Case based learning and traditional teaching strategies: where lies the future?

To explore the perceptions of final year medical students about efficacy of traditional teaching methods and Case based learning [CBL] and to evaluate the effect of CBL on students' performance and satisfaction level during their clinical rotation in Obstetrics and Gynaecology Department. Sequential mixed method study. Department of Obstetrics and Gynaecology, Holy Family Hospital, Rawalpindi from January 2013 to June 2013. Students expressed their perceptions on a Likert scale in a questionnaire. It was triangulated with data collected from 4 focus group discussions [FGD]. Students for FGD were selected using purposive sampling. Students' performance in OSPE and long case was compared with another group who was taught with traditional methods. Quantitative data was analyzed by SPSS version 17. For qualitative data, themes and patterns were identified using content analysis technique. Of 141 students, 134 returned completed forms giving a response rate of 95%.Gender distribution was similar in both the groups. There was no statistically sigruficant difference in performance assessment. Strong preference for CBL was expressed by 97% as it improved their confidence [83%], clinical and presentation skills [91and 80%], attitude and student teacher relationship [68 and 77%], strengthened link between theory and practice [90%], and integrated basic and clinical knowledge [92%]. Seventy six percent stated that all teaching should be CBL. Qualitative data from SGD strongly supported these views. Although test performance was similar in both the groups, students expressed strong preference for CBL as compared to traditional methods

Role of labetalol in control of severe hypertension in pregnancy

To determine the efficacy of Labetalol in the control of severe hypertension in pregnancy. Therapeutic Clinical Trial. Gynae unit 1, Holy Family Hospital, Rawalpindi. 1stApril 2010-31st Dec 2010. All the pregnant women with BP of >/= 160/110 mm of Hg admitted in labour ward were included in the study. Those with bronchial asthma, cardiac failure, heart block, cardiogenic shock, severe bradycardia and hypersensitivity to the drug were excluded from study. Data was collected on a pre-designed proforma. Outcome measures were dose required to achieve the target BP, time taken to achieve the target BP[diastolic BP< 100mmHg], adverse reactions and feto-maternal outcome. Analysis of data was done on SPSS Version 16. Total patients included in the study were 71. Women between 21-30 years were 54 [76%] and 17 [24%] were between 31-40 years. Twenty seven [38%] were Primigravida, 38 [53%] were P1-P4 and 6 [9%] were P5 and above. Out of 71 patients, 10 [14%] presented with PIH, 18 [25%] with Preeclampsia, 39 [55%] with Eclampsia and 4 [06%] with Chronic HTN. Sixty four [90%] of patients presented in 3rd trimester. Range of BP at the time of presentation was from 160/110-250/140 mm of Hg. In 45 [64%] women BP was controlled with labetalol 20-100 mg, while 13 [18%] required >100-200mg and13 [18%] >200-300 mg of labetalol. Time taken to achieve the target BP was 1hour in 43 [60%] women, 2 hrs in 14 [20%], 3 hrs in 14 [20%]. Thirty six [50%] women experienced no side effects and in the remaining 50% nausea and vomiting were the common side effects. None of our patients experienced arrhythmias. After the achievement of target BP, 2/3rd [n=52] were switched over to oral preparation of labetalol. Thirty two patients [45%] delivered vaginally and 39 patients [55%] delivered by caesarean section. Regarding the neonatal outcome 59 [83%] delivered alive and 12 [17%] delivered dead babies. Out of the babies delivered alive, 19 [32%] were shifted to nursery, one baby expired and remaining, 18 were discharged. Majority of women were discharged in healthy state [n= 63] [89%], 08 [11%] were transferred to ICU/ medical unit, out of whom 2 expired later. Labetalol is an effective drug in controlling severe HTN in pregnancy and is associated with mild side effects Foetomaternal outcome was good.