ABSTRACT
Student doctor method of clinical training or clinical clerkship provides students with exposure to the entire longitudinal illness of the patient. The students participate in patient care as a part of treating team and can refine their clinical, communication and procedural skills. It provides them with an opportunity to work with the faculty and experience the future workplace. Although the graduate medical education regulations (GMER) provide for student doctor method of training, the time provided is too little and opportunistic. Electives have also been recently added to the new curriculum for the first time. We propose a model to deliver the electives using the clerkship method, so as to consolidate what students learn from the ongoing clerkship. This model is feasible, practical and can be introduced in the current GMER for Indian medical undergraduates without any major disruptions.
ABSTRACT
Context: Feedback processes are intricate, generally misunderstood, hard to execute efficiently, and often fail in their goals to influence students learning. Research highlights that students usually do not value the benefits of feedback. This paper reviews the literature on the definition, purpose, and models of feedback; and on exploring why some students do not value feedback, what factors are influencing the effectiveness of feedback, and how to improve the efficacy of feedback. Evidence acquisition: The relevant articles were searched through ‘Google Scholar,’ ‘CINAHIL’ and ‘PubMed’ using the key terms- “Student feedback,” “Frameworks of feedback,” “Barriers to effective feedback,” and “Students’ perspectives on feedback.” The search criteria included: review and original research articles in the English language published in high-impact journals in the past ten years. Results: The results of different studies have illuminated diverse factors demanding the attention of educators to the effectiveness of feedback. Personal, relational, procedural, and environmental factors seem to affect the utility of feedback. To be effective, feedback should be actionable, non-judgmental, descriptive and specific, based on observable behavior, and should be given at a mutually agreeable time and place. Conclusion: The efficacy of feedback can be enhanced by creating students’ feedback literacy, addressing students’ perceptions and expectations, encouraging productive educational alliances, improving procedural elements of feedback, and environmental conditions.
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Background: Diabetes mellitus is an endocrine and metabolic disorder, characterized by hyperglycemia. Metformin is the first line pharmacotherapy recommended by ADA. It has been recognized that metformin use is associated with serum vitamin B12 deficiency. The objective of this study is to determine the prevalence of serum vitamin B12 deficiency among Indian patients with type 2 diabetes mellitus on metformin therapy compared to those who are not on metformin.Methods: Here, 90 patients of type 2 diabetes mellitus of both sexes were included in this cross-sectional study conducted from January 2018 to August 2019 in SGRDIMSR, Sri Amritsar. They were divided into two groups; Group A of 60 subjects of type 2 diabetes mellitus on metformin therapy >1 year and group B of 30 subjects of type 2 diabetes mellitus not on metformin or had stopped taking metformin 6 months back. Serum vitamin B12 levels were measured using a Chemiluminescence method. Data was statistically analysed.Results: The serum vitamin B12 levels were 190.02�.75 pmol/l in group A (metformin users) and 586.9�3.69 pmol/l in group B (not metformin users) (p value=0.002). A significant negative correlation existed between the serum vitamin B12 and duration and dose of metformin use (r? -0.676) and (r -0.855) by using Pearson抯 correlation coefficient in group A.Conclusions: Metformin is associated with decrease in serum vitamin B12 levels. Annual screening of serum vitamin B12 is recommended for patients of type 2 diabetes mellitus who are on metformin therapy for longer duration and /or in higher doses.
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Background: Magnesium (Mg) is the fourth most abundant cation in the human body and plays a key role in many fundamental biological processes including metabolism and DNA synthesis. Hypomagnesaemia has also been associated with poor glycemic control and albuminuria in patients with type 2 diabetes mellitus.Methods: The present study was undertaken in the Department of Medicine in SGRDIMSAR, Amritsar on 100 patients diagnosed with type 2 Diabetes Mellitus as per the latest ADA criteria. The patients were divided into 2 groups. Group A with 50 patients with type 2 diabetes mellitus with urinary albumin level >30 mg/dl (Study Group). Group B with 50 patients with type 2 diabetes mellitus with urine albumin levels <30 mg/dl (Control Group).Results: Hypomagnesemia was present in 16 patients i.e. 32% in study group and 12 patients i.e. 24% in control group (P=0.034). In study group with hypomagnesemia, 13 patients i.e. 81.25% and in control group with hypomagnesemia, 4 patients i.e. 33.33% have poor glycaemic control (P=0.033). In study group with hypomagnesemia, 14 patients i.e. 87.5% and in control group with hypomagnesemia, 5 patients i.e. 41.67% were found to have diabetic retinopathy (P=0.010).Conclusions: Hypomagnesemia was directly correlated with hypertension (P=0.004), poor glycaemic control (P=0.033), diabetic retinopathy (P=0.010) and diabetic nephropathy (P=0.034). Hypomagnesemia leads to early microvascular complications as compared to macrovascular complications. Thus, screening of serum magnesium levels in T2DM with albuminuria should alert us to look for hypertension, poor glycaemic control and retinopathy.
ABSTRACT
Background: Primary hypothyroidism is a clinical conditiondue to deficiency of thyroid hormones. Thyroid hormones haveprofound effect on renal development, renal hemodynamics,glomerular filtration rate, electrolytes and water homeostasis.The aim of this case control prospective study is to evaluatethe effect of primary hypothyroidism on renal functions.Methods: Serum creatinine, blood urea nitrogen, uric acid,urinary albumin creatinine ratio and eGFR levels wereestimated in 75 newly diagnosed and untreated patients ofprimary hypothyroidism in the age group of 20 to 60 years ofeither sex (Study group) and 75 healthy, age and sex matchedindividuals with normal thyroid profile (Control group). Followup of patients in study group was done after 8 weeks ofthyroxine replacement and serum creatinine, uric acid, urinaryalbumin creatinine ratio and eGFR levels were estimated.Results: The mean eGFR level in study group at baseline waslower and mean serum creatinine, blood urea nitrogen, serumuric acid and urinary albumin creatinine ratio (UACR) levelswere higher than control group. After 8 weeks of thyroxinereplacement; the mean serum creatinine, uric acid, bloodurea nitrogen levels were decreased and eGFR levels wereincreased. Also serum TSH shows positive correlation withserum creatinine, blood urea nitrogen, uric acid and urinaryalbumin creatinine ratio but negative correlation with eGFR.Conclusion: Primary hypothyroidism is associated withsignificant alteration in renal function which is reversible onthyroxine replacement.