Clinic follow-up compliance of persons with type1 diabetes in tertiary care hospital

Objective: The objective of the study was to assess the compliance with clinic follow up in people with type I diabetes mellitus and its relation with their glycemic control

Methods: Total of 97 subjects with type 1 Diabetes Mellitus were included in this cross sectional study. In addition to the scheduled follow up, the patients were telephonically called by the clinic reception to make an additional appointment. We compared the glycemic control amongst the clinic follow up compliant and non-compliant group. To data was analyzed on SPSS 18.0 version

Results: Out of 97 subjects, 48 [49.5%] were male and 49 [50.5%] were female. The mean age of subjects was 17.03 +/- 6.54 years. Mean duration of diabetes was 4.61 +/- 5.2 years. Mean hemoglobin A1C [HbA1c] was 10.59 +/- 3.09%. There was a significant difference in glycemic control of subjects who were compliant towards clinic follow up as compared to those who were non-compliant. The turn up of people with type 1 Diabetes Mellitus who were asked for an additional appointment, was only 15%

Conclusion: It was concluded that there was a strong relation between compliance towards follow up visit and the glycemic control. It was also observed that majority of the subjects with type 1 Diabetes Mellitus responded to the phone calls however did not turn up

Frequency and antibiogram of isolates from surgical units of a tertiary care hospital in Quetta

Objective: To determine the frequency and antibiogram of the isolates from infected patients in surgical units of a tertiary care hospital

Study Design: Cross-sectional, descriptive study

Place and Duration of Study: Department of Microbiology, Combined Military Hospital, Quetta, from March to October 2015

Methodology: Clinical samples from the surgical units received in Department of Microbiology for culture and sensitivity were analyzed by Gram stain, culture and biochemical tests for identification of the isolates; and the antibiotic susceptibility was determined by modified Kirby Bauer disc diffusion method. Data was analyzed by Statistical Package for Social Sciences [SPSS] version 19

Results: The commonest isolate was Acinetobacter baumannii [22%] followed by Escherichia coli [20%], Pseudomonas spp. [15%] and Methicillin-resistant Staphylococcus aureus [MRSA] [11%]. Acinetobacter baumannii showed highest susceptibility to doxycycline [41%], Enterobacteriaceae to meropenem [96%], Pseudomonas spp. to polymyxin-B [100%] and Gram positive bacteria to linezolid [100%]. Seventy-two percent of the isolates were found to be multi-drug resistant

Conclusion: There was a high infection rate in surgical patients with Acinetobacter baumannii, Eschericia coli, Pseudomonas spp. and MRSA being the commonest isolates. Acinetobacter baumannii showed highest susceptibility to doxycycline, Enetrobacteriaceae to meropenem, Pseudomonas spp. to polymyxin-B and Gram positive bacteria to linezolid

Role of preloading with and without intramuscular ephedrine to prevent post spinal hypotension in elderly patients

To evaluate the efficacy of intramuscular ephedrine along with preloading in prevention of post Spinal hypotension in elderly patients. Randomized controlled trial. Department of Anaesthesia and Intensive Care Combined Military Hospital Peshawar, from 20[th] March 2007 to 20[th] March 2008. A total of 100 patients of ASA I and II were selected. The patients were randomly divided by random numbers table into two groups of 50 each. Group A was preloaded with ringer solution 15 ml/kg and intramuscular injection of 1 ml normal saline as placebo was given. Group B preloaded with 7.5 ml/kg and intramuscular injection of ephedrine 0.5 mg/kg was given. Heart rate and mean arterial pressure were monitored after the spinal blockade. Hypotension was treated with intravenous bolus of 5mg ephedrine and additional rapid infusion of lactated ringers. In group A, hypotension occurred in 30 [60%] patients as compared to group B, where hypotension occurred in 11 [22%] patients. In group A, ephedrine 10mg [2 boluses] were given in 14 [28%] patients, while in group B, ephedrine 5mg [1 bolus] was given in 11 [22%] patients. It is concluded from the results of this study that less preloading is required in intramuscular preloading along with intramuscular ephedrine is more effective in preventing patients after spinal anaesthesia as compared to preloading alone

Assessment in higher education

Assessment drives learning and influences the quality of learning by directing the approach students take towards learning and by aligning the outcomes of the educational program with teaching methodologies and the educational environment. Assessment needs to be recognized as a multidimensional entity and not a singular activity or concept that transcends across three domains cognitive, affective and psychomotor. Any assessment requires activation of and access to different cognitive, affective andpsy-chomotor skills at multiple levels and their applications through a fusion in a multidimensional collusion of stored memories, learned knowledge and behaviour and acquired skills. Another dimension that requires consideration here is the context in which assessment takes place. Context of assessment can be defined in terms of the environment in which assessjnent takes place, its background, stakes as well as the stakeholders involved. New formats and mediums are being used in all areas of education both as a learning / teaching strategy as well as for assessment. Computerized, computer - aided or online teaching and learning have paved the way for computer - assisted - assessment techniques. Whether assessment is formative or summative, influences its design, approach and outcomes. To the adjninistrator, the results of the assessment, either formative or summative, provide data that will help establish current policies or bring changes to them. To the program developers, the same results establish the worth of the program or otherwise. To the trainees, the scores or feedback help in understanding their deficiencies in relation to the clearly predefined goals and objectives of the educational program. The public places great emphasis on the native of assessment and the outcomes related to it since it is the public that is going to use the product of the medical education programs and confidence in the product will be related to their acceptability of the assessjnent and its outcomes. This paper identifies different formats of assessment and their contextual relevance

effect on student performance of scrambling questions and their stems in medical colleges admission tests

Assessment is an indispensable part of an educational program. Multiple Choice Questions [MCQs] is an objective tool of assessment provided cheating is controlled. A method employed to reduce the chance of cheating is to scramble the sequence of the MCQs and responses in multiple papers having the same content. It is assumed that the performance of students is mainly dependent on the difficulty of the items and not the order in which they are placed within the instrument. The marks obtained by 1,02,211 candidates sitting in Medical Colleges Admission Test [MCAT] from 2008 to 2011 and given similar-content but scrambled-sequence question paper codes were analyzed using parametric tests. A significant difference amongst the mean marks of candidates in the different codes of MCAT 2008 [F = 22.15, p < 0.001] and MCAT 2011 [F = 3.85, p = 0.009] was identified. No significant difference was found in the mean marks of the candidates' each year for different codes in each centre.

case study of multidimensionality of organizational culture

The right kind of institutional culture enhances its effectiveness that ultimately leads towards achieving its missions, objectives and goals. This case-study was conducted in the University of Health Sciences, Lahore to identify the Institutional Culture in the University. Academic Culture Inventory [ACI] and Values Survey Module [VSM] 08 were used as survey questionnaires. Fifty ACI questioners were distributed among grade 16 - 20 officials, 10 in each grade. Hundred VSM 08 Questionnaires were distributed among the garde 1-15 employees. Ten questionnaires from each category and fifty six VSM 08 questionnaires were retuned and institutional culture was identified. Responses and behaviors of the people on different social and job situations were determined on the findings of VSM 08 through Chi-Square Test. Microsoft Excel and Statistical Package for Social Sciences [SPSS] were used to generate the results. A p-value of = 0.05 was considered as statistically significant. Developmental Culture' and 'Virtual Culture' were identified as the strongest institutional cultures by the higher and lower grade officials respectively. 'Tangible Culture' was identified as the weakest institutional culture in both cases. In the VSM 08 questionnaires, the response rate was 56%. Various demographic variations within the culture were identified based on the VSM 08 questionnaire survey. Communication gap between the Higher-grade officials and lower-grade employees should be bridged by holding various meetings, conferences and seminars where the lower-grade staff gets the opportunity to interact with their officers and share their own ideas about the policies and strategies of their institutes

Medical colleges admission test in Punjab, Pakistan

Nearly 18,000 candidates securing 60% and above marks in Higher Secondary School Certificate [HSSC] examination contest for admission in Medical Colleges, in Punjab, Pakistan by sitting in the Medical College Admission Test [MCAT] each summer. This cross-sectional study was conducted to identify patterns related to demographic, economic and educational backgrounds, over a two-year-period, in this population, and how HSSC and MCAT marks predict future performance of the selected candidates. Marks obtained by candidates in HSSC, MCAT, and 1st Professional MBBS [Part-I] Examinations over two years 2008-2009, were analysed using parametric tests in SPSS. Total 18,090 candidates in 2008 and 18,486 in 2009 sat in the MCAT. National HSSC candidates scored higher marks in HSSC and MCAT but lower marks than their foreign qualified HSSC counterparts [e.g., Advanced-Levels from Cambridge University, UK] in Part-I overall and in all its subcomponents individually [p<0.05]. Female students scored higher marks than males in HSSC [p>0.05], MCAT [p>0.05] and Part-I theory, practical, viva voce, continuous assessment and Objective-Structured Performance Evaluation [OSPE] components [p<0.05]. In both years, students from the Dera Ghazi Khan District scored the highest marks in the HSSC Examinations [p<0.05] but least marks in MCAT in 2008 [p<0.05] and in Part-I in 2008 and 2009 [p<0.05]. Students from 'tougher' Boards like Rawalpindi in 2008 and the Federal Board in 2009 who scored least marks in HSSC scored highest marks in MCAT, and in Part-I Examinations [p<0.05]. Linear regression on Part-I by taking HSSC and MCAT marks as independent variables showed that the MCAT marks exerted the greatest positive influence consistently at 0.104 [2008] and 0.106 [2009]. In 2009 HSSC marks were shown to exert a negative influence [-0.08] on Part-I. There is need to standardise HSSC education and examination across all Intermediate Boards. MCAT is a better predictor of Medical Students' future performance

Frequency of persistant backache in patients of spinal anaesthesia in the absence of prior history of backache

To determine the frequency of persistant backache in patients of spinal anaesthesia in the absence of prior history of bachache. Quasi experimental study. CMH Kharian from May 2008 to Sep 2009. Total 150 patients who were admitted at CMH Kharian during the study period were included in the study. The selection criteria included male and female patients above twenty years of age due for elective gynaecological, orthopaedics, urology and general surgical procedures. Only 112 patients reported for complete follow up for one year. Out of 112 patients, 61.6% were males while 38.4% were females. All patients with prior history of back pain were excluded from the study. At the end of one year the frequency of persistent back pain after one year of spinal anaesthesia is [1/112] 0.89% in the absence of previous history of back pain. The results of this study indicate that frequency of persistant back pain after spinal anaesthesia in the absence of previous history of back pain is very low

Hemodynamic response of low dose bupivacaine with fentanyl spinal anesthesia in elderly patients

To determine whether a reduced dose of bupivacaine in combination with fentanyl could give reliable block with greater hemodynamic stability in elderly patients. Quasi experimental study. Department of Anaesthesiology, Intensive Care and Pain Management Combined Military Hospital Rawalpindi. One year duration, from May 2006 to April 2007. ASA I-III elderly patients [n=60] undergoing surgery for fracture neck of femur, meeting the inclusion and exclusion criteria. Sixty elderly patients were randomized in two groups. The study group [group-A] received spinal anesthesia as a combination of hyperbaric bupivacaine 7.5 mg and fentanyl 15 µgm while the control group [group-B] received hyperbaric bupivacaine 15 mg. The hemodynamic stability of the patients and the quality of the blocks were compared. All patients had adequate duration of block. There was no significant difference in the change of heart rate between the two groups. Fall in blood pressure was more pronounced in the control group [group-B] patients requiring more ephedrine as compared with the study group [group-A] patients which remained more hemodynamically stable. A reduced dose of hyperbaric bupivacaine in combination with fentanyl provides reliable spinal anesthesia in elderly patients with few events of hypotension and little need for vasopressor support of blood pressure.

Concept mapping; Rational of learning theories

The explanations of different concepts of learning are called theories and approaches towards the learning process. The difference of concepts is based on interpretations of learning rather than the definition of learning. Five major learning theories: behaviorists, humanists, cognitivists, social cognitivists and constructivists exist, which explore the process of learning. In this paper, the concept maps of all these theories will be discussed separately. The overarching linkages between the theories shown in the concept maps will also be explained

Bcl-2 protein expression in mucoepidermoid carcinoma of salivary glands: a single institution experience

Mucoepidermoid carcinoma is the most common salivary gland tumor with varying behavior among different histopathological grades. The objective of this study was to determine the expression of Bcl-2 protein in mucoepidermoid carcinoma [MEC] and to correlate with histological grades. The records of 40 cases of MEC were collected from the histopathology department. Fresh slides were prepared and fresh diagnoses were made using the grading criteria for MEC. Immunohistochemical markers for Bcl-2 were applied and the results analyzed using the chi-square test. Of 40 cases, 20 were males and 20 were females. The range in age of the patients was 6 to 67 years mean [SD] was 42.6 [1.85] years. Twenty-two were low grade [55%], 11 high grade [27.5%] and 7 [17.5%] were intermediate grade MEC. Among these 40 cases, Bcl-2 expression was positive in 24 cases and negative in 16 cases. In 22 cases of low-grade MEC, 19 were positive while only 3 were negative. In high-grade tumors, all 11 cases were found to have a negative expression of Bcl-2 protein. In intermediate-grade MEC, 5 cases showed positive expression while only 2 cases showed negative expression. Bcl-2 protein expression showed positive expression in low-grade and negative expression in high-grade MEC. Intermediate grade showed more than 50% positive results for Bcl-2. Correlation between grades of MEC and expression of Bcl-2 is statistically significant and can be used for the depicting the prognosis of MEC along with other prognostic and clinico-pathological parameters

Comparison of haemodynamic changes following tracheal intubation by using laryngoscope with intubating laryngeal mask airway

To compare haemodynamic changes following tracheal intubation using direct laryngoscopic technique with intubating laryngeal mask airway technique. Randomized control trail [RCT]. Military Hospital Rawalpindi from Jan 2008 to Dec 2008. After approval by the hospital ethics committee, 100 patients admitted for elective surgery from OPDs were randomly distributed equally in groups I and II for either direct laryngoscopy or laryngeal mask airway intubation respectively, as a part of general anaesthesia. A uniform protocol of general anaesthesia was followed. Heart rate and mean blood pressure were recorded before and at 1, 3 and 5 minutes after intubation. It was observed that increase in mean arterial blood pressure and heart rate at 1 and 3 minute was significant in patients intubated with laryngoscope as compared to patients intubated with Intubating laryngeal mask airway [ILMA]. Intubation with ILMA produces less haemodynamic response as compared to direct laryngoscopy

Assessment in medical education in Pakistan: evaluating evaluation

Over the past decade, Pakistan has seen phenomenal growth in Health Profession Education. As the products of these newer medical colleges join the industry, we have received anecdotal accounts of considerable variations in competency, knowledge and attitudes towards the profession, peers, patients and the industry. The question addressed in this article is whether the assessment techniques used in medical education in Pakistan evaluate higher order critical thinking. A review of published literature in four international medical education journals, Medical Teacher, Medical Education, Journal of Pakistan Medical Association and Journal of Phy-sicians and Surgeons Pakistan was conducted through systematically searching their databases using keywords. This review covers only the methods used for assessment in medical education in Pakistan at present and their contextual relationship to measurement of critical thinking. Multiple tools used to assess each of the three domains, cognitive, psychomotor and affe-ctive were identified. Each one of these tools in relation to the context can effectively evaluate cri-tical thinking but requires careful planning and proper application. Tools used elsewhere [outside Pakistan] were holistic in their measurement with high contextual relevance. Critical thinking sets higher education apart. Currently the tools of assessment emplo-yed to evaluate knowledge, skills and attitudes in medical education in Pakistan are sound but re-quire a critical analysis and review in their construct and applicability in relation to the context. Better tools are also available that can be used to 'teach' as well as 'assess' critical thinking

Perceived variations in dental graduate competency outcomes based on demographic variables

The 30 final competencies required to be possessed by a dental graduate to be identified as a 'safe' health professional practicing dentistry in the community have already been validated and grouped into five overarching integrative themes i] Clinical competence, confidence and a multidisciplinary approach; ii] Role of dental house officer in the health services; iii] Treatment Planning; iv] Attitude, ethical stance and legal responsibilities and v] Communication Skills, information handling and teaching. These themes encompass all three domains of cognition, affect and skills. The purpose of this study was to identify variations in the acceptability of the 30 competencies amongst the three stakeholders, the students, the public and the faculty based on gender and demographic socioeconomic variables. 1876 students in the three public and seven private dental colleges were administered a questionnaire eliciting responses in the 30-item dental graduate competency document. 103 Faculty of the affiliated dental colleges and 173 general public were included in the survey. The response rate was 95% in students, 85% in public and 92% in faculty. Variations in the perceived value in each item and overall were identified within each group based on gender, socioeconomic status, educational background, urban/rural setting and public/private work place settings. These differences are real and will be encountered by the junior dental practitioner in his/her practice and should therefore be factored in to the educational outcomes

English language proficiency; an important socio-economic factor and its impact on student's performance

Each year, more than 30,000 students sit in the Government sponsored Entrance Test conducted by University of Health Sciences, Lahore for admission in Public and Private Medical and Dental Institutes of Punjab, Pakistan. In this study, we have embarked to seek the relationship of the performance of students in the English component of the test and their sciences components scores and how this English-Science relationship varies amongst the developed and underdeveloped districts of Punjab, Pakistan. Three years from 2008 to 2010. The sciences components scores of the candidates in MCAT, their scores in English portion in the test and their demographic variables were entered into Statistical Package for Social Sciences [SPSS] v.16. Parametric tests were applied. Nearly 14% of the question paper tests proficiency of the candidates in the English Grammar. The students from the socioeconomically challenged districts scored less marks in English component as well as in the sciences component of Entrance Test when compared with the scores of the students of more developed districts [p<0.05]. The difference in the mean marks of English and Sciences components of the test when adjusted for weightage was higher in the socioeconomically developed districts [p<0.05]. A steady improvement from 2008 to 2010 in the scores obtained by candidates in English component of the Entrance Test was observed [p<0.05]. For admission in Medical and Dental Colleges in Punjab, candidates scoring more than 60% marks in their Higher Secondary School Certificate Board Examination, have to sit in a uniform Entrance Test in which from the year 2008-2009, candidates from socioeconomically low districts have performed poorly in both English component and sciences components of test in comparison to the candidates from more developed districts. The comparatively lower score is more significant in sciences components of test. The lower scores of the less developed districts, candidates can not therefore be attributed to their low proficiency in the English language but rather to a lower general educational performance

Experience with polyclonal immunoglobulin therapy in poly trauma patients with severe sepsis

To evaluate the effects of intravenous immunoglobulin therapy on progression of severe sepsis in patients of poly trauma. Quasi-experimental study. Combined Military Hospital Peshawar from June 2008 to Dec 2009. Forty six patients of poly trauma with severe sepsis were included. Along with the standard management i.e., surgical management, fluid resuscitation, antibiotics, analgesics, ionotropic, ventilatory and nutritional support, IVIG 5% [intravenous immunoglobulin] was infused over a period of 6 hours and repeated for three consecutive day. Sequential Organ Failure Assessment [SOFA] score was used to assess the progress in all the patients. At the time of enrolment mean SOFA score was 5.41 +/- 1.127 and on the 15th day it was 1.62 +/- 2.24, mean age was 39.21 +/- 10.26 years. Thirty four patients [73.91%] developed gram negative sepsis and eighteen patients [39.13%] developed septic shock. Mean duration of stay in ICU and on of these patients was 30.43%. The IVIG administration, when used along with the standard management appears to improve significantly the prognosis in patients of poly trauma with severe sepsis

Clinicopathological aspects of malignant salivary gland neoplasms - a study of 150 cases at Afip, Rawalpindi [Pakistan]

To study the clinicopathological aspects of malignant salivary gland tumors, diagnosed at AFIP, Rawalpindi [Pakistan]. Descriptive study. Armed Forces Institute of Pathology, Rawalpindi from Jan 2005-Dec 2009. The study included all the cases diagnosed as malignant salivary gland tumors in the last five years. Records of all the tumors of head and neck region that presented during this period were analyzed and out of these clinicopathological features of malignant salivary gland tumors were studied. The data analysis included the age, gender, site of tumor and histopathological pattern. A total of 18685 malignant tumors presented in the last five years. Out of these, malignant tumors of head and neck were 2165. Total malignant salivary gland tumors were found out to be 150 with an overall frequency of 0.8% and frequency in head and neck malignancies was found out to be 6.9%. The age ranged from 6-80 years [mean 48.02 + 1.23]. Of these 150 cases, 58.7% were males and 41.3 were females with a male to female ratio of 1.4:1. The most common tumor seen was mucoepidermoid carcinoma [49.3%] followed by adenoid cystic carcinoma [31.3%]. A total of 48.7% of the tumors originated in minor salivary glands. Parotid gland was the second most commonly involved site [40.7%]. Malignant salivary gland neoplasms are a common malignancy of head and neck region and their frequency is slightly more in our population. Almost half of the tumors originated in minor salivary glands and mucoepidermoid carcinoma was the most common type of malignancy

Expression of p53 in adenoid cystic carcinoma of salivary glands - a clinicopathological and immunohistochemical correlation

To document p53 protein expression in Adenoid cystic carcinoma [AdCC] of salivary glands and correlate this expression with clinicopathological parameters in prognostic assessment of AdCC at microscopic level. This Correlation study was carried out at Armed Forces Institute of Pathology [AFIP], Rawalpindi for 6 months. A total of 40 cases of AdCC diagnosed in salivary glands of five years duration [2006-2010] were retrieved from tumor registry. Clinical information was extracted from histopathology request forms submitted with the specimens. Fresh slides were prepared for histopathological [H and E stalling] and subsequent p53 immunohistochemical evaluation. Out of 20 patients [50%] belonging to 31-50 years age category, 12 were positive and 8 cases were negative for p53 expression. Majority of patients were male [n=27, 67.5%], among which 17 yielded positive while 10 had negative p53 expression. Among tumors evolving from major salivary glands [n=13], 10 showed positive whereas only 3 displayed negative results for p53 expression. Maximum number of tumors [n=17, 42.5%] were greater than 4 cm in size with 12 of them as p53-positive and 5 as p53-negative. Results for histopathological subtype and tumor grade were similar, with 34 [85%] revealing cribriform growth pattern, thus having grade Il neoplasms, with equivocal p53 staining, yielding 18 as p53-positive and 16 as p53-negative neoplasms in each parameter. Though small in count, all tumors with solid histological subtype [n=5, 13%], hence with grade Ill neoplasms exhibit positive p53 expression. Perineural invasion '.vas present in 77% [n=31] of tumors, among which 17 were having positive while 14 were having negative p53 expression. Lymphovascular invasion was present in 37 [92.5%] cases, among which 22 yielded positive while 15 had negative expression of p53. Tumors with larger size [_4cm], solid growth pattern, grade Ill neoplasm and major salivary gland as primary tumor site bear positive correlation with p53 protein. Though none of the correlation turned out as statistically significant to be used as key element in prognostic assessment of AdCC at microscopic level, however the above mentioned parameters can be considered important while planning the management which may need an aggressive approach in these cases. There is a need of more research for additional comprehensive prognostic assessment of salivary gland AdCC

Evaluation techniques in Punjab, Pakistan: eight years of reforms in health professional education

Pakistan, the most populated country in the WHO Eastern Mediterranean region has a population of over 170 million, spread over five provinces and four federally administered areas. It has a growth rate of 1.9%. Punjab is the most populous and developed province with an estimated population in 2010 of 81 million. In 2008, Punjab's development index of 0.60 and a literacy rate of 80% were the highest in the country. In Pakistan, the number of doctors and nurses has risen from 48 to 71 per 100,000 and from 16 to 30 per 100,000, respectively between 1990 and 2003. The major challenge, still, is the imbalance of the population to health-care workers ratio. At the time of creation of Pakistan, King Edward Medical College was the only fully functioning medical college. Over the years, as a result of health reform initiatives, a number of government medical colleges were established in the country. University of Health Sciences, Lahore was established in 2002, having sole jurisdiction over all medical, dental and allied health institutes in the province with the aim of moving medical education towards an outcome-based patient and community oriented competency-driven system. This paper attempts to clarify how initiatives and reforms in the evaluation process have helped the UHS realise its aims. Evaluation in all branches of higher education has long been taken as a means to an end. The focus of UHS on teacher-training, introduction of behavioural sciences as a compulsory subject and setting up an outcome-based evaluation process, has established a knowledge-acquisition medical education atmosphere. The challenges in the future relate to sustainability through capacity-building and staying abreast with the Best Evidence Medical Education practices worldwide, implementing them to fit our local needs and resources

Assessment driven integrated learning [ADIL]: assessment directed medical education [ADME] curriculum

Assessment has been shown to drive learning. For assessment to drive learning in the right direction, it needs to fulfil certain criteria including reliability, validity, educational impact, feasibility, acceptability to stakeholders, cost-effectiveness etc. Assessment has the greatest effect as a driving force in learning if it is authentic, context relevant and samples widely. In this paper, we present a new curriculum design and a model for experiential learning through assessment. We call it Assessment Directed Medical Education [ADME] Curriculum using Assessment Driven Integrated Learning [ADIL]. In this model, we propose a cent percent rightest shift in the curriculum design and learning strategy by using assessment as the sole tool to a self-directed learning process through supervised simulated and real-patient encounters testing competencies in cognitive, psychomotor and affective domains in an integrated approach utilising key resources for active learning. It is presumed that, this will, in the long term improve health care delivery by producing competent healthcare professionals that have learned through direct student-'patient' encounters from day one of their medical education and are competent in making professional judgments, exhibit appropriate skills and behaviours