Learning the pelvic examination by clerkship medical students: evaluating skills by standardized patient model

To compare the effectiveness of training of pelvic examination [PE] of medical students on standardized patients [SPs] with the training on regular patients [RPs] during clinical rotations. A prospective controlled study. Obs/Gynae Unit I and II, Pakistan Railway Teaching Hospital, Islamic International Medical College - Rawalpindi; from April 1[st], 2013 to December 31[st], 2013. The fifth year MBBS students, doing their clerkship in Obs/Gynae department were included in the study through simple random sampling [probabilistic sampling]. Sixty seven medical students participated in the study. Group I comprised of 35 students who were trained on RPs. However 3 students of this group did not appear for assessment by OSCE so finally 32 students were left for OSCE assessment and data collection. Group II comprised of 35 students who were trained on SPs. After the completion of training, PE skills of both the groups were assessed through OSCE. The average assessment scores, technical skill scores, and communication skill scores of both the groups were calculated and standard deviation was obtained. After applying t-test, p-value was calculated, p-value less than 0.05 was considered to be statistically significant. The OSCE based average assessment scores of combined modular examination of Group I and Group II was 6.0 and 7.7 respectively. The p-value was <0.001, which was statistically significant. Similarly the average assessment score for group I and II for Technical skills in combined modular examination was 6.0 and 7.75 respectively. The average assessment scores of group I and II for communication skills was 6.25 and 8.0 respectively. Statistically significant p-value of <0.001 was calculated. It was significantly found that the students trained on SPs were more competent in technical as well as communication skills of pelvic examination as compared with the students trained on RPs. To conclude, SPs are a much more useful and efficient alternative to RPs for the clinical training of medical students of PE

Emergency Peripartum Hysterectomy in Pakistan Railway Teaching Hospital Rawalpindi: Eleven Years Review

Emergency Peripartum Hysterectomy [EPH] is a major surgical procedure. There appears to be a rise in the rate of emergency peripartum hysterectomy [EPH] in the developed world. Peripartum hysterectomy is high risk but a life saving operation. It is usually associated with significant maternal and fetal morbidity and mortality. Obstetricians should identify patients at risk and anticipate the complications, as early intervention and proper management results in optimal outcome. To determine the incidence, indications, risk factors, complications and management of EPH over the last eleven years. A descriptive study. All cases of EPH performed in the period between January 2001 and December 2011 were included in the study. Study was conducted at Railway Teaching Hospital, Rawalpindi [in northern Pakistan]. Data of all the cases of EPH cases operated during the study period was collected from the hospital obstetric record. Data of basic demographics, mode of delivery, maternal and fetal outcome along with associated complications was collected and entered into the Statistical Package for Social Sciences version 14.0 [SPSS Inc., Chicago, IL, USA] for further analysis. Indications, pre-op planning, type of operation, emergency decision, blood loss, transfusion, complications, were compared and cross-tabulated. Statistical analysis included: Chi-square and Fisher exact tests, where appropriate, and two-sample t test. Total deliveries were 13560 in 11 years. Twenty Six EPH cases were performed among deliveries, giving an incidence of 1.8 per 1000 deliveries i.e. one in 566 deliveries. The indications were uterine atony [34.61%], ruptured uterus [23.07%] and cervical/vaginal tears [11.53%], placenta praevia [11.53%], invasive placental adhesion [accreta, increta, percreta [11.53%]]. A significant association between previous uterine surgery and abnormal placentation was shown [p=0.02], especially those with previous caesarean [p=0.003]. One maternal and six perinatal mortalities were recorded. Four perinatal deaths were of non-booked patients, handled by traditional birth attendants/private clinics. Out of two perinatal deaths of booked patients, one was pre-term and other was delivered by forceps. Maternal morbidity was prevalent, including twenty three intensive care admissions, three disseminated intravascular coagulopathies, three bladder injuries, three re-explorations, multiple blood, FFPs and platelet transfusions, two pulmonary embolism and one cardio- respiratory failure. Maternal death was of non-booked patient with previous scar, home delivery, uterine rupture and brought to hospital with un-recordable BP and very weak pulse. Incidence of peri-partum hysterectomy is increasing. It is a major operation, and almost always an emergency with significant blood loss. An early decision should be made to save life of the patient and prevent complications. The most important risk factor for peripartum hysterectomy in our patients is hemorrhage, most notably caused by uterine atony, uterine rupture, placenta previa and abnormally adherent placenta

Patients' Attitude towards Medical Students in a Teaching Hospital of Pakistan

To study patient's attitude towards medical students on clinical clerkship rotation in a hospital Descriptive Cross Sectional Study. Medical, Surgery and Gynae/Obs Departments of Pakistan Railway Teaching Hospital, Rawalpindi from March 30, to May 30, 2013. Two hundred and seventy five patients were included in the study through non probability purposive convenient sampling. A questionnaire was prepared to interview the patients participating in the study. Data collected was entered into Statistical Package for Social Sciences [SPSS Version 17]. Descriptive statistics were applied for all the variables to present the frequencies and percentages. For history taking, a larger preference was shown by the patients to the students' involvement irrespective of the gender; 55% patients recommended the presence of both male and female students, 50% patients were willing to allow medical students of either gender to take their medical history in the doctor's presence and 43% patients were willing to permit without a doctor's supervision. For medical examination by the medical students, patients were more inclined to the presence of a doctor but much more patients became gender conscious. 36% preferred the presence of both male and female students, 31% patients were willing to allow medical students of either gender in the doctor's presence and only 22% to permit medical students to carry out their examination without a doctor's supervision. Patients' preference to students' involvement while a medical procedure is carried out on them, in general, around 50% of the patients were reluctant; 48% patients would not allow medical students to be present as observers, 57% were reluctant to allow the students to carry out a procedure on them in the presence of a doctor and 68% patients were unwilling to let medical students to carry out a procedure on them in the absence of doctors. For gender conscious patients, a significantly larger preference was shown towards female students over male in all the three situations. It is concluded that the attitude of patients' towards the involvement of medical students in their clinical health care is related to the extent of students' involvement, the presence of a doctor[s] and the gender of the students and the patients

Low amniotic fluid index in high-risk pregnancy and poor apgar score at birth

To determine the accuracy of antepartum Amniotic Fluid Index [AFI] of 5 cm was labeled as predictor of good outcome at birth. The subjects in both the groups were demographically matched and fulfilled the inclusion and exclusion criteria. The Apgar score was calculated at 5 minutes of birth. The newborns, with Apgar score 6 were labeled as healthy. AFI was compared with Apgar score, using Chi-square and a p-value was calculated to determine the statistical significance. Sensitivity, specificity, efficiency and the predictive values of AFI at a cut off point of

Impact of new diagnostic criteria of diabetes mellitus

To compare the frequency of diabetic individuals diagnosed by fasting plasma glucose [FPG] >/= 7.0 mmol/L with previous value i.e. >/= 7.8 mmol/L and to determine the diagnostic accuracy of FPG >/= 7.0 mmol/L. A cross-sectional study. The Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from April to July 2003. FPG of 5250 subjects was checked to compare the frequency of diabetic subjects diagnosed by FPG >/= 7.0 mmoI/L with >/= 7.8 mmol/L. Of them, 301 symptom-free subjects were subjected to 75 g Oral Glucose Tolerance Test [OGTT] and their 2 hours post glucose [2-h PG] challenge level was taken as [gold standard] to determine the diagnostic accuracy of FPG at >/= 7.0 mmol/L. By lowering the cut off point of FPG from 7.8 mmol/L to 7.0 mmol/L, the percentage of diagnosed diabetic subjects increased from 35% to 42%. Statistical analysis revealed a significant increase [p< 0.0001]. FPG >/= 7.0 mmol/L had a diagnostic sensitivity of 70%, specificity 91%, the predictive value of positive and negative diagnosis was 84% and 80% respectively. FPG at cut off point of >/= 7.0 mmol/L, will greatly facilitate the early diagnosis of diabetes mellitus [DM]. An early diagnosis can be further facilitated by a combination of FPG and 2-h PG estimation