness allows for excellent guest faculty, supplemented at times by additional invitees. Activities are developed to fulfill the highest level of AMA Category 1 CME. In recognition of the quality of its program, WMHMC received full accreditation as a state accredited provider of CME by the Committee on Accreditation Review of the Massachusetts Medical Society at its last site survey in 2008. Activities strive to provide quality education towards both maintenance of certification for the components of the American Board of Medical Specialties and for maintenance of licensure in the Commonwealth of Massachusetts which includes hourly requirements for Risk Management activities by its Board of Registration in Medicine (BRM) that are addressed. Not only has WMHMC continued to maintain its regularly accredited activities, in the past 12 months it has greatly expanded the numbers of them. They all fulfill identified specific practice gaps in accord with the 2006 ACCME criterion based system (2) and utilize the core competencies of the Accreditation Council for Graduate Medical Education (ACGME). (3).Physician staff satisfaction measured by attendance, activity evaluation and a yearly survey is overwhelmingly positive. Furthermore, having accredited CME at WMHMC has been a positive recruitment tool in a shrinking pool of available physicians.Community physicians have mandated requirements for CME which at least in part can be successfully implemented in non-teaching practice locales at a time when there is decreased funding, projections of fewer physicians with fewer hours for them to seek CME opportunities requiring time away from busy practices. Physicians and parenthetically affiliated health care professionals are deeply appreciative of opportunities to receive significant portions of their CME internally. The ultimate outcome is projected to be better health in the communities served by a staff that receives a portion of its education largely directed to its specific gaps. Measurements of quality improvement will serve to validate the impact of the educational activities as will state and national public health data over time.text/html2011-07-19T20:54:27+01:00http://www.webmedcentral.com/Prof. Gowrishankar RamaduraiComparison of Trace Element Levels in Fasting and Postprandial Blood Serum Samples
http://www.webmedcentral.com/article_view/2026
Trace elements play important role in Insulin metabolism and alterations in trace elemental concentrations in the human body have been studied for their association with the occurrence of Diabetes Mellitus. However there have been no specific investigations on comparison of trace element levels between Fasting and Postprandial blood. Comparative studies on trace element concentrations in Fasting and Postprandial blood serum samples have been carried out using PIXE. We find that there are no statistically significant differences in the major and trace element concentrations in the two sets of samples.text/html2011-09-09T17:35:26+01:00http://www.webmedcentral.com/Mr. Zaher ToumiPMETB Report of Training in General Surgery in the North West Deanery
http://www.webmedcentral.com/article_view/2175
PMETB: Establishment and MergerThe Postgraduate Medical Education and Training Board (PMETB) was established by the General and Specialist Medical Practice (Medical Education, Training and Qualifications) Order 2003. The PMETB was created in order to address concerns about the perceived lack of transparency in medical postgraduate education and the inconsistency in the quality of medical training across the UK.text/html2011-10-17T10:39:40+01:00http://www.webmedcentral.com/Dr. P Ravi ShankarTeaching Medical Students to use Antibiotics Rationally in a Medical School in Nepal
http://www.webmedcentral.com/article_view/2329
Antibiotic resistance is becoming a major problem all over the world. Inappropriate use by health professionals is a major factor contributing to resistance. A variety of factors influence use of antibiotics and other medicines by doctors. Problem-based learning of pharmacotherapy has been recommended as key intervention to improve the use of medicines. At KIST Medical College, the department of pharmacology teaches students to use essential medicines rationally. The department has identified ten main learning areas in pharmacology. These areas are learning to use essential medicines rationally, the Personal or P-drug selection process, Understanding social issues in use of medicines, Understanding and responding to pharmaceutical promotion, Using independent sources of medicine information, Using antibiotics rationally, Analyzing prescribing using World Health Organization (WHO)/International Network for the Rational Use of Drugs (INRUD) indicators, Communicating with a simulated patient, Reporting adverse drug reactions (ADRs) and carrying out simple calculations in pharmacology. In this manuscript the authors describe how rational use of antibiotics is covered throughout the module and is linked with the different learning objectives.text/html2011-11-13T12:12:43+01:00http://www.webmedcentral.com/Dr. P Ravi ShankarStudent Perception About Peer-Assisted Learning Sessions in a Medical School in Nepal
http://www.webmedcentral.com/article_view/2459
Background: Peer-assisted learning has been informally used in medical schools in Nepal. The manuscript describes feedback from first year students about learning sessions conducted by third year students.Methods: Two third year medical students (BS, AKS) conducted interactive learning sessions for first year students during the last week of March and first two weeks of April 2011. The session for each subject was of 2 hours duration and the number of students was 25 for some sessions and 50 for others. The sessions concentrated on revising concepts of the module and preparing students to answer theory question papers. Student opinion was studied using a questionnaire.Results: Seventy-five of the 100 students (75%) completed the questionnaire. The common feedback obtained were the sessions concentrated on must know areas (36 respondents), the learning environment was friendly (21 respondents), and students learned how to answer exam questions (12 respondents).Conclusions: The feedback suggests that student perception of peer teaching was positive and more sessions can be considered in future. Further studies are required.text/html2011-11-14T15:02:49+01:00http://www.webmedcentral.com/Dr. P Ravi ShankarPrivatization of Medical Education in Nepal and South Asia: An Important Area for Future Research
http://www.webmedcentral.com/article_view/2471
Abstract:In the South Asian region a number of private medical schools have been opened recently. In many countries at present private medical schools outnumber government run schools. There are many opinions and concerns about private medical schools. There may also be advantages. Objective evidence for the opinions and concerns are lacking. In this article the author highlights the urgent need for research in these areas.In the South Asian countries of India, Pakistan, Bangladesh and Nepal many medical schools have recently opened in the private sector. The same is true for nursing, pharmacy and allied health sectors. These schools receive little or no support from the government and are dependent on high tuition fees for their survival and development. In Nepal, medical schools charge between US$ 32000-40000 for Nepalese students, US$ 50000 for Indian students and US$ 60000 for students from other countries [1].I am a medical educator and faculty member at KIST Medical College, Lalitpur, Nepal a private medical school in the Kathmandu valley. In this letter I intend to share possible implications of privatization on various aspects of medical education and medical practice and underline the urgent need for scientific research into these issues. There is a paucity of research on this topic. The author has read newspaper and media articles highlighting lacunae in private medical schools but was able to access very few journal articles on doing a Pubmed and Google Scholar search. Problems have been noted in private medical schools in India [1]. Similar problems have also been noted in Bangladesh, Nepal and Pakistan.Selection process: Student selection procedures vary. In Nepal, private medical schools select students who have passed (secured more than 50% of the available marks) an entrance examination conducted by the respective affiliated university for self-financing seats. The university does not rank students and influences such as money, contacts and political influence can bias the selection process. The colleges are free to select foreign students after an interview.Career plans: Informal interactions with students in my school reveal many intend to migrate to developed nations after graduation. Studies are required on whether private school students are more likely to emigrate compared to government school ones. Private, self-financing students constitute a large proportion of the student body. In Nepal around 70% of medical students are self-financing. The implications on the health system of a large number of doctors emigrating have to be studied. Private school students staying within the country are more likely to work in urban areas and specialized institutions. This was my impression on interacting with students and from preliminary analysis of a study being conducted by me and other authors on student perceptions about working in rural Nepal after graduation. In Nepal private medical schools have to provide 20% of total seats (in case of foreign owned schools) and 10% of total seats (for Nepalese owned schools) in full tuition feel scholarship to students selected by the Ministry of Education. These students have to work in rural Nepal for two years after graduation and are becoming an important source of support to the health system [2].This important phenomenon has again not been properly studied. There is a belief among the general public that treatments provided by private school doctors may be expensive due to overtreatment, use of more expensive medicines and diagnostic modalities to recover the high investment on their education. Hard objective data is lacking and may be difficult to obtain. This is another important area for research.Economic benefits: Privatization of medical education has led to opening of a large number of medical schools. Medical schools with a large number of resident faculty and other staff, students and the teaching hospital with patients seeking treatment can play an important role in socioeconomic development of the area within which they are situated. There are employment opportunities for the local people and the investment of a large amount of money boosts the local economy. Most schools enter into agreements with the local community promising to provide a certain percentage of semi-skilled jobs in the institution to community members. In addition shops, restaurants and lodges are opened to cater to the requirements of patients, students, faculty and other employees. Examinations: Concerns have been raised about standards of examination in private medical schools. The management has the objective to obtain the best results possible. Many want to attain it using the least resource outlay. In Nepal, Tribhuvan University has adopted the system of coding answer papers so that the examiner does not know the student identity. In many universities in India answer papers are sent to a different region of the country. In medical education there are also practical and viva-voce examinations which can offer scope for bias. Improving the assessment system to make it more objective and transparent is an important challenge. College finances: Some schools are run by non-profit trusts while others are managed by businessmen and politicians. Most new medical schools are for profit and investors expect a quick return of investment. These schools have to raise their own resources and their main sources of income are student fees and income from hospital patients. Many private teaching hospitals attract much less patients than government hospitals and often schools cross-subsidize treatment using money gained from students to ensure good bed occupancy rates for teaching purposes. The first ten years require substantial investment to create academic and patient care facilities and other resources. After ten years colleges make a good profit with increasing student admissions and launching of postgraduate programs. Greater commitment towards students: Private medical schools have greater commitment towards students as students are the primary source of revenue for these institutions [3]. Student requirements occupy an important place in the school’s priorities and colleges try to address student requirements as far as possible. The primary emphasis is on ‘good’ results in the university examinations and certain colleges also focus on good performance of their students in licensing examinations. Other issues: The quality of prescribing and care provided by doctors who graduated from government and private schools has not been compared. Self-financing students have used their own money to finance their education and their obligations to the health system and the country may be less. Studying the impact of privatization on education and healthcare in south Asia and in other regions (through emigrated health personnel) may require development of new research modalities and cooperation between health professionals, health school faculty, social scientists and economists. Impact of transparent selection procedures, specialty, area and country of practice of government and private school doctors and cost and quality of healthcare provided by the two categories are specific study areas. Concrete data will enable educators and planners to make proper decisions and take steps to correct anomalies observed.
text/html2012-01-06T14:48:48+01:00http://www.webmedcentral.com/Mr. Adam P KnowldenThe Theory of Planned Behavior as a Model for Predicting the Sleep Intentions and Behaviors of Undergraduate Minority Students
http://www.webmedcentral.com/article_view/2859
Purpose: Minimal data is available concerning the sleep health of minority undergraduate students. A psychometrically robust Theory of Planned Behavior based instrument was employed to specify a theory-based model for predicting the sleep intentions and behaviors of undergraduate minority students.Methods: A convenience sample of African American, Asian American, and Hispanic American students (n=70) attending a large Midwestern university participated in the investigation. A power analysis was conducted to determine an adequate sample size (α = 0.05, β = 0.80, f2 = 0.20).Results: The majority of the sample received insufficient sleep (M=405.09 minutes, SD=112.21). Regression analysis identified perceived behavioral control and attitude toward the behavior as significant predictors of behavioral intention. Conversely, subjective norm was a non-significant predictor of behavioral intention. Further specification of the model found behavioral intention to be significant in the prediction of sleep behavior.Conclusion: Perceived behavioral control and attitude toward the behavior are modifiable constructs which need to be addressed through health education and promotion interventions. In prior research employing the same instrument on a predominately white population, subjective norm was a significant predictor of intention. This discrepancy suggests social pressure is not a salient factor in the behavioral intention to achieve adequate sleep among minority students.Key Words: Sleep health, minority health, college students, Theory of Planned Behaviortext/html2012-01-09T15:49:02+01:00http://www.webmedcentral.com/Dr. Mahdi EsmaeilzadehNanotechnology and Its Applications in Drug Delivery: A Review
http://www.webmedcentral.com/article_view/2867
In recent years there has been a rapid increase in nanotechnology in the fields of medicine and more specifically in targeted drug delivery. At present many substances are under investigation for drug delivery and more specifically for cancer therapy. Interestingly pharmaceutical sciences are also using nanoparticles to reduce toxicity and side effects of drugs. The potential to cross the Blood Brain Barrier (BBB) has open new ways for drug delivery into the brain. In addition, the nanosize also allows for access into the cell and various cellular compartments including the nucleus. Nanoparticles are also considered to have the potential as novel intravascular or cellular probes for both diagnostic and therapeutic purposes (drug/gene delivery), which is expected to generate innovations and play a critical role in medicine. Target-specific drug/gene delivery and early diagnosis in cancer treatment is one of the priority research areas in which nanomedicine will play a vital role. In conclusion nanoparticles for drug delivery and imaging have gradually been developed as new modalities for cancer therapy and diagnosis. This review illustrates the emerging role of nanotechnology in drug delivery.text/html2012-01-27T20:00:46+01:00http://www.webmedcentral.com/Dr. Mahdi EsmaeilzadehUrinary Tract Infection Due to Salmonella Typhimurium in a HIV Seropositive Adult Male: A Case Report
http://www.webmedcentral.com/article_view/2930
Despite advances in the prophylaxis and treatment, infection due to non typhoidal Salmonella is seen. The isolation of non typhoidal salmonella from urine specimen is unusual and is commonly related to immunocompromised patients. Here we present a case of HIV infected patient with urinary tract infection.text/html2012-02-17T12:27:30+01:00http://www.webmedcentral.com/Dr. Harinder JasejaAlien Communication: A Plausible Telepathic Mode
http://www.webmedcentral.com/article_view/3028
Communication with possible aliens has been a subject of intense interest and exploration not only in the minds of researchers but also general public at large. Serious applications through establishment of search agencies like SETI have failed to yield convincing results till to date, which may be due to constraints at technological or conceptual level or both. However, the quest continues and with ever increasing technological advancements, we may succeed in our endeavor in near future. This brief article explores the possibility and potential of telepathy (a non-conventional mode of communication) that may be exploited in alien communication in view of interstellar hurdles like distance and speed. Further, the yet unknown morphological state and behavior of aliens are also required to be borne in mind.text/html2012-04-16T12:43:58+01:00http://www.webmedcentral.com/Dr. Indira AdigaBacterial Contamination in the Kitchen: Could It Be Pathogenic?
http://www.webmedcentral.com/article_view/3256
Background: Food borne infection is a serious health problem that results from improper food preparation or cross-contamination. Cross-contamination is produced by contaminated raw foods during further processing, preparation of food by infected person or due to inadequate cleaning of kitchen. Present study is carried out to identify various contaminated spots in the kitchen that may harbour pathogenic bacteria.Methods: Ten kitchens were randomly selected for the study. Samples were collected using sterile cotton swabs from five specific sites which included stove knob, kitchen towel, refrigerator handle, and water tap and kitchen sponge used for washing vessels. Samples collected were processed for isolation and identification of bacteria using blood agar and MacConkey’s agar followed by biochemical tests. Antibiotic susceptibility testing was done using Kirby-Bauer disc diffusion test.Results: Fifty samples collected out of which 32 were found to harbour pathogenic bacteria which included 12 samples of Klebsiella pneumoniae, 7 each with Proteus species & Staphylococcus epidermidis, 3 with Escherichia coli, 2 with Staphylococcus aureus and one with Enterobacter species.Conclusions: This study demonstrated that cross-contamination from the various sites in the kitchen that harbour pathogenic bacteria may contribute to food associated infections. Therefore, frequent cleaning of commonly contaminated areas in the kitchen is essential to prevent vulnerable people from developing food poisoning.text/html2012-04-17T12:18:36+01:00http://www.webmedcentral.com/Dr. Peter HayesEvaluation of the Role of Patient Video Diaries as a Part of a Professionalism Module for Pre-Clinical Undergraduates
http://www.webmedcentral.com/article_view/3251
Background: In an ideal world we would expect students to favour seeing ‘real patients’ in our workshops but resource constraints may not allow this. We wondered what second year students (N=127) thought about a single station per workshop which allowed them to watch two short patient video diary clips (You-Tube), followed on by a group based discussion. This was a new station in contrast to the typical tutor-student role play scenario stations.Summary of Work: We picked the G.I workshop and the C.V.S workshop to show the patient video diaries. Each clip was 2-3 minutes. A group discussion took place after each set of videos and a worksheet was given to all students based on the patient’s perspective5 .The students gave module feedback online some time later.Summary of results: 86 % completed this. Q1: Are patient video worthwhile? (22% strongly agree, 50% agree, 15% neither agree nor disagree, 7% disagree, 6% strongly disagree). Q2: Do patient video diaries help you understand the patient perspective to a larger degree? (32% strongly agree, 50% agree, 12% neither agree nor disagree, 5% disagree). Q3: I would like access to more patient video diaries? (6% strongly agree, 42% agree, 34% neither agree nor disagree, 17% disagree, 1% strongly disagree). Qualitative data received from students in a free text space on ‘patient video diaries’ produced some interesting themes (70% completion).Themes which scoredDiscussion: The student evaluation of the patient video diaries was mixed. The vast majority found that they were worthwhile but another cohort found them valueless. Perhaps different learners do not value the same learning tools. The majority felt that the patient video diaries were helpful in showing the patient’s perspective when it came to disease.Conclusions: Patient video diaries are a useful teaching tool but will not suit all learners
text/html2012-05-10T06:45:32+01:00http://www.webmedcentral.com/Mr. Muhammed R SiddiquiThe effectiveness of Knowledge Management in the Map of Medicine compared with Nonaka\'s Knowledge Spiral
http://www.webmedcentral.com/article_view/3350
Recently, the business world has reaped the benefits of an effective Knowledge Management (KM) set up. It has helped propel them into an age of information and this has quickly transformed itself into commercial assets. The importance of integrating this attitude, from the aspect of the medical world, can potentially be central to effective patient care and staff management. Through the use of KM schemes there can be an acceleration of productivity due to the competent way knowledge is created, critiqued and disseminated amongst employees.
The medical profession deals with an ever-growing amount of information from a number of publishers, articles, journals and regulatory bodies. This can be overbearing for a healthcare practitioner particularly with respect to the intimate nature of medicine. Nevertheless, using KM models and theories these issues can be dealt with more efficiently by creating a regulated flow of knowledge that maximises its, access, accuracy and the standard of care delivered by the NHS and is personnel.
The Map of Medicine is thought to be a useful support system for doctors in a clinical environment in a field they are least confident in. at the heart of its concept it relevantly sifts through the databases of information and presents it in a way that is user-friendly and up-to-date with modern findings.
text/html2012-05-14T12:24:53+01:00http://www.webmedcentral.com/Dr. Brijesh SathianRelevance of Post or Pre Peer Review Process Journals for the improvement of Medical Research in Nepal
http://www.webmedcentral.com/article_view/3368
Despite valuable research going on in developing countries like Nepal and the large number of existing scientific journals, this information does not reach international visibility. Not only are such journals obscure, but they also perpetuate a vicious circle of inadequacy that may directly be damaging the local science and research culture. Journals should prevent this by constructing an editorial board including qualified editors from developed and developing countries in the editorial board. There are several pre peer reviewed visible medical journals with this quality but the problem with them is publication delay because of peer review process. If the peer review process is fast then the publication charge will be more and the authors of developing countries cannot afford. But the journals like WebmedCentral have the post peer review system which will fasten the publication of the manuscript. After publication, manuscript will be peer reviewed by the reviewers and the one of the world’s biggest well qualified editorial team of WebmedCentral. It will give the authors tremendous amount of knowledge in their domain with the help of international editors. text/html2012-06-04T14:37:58+01:00http://www.webmedcentral.com/Mr. Rajeev K SinglaInvestigation of Analgesic & Anti-Pyretic Potentials of Callicarpa Macrophylla Vahl. Leaves Extracts
http://www.webmedcentral.com/article_view/3447
Leaves of Callicarpa macrophylla, an indigenous plant of India, had been the plant of study for the current research work. Aqueous as well as ethanolic extracts of C. Macrophylla leaves were evaluated for their analgesic as well as anti-pyretic effect using Tail Immersion Model and Brewer’s Yeast Induced Pyrexia Model respectively. Aqueous extract of leaves induced better analgesia and have anti-pyretic potential than ethanolic extract when compared to standard drugs. Combination of analgesia as well as anti-pyretic effect will ascertain its significant role in infection induced fever.text/html2012-06-09T16:06:13+01:00http://www.webmedcentral.com/Dr. Khue V Nguyen The Human Folate Receptor 1 Gene: Molecular Diagnostic of Folate Deficiency
http://www.webmedcentral.com/article_view/3461
Folate is a water-soluble vitamin of the B complex group, and is required for optimal health, growth, and development. In human, it cannot be synthesized de novo, hence, dietary sources must meet metabolic needs. Folate deficiency is one of the major dietary health problems worldwide and is associated with a variety of diseases including anaemia, birth defects, cardiovascular disease, and neurological conditions. In the present study, we report an application of the human folate receptor 1 gene (FOLR1) for molecular diagnostic of folate deficiency. The cloning of the entire coding sequence (CDS) of the FOLR1 gene is also reported.text/html2012-06-18T17:01:49+01:00http://www.webmedcentral.com/Dr. Chaitanya VarmaMolecular Targeted Therapy: Cancer Therapy of the Future.
http://www.webmedcentral.com/article_view/3496
Introduction:Present day cancer treatment is multidisciplinary and usually includes various combinations of surgery, chemotherapy and radiation therapy. In spite of various advances, these treatments are still associated with toxicity risks. This has lead to the development of a fourth type of treatment called Targeted Therapy. During the late 20th century, it was realised that mutations in proto-oncogene and deletion of tumor suppressor genes can lead to carcinogenesis. Targeted therapy employs small chemical molecules or other substances, such as monoclonal antibodies, to interfere with specific targeted molecules needed for carcinogenesis and tumor growth, rather than by simply interfering with rapidly dividing cells like in traditional chemotherapy . Molecular Targeted Therapy (MTT) has an advantage of high therapeutic index, high selectivity and low toxicity.Types of Targeted Therapy:Small molecule drugs: Small molecule drugs have the ability to pass through cell membranes including plasma membrane1. They can be used to interfere with specific areas of the target proteins located either outside or inside the cell, modify its enz activity or its interaction with other molecules and inhibit key signaling pathways that lead to carcinogenesis. These pathways include signal transduction via the activation of kinases, programmed cell death or “apoptosis”, regulation of gene transcription, or tumor angiogenesis. Imatinib was developed in the late 1990’s by biochemist Nicholas Lydon, oncologist Brian Drucker and Charles Sawyer. Imatinib (Gleevec) received FDA approval in May 2001 and was hailed by TIME magazine as the "magic bullet” that can cure cancer .Originally developed as a specific inhibitor of the bcr/abl tyrosine kinase that characterizes chronic myeloid leukemia (CML), this drug was subsequently found to inhibit the activity of several other tyrosine kinases, and the platelet-derived growth factor (PDGF) receptor. Imatinib inhibits these kinases by binding to the active site on the kinase molecule. Some kinases are required for the continued survival of cancer cells, and inhibition of these kinases results in the death of the cancer cells. Nilotinib and Dasatinib are second generation drugs that are currently in the last stage of clinical trials. Small molecules can be used not only to inhibit the function of cellular enzymes, but also to activate them like the Tumor Necrosis Factor-related Apoptosis-inducing Ligand (TRAIL). TRAIL binds to and activates two distinct cell surface receptors called Death Receptor 4 (DR4) and Death Receptor 5 (DR5) and lead to the activation of pathways within the cell that ultimately lead to programmed cell death (apoptosis).Monoclonal Antibodies: Monoclonal antibodies (MAbs) are created from a single cell type and act by recognizing the protein on the surface of the cell and then locking onto it2. Monoclonal antibodies can interfere with the interaction of signaling molecules with receptors on the outside of a cell which often activates pathways inside the cancer cell. Antibodies can be engineered to interact with very specific targets and so have a high degree of specificity which helps avoid unwanted side effects. Rituximab is an anti-CD20 monoclonal antibody that has demonstrated efficacy in patients with various lymphoid malignancies, including indolent and aggressive forms of B-cell non-Hodgkin's lymphoma (NHL) and B-cell chronic lymphocytic leukaemia (CLL).Angiogenesis Inhibitors: A theory proposed by surgeon Judah Folkman in 1971, that if the development of new blood vessels could be stopped, a tumor could not grow or spread, is the basis for research into antiangiogenic drugs. Interferon-alpha and Thalidomide are believed to have some ability to inhibit angiogenesis and are being studied in specific cancer types of cancers. Many antiangiogenesis agents are still under clinical trials and require FDA approval3 .Therapeutic Cancer Vaccines: Cancer cells are not recognised by the body’s immune system and hence no immune response is mounted against them which leaves them to potentially develop into tumors. Some cancers suppress the body’s immune systems. Therapeutic cancer vaccines try to activate the body's immune system to make it recognize and attack cancer cells4. They are used on patients who are already undergoing treatment .The cancer vaccine may contain inactivated cancer cells, viruses that express tumor antigens, or any antigens that are overexpressed by cancer cells. An adjuvant, usually Interleukin-2 is used to induce a strong immune response.text/html2012-06-21T21:28:41+01:00http://www.webmedcentral.com/Dr. Chaitanya VarmaYoga Therapy In Pediatrics.
http://www.webmedcentral.com/article_view/3506
INTRODUCTION:Yoga is an ancient science which has its origins in India. The term yoga literally means to “yoke” from the sanskrit word yug. Yoga if practiced correctly can help in the improvement of many childhood disorders.MENTAL HEALTH:Attention deficit hyperactivity disorder (ADHD) is a behavioural disorder, present in up to 5% of school children characterised by inattentiveness, hyperactivity, impulsivity or a combination. These children usually have normal intelligence but poor school performance. Stimulant drugs like amphetamines and Ritalin are used but one third of the children do not respond or develop side effects to these medications. Behavioural modification is one other treatment modality. Yoga is being increasingly used as an alternative therapy. It enhances relaxation, develops greater attention and ability to concentrate and improves self esteem. It also reduces depression, anxiety, anger and neurotic symptoms. Studies have shown that practicing yoga regularly improves ADHD symptoms significantly when compared to children on drug and behavioural therapy. Yoga also helps in improving mood disorders in adolescents. Yoga may also improve visual and cognitive skills, memory and visual perception. PHYSICAL HEALTH:Moorthy et al demonstrated that yoga increased the number of children that were able to pass a fitness test which they failed to clear the first time1. Studies have proved that regular yoga helps in improving the cardiovascular fitness, increase the lean muscle mass, improve balance and fine motor skills. Raju et al demonstrated that regular pranayama could result in higher work rates with reduced oxygen consumption without an increase in the blood lactate levels2.RESPIRATORY DISORDERS:Asthma is one of the most common conditions encountered in pediatric practice. It has multiple aetiologies including allergic, infective, climactic, endocrinal and emotional. The children are usually put on long term drugs and inhalational devices which are very cumbersome. Jain et al showed that regular yoga increased pulmonary functions and lung capacity in adolescents with asthma3. It also decreased frequency and severity of symptoms and drug requirements. Deep breathing exercises and the calm mental state help in ameliorating most of the multi aetiologies of this condition4. Yoga also helps in improving the lung capacities of children with congenital chest deformities.PAIN MANAGEMENT:Children with oncological conditions, fibromyalgia, juvenile arthritis, chronic pancreatitis, peripheral neuropathy and hemodialysis are prone to chronic pain and anxiety. Moody et al put children in their hemato-oncological unit on an individualised yoga plan and found a significant reduction in both pain and anxiety5. Children with musculoskeletal problems like arthritis have been shown to have decreased stiffness, pain and prevalence of deformity when on yoga therapy.OTHER CONDITIONS:Irritable Bowel Syndrome (IBS), migraines, endocrinological disorders like diabetes and sleep disorders are some of the other conditions where yoga is helpful. More studies are required to quantify the degree of usefulness of yoga therapy in dealing with conditions which require an alternative therapy.text/html2012-07-07T07:45:15+01:00http://www.webmedcentral.com/Dr. Mahdi EsmaeilzadehMedical Care in Islamic Tradition During the Middle Ages
http://www.webmedcentral.com/article_view/3549
The present paper is an endeavor to study some issues related to medical care and hospital during the Middle Ages. Promotion of Medical Care and; the contribution of eminent Physicians during the middle ages; Muslim Views on Seeking Medical Treatment; Examination of Patient by Member of Opposite Sex in Islam; and Al-Bimarsitan (Hospital) As a Centre for Medical Care and Education; are among the major themes in this paper.text/html2012-09-15T11:33:52+01:00http://www.webmedcentral.com/Mr. Rajeev K SinglaSynthesis, Spectral Characterization and Evaluation of Antibacterial Activity of 1,3-Oxazolidin-2-ones
http://www.webmedcentral.com/article_view/3660
1,3-oxazolidin-2-one, an oxygen and nitrogen comprising heterocyclic structure attracts many researchers all over world, evidenced to have unique and potential antibacterial activity. We had designed and synthesized few analogues of 1,3-oxazolidin-2-ones. Their structures were characterized using physical and spectral data. To evaluate their antibacterial potential, Kirby Bauer Agar Diffusion Assay procedure was adopted. Results are very significant and revealed that 1,3-oxazolidin-2-ones have potential antibacterial activity when compared with standard Oxytetracycline. In case of E. coli, unsubstituted parent molecule have better inhibitory effect than the substituted ones while in case of P. vulgaris, substituted analogs have higher effect than the parent one.text/html2012-09-26T13:46:53+01:00http://www.webmedcentral.com/Dr. Khue V NguyenAntithrombin Hanoi: Arg 393 to His Missense Point Mutation in Antithrombin Gene and Cancer
http://www.webmedcentral.com/article_view/3720
A heterozygous Arg393His point mutation at the reactive site of antithrombin (AT) gene causing thrombosis in a Vietnamese patient is reported. The present variant is characterized by a severe reduction of functionally active AT plasma concentration to 42% of normal resulting in multiple severe thrombotic events such as cerebral venous thrombosis, recurrent deep veinous thrombosis (DVT) and the development of kidney cancer. This is the first report of a patient with kidney cancer in whom mutation of AT gene has been investigated. The “two-way association” between cancer and thrombosis in which thromboembolism (VTE) can be both a presenting sign and a complication of cancer is discussed. Efficacy of low-dose wafarin anticoagulant used for preventing DVT and kidney cancer from this patient is also mentioned. For this variant AT (Arg393His), the name AT Hanoi is proposed.text/html2013-03-05T06:37:17+01:00http://www.webmedcentral.com/Dr. P Ravi ShankarMedical Student Assessment in the Basic Sciences in Nepal and the Caribbean: Personal Observations
http://www.webmedcentral.com/article_view/4097
Abstract:
Medical student assessment has received a lot of attention recently. The issues of objectivity and subjectivity and extrapolating the results of assessment to actual conditions of practice are important. In both Nepal and the Caribbean the basic science subjects are taught during the first two years of the undergraduate medical course. In the present article the authors share their personal observations on basic science assessment in these two regions. In Nepal assessment uses a greater diversity of methods and is largely subjective. There is greater emphasis on community medicine and viva-voce continues to be an important assessment method. In the Caribbean the major focus is towards preparing students for the USMLE step 1 exam and multiple choice questions are the major assessment method. Other methods of assessment being introduced at the Xavier University School of Medicine are also described.
In recent years medical student assessment has received a lot of attention. The major challenge in medical student assessment is deciding whether performance of a student under standardized conditions can predict his/her future performance in medical practice.1 The principles of fairness and reliability may dictate that all students be tested on the same set of patients and be graded objectively by an observer or even better by a machine. The problem in extrapolating the results of this standardized assessment may be that in real life a doctor will be dealing with non-standardized patients who will nearly always present with a unique set of signs and symptoms; patients and others will most often judge the doctor’s performance using subjective personal criteria.
We have had a long association with medical schools in Nepal and the Caribbean. In this article we share our impressions of assessment in the basic sciences in these two regions. The regions are similar in that a good percentage of students from other countries come to this region to study. Also the basic science subjects are taught during the first two years (four semesters) with a fifth semester in Caribbean schools being devoted to preparing for the United States Medical Licensing Exam (USMLE) Step 1. In Nepal most medical schools are in the private sector and are affiliated to two universities, Kathmandu University and Tribhuvan University.2
The major difference we have noted in assessment is that in Nepal short answer questions (SAQs) and modified essay questions (MEQs) are the major assessment methods used while in the Caribbean multiple choice questions (MCQs) predominate. In the Caribbean with majority of students originating from the United States (US) the USMLE step 1 casts a long shadow over assessment methods and teaching-learning. The majority of questions follow the USMLE format with a clinical vignette for a stem and five choices for answers.
The assessment in basic sciences in Nepal uses a greater variety of methods ranging from SAQs to practical assessment to viva-voce. The methods used are more subjective with the examiners making a judgment about the students. MCQs are not frequently used though recently Kathmandu University has introduced MCQs. The drawback is that assessment can be subjective and vary from student to student. There is a lack of guidelines to assess the answers and hence marking can vary according to the examiner. Community medicine occupies an important part in the curriculum and there are marks provided for community health exercises and community diagnosis though the emphasis on and implementation of community-based learning may vary between schools. A problem affecting assessment could be an ‘unholy’ understanding between the internal examiners from the institution and the external examiner nominated by the university with an intention to pass the maximum number of students. Also examiners being human beings differ from each other with some being lenient and others being stricter affecting the exam marks and the results. Another problem is the long duration of the examination with a separate day being allotted for ‘practical’ examinations in each subject and the need to stagger examinations in different institutions with regard to the availability of examiners.
The major benefit we feel of the Nepalese exam system is that it encourages students to write and put down their thoughts on paper. In today’s modern digital age we rarely ‘write’ in the traditional sense of the term. Overemphasis on MCQs throughout the education system in some countries has resulted in students who are unable to put their words together in a logical and proper sequence to construct sentences and paragraphs. Also students face a ‘viva voce’ (again a much criticized and non-standardized assessment system) with examiners, developing the skills of accurately analyzing and responding to questions and conveying information within a limited time frame. We feel the viva-voce if properly used is a powerful assessment tool where a skilled examiner makes a judgment about the candidate. However, a recent article states that viva-voce examinations show a general tendency towards leniency with examiners indulging in giving high marks to enable an otherwise undeserving candidate to pass.3,4 This may also be true in Nepal where there is a general tendency towards leniency in undergraduate medical examinations due to various reasons. Integrity of examiners and a willingness to take ‘tough’ decisions may be needed.
In Nepal the quality of practical teaching-learning and the exercises carried out during the practical examination vary widely between medical schools and external examiners give a very high weightage to student performance in the viva-voce conducted by them with regard to making pass fail decisions. This is especially true if they have doubts about the standard of the questions and activities set for the practical examination.
In the Caribbean, students mostly from the US or Canada complete four or five semesters of study in an ‘offshore’ medical school and then appear for their USMLE step 1 examination.5 After passing this examination students do their clinical training in a set of affiliated hospitals in the US. The teaching-learning at the schools mainly focuses towards coaching students to obtain a good score in the step 1 exam. More than half the graduates from Caribbean medical schools are practicing in primary care specialties and are making a big contribution to the primary care workforce of the United States.6 Compared to Nepal class sizes in the Caribbean are smaller. There is also more emphasis on student presentations and assessment is mainly through quizzes and performance in periodic exams which use exclusively MCQs framed following the USMLE pattern. The test is conducted using a computer program and students obtain their scores immediately on completion. The system is objective, transparent and not influenced by examiner ‘biases’. Also it tests the ability of students to assimilate information and concepts learned and apply it to a clinical scenario.
The drawback is MCQs are often the only or the predominant method of assessment. There is very little emphasis on ‘writing’ in the traditional sense of the term so students often find it difficult to put down their thoughts in a logical sequence and find answering SAQs very difficult. Also the emphasis on public health and community medicine in the curriculum is less compared to Nepal and there are no community diagnosis programs or community visits. We feel the involvement with the local community is lesser compared to Nepalese schools. At the Xavier University School of Medicine (XUSOM) we conduct a health fair every semester where students interact with the local community. The emphasis on rational use of medicines and on essential medicines is low following the US pattern.
At present we are in the process of introducing other assessment methods also. We have introduced audience response technology (ARS) in two semesters (third and fourth) to improve student participation in the classroom and are also using the clickers for quizzes and assessments. ARS has been shown to be a valuable technology which increases student engagement and stimulates discussion but teachers may need to be technically and pedagogically well prepared to use the tool.7 A recent review examines the benefits of ARS on learning.8 ARS will be introduced in other semesters in XUSOM in a phased manner. Formative assessment using objective criteria has been introduced during the small group activity-based sessions in pharmacology and medical humanities. We are also planning to introduce other methods of assessment like grading participation in student seminars, PBL sessions and even use short answer questions for assessment. Students undergo a period of observership in the hospital where they are assessed by doctors, nurses and other health personnel. text/html2013-04-15T05:48:41+01:00http://www.webmedcentral.com/Dr. P Ravi Shankar\'Modernizing\' the Basic Sciences MD program at XUSOM, Aruba
http://www.webmedcentral.com/article_view/4198
Abstract:
Xavier University School of Medicine is a private medical school in Aruba, Dutch Caribbean mainly admitting students from the United States and Canada to the undergraduate medical (MD) course. Recently the school is in the process of modifying its curriculum in line with its objective of creating leaders in primary care medicine. Among the changes are shifting to an integrated, organ system-based curriculum, using standardized patients for learning and assessment, introducing a medical humanities module, starting problem-based learning sessions, introducing early clinical exposure, conducting family health visits, and teaching students to use essential medicines rationally. In this manuscript the authors briefly describe these initiatives.
Aruba, Caribbean medical school, curriculum, innovations, teaching-learning
‘Off shore’ medical schools in the Caribbean mainly admit students from the United States (US) and Canada to the undergraduate medical (MD) course.1 Student pursue their pre-clinical study in the Caribbean and then return to the US for their clinical study. A recent article had described considerable variation in the academic programs and performance of students in Caribbean medical schools.2 In the Caribbean the thrust of the schools and the graduates is on obtaining a good score in the United States Medical Licensing Exam (USMLE) step 1 exams and starting the clinical phase of their study. The pass rates of students in the step 1 exams varies significantly between medical schools.3 The teaching program primarily focuses on preparing students for the step 1 exams and multiple choice questions (MCQs) in the USMLE pattern is the major method of assessment.4
Xavier University School of Medicine (XUSOM) is a private medical school in Aruba, Dutch Caribbean admitting students mainly from the US and Canada to the undergraduate medical (MD) program. There are also a few students from Nigeria and India. In addition to the MD program the school also runs a pre-medical program.
Shifting to an integrated curriculum: Recently however the school’s academic leadership driven by a variety of reasons felt an urgent need to further develop and enrich the MD program. The school has the vision of creating leaders in primary care medicine and has recently (from the January 2013 semester) shifted to an integrated, organ system-based curriculum for the new student intakes.5 The subjects of anatomy, physiology, biochemistry, neuroscience and epidemiology will be covered during the first two semesters dealing with the normal human while pathology, microbiology, and pharmacology will be studied during semesters 3 and 4 dealing with the abnormal human. The fifth semester of the program was shifted to the campus at Aruba and the primary focus of the semester is on reviewing the basic science subjects with the objective of helping student perform well in the step 1 exams and also strengthen their clinical skills.
Standardized patients (SPs) have been widely used in medical student education and assessment.6 XUSOM has started training standardized patients who will provide a general history and a history of a particular simulated condition like chest pain, fever to students during the spring 2013 (January-April) semester. SPs have been used for student assessment during objective structured clinical examinations (OSCE). We plan to extend the use of SPs to other areas soon.
Medical humanities (MH) is being widely used in the education of medical students and has a number of advantages in the education of future doctors.7 A MH module was offered to all first semester (MD1) students during the spring 2013 semester. The small group activity-based sessions used case scenarios, role-plays, facilitator and student presentations, interpretation of paintings to explore different aspects of MH. Eight sessions were conducted and student feedback has been positive. The sessions were conducted on Tuesdays from 3 to 5 pm. The module will be further improved based on feedback from students and other faculty members and will be offered to all MD 1 students during the coming semesters.
Problem-based learning (PBL) has been widely used in medical education and many studies report a favorable outcome on student learning and preparation for prcatice.8 Self-directed learning (SDL) strategies are becoming increasingly important in medical education and practice and the curriculum should develop SDL skills among students.9 During the spring semester a few PBL sessions were conducted for the MD 1 students. During the summer 2013 (May-August) semester the school is planning to conduct weekly sessions for MD1 and MD 2 students. The PBL sessions will primarily focus on learning objectives from anatomy, physiology, biochemistry, history taking and social issues during the first two semesters and on pathology, microbiology, pharmacology, clinical examination skills, social issues and diagnosis during the next two. Student performance during the PBL sessions will be assessed using a standardized instrument.
Early clinical exposure (ECE) is become increasingly common in medical schools10 and has the advantage of developing students’ history taking and clinical examination skills and highlighting the clinical importance of the basic science subjects. XUSOM is in the process of signing an agreement with two general practitioners in Aruba to use their facilities for early clinical exposure. SPs will also be used during the program. The emphasis will be on history taking skills during the first two semesters and physical examination skills during the MD3 and 4 semesters.
Family health visits are being used in student learning.11 XUSOM is planning to introduce family health visits which will be done in small groups. A group of six students will follow up three families over a six month period. A minimum of three visits is being proposed. During the first visit students will obtain demographic, economic and health characteristics of the family and during subsequent visits changes in these characteristics if any will be studied.
Critical appraisal is the process of assessing and interpreting evidence by considering its validity, results and relevance to an individual’s work.12 Critical appraisal of scientific literature is widely taught in medical schools. XUSOM is introducing activity-based learning of critical appraisal skills from the next semester. Students will learn about objective sources of health information, assessing the quality of health information on the internet, critically appraising clinical trials, meta-analysis and systematic reviews and dealing with information obtained from the pharmaceutical industry.
Learning to use essential medicines rationally is an important skill for doctors. In a medical school in Nepal ten basic competencies for undergraduate pharmacology education were defined.13 At XUSOM small group sessions addressing this topic had been introduced during the spring semester and will be further expanded during the coming summer semester. During the sessions students will learn to select personal (P) drugs for a particular disease condition, verify its suitability for a particular patient, write a prescription, counsel a patient regarding drug and non-drug management of his/her condition, understand and respond to pharmaceutical promotion and evaluate drug use in healthcare facilities.
The assessment method is being modified to include formative assessments, assessment of student performance during PBL sessions, small group sessions, and family health visits, OSCEs, and assessment of attitudes in addition to the traditional assessment of knowledge using MCQs.text/html2013-04-18T05:31:12+01:00http://www.webmedcentral.com/Dr. William HoggPeer Visiting as a Tool to Enhance Teaching and Learning in Post-Graduate Medical Training
http://www.webmedcentral.com/article_view/4192
Purpose: The Peer Visiting model is a new model for educational assessment in postgraduate training in Family Medicine. In this paper we describe the model and a qualitative study designed to determine: First, how the model is perceived by the preceptors and their residents and second, whether or not preceptors and residents believe the model enhances teaching and learning.
Methodology: In Phase I focus groups were used to identify the underlying constructs and language used by family physicians and residents in describing the Peer Visiting experience. The constructs identified in Phase I were used in Phase II, which evaluated the perceived effect of the peer visiting program.
Findings: The thematic areas identified were: 1) Interpersonal Relations, 2) Learning Process, and 3) Faculty Development. Participants in Phase II of the study overwhelmingly believed Peer Visiting to be a positive experience. Most felt that the interpersonal relationship between the preceptor and resident was improved by the visit. All preceptors planned to make pedagogical change as a result of the peer visit. After the Peer Visit, residents became more aware of their responsibility to direct their own learning.
Conclusion: Important issues were addressed during the visits. Including the resident as a member of the visiting team is an innovative aspect of this model of peer review, which the participants felt was an essential aspect of the model. Peer visiting holds the potential to improve aspects of the resident’s relationship with their preceptor and their overall resident experience, and to make students more self-directed. text/html2013-06-27T12:09:03+01:00http://www.webmedcentral.com/Dr. Brett WhiteDeveloping a Longitudinal Curriculum in Information Mastery in a Family Medicine Residency
http://www.webmedcentral.com/article_view/4299
This article will outline the background and development of a longitudinal curriculum in information mastery in the Oregon Health & Science University (OHSU) Family Medicine Residency program.text/html2013-07-29T04:34:58+01:00http://www.webmedcentral.com/Dr. Megha SharmaRise and fall of NEET
http://www.webmedcentral.com/article_view/4356
Medical education is India is one of the largest in the world with more than 300 medical colleges (including both government sector and private sector medical colleges) with annual intake of more than 32,000 medical students who add to the existing medical manpower 1, however, it is marred by multiple issues including but not limited to, lack of ongoing reforms 1, no impetus on quality clinical research 2,3 and frequent strikes by in-training residents 4,5, all of which by themselves contribute to compromise in effective health care delivery 6,7. Rise and fall of NEET is another such story.
Medical colleges in India are primarily either managed by government sector or private sector. However, private sector has always been under fire for allowing admission by charging heavy fee under name of capitation fee. Moreover, students had to write separate exams for government and private sector medical colleges, as a result students had to apply for different exams and travel all across country to appear for those exams which imposed several limitations of people especially from poor financial background. Medical Council of India in 2010 decided to start NEET (National Eligibility cum Entrance Test), a nationwide central exam for all medical colleges of India in an attempt to bring uniformity across different exams. It was implemented in 2012 with first exam conducted last year. However, it did not last long and after a long legal battle between MCI and representative of private medical college in the highest court of India, the exam was finally scrapped in July 2013.
While MCI has always been condemned for not bringing reforms to medical education in India, its attempt to standardize entrance exam all across nation was thrashed by the apex court. Still a lot needs to be done in order to raise standard of medical education including more impetus on clinical and practical training, standardizing training of residents by collaborating MD-DNB programs 8,9. However, these changes would need stringent joint efforts by bureaucrats at different levels before medical education standards can be improved in India.text/html2015-09-14T09:29:31+01:00http://www.webmedcentral.com/Dr. Deepak GuptaConfessions in Essence: The Power of Observation, Acknowledgement and Pure Enlightenment
http://www.webmedcentral.com/article_view/4974
Background
In our department of anesthesiology there has been informal discussion forum called "Confessions" regarding difficult anesthetic scenarios where no patient harm had occurred (defined here as near-hit-near-miss {NHNM} incidents). These confession sessions are currently held only among the anesthesiology residents during didactics sessions and are based on the principle of developing a practice of intellectual honesty without repercussions similar to religious "confessions" in essence [1]. These "confession" sessions are in no way related to the Anesthesia Quality and Assurance (Q&A) Committee forums (including Mortality and Morbidity {M&M} Forums) which are required by law to maintain the accountability/answerability in reporting events of anesthetic adverse events/ poor clinical practices. Q&A committees are confidential but not anonymous. Q&A forums are used in part to improve education based on these peri-anesthesia incidents/events. However, there are numerous underreported near-hits-near-misses (NHNM) which can also provide valuable information regarding anesthetic practices.
As peri-anesthesia incident reporting systems are an integral part of clinical education through local Q&A committees and M&M forums, the American Society of Anesthesiologists constituted the Anesthesia Quality Institute (AQI) and initiated National Anesthesia Incident Reporting System (AIRS) with the aim for dispersion of local Q&A sessions' elicited observations for the benefits of nationwide readers [2]. AIRS system has novel Anonymous Electronic system for report submissions [3]. This national concept further inspires local system to collect NHNMs anonymously without overlapping the domains of Q&A committees and Risk Management committees [4-5]. This is the basis for the formal development of the current Confessions Model.
Confessions in essence (whether academic or spiritual) envisage primarily the power of observation, acknowledgement and "pure enlightenment" and relegate the legality/liability issues and accountability/answerability concerns to be managed by risk management agencies. Similar to religious/spiritual confessions model [1], this anonymous portal is envisaged to empower the confessors to acknowledge their mistakes or oversights, and to facilitate the educators to share newly-found or revisited anesthesia knowledge (gained from anonymous confessions) with fellow colleagues for prevention of similar future NHNMs.
Objectives
Primary Objective is to devise formal-local-institutional system called "Confessions" for voluntary reporting of NHNMs that
is totally anonymous
will not replace mandated Confidential Q&A forums
will be an additional forum for intellectual stimulation
i. Anesthesia care providers to discuss NHNM incidents
ii. Anesthesia care providers to analyze pathophysiology of observed NHNM incidents
iii. Anesthesia care providers to learn from the newly-found understanding
iv. Anesthesia care providers to acknowledge their mistakes/oversights of diseases and clinical scenarios secondary to uniqueness of each individual patient, procedure and/or operator
v. Anesthesia care providers to educate the community through the anonymous confessions without any repercussions
increases the amount of shared anesthesia knowledge related to NHNM incidents due to anonymity of confessions
can improve anesthesia education of all local peers and their anesthesia practice in the long run
can hopefully decrease the number of future peri-anesthesia NHNM incidents
Materials and Methods
The first and foremost step is the education of Anesthesiologists (Board-Certified or Board-Eligible) to attend the faculty development presentation as Faculty Development Power-Point presentation (See Attachment) explaining the underlying thought process, our shared experiences at our worksites and our recommendations for other institutions so that they can imbibe the methods as well as raise their own worksite specific concerns/concerns/solutions for better application of the "Confessions" Model.
The next step is prompting all anesthesia care providers to come forward and confess as explained below but only after reading the detailed Instructions to the Submitter document. The general forum of all anesthesia care providers' can be first time informed about this process utilizing one 15-minute time slot informal chit-chat presentation (See Attachment) during any regular anesthesia didactics sessions that are attended by maximum anesthesia care providers (in our institution, it is usually our monthly M&M meetings). Subsequently, all the attached forms with the detailed information can be sent out as a group email to all providers so that they can further review and get used to the forms and instructions. Additionally, small single-page fliers (See Attachment) can be attached to "Confessional" Boxes to reminding one-last-time how to confess in this forum.
Essentially, Anesthesia care providers [Anesthesiology Residents, Anesthesiology Sub-specialties' Fellows, Certified Registered Nurse Anesthetists, Student Registered Nurse Anesthetists, and Anesthesiologists (Board-Certified or Board-Eligible)] are asked to anonymously report NHNM events. All peri-anesthesia events that amount to NHNM are eligible for these submissions. These NHNM events are collected in sequential order on 4 different forms (See Attachments FORMS A-D) as:
FORM A Confession Submission (CS): written anonymously by the confessor
FORM B Confession Discussion (CD): anonymous comments of the peers in regards to CSs
FORM C Confession Follow Up (CFU): confessor's anonymous reply to CDs
FORM D Averted Confession (AC): written anonymously by peers as an event that was averted due to information learnt from previous confessions.
The forms submitted as printed typed documents needs to be placed in locked "Confessions" Boxes. Completed confession forms can be collected at the end of each month. Confessions then need to be reviewed by the designated clinical educators' teams as follows:
Step 1. Removal of any identifying marks with correction white colored fluid
Step 2. Sorting of de-identified forms by the Q&A liaison officer to remove any confessions that were not NHNMs. These removed confessions can be anonymously discussed in Q&A forum. N.B. These non-NHNM confessions can be used in classroom teaching and discussions and these removed confessions can NOT be electronically shared
Step 3. The remaining confessions (NHNMs) are reviewed with the aims of
Better understanding of the pathophysiology of the confessions
Addressing the event management issues (if any)
Advocating a plan for prevention of recurrences of these confessions
Step 4. Reviewed confessions can be shared via monthly email to anesthesia providers
For continuing medical education (CME)
For eliciting comments (CDs) as typed forms and NOT electronic forms
For continuing anonymous dialogue with the confessor through his/her CFU forms
For encouraging more submissions (AC) if any confession is averted by the electronically shared confessions
Step 5. Selected confessions can be ANONYMOUSLY shared with the National Anesthesia Incident Reporting System for the benefits of nationwide audience
Outcomes
Primary Outcome
Number of Averted Confessions per month as an objective indicator of Confessions Model's success
Secondary Outcome
Number of Confession Submissions (CSs) per month over time (an indication of acceptance for model)
Number of Confession Discussions (CDs) and Confession Follow Ups (CFUs) per month as a learning interests indicator of anesthesia care providers' group
Frequency of various characteristics (patients' and personnel's) among the submitted confessions
Our Experiences
As the running title suggests "Confessions are NOT rare but Confessing itself is rarity", there are no formal outcomes to report. However, this is a vision for future sprouting from past observations that had led us to initiate the formalization of the existing informal confessions model within the anesthesiology residency program to extend beyond the confined boundaries of closed door resident didactics sessions. Though it out-rightly failed to prompt any of the "confessors" to "confess" their "confessions", it has been still worth a honest try on the part of the developers.
"Confession" 1. As an internal medicine intern, the management of esophageal injury in a post-cardiac surgery patient in a medical intensive care unit ensured the extra-vigilance to avoid trans-esophageal echocardiography based esophageal burns when the same intern started cardiac anesthesia rotation.
"Confession" 2. Difficult endotracheal intubation in a patient who was unable to tolerate supine position secondary to history of gastric pull-through procedure (s/p total esophagectomy) led to the development of the feasibility research and popularity of endotracheal intubation in sitting position.
"Confession" 3. When a multicity anesthesia educational meeting discussed the consequences of un-recognized and often overlooked diagnosis of patent foramen ovale (PFO) as a cause of hypoxemia in intensive care unit (ICU), the immediate-next month ICU rotators diagnosed and confirmed two patients wherein if PFO (intracardiac shunting with/without intrapulmonary shunting) would have been overlooked, the patients would have been unwarrantedly managed with mechanical ventilation.
"Confession" 4. In a morning educational session, the guest speaker (a plastic surgeon) was applauding the mother of a child who (un)knowingly kept her child's injured airway intact by placing the child prone so that the child's detached and overhanging tonsils do not catastrophically obstruct the glottic opening; and the same day, the anesthesia team encountered the detachment of an enlarged tonsil while attempting endotracheal intubation and the catastrophic intraoperative diagnosis was made in no-time thanks to listening to the morning educational sessions.
"Confession" 5. Constant caution elicited by cardiothoracic surgeon regarding fentanyl based pancreatitis (based on anecdotal experiences) in post-cardiac surgery patients led the ICU rotator to consider fentanyl induced pancreatitis in a chronic pain patient during pain clinic rotation; and subsequent to consideration of this pain management causing physical pain scenario, a different patient was considered as fentanyl induced vesico-ureteric spasms eliciting the difficulty of managing pains caused by pain management itself.
These are just a few of the many examples that have strengthened (irrespective of whatever) authors' resolve to develop, promote and propagate Confessions Model.
Our Recommendations
Based on our experiences (or our limitations causing lack of any first-hand experiences of confessors coming forward), our recommendations for "Confessions" Model's future use and expansion into other anesthesia institutions:
Place Locked "Confessional Boxes" in Anesthesia Care Providers' LOUNGES rather than Worksite Chief's Offices
Mandate Anesthesiologists (Board-Certified or Board-Eligible) to "Confess" as Surrogate for the Supervised Residents/Fellows/CRNAs/SRNAs during the submitted NHNMs
Inspire Residents/Fellows/CRNAs/SRNAs to "Confess" even if they were NOT directly involved in submitted NHNMs but had enough first-hand/direct knowledge of submitted NHNMs
Averted Confessions can actually be used as Sign of Improved Patient Outcomes directly related to the "Confessions" Model that can be turned into Money-Saved-Money-Made-Model in current paradigm of Outcome-Based-Reimbursements
text/html2015-10-09T09:53:25+01:00http://www.webmedcentral.com/Dr. P Ravi ShankarSeven semesters of problem-based learning at a Caribbean medical school
http://www.webmedcentral.com/article_view/4989
Problem-based learning (PBL) in medical schools/courses uses patient problems as a context for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences. In PBL learning begins with a problem [1] but the activity is not directed at solving the problem/case but rather learning from it.
Characteristics of PBL: PBL is compatible with the modern theories of learning. A recent article highlights that PBL is based on information processing theory, student interactions, mixed practice, constructivism, self-determination theory, self-directed learning and adult learning [2]. Activation of prior knowledge, elaboration, context matching, student interaction and cooperation are important. PBL cases bring together information from the basic and the clinical sciences (mixed practice). PBL has a number of advantages with the learning process being active, and in addition to knowledge acquisition, also promotes communication skills, team work, problem solving, and students acquire increasing responsibility for their own learning [3]. Disadvantages mentioned have been students may not have teachers available as role models, certain faculty may consider facilitating as demotivating and inefficient, knowledge may be less systematic and well organized, there may be a greater requirement for facilitators, and greater time requirement for self-directed study.
The institution: Xavier University School of Medicine (XUSOM), a Caribbean medical school situated in Aruba, Kingdom of the Netherlands admits students from the United States, Canada and other countries to the undergraduate medical (MD) course. Recently the MD curriculum has undergone a number of modifications [4]. Among these were shifting to an integrated curriculum, use of standardized patients, early clinical exposure, initiating a medical humanities module, introducing sessions on personal drug selection, prescribing skills and on the critical appraisal of scientific literature. The school shifted to a fully integrated curriculum from January 2014 with all basic science subjects being learned together integrated as organ systems [5].
PBL at the institution: PBL sessions were initiated during the summer (May-August) 2013 semester for the partially integrated first and second semesters. A PBL working group was formed with the PBL Chair, the chair of the Curriculum Committee and selected faculty as members. The partial nature of integration created challenges with regard to conducting PBL sessions as the first and second semester students were only learning the normal human subjects of anatomy, physiology and biochemistry. After discussion among faculty members we decided that during PBL students will define their learning objectives from the normal human subjects during the first two semesters. The same PBL scenario would be revisited during semesters three and four and students would define and work on learning objectives from the abnormal human subjects of pathology, microbiology, pharmacology and clinical medicine and social and behavioral sciences. There were challenges in implementing this especially during semesters one and two as students were strongly driven to understand and ‘solve’ the clinical problem which was difficult without adequate knowledge of pathophysiology. The clinical scenarios used were common/important diseases from the organ system being covered during the particular period. The PBL working group selects the diseases/conditions for the sessions with inputs from different subject faculty members. The prevalence and public health importance of the selected disease condition in the United States and Canada, the primary area of practice of the graduates and the ability of the case to incorporate ‘must know’ teaching-learning objectives from different subjects are criteria considered while selecting diseases/conditions for the PBL cases.
PBL under a fully integrated curriculum: A fully integrated organ system-based curriculum with early clinical exposure was started from January 2014. An additional semester was added to the basic sciences program. Like in most offshore Caribbean medical schools a semester at XUSOM is of 15 weeks duration. During the first semester Fundamental concepts and musculoskeletal system are addressed. The organ systems learned during the second semester were Nutrition and Nervous system while during the third semester Respiratory and Gastrointestinal system are addressed. During the fourth semester Cardiovascular and Hematopoietic system are taught while during the fifth semester the systems covered are Renal, Endocrine and reproductive system and Infection and immunity. Patient, doctor and society and Healthcare quality improvement run concurrently with the organ systems during all semesters. Table 1 shows the disease conditions/clinical scenarios used for PBL during different semesters. Sessions are held once every week from 10 am to 12 pm. The brainstorming session is followed by the discussion/presentation session during the following week.
Faculty and the PBL process: External experts conducted sessions for faculty before PBL was initiated in the institution. Writing PBL cases, facilitating sessions, and assessing students were addressed. A PBL working group was constituted in April 2013 to prepare the groundwork for conduct of the sessions. A PBL chair was also designated. The PBL chair writes the PBL case with inputs from faculty. As XUSOM is a ‘small’ medical school most faculty are involved in providing inputs on the PBL scenario, defining student learning objectives from their subjects, facilitating sessions and assessing students. Table 2 shows selected PBL case scenarios used in the institution. Every year the scenarios are refined and modified. The finalized and refined scenarios are circulated among faculty to provide learning objectives from their subjects. New faculties are mentored by faculties who have experience with facilitating sessions. Following this they facilitate a couple of sessions under the observation and guidance of senior faculty before they facilitate sessions independently.
Challenges with PBL: As the school follows a hybrid curriculum with didactic lectures being the predominant teaching-learning method there were many challenges with regard to conducting PBL. There were challenges for the faculty in managing time to facilitate the sessions, to refine patient problems, define learning objectives and for frequent meetings. As didactic lectures and other teaching-learning strategies occupy a considerable portion of curriculum time students are challenged to find time for self-study and preparing for the discussion sessions. In a hybrid curriculum students and faculty may face challenges in switching from the teacher-centered instructivist learning strategies employed during didactic lectures to the student-centered constructivist learning strategies during PBL sessions [6]. At XUSOM during initial sessions some students had used power point slides of faculty members as resource material to prepare for PBL discussion sessions.
There were differences noted in the learning objectives defined and presentations and discussions among different groups. Another observation was that sometimes the groups concentrate on a disease or condition which was not being learned during the particular organ system. For example during the nervous system we had used a case scenario of a patient suffering from prostatic cancer which had spread to the vertebrae to serve as a base for students to explore the issue of pain management. However some groups defined most of their learning objectives and discussion time on prostatic cancer, a topic covered during the endocrine and reproductive system (fifth semester). We had a similar problem with the case of an obese lady also suffering from type 2 diabetes mellitus. Type 2 diabetes mellitus is again covered in the fifth semester. We are considering having a PBL wrap up session where the facilitators can come together and discuss various aspects of the PBL process including the group work and the PBL case and mention areas which require improvement and approaches to further improve future sessions. A structured format is being used to obtain feedback from the facilitators about the PBL case based on their inputs regarding how their student group handled the case provided. The issue of whether the case was effective in stimulating the student group to work out the different learning objectives is emphasized.
Defining learning objectives: Also during certain instances it was noted that the student groups were not able to derive all the learning objectives from the case scenario as defined by the faculty. A solution for this suggested by the external experts was for the PBL chair to invite learning objectives related to the disease condition first from different faculty members and then write/construct the case so that these objectives could be derived from the case by student groups during the brainstorming process. During the fourth and fifth semester after extensive deliberation it was decided not to cover the disease condition addressed during the PBL session in didactic lectures. If any deficiencies in knowledge were noted after the discussion then a resource session would be conducted by the faculty.
Group dynamics: The problem of the ‘free rider’ or the student who may be non-performing or under-performing and relies solely on the efforts of the competent members of the group has been mentioned in the literature [7]. We have noted problems with group dynamics and group work in a few PBL groups. These problems are usually handled first by the group members and if they cannot address it by the group facilitator and if no solution is forthcoming even at that level by the PBL chair. We had studied student perceptions regarding effectiveness of small groups during PBL sessions recently using the previously validated tutorial group effectiveness instrument [8].Student perception about small group effectiveness was mostly positive though the issue of certain student not contributing fully to the group activities was commented on by a few respondents.
Assessment during PBL sessions: The facilitator assesses individual group members using a rubric developed by Elizondo-Montemayor [9] which was modified to suit the requirements of PBL at the institution. Application of knowledge base, clinical reasoning skills, self-directed learning, collaborative work, and attitudes towards learning and professionalism are among the criteria being considered. At the end of the second session the facilitator and the group members engage in self-reflection and provide peer feedback. The facilitator assessment during the PBL sessions accounts for a certain percentage of final marks in the organ system. The assessment scheme is posted on the student learning system at the beginning of the semester. We are considering introducing a short content assessment at the end of the discussion/presentation session. In a medical school in Nepal students had a positive reaction toward PBL and wanted more session with a short content assessment at the end of the sessions [10]. We plan to evaluate the scores provided by different facilitators over the different semesters during which they have been facilitating PBL sessions to examine whether they are consistently providing lower or higher scores to their group compared to the mean facilitator scores. text/html2016-07-20T04:45:57+01:00http://www.webmedcentral.com/Dr. Deepak GuptaGreat Responsibility with Exposing Human Emotion: Explore Futuristic Automated Face Reading
http://www.webmedcentral.com/article_view/5166
For the sake of its incorporation into clinical diagnosis and management when practicing medicine, Ragsdale et al [1] studied human emotions based on under-appreciated explicitness in the subtleties of human face, a phenomenon recently popularized by Dr. Paul Ekman. I have been interested in Dr. Ekman's courses [2] since my addiction to television series "Lie To Me" [3]. However, I have been hesitant to delve into learning the intricacies of human emotions because the learner cannot unlearn the learning or un-know the knowing despite the learned being bestowed with the great responsibility of self-limiting the unlimited access to the privacy of human mind. Conceptually, when deciding to tread this path, one has to remember that one may only sharpen the innate "gut feeling" to read human face for exploring human mind because Ragsdale et al [1] reported that more than-half participants recognized portrayed emotions correctly before workshop, and that too unknowingly as reflected by less-than-one-third participants succeeding in knowledge questions. After workshop, face-expression-reading skill itself got sharpened in more participants than the acquisition of its knowledge (80% vs. 70%) [1], suggesting objectivity lagging behind subjectivity when reading human mind. Presence of prior training not helping to sharpen skills more [1] highlights natural "gut feeling" suffering with inherent trait of non-attainable near-perfect learning despite "zealous" medical students demonstrating more improvement in skill acquisition than "experienced" faculty or "indifferent" trainee-volunteers. The underlying reason for absence of superlative confidence ratings [1], while self-evaluating non-self-interpretations, could be apprehension "what if I would act based on my imperfect interpretation." This brings me to the finality requesting Dr. Ekman to develop futuristic face-expression-reading software (as similar to facial-recognition-system [4]) on air-gapped computers deriving data from cameras locked onto the faces of informed, consented individuals for pre-defined scenarios/indications because automated reads of the facial expressions, while prompting the blissfully untrained humans into actions based on the computerized interpretations, would thankfully not educate human eyes or human brains for unknowingly yet recurrently crossing the final hurdle and breaching the privacy of considerably-inviolable sanctity of human minds/emotions of people around them.text/html2018-05-15T07:40:52+01:00http://www.webmedcentral.com/Dr. Deepak GuptaProgress Bar On ERAS Portal
http://www.webmedcentral.com/article_view/5463
The variable application fees' model of Electronic Residency Application Service (ERAS) might be expecting that the fees per application becoming higher with increasing number of applications per specialty may deter the number of applications per applicant from soaring. However, this ploy to control the number of applications to manageable proportions for graduate medical education (GME) programs' appropriate and fair review may NOT have been adequately effective, considering that the number of total applications during ERAS season runs into millions. Herein we suggest that the incorporation of two progress bars into ERAS portal may be an additional provision to make applications' numbers manageable.
In the first progress bar at the time of finalizing each application's submission, the applicant must be able to see the total number of applications which have already been submitted to the chosen GME program. This may help the applicant in real-time to consider "less popular" GME programs wherein the manageable numbers of submitted applications will be more likely to be duly reviewed. As corresponding to the total number of interviewees planned by each GME program, the disclosed manageable applications' numbers may further enhance the efficacy of first progress bar in preventing applicants being overwhelmed to apply for numerous GME programs and GME programs being flooded with innumerable applications.
In the second progress bar at the time of finalizing an applicant for interview call, the GME program must be able to see the total number of interview calls which have already been confirmed by the chosen applicant. This may help the GME program in real-time to consider "less popular" applicants who all, because of manageable number of interview invites received, will be more likely to confirm the interview calls. As corresponding to physical feasibility for attending multiple interviews based on joblessness status of each applicant, the deciphered manageable interviews' numbers may further enhance the efficacy of second progress bar in preventing GME programs' interview calls being rejected by the overwhelmingly invited applicants and the innumerable applicants being potentially overlooked for interview calls.
Summarily, these two progress bars can be worthwhile enhancements to ERAS portal.text/html2018-07-03T06:19:34+01:00http://www.webmedcentral.com/Dr. P Ravi ShankarObtaining a clearer perspective on the differently abled: a case study from a Caribbean medical school
http://www.webmedcentral.com/article_view/5499
Movies are used in medical schools for a variety of purposes ranging from learning of professionalism, public health, drug dependence, disability among others. In a medical school in Aruba, Dutch Caribbean movies and activities were used to strengthen learning of communication skills, empathy, professionalism, and death and dying. American International Medical University in Saint Lucia admits students for graduate courses in medicine and nursing. Recently innovations have been carried out to the basic sciences curriculum. A movie screening and activity was used at the institution to provide a clearer perspective about the differently abled. The movie ‘My left foot’ was screened followed by group activities and presentations. Participant feedback was obtained using a simple questionnaire and noting the degree of respondents’ agreement with a set of eight statements. The mean score was 33.9 (maximum score 40). Student feedback about the session was positive. Similar sessions can be considered in future and could be expanded to involve all basic science students.text/html2020-02-26T10:22:46+01:00http://www.webmedcentral.com/Dr. Deepak Gupta2019 College Admissions Story And ERAS/NRMP/GME
http://www.webmedcentral.com/article_view/5604
2019 College Admissions Story is pertaining to Honest Services Fraud statute [1-2]. This federal statute safeguards the third party from the harms caused by transactions between two parties whereby the transactions have caused the recipient party to be non-compliant in its duty to provide honest services to the collaterally damaged party. It is our understanding that while corruption is when actual breaches in the statute have occurred, conflicts of interest are the avenues which can potentially evolve as future breaches in the statute [3]. Therefore [4], the questions arise if and how 2019 College Admissions Story affects ERAS®/NRMP/GME when programs are shortlisting and selecting their future residents.
USMLE in Pass/Fail format [5]: Will the proposed change in USMLE format make screening of ERAS® applications unpredictable and liable when resident selection process becomes dependent on everything else except USMLE scores which have been the lone objective grading tool available to GME recruiters [6]?
Demand-supply mismatch: Will solicitations for Visiting Student Learning Opportunities (VSLO) warrant enhanced scrutiny for conflicts of interest because VSLO externships/observerships can act as stepping-stone to GME admissions [7]?
Future of one-on-one interview model [8]: Will group-cum-panel interviews replace one-on-one interviews to avoid undisclosed conflicts of interest being misconstrued as improprieties?
Diversity in GME [9]: Will increased caution and conscious efforts therein by GME recruiters improve diversity and inclusion for underrepresented communities in GME programs?
“A” vs. “B” vs. “C” students [10]: Will the heightened awareness among GME recruiters ensure selection opportunities for all grades of applicants?
Future of “legacy” admissions [11]: Just like “sportsperson” admissions serving needs of colleges to excel in competitive college sports, will the “legacy” admissions evolve to be rechristened as “fundraiser” admissions serving the cash/in-kind needs of admitting institutions [12]?
High NRMP Match Rates [13]: While >50% applicants don’t get selected to medical schools, only < 10% matriculants fail to graduate medical school [14]. Thereafter, only < 10% medical graduates fail to match into GME residencies [13]. Moreover, GME residents’ attrition rates remain very low in stark comparison to alarmingly high college dropout rates [15-16]. Even practicing physicians are unable to retire early or quit practicing medicine by choice [17]. Therefore, is 2019 College Admissions Story more burdensome to medical school recruiters rather than ERAS®/NRMP/GME recruiters when ~90% admitted to medical schools are anyway going to practice medicine in their chosen specialty?
During ERAS®/NRMP/GME season, one of the efforts for “well-rounded” classes can be development and disclosure of objective parameters utilized to quantify emotional quotient (EQ), social quotient (SQ) and collective quotient (CQ) beside intelligence quotient (IQ) of GME applicants [18-21]. GME programs should always seek happy applicants having big potential to satisfy the reality-bending needs of world whereby collegial collaborative service providers adapt, survive and excel better than eccentric disruptive academic geniuses [22-24]. To accomplish the above-mentioned:
(a) IQ/EQ/SQ/CQ Portals: ERAS® may have to develop standardized-personalized-centralized online IQ/EQ/SQ/CQ assessment via video-recording-portals to serve as applicant-screening tools for programs
(b) Group Interviews: Programs may have to arrange interviews as visits by small groups of one-day hands-on observers followed by end-of-the-day group-cum-panel discussions
(c) CQ Weightage: Programs may have to give more weightage to CQ of one-day observers-cum-interviewees when submitting their rank order lists to NRMP.
(d) Mandatory VSLO [25]: Futuristically, ERAS® may have to consider mandating its VSLO program to match all third year medical students for at least three cost-effective externships in fourth year of medical school wherein GME programs as well as their matched externs will have ample opportunities to evaluate each other before ranking and eventually matching to GME residencies through NRMP.
Summarily, ERAS®/NRMP/GME may preemptively overcome 2019 College Admissions Story effect by continuing constant and conscious efforts to honestly and transparently select future physician leaders of the world.text/html2020-02-26T10:22:32+01:00http://www.webmedcentral.com/Dr. Deepak GuptaSelf-Healing Ceiling
http://www.webmedcentral.com/article_view/5606
The prominent weightage accrued to letters of recommendation and personal statements make one wonder whether the standardized examination-adjudged meritocracy misses out on applicants’ assessment as whole persons. However, the origin of letters of recommendation and personal statements a century back may be speaking for itself according to “Affirmative Action for the Rich: Legacy Preferences in College Admissions” in United States and “The Class Ceiling: Why it Pays to be Privileged” in United Kingdom [1-2].
Irrespective of the original reasons to institute letters of recommendation and personal statements a century back, the current application processes to judge wholesomeness of applicants have inducted too many parameters to assess during the application processes [3]. However, these parameters’ quantifiable objectivity is always in question imploring futuristic thinkers to consider developing standardized intelligence-emotional-social-collective quotient assessment portals to level the field for the applicants [4]. In the interim, it may be better to consider replacing the current interviewing processes assessing sociability among fitting-in applicants with practical examinations wherein the applicants may be able to objectively demonstrate their technical know-how as pertaining to their fields so as to complement their theoretical know-how demonstrations during written examinations.
The principal question is: Isn’t it getting obsolete to only seek knowledgeable talents instead of sociable collaborators? However, the selection processes’ biases while seeking sociable collaborators must be overcome by exploring futuristic collaboration know-how assessment tools sans their all-pervasive subjective dimensions. Herein independently functioning artificial intelligence may come in handy. The bottom line is: One cannot surrender or squander one’s naturally endowed innate privileges secondary to the accident of one’s birth or origins or familial support systems or finances [5].
Reflectively, if the system favoring those born with a silver spoon in their mouths had been so counter-productive, the societies based on such systems may have failed long time ago unless few or all of the following things may be happening:
There is a large lag period before such inequitable system fails
This is the only way the system is supposed to work whereby achieving equality in the nature always remains elusive
This is just system adapting to the rising costs of education and training warranting legacy/development case contributions to sustain nurturing the excellence of super-selectively talented few from humbler backgrounds whose super-excellence in their fields is immune to ambiguities of the system and on whose shoulders the same system rises up to excel further in spite of its ambiguities [6]
There is the immateriality of institutional education and training as compared to life experiences and teachings making the issue of equitable access to institutions moot [7]
Therefore, the question arises: Should there be a cry for breaching the ceiling? It may be painfully truthful that the glass/class ceiling may be a “Self-Healing Ceiling” wherein even when breached, it self-heals underneath the ones who have breached the existing ceiling [8]. Thereafter, in time the ceiling self-perpetuates above them especially when too many have breached the existing ceiling turning it into an unstable doomed floor. Henceforth, the call for breaching the ceiling may be just a cry to renegotiate the existing terms and conditions of the ceiling because the classes constantly warrant restructuring based on their differential access across the self-healing ceiling.
Evolutionarily, the opportunities for growth and even survival turn leaner as the societal classes rise up within their hierarchies. Thereafter, the selfish gene overtly interferes regarding whom to collaborate with [9]. Although it may have appeared more equitable when choosing among the larger populations while dwelling at open-spaced bottoms, it may become impossible to ignore family and kinship when competing at tight-spaced horizons. Innately, everything may be boiling down to the selfish gene which may be propagating a convoluted misconception that whoever survives must be the fittest.text/html2020-12-27T08:17:06+01:00http://www.webmedcentral.com/Dr. Deepak GuptaQuestions Worth Raising: Automated Writing Evaluations And Legacy Admissions
http://www.webmedcentral.com/article_view/5673
As medical education researchers, we have a vision and that is why we are raising these questions. Can automated writing evaluations of personal statement help in objective assessments of applications? Can legacy admissions be objectively streamlined in graduate medical education?text/html2021-10-13T11:05:17+01:00http://www.webmedcentral.com/Dr. Deepak GuptaAvoiding Work Authorization Status Related Conscious And Explicit Bias
http://www.webmedcentral.com/article_view/5746
As elicited by Balhara et al [1], graduate medical education (GME) in the United States (US) is finally lapping up to objectively recognize and ostracize bias [2]. However, this pursuit of equitable recruitment freed of unconscious and implicit bias will be incomplete without addressing the conscious and explicit bias based on applicants’ work authorization status. Understandably, national policy may preclude GME from recruiting non-resident aliens unless there is a shortage of eligible US persons (citizens, nationals and permanent residents). However, categorization in Electronic Residency Application Service (ERAS) applicant worksheet apparently highlights that it may only be about the bottom line with non-resident aliens’ visa sponsorship entailing monetary and non-monetary costs to the GME programs [3]. As non-resident aliens may NOT have any say in shaping the national and institutional policies, they can only hope that their applications are not overlooked during screening, interviewing and ranking by the GME programs due to their work authorization status. If GME programs want to ensure equitable opportunities to non-US persons applying for GME while concurrently avoiding the risk of misrepresentations by non-US persons in their ERAS applications to take advantage of perceived systemic bias against non-US persons, documentary evidence for identity and work authorization will have to be required from all applicants (US persons as well as non-US persons) during ERAS season so that GME programs can screen them at least before ranking the applicants because GME programs will need to uniquely quantify monetary and non-monetary costs as pertaining to each applicant. Although the faraway future may entail foreseeable mandatory global background check for all ERAS applicants [4], it is not difficult to envisage mandatory documentary evidence of applicants' identity and their work authorization status happening in the immediate future considering that we are already relying on the authorities rather than the applicants to submit supporting documents like Medical Student Performance Evaluation, Medical School Transcripts and Letters of Recommendation on applicants’ behalves. Although documentary evidence of identity and work authorization status should come directly from the authorities, the copies of documentary evidence owned and submitted by the applicants to ERAS may be a good start. Interestingly, once the documentary evidence for identity and work authorization status has been uploaded, the data fields in ERAS applications can be auto-populated as according to the submitted evidence so as to avoid any inadvertent misrepresentation by the applicants in their applications. If the digital system itself cannot automatically recognize the conflicting information in application contrasting the supporting documentary evidence, the manual check by ERAS personnel at a predetermined fee surcharge can be envisaged in the interim till the digital system turns mature enough to screen the authenticity of ~50,000 GME applicants per year. Summarily, to avoid blanket bias against all as based on their work authorization status [5], it is important for ERAS to walk away from self-reported identity and work authorization status by applicants and to move towards documentarily evident identity and work authorization status (passports, driver licenses, permanent resident cards and visa pages to name a few) as submitted by the applicants and/or as confirmed by the authorities so as to allow appropriate screening by ERAS before the GME interview season begins.