Medical students' perception of the reformed medical curriculum at King Saud University

Objectives: To evaluate the King Saud University [KSU] medical students' perceptions of the educational programmes' quality

Materials and Methods: A total of 289 medical students at KSU, College of Medicine were selected randomly from year 1 through year 5 and were invited to participate in a descriptive cross-sectional study design. A questionnaire was distributed to the students and collected on completion. The questionnaire measured the students' perceptions of the educational programmes and their competence, as well as their overall satisfaction with the training delivered and the feedback system

Results: About 60.5% of the students declared that the educational programmes provided them with the necessary knowledge while only 48.5% of students believed that it provided them with the necessary skills required. Only 34% of students stated that the intended learning objectives were known to them at the beginning of the courses. About half of the students indicated that the programmes actively involved them in the problem-solving process. Half of the students believed that the amount of basic science knowledge provided was enough; however, 39.5% of students [in their clinical years] believed that the amount of knowledge delivered in the basic science courses was inadequate. Only 18.4% of students considered that the basic science courses prepared them for a clinical clerkship. 17.7% of the students declared that the research activities improved their research skills. 47.3% believed that the research activities helped them in understanding community characteristics, 57.6% asserted learning the basics of medical statistics, 44.6% believed it helped them in using the available resources in solving community problems and 49.5% believed it helped them in learning as well as acquiring project management skills. 34% of the students participated in planning educational activities while 53.7% participated in evaluating these educational activities. 36.1% of students gave frequent feedback to the college. Only 30.2% of the students were satisfied with the overall quality of the educational programmes

Conclusion: The students' perception of the educational programmes was illustrated and important aspects were highlighted which needed to be addressed and revised in order to improve the quality of the curriculum

Clinical predictors of resectability of pancreatic adenocarcinoma

Identifying patient-related factors as well as symptoms and signs that can predict pancreatic cancer at a resectable stage, which could be used in an attempt to identify patients at an early stage of pancreatic cancer that would be appropriate for surgical resection and those at an unresectable stage be sparred unnecessary surgery. A retrospective chart review was conducted at a major tertiary care, university hospital in Riyadh, Saudi Arabia. The study population included individuals who underwent a computed tomography and a pancreatic mass was reported as well as the endoscopic reporting database of endoscopic procedures where the indication was a pancreatic mass, between April 1996 and April 2012. Any patient with a histologically confirmed diagnosis of adenocarcinoma of the pancreas was included in the analysis. We included patients' demographic information [age, gender], height, weight, body mass index, historical data [smoking, comorbidities], symptoms [abdominal pain and its duration, anorexia and its duration, weight loss and its amount, and over what duration, vomiting, abdominal distention, itching and its duration, change in bowel movements, change in urine color], jaundice and its duration. Other variables were also collected including laboratory values, location of the mass, the investigation undertaken, and the stage of the tumor. A total of 61 patients were included, the mean age was 61.2 +/- 1.51 years, 25 [41%] were females. The tumors were located in the head [83.6%], body [10.9%], tail [1.8%], and in multiple locations [3.6%] of the pancreas. Half of the patients [50%] had Stage four, 16.7% stages two B and three, and only 8.3% were stages one B and two A. On univariable analysis a lower hemoglobin level predicted resectability odds ratio 0.65 [95% confidence interval, 0.42-0.98], whereas on multivariable regression none of the variables included in the model could predict resectability of pancreatic cancer. A CA 19-9 cutoff level of 166 ng/mL had a sensitivity of 89%, specificity of 75%, positive likelihood ratio of 3.6, and a negative likelihood ratio of 0.15 for resectability of pancreatic adenocarcinoma. This study describes the clinical characteristics of patients with pancreatic adenocarcinoma in Saudi Arabia. None of the clinical or laboratory variables that were included in our study could independently predict resectability of pancreatic adenocarcinoma. Further studies are warranted to validate these results.

Pylorus preserving pancreaticoduodenectomy for peri-ampullary carcinoma, is it a good option?

Pancreaticoduodenectomy [PD] is the standard surgical treatment for respectable peri-ampullary tumors. It can be performed with or without pylorus preservation. Many surgeons have a negative opinion of pylorus preserving PD [PPPD] and consider it an inferior operation, especially from an oncological point of view. This article reviews the various aspects of PD in the context of operative factors like blood loss and operation time, complications such as delayed gastric emptying and anastomotic leaks, and the impact on quality of life and survival. We aim to show that PPPD is at least as good as classic PD, if not better in some aspects