Development, validation and use of appropriate assessment tools for certification of entrustable professional activities in community medicine to produce a competent postgraduate: A pilot study

Background: Adoption of competence-based medical education (CBME) is the need of the hour. Objectives: The objective of the study is to develop and validate appropriate assessment tools for the community medicine entrustable professional activities (EPAs) and to assess the usefulness of the validated tools in the assessment of postgraduate (PG) students. Methods: An interventional study for 14 months was done in the department of community medicine. After the sensitization of faculty members and PGs, three EPAs were selected through consensus between faculty members and appropriate assessment tools mini-clinical evaluation exercise (Mini-CEX), case-based discussion (CBD), and direct observation of procedural skills (DOPS). Rubrics of milestones were formulated for the selected tools, and the designed tools were validated. These three validated tools were used for the quarterly assessment. Results: The item-content validity index for all three assessment tools was one, while Scale Content Validity Index for Mini-CEX and CBD were 1, and for DOPS, it was 0.87. Three PG students were assessed using the validated tools thrice for the three selected EPAs. The PGs opined that assessment using rubrics made their task-specific, while faculties were quite satisfied with the assessment process as it removed subjectivity. Conclusions: The developed and selected tools of EPAs were found to have a substantial level of both face validity and content validity. The tools were also found to useful for periodic assessment in workplace settings and acceptable to both PG students and internal/external faculty members.

Appropriate body mass index cut-off point in relation to type 2 diabetes mellitus in the population of Kavre district.

OBJECTIVE: The objective of the present study was to find out the appropriate BMI cut-off point in relation to type 2 diabetes mellitus (DM) in the population of Kavre district of Nepal. MATERIALS AND METHODS: Thirty-five "known type 2 diabetic" and Thirty-five "self-reported non-diabetic" subjects above thirty years of age were included in the present study. Height and weight were recorded for every subject. BMI was calculated by the standard formula. The data was analyzed using SPSS Version 11.5. RESULTS: Our results showed that the reference BMI range for both diabetic male (23.26 +/- 6.88 kg/m(2)) and diabetic female (22.51 +/- 6.28 kg/m(2)) subjects were within normal BMI range according to WHO. Odds ratio showed an irregular pattern at different BMI ranges indicating the risk of having diabetes did not increase constantly. Comparison of number and percentage of both diabetic and non-diabetic male and female subjects according to various recommended normal BMI categories showed gradual reduction in percentage of both diabetic and non-diabetic male and female subjects that were within normal ranges from BMI category 18.5-24.9 kg/m(2) to BMI category 18.5-21.9 kg/m(2). The BMI cut-off point was found 22 kg/m(2) using Receiver Operating Characteristic (ROC) curves. CONCLUSION: The appropriate BMI cut-off point for both men and women was found 22 kg/m(2) in the population of Kavre district of Nepal.

The morphology of central tympanic membrane perforations.

The objective of this study was to assess the extent of conductive hearing loss in relation to different sizes and sites of simple central tympanic membrane perforations. Total 100 cases attending ENT OPD, BPKIHS during period of April 2003 to Mar 2004 without any discrimination of sex, race and religion were taken for the cross sectional prospective study. Dry, clean central tympanic membrane perforations due to various causes like chronic suppurative otitis media-tubotympanic, post acute suppurative otitis media residual perforations or simple traumatic perforations with conductive hearing loss and without preexisting hearing loss were clinicoaudiologically evaluated and analyzed. Hearing loss was found to be directly proportional to the size of perforation irrespective of their cause, which was statistically significant. Hearing loss in the study was found to range from negligible to 53dB. Overall, perforations involving posterioinferior quadrant were found to have maximum hearing loss.

Fungal maxillary sinusitis: a prospective study in a tertiary care hospital of eastern Nepal.

INTRODUCTION: The incidence of mycotic infections and the diversity of pathogenic fungi have increased dramatically in recent years. Fungal sinusitis should be considered in all the patients with chronic maxillary sinusitis (CMS), especially in association with certain clinical features that serve as clue to the diagnosis. Aspergillus is the most common fungal pathogen in maxillary sinus. METHODOLOGY: A total of 100 patients those who fulfilled the diagnostic criteria (Lanza and Kennedy, 1992) for chronic rhinosinusitis were eligible for this open level and randomized prospective study. Only those above 14 years of age were included. RESULTS: Fungal maxillary sinusitis was seen in 14% of all cases of chronic maxillary sinusitis in eastern part of Nepal. We identified Acremonium and Candida species as commonest fungi involved in fungal maxillary sinusitis (FMS). To the best of our knowledge this is the first such study conducted in eastern Nepal.

Sinonasal inverted papilloma in eastern part of Nepal.

OBJECTIVE: To evaluate the clinicopathological profile of sinonasal inverted papilloma in a tertiary referral center in eastern part of Nepal. METHODS: A prospective study consisting of total 28 histologically proven cases of sinonasal inverted papilloma was conducted in the ENT department of the center. The study period was from April 2002 to November 2005. RESULT: Out of 28 cases studied, 21 were males and 7 were females with male to female ratio of 3:1. The highest incidence was seen in the 5th and 6th decades of life. The duration of symptoms varied from 5 months to 20 years with mean duration of 3.9 years. The lateral nasal wall and nasal cavity involvement was seen in all 28 cases. Maxillary sinus was involved in 27(96.4%) subjects followed by ethmoid (20), sphenoid (10) and the frontal sinus (7). The principle presenting symptom was nasal obstruction seen in 96.4% of the patients. Twenty two cases were treated by lateral rhinotomy with medial maxillectomy while, orbital exenteration was done in two cases. Associated carcinoma was noticed in 10.15% of all the subjects studied. CONCLUSION: Sinonasal papilloma mostly presented in fifth to six decades of life mainly affecting the male patients. Majority of the patients were treated by lateral Rhinotomy with medial maxillectomy surgery. Early presentation would have given chances for endoscopic surgery.

Cervical necrotizing fasciitis in an uncontrolled type II diabetic patient.

We report a case of cervical necrotizing fasciitis (CNF) in a female having uncontrolled type II diabetes mellitus. The patient was presented to us after 20 days of preliminary symptoms. The aetiology of microbial inoculation in subdermal tissue was not known. The isolate was Staphylococcus aureus. In spite of the delay in presentation, the patient was successfully treated with combined antimicrobial and surgical intervention.

Nutritional status and morbidity pattern among governmental primary school children in the Eastern Nepal.

OBJECTIVE: To assess the nutritional status and morbidity pattern of primary school children. METHODS: Descriptive, cross sectional study was administered in the five governmental schools located in Dhankuta town (Dhankuta district) and Ineruwa town (Sunsari district). The schools were selected using simple random sampling technique. From these selected schools, a total number of 818 students studying from Grade I to V were enumerated in the study using census survey method. RESULTS: Among 818 students, 61% of the students were found to be malnourished. The students were more stunted (21.5%) than wasted (10.4%). Only 5.4 % of the students were found to be both wasted and stunted. The collected blood and stool samples from the students revealed parasitic infestation of 65.8% and anaemia of 58%. The most common diseases in those schools were: skin diseases (20%), dental caries (19.8%), and lymphodenopathy (10.5%). Among skin diseases, pediculosis was more common among girls while ringworms and scabies were common among boys. CONCLUSION: The study revealed that high percentage of primary school students was malnourished. It was found that there was a high prevalence of parasitic infestation and anaemia. The study result revealed the urgent need for initiation of school health program with specific emphasis on prevention of diseases, improvement of personal hygiene and nutritional status with the collaboration of governmental and non governmental institutions.