Educational impact of mini-clinical evaluation exercise: a game changer

Background and objective: Workplace based assessment has a strong educational impact in terms of student's clinical performance by steering their learning towards the desired learning outcomes. Educational impact is hardly measured in the sphere of medical education and this study is an attempt to measure educational impact of post graduate residents. The aim of this study was "To explore educational impact of Minicex [Mini-clinical evaluation exercise] on residents with respect to their learning"

Methods: A mixed convergent parallel method was selected, participants were identified through non-probability convenience sampling, total 10 participants were chosen for data collection, all of them experienced four minicex encounters which generated their scores [the quantitative data], after first two Minicex encounters each participant was interviewed using a structured interview technique, similarly, after 3rd and 4th Minicex encounters. Data was entered in the SPSS version -21 to calculate descriptive statistics. Inferential statistics were determined using ANOVA to calculate improvement in score over time and P-value to report statistical significance. Qualitative analysis was done using thematic analysis approach with the help of themes based on interview questions: priori theme. NVIVO was used for triangulation of themes accordingly

Results: The results indicate statistically significant improvement in scores and p values were considered significant at 0.05. Also, qualitative analysis provided reasons for improvement in scores and residents' satisfaction such as feedback, motivation, self-directed learning, peer assisted learning

Conclusion: The study concluded that residents learning behavior and ,their satisfaction from assessment method can be enhanced through work place based assessment particularly in context of minicex [mini-clinical evaluation exercise] so encouraging its use in similar situations. However, the scope for generalization of results remains limited owing to a small sample size

Reliability of OSTE in the health professions education exit examination of college of physicians and surgeons, Pakistan: a psychometric analysis

To determine reliability and validity of objectively structured teaching examination [OSTE] and the difference in the examination scores of two consecutive Health Professions Education batches. Cross-sectional analytical study. The College of Physicians and Surgeons Pakistan, Karachi, from November 2011 to April 2012. The OSTEs were designed on the basis of examination blueprints. Scores of participants of two consecutive years [group-I n = 14, group-II n = 15] were analyzed by using SPSS version 16. Mean +/- SD was computed and overall means were compared by t test. Reliability was determined by Cronbach's coefficient. Standard error of measurement [SEM] was computed for precision of scores. OSTE stations were not uni-dimensional, factor analysis including varimax rotation was performed. For convergent validity [Pearson correlations] was determined between scores of OSTE, lectures delivered and workshops conducted. The overall mean score was 7.64 +/- 0.65 in group-I and 7.33 +/- 1.03 in group-II [p = 0.429], [group-I SEM = 0.35 and group-II, SEM = 0.48]. Factor analysis yielded four factors in group-I and five factors in group-II with Eigenvalues > 1. The Pearson's correlation of average scores of OSTE and lecture was significant for group-I [r = 0.61, p 0.019], and insignificant for group-II [r = 0.46, p = 0.08]. Correlation between OSTE and workshops conducted was insignificant in group-I [r = 0.51, p = 0.057] and significant in group-II [r = 0.53, p = 0.04]. OSTE is a reliable, valid assessment tool for discerning competency among learners of HPE program

Reduction of occurrence of hypotension during spinal anaesthesia for cesarean section: prophylactic intramuscular ephedrine versus fluid preload

In this study, 40 women undergoing elective cesarean surgery [CS] at term were allocated randomly to receive either a preload of 20 ml/kg of normal saline over 10-15 min immediately before spinal anesthesia [fluid group] or prophylactic ephedrine 50 mg in 10 min before spinal anesthesia [ephedrine group]. The two techniques were compared for their maternal and neonatal effects. Moderate hypotension was defined as >20% reduction in systolic blood pressure [SAP] and severe hypotension as >30% reduction in SAP. The study concluded that ephedrine e 50 mg given intramuscularly ten minutes before induction of spinal anesthesia reduced the incidence of hypotension and the total dose of rescue ephedrine therapy than preloading with 20 ml/kg crystalloid during spinal anesthesia for CS. The incidence of nausea and vomiting was also reduced and the fetal outcome was improved. However, this dose of ephedrine did not completely eliminate hypotension, nausea and vomiting

Role of crystallin insolubilization in cataract formation

This work aimed to study the electrophoretic pattern of lens proteins and to study the pathological variation in lens protein in cataract to decide if cataract results from insolubilization of lens protein or due to appearance of a new type of protein. Also, decide if these changes in lens protein composition occur in equal proportion among various types of cataract. The results stated complete absence of crystallin in the water soluble moiety of both nuclear cataract and cortical cataract. There is an increase in proteins of high molecular weight and decrease in low molecular weight protein. Bs crystallin is incorporated into the high molecular weight aggregates of the water insoluble moiety of lens protein