Students’ feedback on the foundation course in competency based medical education curriculum

The Medical Council of India (MCI) has formulated a new Competency Based Medical Education (CBME) Curriculum for the Indian Medical Graduates with an objective of making medical education outcome based. A one month long Foundation Course (FC) is a hallmark of this CBME which is implemented during the first month of first professional MBBS studies. The objective is to acquaint, allay apprehension and prepare freshers for further studies using andragogical and heutagogical approaches. The MCI also released the guidelines for the medical colleges for uniform conduct of FC across the country. The FC was divided into six modules, i.e. Orientation Module, Skills Module, Community orientation module, Professional Development and Ethics Module (P and E), Enhancement of Language and Computer Skills Module, and Sports and extracurricular activities. A total of 175 hours were allotted to these modules. Like every institute, our institute also developed the implementation program and time-table of FC using MCI guidelines and taking into account the available resources.  The FC at our institute was conducted from 1st August 2019 to 31st August 2019 and was meticulously planned and implemented. The effective implementation  required committed efforts of 30 faculty members (12 Professors, 11 Associate Professors and 7 Assistant Professors), two language and one fine arts teacher,  and 4 non-teaching members  (Librarian, IT-personnel, Coach for sports and motivational Guru). The students were trained to write reflections daily in their log - books which are being analysed further.

An implementation program for Foundation Course in Competency Based Medical Education Curriculum

After a gap of nearly two decades, Medical Council of India (MCI) has revised, rather revamped, the Undergraduate (UG) medical curriculum, making it competency based (CBME) and learner centric.

Study of Exchange Transfusion by Reconstituted Blood in Hemolytic Disease of Fetus & New Born

Introduction: In newborns with hemolytic disease of fetusand newborn, exchange transfusion is one of the treatments.The main objective of this study was to review and establishthe practice of exchange transfusion with reconstituted bloodin neonates and to observe fall of bilirubin and also rise inhemoglobin and its comparison with related studies.Material and methods: Total 31 neonates with hemolyticdisease of fetus and newborn were included in thisstudy and exchange transfusion was carried out to treathyperbilirubinemia. Exchange transfusion with O Rh negativecells suspended in AB plasma were done for neonates havingRh hemolytic disease of fetus and newborn and O Rh positivecells suspended in AB plasma were used for exchangetransfusion to ABO hemolytic disease of fetus and newborn.The pre and post exchange transfusion blood samples weretested for serum bilirubin and hemoglobin.Result: Out of the 31 cases, 20 were of Rhesus (Rh) hemolyticdisease of fetus and newborn, while ABO and other bloodgroups constituted 08 and 03 hemolytic disease of fetus andnewborn cases respectively. The average post-exchange fallin serum indirect bilirubin was (53.47%) and average rise inhemoglobin level was 3.06 gm/dl in all 31 cases.Conclusion: The reconstituted blood is immunologically muchsafer and better than whole blood for purpose of exchangetransfusion in hemolytic disease of fetus and newborn becauseof its superiority in minimizing transfusion reactions and inachieving all the therapeutic effects of exchange transfusionin better way

Effect of music on post-exercise recovery rate in young healthy individuals.

Background: Music has been used in exercise classes for many decades. The role of music in increasing the exercise performance is well recognized but there is very little information about effect of music on post-exercise recovery time. Methods: The present study was conducted to see the effect of musical sounds on post-exercise recovery time following moderate exercise with Harvard step test in young healthy volunteers. 30 young healthy volunteers (17 males, 13 females) aged between 17 to 20 years were recruited for the study. Pulse rate, systolic BP, diastolic BP were recorded prior to exercise in lying down position. The participants were subjected to moderate exercise by Harvard step test for 3 minutes on 3 consecutive days. They were allowed to rest in silence on 1st day, rest with hearing slow music on 2nd day and rest with hearing fast music on 3rd day. During the post-exercise relaxation time PR, SBP and DBP were measured immediately and after every 1 min. until the parameters returned to resting values. Data was statistically analysed using ANOVA test and 0.05 level of significance was set prior to the study. Results: The result showed that with slow music, recovery time of pulse rate (5.2 ± 2.1), systolic blood pressure (3.9 ± 1.1) and diastolic blood pressure (3.2 ± 1.7) were significantly faster as compared to both no music and fast music. Conclusion: The study concluded that music hastens post-exercise recovery and slow music has greater relaxation effect than fast or no music.

Estimation of Stature from Foot Length and Hand Length Measurements In Gujarat Region.

Background & objectives: Stature is considered as the height of a person measured in erect position. It is one of the most important factors in establishing identity of a person. In certain medico-legal cases, where only parts or fragments of human body are found. Such a need arises when there is mass casualty. Aim of current study was to establish anthropometric correlation of stature with hand length and foot length in population of Gujarat and also to derive regression equations for correct estimation of stature of male and female in Gujarati population. Material and Method: 150 asymptomatic, apparently healthy, adolescent and adult medical students with age between 18 to 22 years belonging to various regions of Gujarat were selected. Left foot and left hand was selected for measurement. Result: Regression equation for estimation of height using both foot length and hand length were formulated. By using the derived regression equations, height of subjects was calculated and then compared with actual height of subjects. Conclusion: By the present study we conclude that both foot and hand length can be used in estimation of stature of both males and females with fairly accurate results in Gujarati population.

Morphometric study of interparietal bone in Gujarat region.

Background: The occipital bone develops partly in cartilage and partly in membrane. The squamous part of occipital bone between two parietal bones occasionally presents a separate bones which are termed as inca, pre-interparietal bone or interparietal bone. Aims & Objective: (1) To determine the incidence of interparietal bone in skulls of Gujarat region. (2) To study different anomalies of interparietal bone and compare it with other studies. Material and Methods: Total 289 dried macerated skulls from Gujarat region were studied for incidence and type of interparietal bone anomaly. Results: Out of total 289 skulls interparietal bone was found in 23 bones giving incidence of 7.96%. Eight different varieties of interparietal bone anomalies were found and noted. Conclusion: Different anomalies of interparietal bone can be easily interpreted using the knowledge of ossification of interparietal part of occipital bone. Pre-interparietal bone is a misnomer and should not be reported separately.

Morphological and quantitative analysis of human liver- A cadaveric study.

Introduction: Knowledge of the normal liver morphology and its variants important in the era of diagnostic imaging and minimally-invasive surgical approaches. Method: 50 formalin-fixed livers were utilised for the study. Studied liver classified according to morphological types. Result: Normal liver found in 48% cases. Remaining 52% cases found variations out of that 28% cases found liver with lingular process and 12% cases found liver with diaphragmatic surfaces. Costal liver with very small left lobe and deep impressions in 6% cases,2% cases of Liver with total atrophy of the left lobe,2% cases of Liver with deep renal impressions and “corset” type constriction and 2% cases of Liver with right lobe very much smaller than the left. Conclusion: Our study highlights variations in liver morphology ,knowledge of these important for surgeon and radiologist.

A study of origin of sinuatrial nodal artery.

Introduction: The sinuatrial (SA) node is known as natural pacemaker of the heart. SA node is supplied by the sinuatrial (SA) nodal artery is an atrial branch. Ischemia of SA nodal artery due to injury or during surgical intervention leads arrhythmia. Origin of sinuatrial (SA) nodal artery is variable; most commonly arise from right coronary artery. It may arise from the circumflex branch of the Left circumflex artery (LCA). In some cases it may originate from the trunk of left coronary artery, aorta or left bronchial artery. SA node may be supplied by single SA nodal artery or may have dual and triple arterial supply. Methods: This study was conducted on 25 cadavers from the dissection laboratory with an age range of 50 – 70 years. The cadavers were embalmed through carotid arterial perfusion of formaldehyde solution, spirit, water and glycerine and preserved in a weak formalin solution before dissection. Dissection method was employed for this study. Result and Observation: Single SA nodal artery found in 22/25 hearts (88%) and dual supply found in 3/25 hearts (12%). The SA nodal artery originated from proximal segment of right coronary artery (RCA) in 16/25 hearts (64%), from proximal segment of circumflex branch (LCX) of left coronary artery (LCA) in 6/25 hearts (24%). The Mean+SD of diameter of SAN artery from right coronary artery was 1.7+0.42mm. The Mean+SD of diameter of SAN artery from circumflex branch of left coronary artery was 1.29+0.30mm. The termination types were 1) precaval found in 44% (11/25), 2) retrocaval in 52% (13/25) and 3) pericaval found in 4%(1/25) of all SA nodal arteries.Conclusion: To be aware of the origin and course of SAN artery may provide a safe approach to interventional cardiologist and cardiac surgeon during cardiac interventions. Cardiac surgeons especially should be careful because compensation.

Anatomical variation in musculocutaneous nerve –A cadaveric study.

Introduction:-Variation in origin, branching pattern, course and termination of musculocutaneous nerve are common. These anatomical variations important for anatomist, clinicians, anaesthetics and surgeons for avoid unexpected complication. Material & method:- Detailed study of 50 upper limbs of cadavers carried out in last 3 year. Result –in this study 4% cases there is absence of musculocutaneous nerve. Musculocutaneous nerve not piercing coracobrachialis and communicate with median nerve in 4% cases and musculocutaneous nerve rejoins with median nerve in 2% cases. Conclusion:- In this study we found significant variation in musculocutaneous nerve which is important for surgeons, while planning surgery in axilla and arm to avoid injury.

A study of placental vascular pattern by corrosive cast in Gujarat Region.

Introduction: A study of placental vasculature pattern was undertaken by using corrosion cast technique. The placenta is a highly vascularised organ. In this study we aimed to elucidate the structure of the cotyledonary vasculature of the human placenta after delivery, which serves as a core for the shape of the whole foetal villosity. Material & Method: Appropriate cast material was injected through placental vessels to form a corrosion cast model of placental blood vessels which was followed by meticulous dissection. Results: The cast models demonstrated very well the Hyrtl anastomosis between the umbilical arteries in the vicinity of the umbilical cord insertion into the placenta but no extra-placental anastomosis found between umbilical artery and umbilical vein. The chorionic vasculature exhibits a combination of the dichotomous and monopodial patterns. The chorionic vessels branch through 6 to 8 generations from the cord insertion towards the margins of the chorionic plate. The vein bifurcated twice immediately after insertion into the placenta. Conclusion: 3-dimensional structure of placenta can be demonstrated by micro vascular casts which reflect the shape of the whole or part of the organ, and include specific details such as the capillary architectural structure. Macroscopic visualisation can technically be advanced in 3 ways: treatment of maternal and fetal circulatory systems in common or each of the 2 systems separately.

A study of morphology of coeliac trunk in 100 cadavers.

Background: The coeliac trunk is an integral part of the circulatory system as it delivers blood from the heart to major organs within the abdominal cavity. The blood that it delivers is oxygenated and carries essential nutrients and immune system particles that can aid in life sustaining processes and can also prevent the development of diseases and complications from illnesses. Aims & Objective: (1) To study the anatomy of coeliac trunk, through its diameter, length related to their branches and distance from superior mesenteric artery. (2) To study the clinical implication of coeliac trunk in case of the variations and anomalous formation of coeliac trunk. Material and Methods: Morphology of coeliac trunk was studied in 100 formalin embalmed cadaver, aged between 50 to 80 years. Dissection method was use for this study. Results: Measurement of the length of the coeliac trunk up to the left gastric, Measurement of the length of coeliac trunk up to common hepatic and/or splenic artery, Measurement of coeliac trunk diameter, Distance between coeliac trunk and the superior mesenteric artery were taken. Conclusion: Knowledge of variations concerning the coeliac trunk is of extreme clinical importance in the areas of the laparoscopic surgery, and radiological procedures in the upper abdomen, and should be kept in mind by clinicians to avoid complications.

Effectiveness of image guided fine needle aspiration cytology in cases of deep seated lesions.

Background: Newer development in radiology has completely revolutionized the approach to percutaneous aspiration of space occupying deep seated lesions making it rapid, inexpensive, versatile and an adjunctive tool for evaluating internal organs. Aims & Objective: The present study was conducted to evaluate the effectiveness of image guided fine needle aspiration cytology in cases of deep seated lesions. Material and Methods: Total 169 aspirations performed from 161 cases in period of two years, 131 (77.51%) were under USG guidance and 38 (22.49%) were under CT guidance. Results: Overall adequacy rate was 76.92% for guided aspirations. Adequacy rate in case of aspirations done by pathologist was much higher than clinicians with P value (with Yates correction) of < 0.05. The most common organ for aspiration was liver (30.18 %), followed by ovary (23.67 %). Guided aspirations were also done from various organs like lung, retroperitoneal lymph nodes, pancreas, stomach, gall bladder, kidney, mediastinum, pleura, suprarenal gland and abdominal wall with high adequacy rate and without complications though with smaller sample size. Cytological diagnosis was possible in 73% cases. Conclusion: Guided aspiration is a simple, safe and cost effective screening test for deep seated lesions with a significant role in the detection of clinically unsuspected malignancy making it an investigation of choice for early confirmation or exclusion of pathology.

Factors influencing yield of platelet aphaeresis using continuous flow cell separator.

Background: In Transfusion Medicine, screening for suitable donor for platelet aphaeresis is difficult and time consuming procedure. This might lead to delayed supply of life saving Single Donor Platelet to critically bleeding patient. Aims & Objective: The aim of this study was to analyse the effect of various donor and procedure related parameters on the yield of single donor platelet so that the transfusionist as well as clinician can screen blood donors effectively in less time. Pre-donation platelet count, haemoglobin, haematocrit & weight were included as donor related variables. Processing time and blood volume processed were assessed as procedure related variables. Material and Methods: A total number of 265 platelet aphaeresis procedures were performed on CS 3000 plus with AMS cell separator (Fenwal, USA) using closed & open system aphaeresis kits & studied with respect to donor’s, procedure’s & patient’s related data. The statistical analysis used in this study was Pearson Correlation (‘r’ value). Results: The mean pre-donation platelet count was 286 ± 55 x 103/cu mm & mean platelet yield of all procedures was 3.3 ± 0.68 x 1011. Conclusion: Platelet yield correlated positively with pre-donation platelet count (r = 0.302, P < 0.0001). Donor’s weight, haemoglobin & haematocrit were not correlated with the yield & did not affect the yield of single donor platelets.