Attitudes of first-year medical students towards the doctor patient relationship.

In recent years, medical schools all over the world have instituted a variety of curricula to teach communication skills, professional values and ethics to medical students. Studies on the student attitudes towards doctor-patient relationships are lacking in Nepal. The present study was carried out to obtain information on the sharing and caring dimensions of the doctor-patient relationship and note any association of the dimensions with the demographic characteristics of the respondents. The study was carried out among first year students of the Manipal College of Medical Sciences, Pokhara, Nepal in August 2003 using the patient-practitioner orientation scale. One hundred and sixty-five students participated. The mean +/- SD total, caring and sharing scores were 3.71 +/- 0.48, 3.51 +/- 0.55 and 3.91 +/- 0.62 respectively. Students whose first degree relative was a doctor had higher sharing score compared to those without doctor relatives. Female students had higher scores. Students had a positive attitude towards the doctor-patient relationship. Our scores were lower than those reported previously. Further studies are required and the results obtained will be helpful in designing a doctor-patient relationship course for Nepal.

Learning styles of preclinical students in a medical college in western Nepal.

OBJECTIVES: Information on the learning styles of medical students are lacking in medical colleges in Nepal. Learning styles may be associated with student understanding and may predict success in examination. The present study was carried out to obtain information on learning styles and preferences for teaching of fourth semester medical students and note the association, if any, between respondents' personal characteristics and preferences for learning styles and types of teaching. The correlation between preferences for learning styles and types of teaching and performance in the second year university examination was also explored. METHODS: The study was carried out during October 2003 at the Manipal College of Medical Sciences, Pokhara, Nepal using the Approaches and Study Skills Inventory (ASSIST) instrument. Information on the respondents' personal characteristics was collected. Respondents had to indicate their degree of agreement with a set of statements using a modified Likert-type scale. The statements were grouped into three main learning styles and two types of teaching. The median scores among different subgroups of respondents were compared using appropriate non-parametric tests (p<0.05). RESULTS: Ninety-two students (92%) participated; fifty-six were male. Thirty-one respondents were Nepalese, 48 were Indians. Majority were educated in English medium schools. The median scores for deep and surface learning styles were 64 and 49 respectively (maximum score=80). The scores for strategic learning was 75.5 (maximum score=100). There was no clear preference for any particular type of teaching. Indian students used more surface apathetic learning strategies compared to others. There was a negative correlation between surface learning and marks obtained in the final examination. CONCLUSIONS: The students mainly used deep and strategic learning styles. Differences in preference for learning styles and types of teaching were noted according the respondents' personal characteristics. This was a preliminary study and further studies are required.

Medication counseling center in a teaching hospital.

Patient compliance is often not achieved during drug therapy. Many reasons including lack of patients' understanding regarding medication and disease, poor socioeconomic pattern, unavailability of drugs are attributed to this situation. Providing counseling to patients can improve their understanding regarding medication, disease and life style modifications which in turn improves compliance. Medication counseling centers are one of the means to counsel the patients. The study was conducted to analyze the performance of such a center at Manipal Teaching Hospital, a teaching hospital in Western Nepal. Patients were counseled as per the Omnibus Budget Reconciliation Act-1990 guidelines and data were collected from the documentation form of the center and analyzed. Results indicated that 84.5% of the patients were directed to the medication counseling center by the pharmacists. Nearly one quarter of the population was either asthmatic or chronic obstructive pulmonary disease patients. Bronchodilators were found to be the major therapeutic category of drugs and were found in 26.7% of the patients. Among the various counseling aids, placebo inhalers were used in 45.1% of the patients. The counseling pharmacists dedicated an average time period of 6-10 minutes in about 42.1% of the patients. Language was found to be the major barrier while counseling 16.5% of the patients. The study concluded that the medication counseling center can play a definite role in enhancing patients' understanding about medications and disease pattern, which in turn may improve patient compliance.

Initiating and strengthening medical student research: time to take up the gauntlet.

Self-directed learning and evidence-based medicine are becoming increasingly important in medical education. Medical student research projects can enable students to learn research methodologies and critical analysis skills. Medical schools in developed countries have introduced research programmes for medical students. A few medical colleges in developing countries have initiated student research programmes. South Asia has a huge population and massive health problems and research may be helpful in finding solutions. Student research can contribute to the published output of institutions. Research projects can help students to develop critical analysis skills, teach them to write for peer-reviewed publications and can foster student-faculty interaction. In Nepal, opportunities and funding for research are limited. Principles of scientific research should be taught to students. A community research project should be made compulsory. Funding for research should be boosted and infrastructure strengthened. Faculty members actively involved in research can serve as powerful 'role models'. Marks should be allotted for research projects and students must be encouraged to publish their findings. Publications and projects should be considered during admission to postgraduate courses. Student research should be initiated, actively pursued and strengthened.