Tips for Managing Resistance to Innovation in Medical Education

@#Resistance to innovation is a natural protective mechanism and it should be perceived as a “conditional acceptance” rather than outright rejection. The change agents need to take a number of steps to convert the conditional acceptance to a “welcome change”. The aim of this article is to equip the staff members in the institutions of higher learning with tools for effectively managing the resistance to innovations in medical education. We examined the published literature in the area of managing the resistance to change and combined it with our own experiences in the established as well as new medical schools in two Asian countries and developed 12 tips to assist the change agents to manage the resistance to innovations effectively. Application of these tips will help change agents to use their time and efforts efficiently and effectively to achieve credible and lasting changes in the field of medical education.

Successful Academic Remediation of Undergraduate Medical Students for Exit Examination: Lessons Learned

@#Introduction: To ensure that they will be the safe health-care providers, the medical schools must guarantee that their students meet the predetermined criteria before graduating. To fulfil this condition, usually a small proportion of students, need remedial training before they could graduate. In October 2018 we designed an academic remediation programme for 24 students who were to re-appear in their Final Professional MBBS Examination (FPE) in March/ April 2019. Aim of the remediation programme was not only to help the students to pass the examination but also to train them as safe future doctors. Methods: A rotational programme was drawn to cover all the relevant disciplines. A number of well-planned interventions were applied. A clinical examination in various combinations of a long case, short cases and OSCE stations was conducted at the end of each rotation and the written examination was conducted after completing the full 24 weeks of the programme before they sat in the FPE. Results: The five most useful interventions identified in the students’ feedback included: “Patient to book approach”; Mentoring; Group study; Mock examinations and Flipped class-rooms. Eighteen of the 24 (75%) students passed the FPE. The five of the six students failed because of the poor performance in the clinical examination. Conclusion: Remedial interventions can be successful by having clear goals and directions. Individualized approach in identifying and addressing the issues and by seeking help from the relevant professionals ensures the success.

Tips for Developing an Outcome-based Undergraduate Medical Curriculum

@#Although the transformation towards adopting an Outcome-based Education (OBE) is gathering momentum globally, several medical schools are finding it hard to implement the change. Based and built on authors’ experience and cues from the literature, the tips – relating to the process of identification, description and dissemination of learning outcomes (LOs); usage of LOs to ascertain the curricular contents, the teaching/learning and assessment methods; implementing, monitoring and reviewing the curriculum – are the actions that the institutions of higher learning need to perform to transform the existing curriculum or to develop an altogether a new curriculum according to OBE approach. The development of the faculty through dialogues, discussions and training sessions should be an initial and essential step in this process. It is hoped that these tips will alley some of the fears and facilitate the adoption of OBE curriculum in new as well as in existing established institutions.

Developing a Bank of Faculty-authored, Valid and Reliable Objective Questions for Institutional Use: Sharing the Experience

@#Introduction: With the increasing number of institutions implementing competency-based education which demands to provide feedback to students at regular intervals, there is an increase in the frequency of assessments. For this purpose, the written examinations using multiple choice questions (MCQs) are the most feasible form of assessment. However, constructing MCQs is an arduous task and significantly adds to the work-load of the academic staff members. To ease this burden, the institutions may consider to develop banks of valid and reliable MCQs. Methods: Based and built on our experience and literature review, the steps – relating to the process of constructing valid and reliable questions and development of question banks (QBs) – are the actions needed to develop new QBs or improve on the existing ones. Results: We have described ten practical steps for developing and banking of MCQs. The first five steps relate to the development of quality items and the remaining steps relate to the development of QBs, their maintenance, growth and safety and security. We have also established the criteria for selection and the frequency of reuse of questions. Conclusion: Using QBs will alleviate some of the burden of constructing novel quality questions needed for frequent assessments of students using 21st century teaching/learning approaches. The use of banked questions with known psychometric properties would allow the authorities to take charge and control of items’ quality and overall examination standards.

Role of diet on the enterohepatic recycling of estrogen in women taking contraceptive pills

The effect of diet on the entrohepatic recycling of estrogen after oral administration of 1 mg non-radioactive estriol [E[3]] was studied in six women using contraceptive pills. The women were followed for two consecutive menstrual cycles, firstly on a high fibre diet [HFD] and then changing on to low fibre diet [LFD] during the next cycle, hence each subject acted as its own control. The extent of enterohepatic recycling of estriol [E[3]] during the early follicular phase of menstrual cycle was assessed by monitoring during 48 hours, the urinary excertion of its two major metabolites, i.e., estriol-3-glucuronide [E[3]-3-G] and estriol 16 alpha-glucuronide [E[3]-16alpha-G]. An increase in values of the variables including E[3]-3-G/E[3]-16alpha-G output ratio, E[3]-3-G output as percent of total [E[3]-3-G+E[3]-16alpha-G] excretion and total E[3] [E[3]-3-G+E[3]-16alpha-G] output as percent dose was noted as a result of change from high to low fibre diet. The urinary excretion of E[3] in the form of its metabolites was also delayed as a result of dietary change. These findings reveal that extent of enterohepatic recycling of estrogen containing contraceptives could be higher in women on LFD as compared to those who are on HFD

Acomparative study on the response of plasmodium falciparum against chloroquine and amodiaquine

Plasmodium falciparum response against chloroquine and amodiaquine was studied in Dera Ismail Khan district using W. H. O. extended field test. The result of the present in - vivo study comprising of 31 plasmodium falciparum infections reveal that 50% of the local falciparum infections are resistant to chloroquine at different levels and these resistant infections could possibly be treated with amodiaquine

Changes with age in creatinine clearance in normal subjects and the patients with different renal disorders

The endogenous creatinine clearance was studied in 33 normal subjects and in 80 patients with different renal disorders including chronic renal failure, nephrotic syndrome and renal calculi. Creatinine clearance apparently increased with advancing age in normal subjects and in the patients with renal calculi upto fourth decade after which it followed a gradual decline, but these age related changes in creatinine clearance were not found to be significant statistically. No such age related pattern of variations in creatinine clearance was observed in patients with chronic renal failure and with nephrotic syndrome. In patients with renal calculi, the values of creatinine clearance were apparently higher as compared with the normal subjects for all the age groups. On the other hand in the patients with chronic renal failure, the values of creatinine clearance were considerably lower than those seen in the normal subjects of corresponding age groups. In patients with nephrotic syndrome, the creatinine clearance was found to be significantly low [P < 0.05] as compared with the normal subjects after the age of 20 years