Impact of combined modular assessment on deep learning and personal development of medical students

Objective: To determine the effect of transition of summative assessment from frequent modular to combined block assessment and its role on learning of medical students

Methods: A descriptive study was carried out at Islamic International Medical College. A questionnaire comprizing of 8 questions with Likert scale [1-5] was designed for 3[rd] year students. The questions were grouped in three categories which included learning acquired, personal development and efficacy of assessment tools used in combined block assessment and frequent modular exam separately. Results of end of year exams were analyzed for difference in performance of students in two exams. The received data was analyzed by using SPPS 21

Results: About 60% students agreed that they need to study regularly in frequent modular exams. Combined block assessment promoted more in depth studies and multiple revisions 51% and 55% students respectively. About 42% students, in comparison with 33%, agreed that CBA helped in their personal development while 42% students agreed to assessment tools used in CBA while only 28% students to those used in frequent modular exam. About 47% students agreed that assessment tools in CBA were useful for deep learning and 47% students agreed that time given in CBA was enough in exam preparation. Comparison of all results [x 2 tests] was statistically significant. The comparison of end of year performance showed improvement in the mean of total marks obtained and decrease in the number of failed students in combined block assessment

Conclusion: Transition from frequent to combined block assessment with regular formative assessment has positive effect on learning, personal grooming and performance in summative assessment

Pattern of altered lipid profile in patients with subclinical and clinical hypothyroidism and its correlation with body mass index

Objective: To compare the lipid profile of the subclinical and clinical hypothyroid patients and to evaluate the correlation between body mass index [BMI] and lipid profile in hypothyroidism

Study Design: Cross-sectional study

Place and Duration of Study: Islamic International Medical College, Riphah International University, Islamabad, and Citi Laboratory, Rawalpindi, from January to December 2013

Methodology: The subjects were selected through non-probability, purposive sampling. On the basis of thyroid profile, the subjects were divided into 3 groups: euthyroids [n=20], subclinical hypothyroids [n=50], and clinical hypothyroids [n=30]. The blood of these subjects was then analyzed for lipid profile. Data was analyzed using SPSS version 18 statistical software

Results: Both hypothyroid groups showed altered lipid profile which was observed to be significantly raised when compared with the euthyroid subjects. Comparison of lipid profile in euthyroid, subclinical, and clinical hypothyroid groups showed significant differences by non-parametric tests [p < 0.05]. An assessment of correlation of lipid profile with the BMI was found to be significant [p < 0.01]

Conclusion: Hypothyroidism causes alteration of lipid profile. Clinical and subclinical hypothyroid patients have altered lipid profile as compared to euthyroids. Thyroid status monitoring is very important, since it can induce changes in lipid profile. Such dyslipidemic status is significant not only for the management of thyroid disorders but also for common diseases like obesity and coronary atherosclerosis in the population

Cardiac autonomic modulation in psychologically stressed subjects as reflected by heart rate variability

To compare the frequency domain parameters of heart rate variability in stressed and non stressed subjects. It was a cross sectional study. The study was conducted at Islamic International Medical College from June 2014 to December 2014. Eighty subjects between 20-40 years of age were inducted in the study after fulfilling DASS questionnaire and were divided into stress and control group. Ten minutes ECG of the subject was taken using power lab and analyzed for heart rate variability following the guidelines of Task Force of European Society of Cardiology and the North American Society of Pacing Electrophysiology. Frequency domain indices of heart rate variability were compared among stressed and control group usingfastfouriertransform. Psychologically stressed subjects have significantly decreased high frequency in absolute unit and normalized unit [p < 0.05] and increased low frequency in normalized unit and absolute unit [p < 0.05 and .001 respectively] and low to high frequency ratio when compared with controls [p < 0.001]. There was significant negative correlation among LF ms2 and HFms2 [p < 0.001,r = -.423], LF ms2 and HFnu [p< 0.001,r = -386],HF ms2 and LFnu [p < 0.05, r = -.361] and HFms2 and LF/HF [p < 0.05, r = -.553],LF/HF and HFnu [p < .001 r = -.553], LFnu and HFnu [p < 0.05, r = -.237]. There was also statistically significant positive correlation of LF/HF and LFnu [p < .001.r = .824]. Assessment of Heart rate variability is an important measure of autonomic nervous system and effect of psychological stress on autonomic nervous system can be indexed by determining heart rate variability

Identification of technical item flaws leads to improvement of the quality of single best multiple choice questions

The purpose of the study was to identify technical item flaws in the multiple choice questions submitted for the final exams for the years 2009, 2010 and 2011. This descriptive analytical study was carried out in Islamic International Medical College [IIMC]. The Data was collected from the MCQ's submitted by the faculty for the final exams for the year 2009, 2010 and 2011. The data was compiled and evaluated by a three member assessment committee. The data was analyzed for frequency and percentages the categorical data was analyzed by chi-square test. Overall percentage of flawed item was 67% for the year 2009 of which 21% were for testwiseness and 40% were for irrelevant difficulty. In year 2010 the total item flaws were 36% and 11% testwiseness and 22% were for irrelevant difficulty. The year 2011 data showed decreased overall flaws of 21%. The flaws of testwisness were 7%, irrelevant difficulty were 11%. Technical item flaws are frequently encountered during MCQ construction, and the identification of flaws leads to improved quality of the single best MCQ's

Short head-up tilt test. Evaluation of time to syncope in nitroglycerine potentiated

The aim of the present study was to evaluate the time to syncope in Nitroglycerine potentiated short Head-up tilt test. This was a descriptive cross sectional study conducted in Armed Forces Institute of cardiology from May 2006 to May, 2007. A total number of 90 patients with orthostatic intolerance both male and female were studied. Head-up tilt test protocol consisted of a Stabilization phase which lasted for five minutes Passive tilt phase: Patients were tilted at 70 [degree sign] for orthostatic stress for 15 minutes. In case of no symptoms the test continued with the drug provocation phase which lasted for 15 minutes. The patients were administered 400 micro g of nitroglycerine sublingually in aerosol preparation. Development of symptoms were noted at 5, 10 and 15 minutes. A total number of 90 patients were examined during the study period. The tilt table test was classified as positive in 58.9% of patients and was negative in 41.1%. The test was positive in five patients without the drug provocation [9.4%]. The responses were classified as positive vasodepressor in 35.8%, 15.09% as mixed and cardioinhibitory 15.09% in patients of neurally mediated syncope. The total time to display of symptoms to positivity in HUTT was 17.89 +/- 6.99. The mean time to syncope after the administration of nitroglycerine was 5.61 +/- 4.17 minutes. Our study concludes that the drug administered phase can be reduced to 12 +/- 3 minutes

Short duration head-up tilt test: a comparison with conventional long protocol in patients of orthostatic intolerance

Orthostatic intolerance is development of symptoms during upright standing relieved by recumbency. An individual's predisposition to orthostatic intolerance [development of symptoms during upright posture] can be identified by Head-up Tilt Test [HUT]. The aim of the present study was to compare the diagnostic yield [Percentage of patients tested positive] of short duration with conventional HUT. The study was conducted in Islamic International Medical College, Rawalpindi in collaboration with Armed Forces Institute of Cardiology/National Institute of Heart Diseases. A total number of 100 patients with orthostatic intolerance were studied. The conventional and short duration HUT protocols were compared. Conventional protocol had a passive tilt phase of 30 minutes and drug provocation phase of 20 minutes while the short duration protocol had both phases of 15 minutes, thereby reducing the test duration by 20 minutes. All patients underwent short duration HUT and patients with positive test were considered positive for conventional HUT as well. Patients having negative short duration HUT underwent conventional HUT after one week. Comparison was done using Chi-square statistics and p<0.05 was considered significant. Diagnostic yield of short duration and conventional HUT was 53% and 63% respectively with no statistically significant difference between the two protocols [p=0.15]. Head-up tilt test [HUT] is an effective investigative tool for orthostatic intolerance with satisfactory diagnostic yield. Short duration HUT may be substituted for conventional HUT to save time and to accommodate more patients