Flipped class - making that one hour effective in a resource constrained setting

Flipped-class teaching has a great potential to replace traditional lectures in medical education. This study was designed to explore attitude of undergraduate medical students from Pakistan towards flipped-class. Five flipped classes were conducted in third year MBBS by a single teacher for a class of 100 students. Quantitative data was collected through a survey questionnaire to assess students' response to the new method. A focused group discussion was then conducted with students who disliked the method and preferred traditional lectures. A sequential mixed methods approach was used for analysis. Seventy-one students participated in the survey, 84.5% students liked this method of teaching. Students identified fruitful interaction, better retention, better conceptualisation, prior knowledge, active learning, individual student attention, and application of knowledge as strengths of the class. Noise, limited time, lack of self-confidence, and presence of uninterested students were identified as problems for engaging in the class

Learning Styles of Final Year MBBS Students Taught Through Problem Based Learning Strategy Over a Period of Five Years

To identify the influence of problem based learning strategy on the learning styles of final year medical students who have been taught through the student centered teaching curriculum over a period of 5 years. A descriptive study. The study was conducted at Islamic International Medical College in April 2013. Learning styles of students of final year medical students of Riphah International University taught in an integrated student centered curriculum over 5 years of medical school were identified by using the Learning Style Orientation Inventory. A total of 90 students were recruited in the study, out of which 40% were males and 60% were females. 51.1% were observational learners, 15.55% were experiential learners, 11.1% were structured learners. The least number of students were discovery [4.44%] and group learners [3.33%]. Our study shows inclination towards group learning in only 8.8% students [both preference and mixed methods] all of which were females. Maximum students still preferred to be observational learners who are passive dependent superficial learners and not open to new experiences and analytical thinking. These findings suggest that further research to look for factors that can inculcate deeper learning habits in the students is needed

Clinical breast examination; the diagnostic accuracy in palpable breast lumps

To determine sensitivity and specificity of standardized clinical breast examination [CBE] for benign and malignant breast lumps. A prospective validation study. The study was conducted at Railway hospital, Rawalpindi from September 2008 to February 2010. A total of 110 female patients presenting with breast lumps were recruited in the study. All of them underwent a standardized clinical breast examination along with complete triple assessment. The sensitivity and specificity of CBE was calculated and compared with that of triple assessment in the same patient. Likelihood ratios for individual characteristics of breast lumps were also calculated. Sensitivity of a structured CBE to pick up carcinoma breast in a patient with lump breast was 100% [95% CI, 0.8-1] while specificity was 94.6% [95% CI, 0.86-0.97]. The likelihood ratio for carcinoma breast was 17.8 [95% CI, 7.6 - 41.7]. The standardized CBE can differentiate between palpable benign and malignant lumps reliably. This is especially important in benign lumps where a policy of follow up clinical examination can be utilized, particularly when the investigative facilities may not be readily available

Breast diseases; pattern in a general hospital

Objective: To determine pattern of breast diseases presenting in the surgical OPD of a General hospital

Design: A prospective observational study

Place and duration of study: The study was conducted at Railway hospital, Rawalpindi from September 2008 to Feburary 2010

Patients and Methods: Female patients presenting with complaints regarding breast were recruited in the study. All of them underwent clinical breast examination followed by necessary radiological and / or histopathological investigations to diagnose the disease. Data regarding personal information, clinical examination findings and results of investigations done was collected on a proforma. Results mainly as frequencies were analyzed using software SPSS 16.0

Results: A total of 207 female patients presented in the OPD with breast complaints. 15 patients were lost to follow up before a definitive diagnosis could be made; therefore they were excluded from the study. Out of 192 patients 21.9% had mastalgia followed by fibroadenoma [19.3%], breast abscess [15.6%], carcinoma breast [13.5%], fibrocystic disease [6.25%], duct ectasia [5.7%], acute mastitis [4.7%], no disease [4.2%], nipple eczyma [2.1%]. Benign phylloides tumour, chronic mastitis, prominent axillary tail, cracked nipple were each 1% and 3 patients presented with mammary fistula [0.5%], accessory nipple [0.5%], and lipoma [0.5%]

Conclusion: Breast diseases make a sizeable portion of the general surgical practice. In our set up benign diseases are far more common than the malignant ones. Mastalgia is the commonest breast problem. Malignancy of breast presents usually in late stages

Relation of pain and operative findings in acute gall bladder diseases

Objective: To observe whether duration of pain is a true reflector of operative findings in patients with acute gall bladder diseases

Study Design: Observational analytical

Place And Duration: Surgical Unit-ll, Pakistan Railway Hospital Rawalpindi spanning over a period of 02 years from May 2010 to may 2012

Methodology: 60 patients with acute gall bladder diseases were included through non probability convenience sampling. A proforma was designed to include clinical features, diagnostic work up, treatment plan and operative findings

Diagnostic work up included complete blood picture, liver function tests, hepatobiliary ultrasound. HIDAscan and CTscan was done if needed. Routine hematological and radiographic studies as indicated were performed

Results:: A total of 60 patients were studied and among them majority 83.3%[n=50] were females. In Patients with biliary colic group 41.7%[n=25], Murphy's sign was positive in 56%[n=14] and pathology on ultrasound scan was detected in 84%[n=21] of the patients. In patients with acute cholecystitis, fever 71.4%[n=25], Positive Murphy's sign 71.4%[n=25] and raised total leukocyte count 88.5%[n=31] were the commonest findings. Per operatively 68%[n=17] patients had chronically inflamed gall bladder and 16%[n=4] had acutely inflamed gall bladder among patients having symptoms of less than 12 hours duration. Acute inflammation of gall bladders commonly observed 65.7% [n=23], followed by chronically inflamed gall bladder 28.5%[n=10]

Conclusion: Duration of pain is a strong indicator of operative findings and thus patients outcome

Comparison between stricture plasty and resection anastomosis in tuberculous intestinal strictures

To compare the effectiveness, safety and morbidity of strictureplasty with resection anastomosis in patients with tuberculous small gut strictures. Design: Prospective comparison study. Place and Duration of Study: Surgical Unit-I of Rawalpindi General Hospital from March 2000 to February 2002. Patients and Thirty patients who presented with intestinal obstruction due to tuberculous strictures, and underwent either resection anastomosis or strictureplasty were included in the study. Data was collected on a proforma and analyzed using software SPSS [version 8.0]. Chi-square and t-test were used to test the hypothesis. Main outcome measures included the presence or absence of postoperative leakage anastomosis, wound infection, recurrence of intestinal obstruction and postoperative stay. Chi-square test applied to see the effectiveness showed no significant difference [p>0.5] between the two procedures. t-Test on the score of morbidity also showed no significant difference [p>0.5] between the two procedures. Both procedures performed were equally effective and had equal morbidity in cases of intestinal tuberculous strictures. Strictureplasty is superior to resection anastomosis in cases of multiple strictures as it conserves gut length and can even be performed safely in cases with coexistent gut perforation