Reflective student narratives: honing professionalism and empathy

The affective domain is not explicitly targeted during medical studies and poor skills in this domain may lead to conflict when dealing with patients. Reflective narratives are said to promote humanitarianism and professional development. We aimed to examine reflective narratives written by medical students in our institution for content relating to ethical and professional Attitude and Behaviour, Communication, respect for Diversity and Disability, and Empathy (the ABCDE paradigm). We were also interested in understanding how far the students enjoyed learning through the writing of narratives and in determining their perceived learning from the exercise. Volunteer medical students were introduced to Gibbs’ reflective cycle during a half-day workshop. After giving written informed consent, they submitted anonymous reflective narratives (online), based on an interaction that they witnessed between a patient and a doctor/student. The authors performed directed content analysis of the submissions, using predetermined codes pertaining to ABCDE. At the end of the study, the participants sent in their feedback through a questionnaire on the process and the learning acquired, if any. Twenty-six students volunteered and 15 narratives were submitted. The issues that had been identified were discussed with the students. Feedback was submitted by 12 students, who strongly felt that the writing of narratives enhanced learning about ethics, professionalism, communication, diversity and empathy. We conclude that reflective student narratives are a useful and enjoyable way of teaching students about issues in the affective domain that are not conventionally taught

Book Review: From a doctor's diary: the authentic physician's voice.

From a doctor’s diary by Shri Gopal Kabra is a small volume about the size of the Indian Journal of Leprosy, and like the journal, arrived wrapped in a sheet of plain brown paper tied cross-wise with white string. It stared hopefully back at me from my table for a few days until my curiosity got the better of me, and I cut the string to look inside. The front cover is designed tastefully, giving the appearance of parchment splotched with dried blood-stains, with drawings of a vertebral column, a brain in saggital section, a stethoscope, and fading, cursive text in the background. The back cover details a frightening list of the author’s qualifications and interests, ranging from medicine and law, anatomy, surgery and medical audit to medical journalism, and authorship of collections of short stories in Hindi. Not quite certain of what lay ahead, I started reading with some trepidation.

Theatre of the Oppressed in medical humanities education: the road less travelled.

Internationally, there is an increasing awareness of the need to include humanities in the medical curriculum. The Medical Humanities Group at the University College of Medical Sciences, Delhi, organised a series of events to explore this area. This paper describes our experience with Augusto Boal’s “Theatre of the Oppressed” (TO).

Mentoring for first year medical students: humanising medical education.

New entrants are vulnerable to the challenges of the medical course; mentoring programmes are known to offer support. This paper evaluated the experiences of students and faculty enrolled in a new mentoring programme. After needs analysis of students and faculty, a small-group mentoring programme for new medical students was initiated.

Whither medical humanities.

Understanding the Medical Humanities (MH) and their role in medical education is in its infancy in India. Students are initiated into professional (medical) education too early in life, usually at the expense of a basic grounding in the humanities, resulting in warped intellectual growth. The author, arguing against the wholesale import of foreign systems, advocates free inquiry by medical educators to evolve a humanities programme for medical students derived from our own cultural context. This essay describes the early experiences of efforts to make a beginning at the University College of Medical Sciences, Delhi. The author reviews the various strategies used and the challenges of introducing the subject to the current generation of medical students.

Masters theses from a university medical college: Publication in indexed scientific journals.

Background: The thesis is an integral part of postgraduate medical education in India. Publication of the results of the thesis in an indexed journal is desirable; it validates the research and makes results available to researchers worldwide. Aims: To determine publication rates in indexed journals, of works derived from theses, and factors affecting publication. Settings and Design: Postgraduate theses submitted over a five-year period (2001-05) in a university medical college were analyzed in a retrospective, observational study. Materials and Methods: Data retrieved included name and gender of postgraduate student, names, department and hierarchy of supervisor and co-supervisor(s), year submitted, study design, sample size, and statistically significant difference between groups. To determine subsequent publication in an indexed journal, Medline search was performed up to December 2007. Statistical Analysis: Chi square test was used to compare publication rates based on categorical variables; Student's t-test was used to compare differences based on continuous variables. Results: One hundred and sixty theses were retrieved, forty-eight (30%) were published. Papers were published 8-74 (33.7 ± 17.33) months after thesis submission; the postgraduate student was first author in papers from 26 (54%) of the published theses. Gender of the student, department of origin, year of thesis submission, hierarchy of the supervisor, number and department of co-supervisors, and thesis characteristics did not influence publication rates. Conclusions: Rate of publication in indexed journals, of papers derived from postgraduate theses is 30%. In this study we were unable to identify factors that promote publication.

A study of clinicohistopathological correlation in patients of psoriasis and psoriasiform dermatitis.

BACKGROUND: Psoriasis has different clinical variants, which mimic diverse dermatological conditions and may require a histopathological confirmation of the diagnosis. Studies to establish a clinicohistopathological concordance (and its determinants), in psoriasis and psoriasiform dermatitis are lacking. AIMS: The present study was designed (a) to correlate the clinicohistopathological features of psoriasis and psoriasiform dermatitis, and (b) to identify determinant(s) that may contribute to the diagnosis of psoriasis and psoriasiform dermatitis. METHODS: This was a prospective study involving 100 patients, with a single clinical diagnosis of psoriasis or with psoriasis as one of the differential diagnoses, and its correlation with histopathological features. RESULTS: The clinical features of typical scale (P = 0.0001) and Auspitz's sign (P = 0.0001), and histological evidence of suprapapillary thinning (P = 0.0001) and absent granular cell layer (P = 0.0001) were found to be statistically significant contributors to the clinicohistological concordance in cases of psoriasis. Vertical orientation of collagen bundles (P = 0.0001) and lymphocytic exocytosis (P = 0.003) were found to be significantly associated with diagnosis of psoriasiform dermatitis. CONCLUSION: The present study reconfirms the diagnostic accuracy of silvery white scale, Auspitz's sign, and Koebner's phenomenon in a clinical setting suggestive of psoriasis. However, in their absence, histological evidence of suprapapillary thinning and absent granular layer, in addition to the Munro microabscess and Kogoj's abscess, may contribute to the diagnosis of psoriasis. Similarly, vertical orientation of collagen bundles and lymphocytic exocytosis may point toward a diagnosis of psoriasiform dermatitis.

Tissue reaction patterns in respiratory infections: a practical approach to a cytological diagnosis.

Infection of the respiratory tract, particularly indolent and chronic disease can be a diagnostic dilemma. Infections associated with immunosuppressive states often require an accurate early diagnosis because it impacts outcome. A wide variety of specimens, such as, sputum, bronchoalveolar lavarge (BAL), transthoracic or transbronchial fine needle aspiration (FNA) can be employed. Cytopathology is diagnostic when the causative organism can be identified failing which, direction can be given to further investigation by examination of the tissue reaction patterns. Three types of reactions seen in lung infections act as clues to the diagnosis: (a) necrosis, (b) inflammatory reactions, and (c) epithelial changes with little inflammation. Identification of tissue reaction types limits the diagnostic possibilities and facilitates the diagnostic process.

Fatal disseminated cryptococcosis in a HIV negative elderly Indian woman--an early diagnosis by polarizing microscopy.

An elderly HIV negative woman with disseminated cryptococcosis is reported. The clinical presentation was unusual. Rapid diagnosis is possible if Maltese crosses are demonstrated on polarizing microscopy of tissue sections or smears. Cutaneous involvement in cryptococcosis is uncommon, however when present, can be a valuable and relatively easily available source of material from which Cryptococci can be demonstrated.