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]

Post-dural puncture posterior reversible encephalopathy syndrome

We report the case of a young patient with 36 weeks pregnancy, and an acute respiratory infection with severe bronchospasm, who developed an occipital headache and neck pain on the third day of inadvertent dural puncture during placement of combined epidural spinal anaesthesia for caesarian section. It was diagnosed as post-dural puncture headache until generalised tonic clonic siezures occurred the next day raising the suspicion of postpartum eclampsia or meningitis. Posterior reversible encephalopathy syndrome was diagnosed on MRI of the brain which showed features of reversible ischemia in the posterior region of the brain. With anticonvulsant therapy and antibiotics there was complete resolution of neurological symptoms. We highlight the importance of high index of suspicion of this reversible encephalopathy .In obstetric cases with intentional or inadvertent dural puncture, with headache similar to post-dural punctural headache, and the essential role of neuroradiology in confirmation of the diagnosis, as placement of an epidural blood patch would be highly detrimental in these cases

Continuing medical education and pharmaceutical industry

Continuing medical education providers' [academia] and industrial relationship is drawing attention all over the world. To date, there are no national commercial support guidelines available in Pakistan to properly regulate cooperation between the two distinct entities. However, the fact is that the future of all continuing medical education depends on pharmaceutical support and the providers are heavily dependent on the pharmaceutical industry to remain in action. It should always be remembered that medical education and profession is regarded as a moral of enterprise based on a blind faith between the physician and the patient. The funding support by the industry should not bind or influence physician's prescription for any reason. To be trusted, medicine must be free of all such dependency; it should be accountable only to the society it serves and to its own professional standards

Neuroleptic malignant syndrome: need for early diagnosis and therapy

Neuroleptic Malignant Syndrome [NMS] is a medical entity that has received little attention in the clinical settings in Pakistan. The aim of our study was to review the predisposing factors, outcomes and characteristics of in-patients diagnosed with NMS. We performed a retrospective chart review of all cases [age > 15 years] at a tertiary care center in Karachi between January 01, 1990 and November 30, 2001, diagnosed using ICD 10 coding. Data was collected using a standardized data entry form and statistical analysis was performed using Epi Info 6, Version 6.02. There were a total of 20 patients diagnosed with NMS [11 male and 9 female] in our study with a mean age of 46.6 +/- 15.9 years. Haloperidol was the most frequently responsible neuroleptic. Of the 18 patients on a neuroleptic, most developed NMS after 8 weeks of therapy. There were 5 mortalities all of which were associated with septic shock. Fourteen patients recovered completely from the episode and did not have any neurologic sequelae. NMS is an important preventable clinical entity. Early diagnosis and judicious use of antipsychotics is warranted to prevent mortality and heightened morbidity

Oral contraceptives and cerebral venous thrombosis: case report and a brief review of literature

Cerebral venous thrombosis remains an important and sometimes an elusive cause of strokes. Oral contraceptives seem to have a strong causative association with this entity. We describe a case that highlights the importance of asking specific questions about oral contraceptive use in patients with strokes due to cerebral venous sinus thrombosis, especially, where the cause remains cryptic

Herpes simplex encephalitis: analysis of 68 cases from a tertiary care hospital in Karachi, Pakistan

To evaluate clinical presentation, radiological and cerebrospinal fluid findings and outcome of patients with Herpes simplex encephalitis [HSE]. The charts of all the patients [n=88], who were admitted to The Aga Khan University, Karachi with diagnosis of HSE, from 1990-2002, were retrospectively reviewed. Sixty eight patients were included in the study. The variables were identified [including demographic data, signs and symptoms at presentation and laboratory investigations such as CSF analysis including, PCR, serum IgM antibodies, EEG and neuroimaging]. The patients were included in the study if they had any three of the five criteria positive in addition to clinical features suggestive of herpes encephalitis. Sixty eight patients, that fulfilled the criteria, were included in the study. Clinical findings included fever, seizures, altered mental status, aphasia and hemiparesis. CSF, analysed in all the patients, was abnormal in 65 patients [96%] and EEG was abnormal in 82% patients. All patients underwent CT or MRI of the brain, 66% patients had abnormal scans. Temporal lobe involvement was seen in 34 patients [50%] and 11 patients had purely extra temporal lesions. All patients were treated with standard Acyclovir. Seven patients died. At the time of discharge, 17 patients showed normal neurological examination, 29 were ambulatory with assistance and 15 were bedridden. Our study suggests that large number of patients with HSE have extra temporal involvement on CT or MRI. Majority of patients had complete or good recovery after completion of therapy