Expanded outcomes framework for effective cme - the way forward for Pakistan

Continuing Medical Education [CME] providers recognize the importance to plan educational activities that focus to improving and assessing knowledge, competency and performance outcomes rather than on attendance and satisfaction. This perspective proposes using an expanded outcomes framework for planning and assessing CME. The expanded outcomes framework supports backward planning, that starts with the population health outcomes [level 7] and moves backward, to providing continuing education for physicians that may result in improved outcomes. We the authors recognize the complexity of this framework, the recently evolved CME system in Pakistan, and the limited resources; and therefore, we suggest that planning and assessment should begin at level 3, physician knowledge. Thus, be mindful of the end and the scope of this framework that is associated and leads toward the improvement of population health outcomes

Task-based learning versus problem-oriented lecture in neurology continuing medical education

To determine whether general practitioners learned better with task-based learning or problem-oriented lecture in a Continuing Medical Education [CME] set-up. Quasi-experimental study. The Aga Khan University, Karachi campus, from April to June 2012. Fifty-nine physicians were given a choice to opt for either Task-based Learning [TBL] or Problem Oriented Lecture [PBL] in a continuing medical education set-up about headaches. The TBL group had 30 participants divided into 10 small groups, and were assigned case-based tasks. The lecture group had 29 participants. Both groups were given a pre and a post-test. Pre/post assessment was done using one-best MCQs. The reliability coefficient of scores for both the groups was estimated through Cronbach's alpha. An item analysis for difficulty and discriminatory indices was calculated for both the groups. Paired t-test was used to determine the difference between pre- and post-test scores of both groups. Independent t-test was used to compare the impact of the two teaching methods in terms of learning through scores produced by MCQ test. Cronbach's alpha was 0.672 for the lecture group and 0.881 for TBL group. Item analysis for difficulty [p] and discriminatory indexes [d] was obtained for both groups. The results for the lecture group showed pre-test [p] = 42% vs. post-test [p] = 43%; pre- test [d] = 0.60 vs. post-test [d] = 0.40. The TBL group showed pre -test [p] = 48% vs. post-test [p] = 70%; pre-test [d] = 0.69 vs. post-test [d] = 0.73. Lecture group pre-/post-test mean scores were [8.52 A +/- 2.95 vs. 12.41 A +/- 2.65; p < 0.001], where TBL group showed [9.70 A +/- 3.65 vs. 14 A +/- 3.99; p < 0.001]. Independent t-test exhibited an insignificant difference at baseline [lecture 8.52 A +/- 2.95 vs. TBL 9.70 A +/- 3.65; p = 0.177]. The post-scores were not statistically different lecture 12.41 A +/- 2.65 vs. TBL 14 A +/- 3.99; p = 0.07]. Both delivery methods were found to be equally effective, showing statistically insignificant differences. However, TBL groups' post-test higher mean scores and radical increase in the post-test difficulty index demonstrated improved learning through TBL delivery and calls for further exploration of longitudinal studies in the context of CME

Evaluating neurology CME in two educational methods using patton's utilization focused model

Generally in continuing education medical education [CME] the most time is consumed for in the planning and preparation of the event. This planning and preparation, however, needs recognition through an evaluative process. The purpose of this study was to evaluate neurology CME in two educational methods, lecture vs task-based learning, using Patton's utilisation focused model. This was an observational, cross-sectional inquiry. The questionnaire evaluated the educational elements such as learning objectives met, content covered, presentations at the level of understanding, level of interaction, knowledge gained, time management, queries responded, organisation, quality of learning material and overall grading of the educational event. General Practitioners were the key participants in this evaluation and consisted of 60 self-selected physicians distributed equally in both the TBL and lecture groups. Patton's utilization focused model was used to produce findings for effective decision making. The data were analysed using Mann-Whitney U test to know the value of the learning method that satisfied the most participants. A total of 58 evaluations were returned, 29 from the TBL group and 29 from the lecture. The analysis of the elements showed higher mean ranks for TBL method ranging between 32.2 and 38.4 versus lecture [20.6-26.8]. Most of the elements assessed were statistically significant [p>0.05], except time management [p=0.22]. However, elements as 'objectives of the activity met' [p=0.07], 'overall grading of the event' [p=0.06] and 'presentations at the level of understanding' [p=0.06] were at border line. Of the 29 respondents in the TBL group, 75% rated all the elements of the program above very good. In the lecture group, 22 [75%] respondents out of 29 rated almost half of the elements above very good. Majority of respondents in the TBL group rated all program elements as exceptional compared to the lecture group in which only half of the elements were rated above very good. Taskbased learning method made the most impact on participants' satisfaction

How does self-efficacy affect performance of learner?

All types of attribution based on which learners make their judgement [i.e., self efficacy], about academic success or failure or about a specific task usually affect their performance and their capabilities to deal with different realities.[1] It is perhaps the most distinctive capability of self reflection. Many of the cognitive theorists have defined it as a meta-cognitive capability. This judgement influence learners choose what to do, how much effort to be invested in the activity, how long to carry the phase of disappointment, and whether to approach the task anxiously or with assurance [2]

Oral hygiene KAP assessment and DMFT scoring among children aged 11-12 years in an urban school of Karachi

To assess the oral hygiene knowledge, attitude and practices among school children and evaluate their DMFT [Decayed/Missing/Filled Teeth] scores. Cross-sectional study. A private school of Karachi from March to April 2008. Convenient sample comprising 300 students of grade 6 within the age group of 11-12 years was selected. A knowledge, attitude and practices survey questionnaire based on quantitative indicators was filled by the students. Clinical examination was done for DMFT. Data analysis was done by using SPSS version 11. Associations were assessed using chi-square test and a p-value of < 0.001 was considered significant. There were 160 males and 140 females in the target group. The mean DMFT was found to be 1.27. The children had satisfactory knowledge of oral health's effect on general health and the problems associated with poor dental hygiene. However, 50.3% children did not have positive attitude towards importance of a dentist's role in maintaining their dental health. Only a few students [11.3%] had familiarity with dental floss. A statistically significant association was found between frequency of brushing and children's knowledge of the problems related to irregular tooth brushing [p < 0.001]. The attitude of school children towards dental health and dental service utilization is determined by certain social and cultural factors. The mean DMFT of 1.27 showed that there must have been some poor oral practices that are contributing towards a higher mean