Impact of case based discussion as an instructional tool on the annual examination results in Ophthalmology for fourth year undergraduate medical students

Objective: Determine the effectiveness of case-based discussion [CbD] in terms of annual professional ophthalmology examination performances [scores] at undergraduate level involving students

Study Design: Quasi experimental study

Place and Duration of Study: FMH College of Medicine and Dentistry for under graduate 4th year MBBS class in Ophthalmology [13 months' duration], from Dec 2013 to Dec 2014

Material and Methods: After approval from the IRB, scores of the historical control group, consisting of all 4th year MBBS students from previous four years included [64, 89, 96 and 85 respectively] were collected, who underwent traditional teaching. A total of 113 students were enrolled using non-probability convenience sampling technique in the interventional group of the study, who were exposed to CbD. Their scores in the annual university examination were collected in the subject of ophthalmology. The data was analyzed for its normalcy and Mann Whitney test was applied for comparison. Scores of both groups were correlated using Pearson's coefficient of correlation to determine similarity of constructs measured through traditional assessment method and CbD

Results: There was statistically insignificant difference [p-value 0.087] between scores obtained by historical controls and those who received intervention [CbD]. There was insignificant negative correlation in [-0.028] between scores obtained through traditional assessment and CbD

Conclusion: CbD fosters higher order thinking among undergraduate students in Ophthalmology. However, traditional assessment methods do not measure constructs that should be evaluated among undergraduate students, urging formal evaluation of the assessment items for further improvement

Clinical learning environment: what do house officers say?

Objective: To explore effect of format change in house job training and other factors, hindering or promoting junior doctors' training/learning in their transition to practical life

Study Design: Mixed Method Sequential

Place and Duration of Study: Sir Ganga Ram hospital Lahore, from Nov 2011 to Oct 2012

Material and Methods: Four hundred and ninety two doctors completed the modified PHEEM survey after completion of their house job from November 2011 till October 2012 after institutional ethical review Board's approval. Second phase comprised semi-structured FGD to triangulate findings of the survey with FGD results, to find out, in detail, about doctors' expectations from their house job training and suggestions for future after ensuring confidentiality and anonymity to study participants

Results: The mean overall score for clinical learning environment was 77.67, implying 57.0 percent satisfaction. Themean total scores for autonomy; teaching and social support was 25.6, 31.9 and 20.0 respectively. Satisfaction with regard to autonomy, teaching and social support was 25.6/48 [53.3 percent], 31.9/52 [61.3 percent] and 20.0/36 [55.5 percent] respectively. Patterns emerged from FGD were lack of standardization, nonexistence of formative assessment, opportunistic learning, poor quality feedback and inappropriate teaching by medical officers. Skill learning under supervision, confidence in patient management and part of clinical team were motivating factors while poor accommodation, sanitation, catering facilities and short duration of rotation were hindering factors for learning

Conclusion: Evidence generated has shown that internship year was very challenging. Dissatisfaction was expressed with unstructured opportunistic nature of training. Unstructured training program, role ambiguity, substandard physical environment and short duration of rotations were perceived to negatively influence learning. A valued member of clinical team, confidence in patient management, opportunity to acquire procedural skills under supervision and being supported were the factors perceived to enhance learning

Issues and remedies related to learning environment of students during maternal, neonatal and child health clerkship

Objective: To gain insight into learning-environment of Maternal Neonatal and Child Health community clerkship, using Dundee Ready Educational Environment Measure questionnaire and focus group discussion to improve students' quality of learning. Study Design: Sequential Mixed Method Study. Place and Duration of Study: Primary Centers [Aga Khan Health Services, Pakistan] and Secondary Center [Aga Khan University], from Nov 2014 to Oct 2015

Material and Methods: All consenting third-year MBBS students after completing maternal neonatal and child health [MNCH] rotation anonymously filled the Dundee Ready Educational Environment Measure [DREEM] questionnaire. Data was entered in MS Excel 2013 and SPSS version 21. Descriptive statistics were calculated such as frequencies, mean and standard deviation of the total/subscale scores. Independent samples t test was used to identify gender-related differences among DREEM scores with p-value of < 0.05 as statistically significant. Focus Group Discussion [FGD] was conducted with all consenting facilitators [Faculty/Lady Health Visitors]. Thematic analysis of qualitative data was done using constant iterative approach

Results: From a total of 99 students, 78 [78.8%] consented, of which 36 [46.2%] were males and 42 [53.8%] females. Mean total DREEM score was 126.26/200 [63.13%] indicating a more positive learning environment. Total means with percentages and interpretation of subscale scores showed 'Students Perception of Learning [SPOL]', 28.92/ 48 [60.25%] indicating more positive approach; 'Students Perception of Teachers [SPOT]', 28.58/ 44 [64.95%] indicating teachers are moving in right direction; 'Students Academic Self-Perception [SASP]', 20.64/32 [64.5%] indicating students felt positive academically; 'Students' Perception of Atmosphere [SPOA]' 31.17/48 [64.93%] indicating positive learning-atmosphere and Students' Social Self-Perception [SSSP], 16.93/28 [60.46%] showing not-too-bad social-environment. Thus, DREEM results showed, students perceived their learning environment to be overall positive. As a composite score in the five domains of educational environment no statistically significant difference was found between males and females. [SPOL: p value 0.655; SPOT: p value 0.760; SASP: p value 0.685; SPOA: p value 0.245; SSSP: p value 0.280]. Common issues identified through DREEM and student-facilitators through FGD were grouped into three themes; 'Challenges faced', 'Student-learning facilitation' and 'Way-forward'. Triangulation of data from DREEM questionnaire and FGD indicated validation of outcomes

Conclusion: MNCH clerkship is a rotation, in a low/middle income country, in early years of inception. Students are satisfied but there is scope for improvement. This evaluation helped = identify problem areas to enable improvement of program and inspire other institutions to arrange community clerkships

principals' perspective of the learning environment in undergraduate medical colleges of a developing country

Objective: To explore the perspective of Principals in a developing country regarding the learning environment of their respective undergraduate medical colleges, thus highlighting the difficulties faced by them and obtaining their recommendations for improving the educational environment. Study Design: A concurrent mixed method study in the pragmatic paradigm using survey and interview techniques to collect data. Place and Duration of Study: Study was conducted from June 2015 to December 2015 involving institutional heads of seven undergraduate medical colleges in the twin cities of Rawalpindi and Islamabad in Pakistan

Material and Methods: Principals of seven undergraduate medical colleges in one city were given a brief questionnaire to fill which was followed by interviews. The data from the questionnaire was analyzed using SPSS-21 and the data from the interviews was analyzed using NVivo 11. Themes obtained were studied in detail for analysis and interpretation

Results: The study determined that while the learning environment in different medical colleges is neither uniform nor optimal, most institutional heads have similar opinions about major factors contributing to the learning environment and face more or less similar difficulties. Curriculum emerged as the most important factor contributing to the learning environment. Lack of resources and shortage of academic staff were the main difficulties identified. Improved standards of student and faculty selection and better coordination between the colleges and the affiliated teaching hospitals were two of the important recommendations

Conclusion: Lack of resources, shortage of the academic staff along with the curriculum issues were identified as the major factor contributing towards the learning environment

Course enjoyment and learning style of participants of a distance learning program in health professions education [HPE]

Objective: To identify and relate enjoyment levels of various components of MCPS-HPE course and the learning styles of the course participants followed by explanation of the reasons for enjoyment, non-enjoyment and how enjoyment factors can be enhanced

Study Design: Mixed method sequential study

Place and Duration of Study: College of physicians and surgeons, Pakistan, Regional Center, Lahore from January 2013 to April 2014

Material and Methods: Learning style of MCPS-HPE course participants of 2011-13 batch was identified through Kolb's Learning Style Inventory version 3.1; and participant's perception of the most enjoyable areas in the contact sessions and assignment completion were sought on two respective survey forms followed by structured interviews

Analysis of the quantitative data was performed using SPSS version 19. [Framework method] was used for the manual analysis of qualitative data

Result: Learners identified social interaction, team work, knowledge construction, active learning and self-efficacy as enjoyable while cognitive overload, disruptions in learning, and deadlines as factors impeding enjoyment. Acquiring learning skills, contextual simplified learning, addressing disruptions and promoting active learning and proactive mentorship were suggested as measures for improving enjoyment level. Predominantly our participants were convergers who enjoyed the course more than those with other learning styles. Conclusion: Team work along with experiential learning improves learners' self-efficacy and enthusiasm. Ensuring contextual learning and proactive mentoring can address negative impact of cognitive overload, inappropriate facilitator's attitude and deadlines on course enjoyment while taking into account various learning styles

Frame factors for implementation of integrated curriculum in public sector medical college - faculty's perspective

Objective: To prospectively explore the frame factors influencing the planned implementation of integrated curriculum at Allama Iqbal Medical College, Lahore from the faculty's perspective

Study Design: Qualitative exploratory phenomenological design using constructivist approach

Place and Duration of Study: Allama Iqbal Medical College Lahore from Sep to Dec 2014

Material and Methods: Purposive sampling was done and consisted of seventeen teaching faculty members of undergraduate subjects and two qualified medical educationists. Face to face semi structured in-depth interviews were carried out which were audio recorded. The interviews were then transcribed and thematic analysis carried out through manual matrix method and by using software N VIVO 1O. Triangulation of themes, subthemes and nodes was done in the content by relating to their respective frequency of quotes and word cluster. Data verification was done through member checking by second and third authors

Results: The promoting factors were political will, strong leadership, faculty training and development, ownership of new curriculum, teamwork, incentives and communication. The potential impediments to curricular change were fear of the unknown, fixed mindset, faculty resistance due to age and competing agendas. However, to address these impediments besides augmenting promoting factors, piloting of the portion of a curriculum for phase was considered essential

Conclusion: The faculty's perspective in regard to the frame factors influencing the planned implementation of integrated curriculum at public sector medical college yielded new information which will serve as a road map to the intended implementation of integrated curriculum at public sector medical colleges from the year 2017

Peer assessment: an innovative tool for assessment in higher education

To determine the correlation between peer and instructor assessment. Correlation study. College of Physicians and Surgeons Pakistan [CPSP], in. department of Medical Education [DME] from November 2011 to March 2012. All participants enrolled in MCPS-Health Professions Education program of 2011-2013 [n=21 in 1[st] session and n=21 in 2[nd] session] consented for inclusion in the study. During contact sessions the participants gave lecture presentations of 10 minutes duration, on topics of their choice but preferably related to medical education. The lecture was appraised by both the instructors and the fellow participants using evaluation forms with 5 point Likert scale. Each aspect of the presentation was assessed and scored. The Pearson's coefficient of correlation, between scores awarded by participants and scores awarded by instructors was found to be 0.63 [p= 0.002] in the l[st] contact session. By 2[nd] contact session the correlation improved from moderate to high turning out to be 0.80 [p < 0.00l]. The study provides a sound evidence that; Peer assessment is comparable to faculty assessment and hence can be used more frequently to steer students' learning towards learning outcomes

Feedforward interview technique in obstetrics and gynaecology residents: a fact or fallacy

To determine the role of Feedforward Interview [FFI] technique in motivating residents of Obstetrics and Gynaecology for better learning and performance. An explorative study with mixed method approach being employed. Department of Obstetrics and Gynaecology, Sandeman [Provincial] Hospital, Quetta, from November 2010 till May 2013. Feedforward interview technique was complimented by survey questionnaire employing similar philosophy of FFI to triangulate data through two methods. Survey questionnaire was filled-up by 21 residents and analysed by SPSS version 17. Fourteen of these participants were identified for in-depth Feedforward Interviews [FFI], based on nonprobability purposive sampling after informed consent, and content analysis was done. Feedforward interview technique enabled majority of residents in recalling minimum of 3 positive experiences, mainly related to surgical experiences, which enhanced their motivation to aspire for further improvement in this area. Hard work was the main personal contributing factor both in FFI and survey. In addition to identifying clinical experiences enhancing desire to learn, residents also reported need for more academic support as an important factor which could also boost motivation to attain better performance. Feedforward interview technique not only helps residents in recalling positive learning experiences during their training but it also has a significant influence on developing insight about one's performance and motivating residents to achieve higher academic goals

Effect of extensive rote learning experience on subsequent academic achievement

To determine the difference between academic achievements in terms of scores of students with prior extensive rote memorization experience with those without it. Ex-post fecto study. Quaid-e-Azam Medical College, Bahawalpur from Dec 2013 to Mar 2014. After Quaid-e-Azam Medical College's ethical review board's approval, scores of medical students first professional examination were selected by purposive sampling technique, making a total sample size of 102 students, constituting 2 comparison groups with 51 students in each. The first group comprised all the students of 3[rd], 4[th] and 5[th] year MBBS who were Hafiz-e-Quran and the other one had non Hafiz-e-Quran students from the same year. Descriptive statistics such as mean and standard deviation of their scores were calculated. The overall mean score in biochemistry, physiology and anatomy was statistically different for these two groups as mean scores were 730.25 +/- 50.66 and 699.94 +/- 48.93 [p = 0.003] respectively for hafiz-e-Quran and non-hafiz-e-Quran. This was because of significant difference in achievement of score in physiology as mean score was 258.47 +/- 24.36 and 248.98 +/- 20.60 for hafiz-e-Quran and non-hafiz-e-Quran respectively [p = 0.036]. The difference in the subject of anatomy and biochemistry was not statistically significant. Prior training of rote learning may provide experience to learn and reproduce bigger chunks of knowledge more effectively

Learning through small group discussion versus didactic lectures

To study and compare the impact of didactic lecturing with small group discussion among undergraduate medical students. Study Design: Sequential mixed method. Quaid-e-Azam Medical College, Bahawalpur, from January 2012 to October 2012. Results of 2 final year classes comprising 566 students [of sessions 2011 and 2012] were analyzed and 30 students from the existing final year were selected for focus group discussion by non-probability convenience sampling technique. In the first phase, quasi experimental design was employed. Small group discussion [SGD] learning format was used as an intervention on the interventional group [277 students] and results were compared with the scores of previous final year student [historical control group: 289 students] who learnt through didactic lecturing. In the second phase, focus group discussions of current final year was arranged to dig out their views about SGD intervention. The quantitative data was analyzed by using SPSS version 17. Content analysis method was applied for qualitative analysis of focus group discussions. The mean scores were 1006 +/- 60 in interventional group as compared to 1026 +/- 57 in non-interventional group [p<0.001]. In second phase, the focus group discussion, students [30], found lecturing was a better way of learning than SGD in terms of content coverage according to 15 students [62.5%], senior people teaching: 9[37.5%], who were better prepared: 6[25%]. Whereas, the downside of small group discussion was related to the fact that the junior teachers were involved in teaching according to 15 [62.5%] who were less prepared: 11 [45.8%] and lack of uniformity in practicing the intervention in different wards: 10 [41.7%].Students consider SGD as a relatively less favored mode of information transfer owing to multiple factors influencing the learning process of students as opposed to didactic lecturing in our set-up

Developing professionalism: dental students' perspective

To explore the undergraduate dental students' insight of their professionalism development through Focus Group Discussions [FGD]. Constructivist approach using qualitative phenomenological design. Fatima Memorial Hospital, College of Dentistry, Lahore, from April to June 2011. Four FGDs of 1st year [8 students], 2nd year [6 students], 3rd year [6 students] and 4th year [6 students] enrolled in Bachelor of Dental Surgery [BDS] program were conducted to explore how they have developed various elements of professionalism namely altruism, accountability, excellence, duty and service, honor and integrity, and respect for all; and how professionalism can be further developed in them. The FGDs were audio taped, transcribed and analyzed through thematic analysis. Triangulation of themes and trends were done through content analysis by relating to their respective frequency of quotes. Data verification was done through audit by second author. Role models and social responsibility were the main reasons in the students' professionalism development thus far with personal virtues and reasons; religion; and punishment and reward contributing to a lesser degree. Training contributed least but was deemed most in furthering professionalism. Excessive workload [quota] and uncongenial educational environment were considered detrimental to the cause. Formal planning and implementation of professionalism curriculum; selection of students with appropriate attributes; control of hidden curriculum, including effective role models, good educational and working environments will foster professionalism among dental students maximally

Perceptions of doctors on being treated by a doctor just completing the house job

To determine the percentage of medical teachers and fresh doctors who feel that graduating doctors are competent or incompetent to handle common ailments and to evaluate the reasons for their perceptions. Sequential mixed method. First phase extending from December 2010 to December 2011 and second phase was conducted in March 2014. First phase comprised electronic distribution of questionnaire to 100 medical teachers and fresh doctors working in hospitals attached with 5 private and 5 public sector medical colleges of Lahore and Karachi to rate an average house officer on a frequency scale of 1 - 6 and do self-assessment, in case of a fresh doctor. The second phase included interviews of 20 medical teachers to explore justification for their rating in the survey questionnaire and for triangulation of data. Quantitative data was analyzed through SPSS version 15 to calculate frequencies and percentages and interviews were analyzed through quasi-statistical approach. In survey, 38.36% out of 73 medical teachers and 30% out of 20 medical teachers in interviews confirmed their confidence on consulting fresh doctors for common ailments as opposed to 61.64% and 70% respectively, expressing their dissatisfaction. Self-assessment of fresh doctors indicated that 40% are confident in handling common medical conditions as opposed to 33.3% out of 75 respondents, who are not confident about their clinical skills. Faculty and self-assessment of fresh doctors has a fair overlap, indicating room for further improvement in the house job training program

Task-based learning versus problem-oriented lecture in neurology continuing medical education

To determine whether general practitioners learned better with task-based learning or problem-oriented lecture in a Continuing Medical Education [CME] set-up. Quasi-experimental study. The Aga Khan University, Karachi campus, from April to June 2012. Fifty-nine physicians were given a choice to opt for either Task-based Learning [TBL] or Problem Oriented Lecture [PBL] in a continuing medical education set-up about headaches. The TBL group had 30 participants divided into 10 small groups, and were assigned case-based tasks. The lecture group had 29 participants. Both groups were given a pre and a post-test. Pre/post assessment was done using one-best MCQs. The reliability coefficient of scores for both the groups was estimated through Cronbach's alpha. An item analysis for difficulty and discriminatory indices was calculated for both the groups. Paired t-test was used to determine the difference between pre- and post-test scores of both groups. Independent t-test was used to compare the impact of the two teaching methods in terms of learning through scores produced by MCQ test. Cronbach's alpha was 0.672 for the lecture group and 0.881 for TBL group. Item analysis for difficulty [p] and discriminatory indexes [d] was obtained for both groups. The results for the lecture group showed pre-test [p] = 42% vs. post-test [p] = 43%; pre- test [d] = 0.60 vs. post-test [d] = 0.40. The TBL group showed pre -test [p] = 48% vs. post-test [p] = 70%; pre-test [d] = 0.69 vs. post-test [d] = 0.73. Lecture group pre-/post-test mean scores were [8.52 A +/- 2.95 vs. 12.41 A +/- 2.65; p < 0.001], where TBL group showed [9.70 A +/- 3.65 vs. 14 A +/- 3.99; p < 0.001]. Independent t-test exhibited an insignificant difference at baseline [lecture 8.52 A +/- 2.95 vs. TBL 9.70 A +/- 3.65; p = 0.177]. The post-scores were not statistically different lecture 12.41 A +/- 2.65 vs. TBL 14 A +/- 3.99; p = 0.07]. Both delivery methods were found to be equally effective, showing statistically insignificant differences. However, TBL groups' post-test higher mean scores and radical increase in the post-test difficulty index demonstrated improved learning through TBL delivery and calls for further exploration of longitudinal studies in the context of CME

Comparison of learning anatomy with cadaveric dissection and plastic models by medical students

The purpose of this study at Army Medical College was to assess differences in learning of students from cadaveric dissection or plastic models; and explore their perceptions about efficacy of various instructional tools used during the gross anatomy practical time. Two phase mixed methods sequential study. This study was conducted at anatomy department Army Medical College, Rawalpindi, Pakistan over a period of three weeks in July 2013 after approval from the ethical review board. Quantiative phase 1 involved 50 second year MBBS students, selected through non probability convenience sampling,They were divided into two groups of 25 students. Group A covered head and neck gross anatomy dissection course through cadaveric dissection and group B using plastic models. At the end of course MCQ based assessment were conducted and statistically analyzed for both groups. In qualitative phase 2, two focus group discussions [FGD] with 10 second year MBBS students were conducted to explore students' perspectives about and their preferences of various instructional tools used during the gross anatomy practical time. The FGDs were audio taped, transcribed, and analyzed through thematic analysis. The results of a post test of group A was 24.1 +/- 4.26 and group B 30.96 +/- 6.23 [p = 0.024]. Focus group discussions generated three themes [Learning techniques used by students during gross anatomy practical time; Preferred learning techniques; and Non-preferred learning techniques]. Students prefered small-group learning method over completely self-directed studies as the study materials were carefully chosen and objectives were clearly demonstrated with directions. Cadaveric dissection and didactic teachings were not preferred. Students exposed to models performed better in gross anatomy examination than those who learned through cadaveric dissection

Comparison of baseline knowledge of undergraduate and postgraduate medical students: exploring the causes of its deterioration

To compare baseline general and scientific knowledge between undergraduate and postgraduate medical students and to explore reasons for its deterioration, if any, over time. Sequential mixed method. Combined Military Hospital and CMH Medical College Lahore; and Dermatology Departments of Mayo Hospital, Services Institute of Medical Sciences and Ganga Ram Hospital, Lahore, Pakistan from Aug to Sept 2011. Thirty undergraduate medical students and 30 postgraduate medical students were selected on the basis of purposive convenience sampling, after taking informed consent and ensuring confidentiality and anonymity. In the first phase, a questionnaire consisting of 50 general and basic scientific questions was distributed among 30 first year medical and 30 postgraduate students of dermatology. Two examiners marked these questionnaires using the same key and awarded marks from 1 to 5 for each question. In the second phase 5 postgraduates, who secured minimum marks, were invited for a confidential structured interview to explore reasons for their low score. Quantitative data was analyzed using SPSS version 20 and the interviews were analyzed through quasi-statistical approach. The mean score of postgraduate students was 151.60 as compared to 170.96 for undergraduates. Out of all framed questions, the postgraduates passed only in 35% of questions whereas undergraduates passed in 59%. There was no question in which all postgraduates could pass whereas there were 6 questions in which all undergraduates passed. There were 10 questions in which more than 80% of postgraduates had failed but there were 7 questions in which more than 80% of undergraduates could not do well. During the interview, 100% of postgraduates blamed mainly themselves for their low scoring and 75%, in addition held the system of rote learning responsible. Also 100% of the interviewees admitted, lack of habit of revising previously learnt concepts. The basic and important general and scientific concepts deteriorate in medical students with advancing level of their respective postgraduate studies, which may lead to hampered construction of knowledge for future studies. A better and rational system of concept building, by improving instructional strategies may help these students to retain important knowledge for future construction of knowledge

Impact of constructive feedback on the undergraduate medical students' attitude towards psychiatry

To determine the impact of constructive feedback, during clinical attachment, on the undergraduate medical students' attitude towards psychiatry. Quasi-experimental study. CMH Lahore Medical College, Lahore, Pakistan from December 2012 to October 2013. Participants were 107 students of final year MBBS. They were divided into study and control groups. Demographic data was recorded and attitude towards psychiatry [ATP-30] questionnaire was administered to all the students before the clinical attachment. Both the groups underwent 3 weeks clinical attachment. However, only the students in study group received constructive feedback. ATP-30 was re-administered to students of both groups soon after completion of attachment. Because of errors and omissions in data, forms of two students were excluded. Statistical analysis was carried out on data of 105 students, which consisted of 53 students in the study group and 52 in control groups. The mean age of study group was 22.21 years [SD=0.885], while that of control group was 22.19 years [SD=0.886]; with 32.1% and 34.6% males in the study and control group respectively. Both the groups had comparable demographic features. Pre-attachment ATP30 scores of both groups were comparable i.e. 84.47 +/- 5.29 versus 84.56 +/- 5.30 [p-value < 0.934]. However, post-attachment scores of both groups increased i.e. 103.11 +/- 5.98 versus 85.85 +/- 4.31 [p-value < 0.001]. This increase in score was statistically highly significant in the study group. Constructive feedback during clinical attachment has a significantly positive impact on the undergraduate medical students' attitude towards psychiatry

Student's perception of labor room learning environment

To assess the quality of the labor room educational environment as perceived by the final year medical students and to explore students7 justifications for rating the environment in a certain way. Mixed method sequential. Sir Ganga Ram hospital Lahore, Pakistan from Nov 2011 to Oct 2012. During stage 1, one hundred and fifty two final year students completed the modified post graduate environment measure [PHEEM] survey after completion of their maternity duty from November 2011 till October 2012 and Institutional Ethical Review Board's approval. Stage 2 involved semi-structured focus group discussions [FGD] for in depth enquiry to explore students' reasons for rating their learning environment in a certain way after ensuring confidentiality and anonymity to study participants. The mean overall score for labor room educational environment, as rated by students was 65.98, implying 47.8% satisfaction, indicating plenty of problems in learning environment. Mean total scores for autonomy, teaching and social support was 20.5, 28.9 and 16.5. Satisfaction with regard to autonomy, teaching and social support was 20.5/48 [42.7%], 28,9/56 [51.6%] and 16.5/32 [51.5%] respectively. The patterns that emerged from FGD were lack of teaching protocol, inappropriate supervision and feedback, enormous workload and unenthusiastic teachers. Skill learning, authentic real life experience and team work were motivating factors while poor accommodation, sanitation, catering facilities and humiliating attitude of paramedic staff were demotivating factors for learning. Labor room rotation provides an excellent real time practical skill learning opportunity in an environment with plenty of problems. In order to make labor room duty a worthwhile learning experience, all detrimental aspects, as pointed out in this study, can be addressed to enhance students' learning

Evaluating neurology CME in two educational methods using patton's utilization focused model

Generally in continuing education medical education [CME] the most time is consumed for in the planning and preparation of the event. This planning and preparation, however, needs recognition through an evaluative process. The purpose of this study was to evaluate neurology CME in two educational methods, lecture vs task-based learning, using Patton's utilisation focused model. This was an observational, cross-sectional inquiry. The questionnaire evaluated the educational elements such as learning objectives met, content covered, presentations at the level of understanding, level of interaction, knowledge gained, time management, queries responded, organisation, quality of learning material and overall grading of the educational event. General Practitioners were the key participants in this evaluation and consisted of 60 self-selected physicians distributed equally in both the TBL and lecture groups. Patton's utilization focused model was used to produce findings for effective decision making. The data were analysed using Mann-Whitney U test to know the value of the learning method that satisfied the most participants. A total of 58 evaluations were returned, 29 from the TBL group and 29 from the lecture. The analysis of the elements showed higher mean ranks for TBL method ranging between 32.2 and 38.4 versus lecture [20.6-26.8]. Most of the elements assessed were statistically significant [p>0.05], except time management [p=0.22]. However, elements as 'objectives of the activity met' [p=0.07], 'overall grading of the event' [p=0.06] and 'presentations at the level of understanding' [p=0.06] were at border line. Of the 29 respondents in the TBL group, 75% rated all the elements of the program above very good. In the lecture group, 22 [75%] respondents out of 29 rated almost half of the elements above very good. Majority of respondents in the TBL group rated all program elements as exceptional compared to the lecture group in which only half of the elements were rated above very good. Taskbased learning method made the most impact on participants' satisfaction