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

Maternal and fetal outcome of pregnancies with umbilical cord problems

To seek relationship between cord problems [like long cords, short cords, nuchal cord and cord knots] and its effects on fetus as well as mode of delivery. Descriptive [case series] Obs/Gynae wards Railway hospital, Rawalpindi from September 2006 to August 2007. It was a descriptive case series study. Hundred patients with umbilical cord problems, detected at delivery were included.Effects of these cord problems on mode of delivery and fetal outcome were observed. Twenty two percent patients had long cord, 14% had short cords.41% had single nuchal cord, 22% had double loop of cord around the neck, and 4% patients had triple loops of Nuchal cord. It was observed that 4% patients were having true kanots in umbilical cord and and only 26% patients had false knots in umbilical cord. In the patients with cord problems, rate of SVD was more than 70% and LSCS < 20%. These problems did not show significant effects on birth weight and Apgar scores when present alone.But multiple cord problems in a single pregnancy were associated with fetal complications. Long and short umbilical cords, umbilical cord knots and Nuchal cords had no significant effects on mode of delivery and Apgar score in 5 minutes. But multiple umbilical cord problems in same case may pose problems to the fetus and early diagnosis can prevent fetal harm