Perspectives of Teachers at Medical Colleges Across India regarding the Competency based Medical Education Curriculum – A Qualitative, Manual, Theoretical Thematic Content Analysis

Background: Competency-based medical education (CBME) curriculum has been implemented in India since 2019 with a goal to create an “Indian Medical Graduate” (IMG) possessing requisite knowledge, skills, attitudes, values, and responsiveness. Objectives: To explore teachers’ perceptions across India at medical colleges on the newly implemented competency-based medical education curriculum. Methods: This was a qualitative cross?sectional study conducted among teachers working at medical colleges across India, between February and April 2022 (n = 192). The data collection was done using Google forms online survey platform on teachers’ perception regarding CBME, its specific components, and perceived bottlenecks. We analyzed this qualitative data using manual, theoretical thematic content analysis following the steps endorsed in Braun and Clarke’s six-phase framework. Results: The majority of the teachers (64.1%) have positively responded to the CBME curriculum’s implementation. However, it came with a caution that the curriculum should continuously evolve and adapt to regional demands. The foundation course, early clinical exposure, and the family adoption program were the specific components of CBME curriculum over which the teachers raised concerns. The need for additional teachers in each department (department-specific teacher or faculty per hundred students ratio to be worked out) and the need for enabling faculty preparedness through adequate training was highlighted. Concerns were also raised regarding implementing CBME with teachers without a medical background (especially in preclinical departments). Conclusion: It is the need of the hour for the curriculum to incorporate a systematic feedback mechanism built into the system, though which such critical appraisals can be meaning collated and acted upon, to ultimately evolve, thereby creating an “Indian Medical Graduate” for the needs of todays’ society.

Impact of COVID-19 pandemic on medical education

Background: Medicine is one of the few academic disciplines that cannot be taught in the distance education mode. Hands-on practice for clinical skills and competency is critical in medical education. Although this pandemic has offered new learning modes such as teleconsultation, videoconferencing, virtual simulations, and digital podcasts, how much actual knowledge transfer and skill gain will be achieved, is unanswered. Aims and Objectives: The present study has been planned to understand the impact of COVID on medical education and to identify the factors which promoted or hindered learning during COVID-19 pandemic. Materials and Methods: This cross-sectional study was conducted among 261 willing MBBS students from various colleges of Tamil Nadu after obtaining Institutional Ethical committee clearance using a pre-validated structured online questionnaire through Google form link in online social platforms through “Voluntary opt in” method of sampling. Results: About 22.6% of the study participants were affected by COVID-19. About 46% of the participants family members suffered from COVID and all of them accepted that it significantly affected their academics. About 71.6% experienced anxiety/depression. About 93.5% were addicted to social media during class hours. About 88.1% welcomed “flipped/blended learning”. More than 90.8% reported that they missed skill-based learning/Primary health care training. About 80.8% positively felt that they got more duration for preparing exams. About 89.3% found that practical exams were challenging. Conclusion: Not only have we witnessed the importance of having a robust health-care system, but the pandemic has created a critical need to transform various aspects of medical education especially to a model of blended learning of online and offline methods to enable a better academic environment so as to reflect the changing medical landscape.

Prevalence And Determinants of Anemia Among Adolescents in Coimbatore District, Tamil Nadu – A School Based Analytical Cross-Sectional Study

Context: The objective of the study was to estimate the prevalence of anemia among adolescents 10 to 19 years of age disaggregated by age group and gender. We also assessed the determinants of anemia among ad-olescents. Methods: An analytical cross-sectional study was carried out between July and November 2019 in a senior secondary public school, located in Coimbatore district, Tamil Nadu, India using a predesigned, semi-structured, pretested proforma that included haemoglobin estimation using oxyhemoglobin method. Results: The overall prevalence of anemia was 88.6% (95% CI 87.2 to 89.8); it was ten percent points higher in females (93.8%, 95% CI 92.1 to 95.1) compared to males (83.9%, 95% CI 81.7 to 85.8). Multivariate regres-sion analysis showed that early adolescents (AOR 3.05, 95% CI 2.19 to 4.24), females (AOR 6.94, 95% CI 4.90 to 9.83), those with A or B or AB blood groups (AOR 2.58, 95% CI 1.92 to 3.49), physical inactivity (AOR 2.18, 95% CI 1.43 to 3.33) and attainment of menarche (AOR 2.69, 95% CI 1.73 to 4.21) were independent predic-tors of anemia in adolescents. Conclusion: It is the need of the hour to identify vulnerable groups; factors that predict occurrence, prioritize them to design and implement an effective public health action. Also, the effectiveness of existing strategies in the form of periodic deworming, Iron and Folic acid tablets (IFA) should be reassessed.

Comparison of high-resolution manometry parameters among type II diabetes patients and normal volunteers

Background: Gastrointestinal (GI) autonomic neuropathy and reflux esophagitis are common in chronic diabetics. To gauge the adequacy of peristalsis, high-resolution esophageal manometry is considered as a reliable test. Aim and Objective: To compare the GI symptoms and high-resolution manometry parameters between type II diabetes patients and normal volunteers. Materials and Methods: This comparative study was conducted on 35 known type II diabetes mellitus patients (hemoglobin A1c [HbA1c] levels ?6.5%) and 35 normal volunteers between the age group of 35 and 70 years. Sociodemographic details, drug history, disease duration, and GI symptoms were elicited among the study participants. HbA1c and High-resolution manometry were measured for all the participants. Results: The frequency of epigastric pain (31.48%), heartburn (34.28%), pharyngeal irritation (31.43%), and loose stools (37.14%) were significantly higher in the diabetics. Significant difference (P < 0.05) was observed in mean basal expiratory pressure (MBEP) and mean basal inspiratory pressure (MBIP) values between diabetics and controls. There was a positive significant correlation between esophagogastric junction contractile integral and MBIP (r = 0.557), MBEP (r = 0.583), Median Integrated Relaxation pressure (r = 0.410). Conclusion: Hyperglycaemia seems to be an independent risk factor for gastroesophageal reflux disease (GERD). Obesity significantly increments the occurrence of GERD in diabetics. Strict adherence to preventive measures such as weight reduction, diet management, glycaemic control will have a great impact on the occurrence of GERD in diabetics.

Intestinal myiasis caused by Muscina stabulans.

Intestinal maggots were isolated from a patient, who had reported to the Department of General Medicine of Sri Manakula Vinayagar Medical College, Puducherry, in southern India with complaints of abdominal distress, bloating of abdomen and intestinal hurry following a meal. He was diagnosed as a case of intestinal myiasis. Maggots obtained from his stool were identified to be Muscina stabulans based on characteristic patterns of posterior spiracles. He was treated with purgatives and albendazole. This intestinal myiasis case caused by M. stabulans is reported here because of its rare occurrence and the need to establish a correct diagnosis.

Toxoplasma gondii IgM antibody prevalence study in patients suffering from neurological disorders.

One hundred and twenty seven patients belonging to Neurosurgery (49), Neuromedicine (48), Cardiac medicine (30) wards and Blood donors (30) as healthy controls were investigated for the prevalence of Toxoplasmosis by means of detecting specific IgM antibody against Toxoplasma gondii (T. gondii) employing Enzyme Immuno Assay (EIA). The detection rate of specific IgM antibody against T.gondii was found to be 32.7% (16/49) among Neurosurgery patients, 20.8% (10/48) among Neuromedical patients and 20% (6/30) among Cardiac medical patients. None of the voluntary blood donors tested was found to have T. gondii IgM antibody. Maximum prevalence rate was found among female patients undergoing Neurosurgery (42.3%) followed by Neuromedical patients (40%). There is an increasing rate of prevalence of Toxoplasmosis from the lower age group upto thirty years and a declining prevalence rate among the higher age groups. The present study revealed high prevalence rate of Toxoplasmosis in Neurosurgery patients (32.7%) and in particular among female (35.2%) than male (17.8%) patients.

A preliminary study on the interaction of cell-polymer extract towards biodegradation.

Two newly synthesised polyurethanes were subjected to a preliminary study, in-vitro, on the interaction of cell polymer extract to understand the phenomenon of biodegradation by employing VERO cells. VERO cells exposed to the saline extract of the polymer showed cytopathic effect with granulations in the digestive vacuoles. It is suggested that the long term material performance of an implant-material can be evaluated by using VERO cells and/or macrophages and by analysing metabolic products secreted by the cells during interaction.

Coxsackie viral myocarditis: a clinical and echocardiographic study.

Thirty two patients with acute onset of cardiac symptoms following an episode suggestive of viral infection, were studied. 11 patients had Coxsackie viral myocarditis. All had 4 fold rise of neutralising Coxsackie viral antibody titres on paired sera tested. Coxsackie B virus types 2 and 4 were commonly detected. Among the eleven patients, 8 presented with congestive heart failure, 2 with ventricular arrhythmias and one with chest pain and S3 gallop. All had ECG changes. Echocardiographic examination showed global left ventricular dysfunction in 7, regional wall motion abnormalities in 2 and normal left ventricular function in one. Serial echocardiographic examination showed progressive myocardial dysfunction in 3 and improvement in myocardial function in two patients. Two patients died during the follow up period. Echocardiography helped in assessing the course of patients with viral myocarditis.

Prevalence of coagulase negative Staphylococcus species among hospital personnel and surgical patients.

Two hundred and fourteen strains of Coagulase negative Staphylococci (CNS) isolated from hospital personnel (114 strains) and patients (100 strains) were identified upto species level. The prevalence rate of CNS in relation to sex, sources and type of specimens were analysed. Most of the CNS strains belonged to S. epidermidis (49.1% among carriers and 39% in clinical isolates) and S. hominis (36% each). Besides, five more CNS species, namely S. saprophyticus, S. capitis, S. haemolyticus, S. cohnii and S. xylosus were also isolated. (0.5 to 10.3% isolation rates). Maximum S. hominis isolated were from hospital personnel and urine from patients (63.4% and 72.2%, respectively), 50.0% and 33.3% of S. hominis were found from urine and blood, respectively. The present study revealed that the leading species S. epidermidis and S. hominis may play an important role in the nosocomial infections, especially among immunocompromised hosts during their hospital stay.

Correlation between beta-lactamase production and MIC values against penicillin with coagulase negative staphylococci.

Two hundred strains of coagulase negative staphylococci (CNS) isolated from various clinical specimens (116) and healthy hospital personnel (84) were investigated for the production of beta-lactamases by means of three iodometric techniques and correlated with the minimum inhibitory concentration (MIC) values of penicillin-G by agar dilution technique and disc diffusion technique. One hundred and fifty (75.0%) of the 200 strains tested produced beta-lactamases. Seventy two per cent of the CNS were found to be beta-lactamase positive by the starch paper technique which was the most sensitive one in our study. The MIC values of penicillin against CNS ranged from less than or equal to 1.25 to greater than or equal to 2000 units. The present study indicated the higher prevalence of beta-lactamase producers with increased penicillin resistance among CNS strains isolated from healthy carriers and hospitalised patients.

Fatal outcome of group-G streptococcal meningitis (a case report).

An adult woman developed meningitis caused by Group-G streptococci. The organism was successfully isolated both from blood and cerebrospinal fluid of the patient. The woman succumbed to infection despite an appropriate antibiotic therapy.