principals' perspective of the learning environment in undergraduate medical colleges of a developing country

Objective: To explore the perspective of Principals in a developing country regarding the learning environment of their respective undergraduate medical colleges, thus highlighting the difficulties faced by them and obtaining their recommendations for improving the educational environment. Study Design: A concurrent mixed method study in the pragmatic paradigm using survey and interview techniques to collect data. Place and Duration of Study: Study was conducted from June 2015 to December 2015 involving institutional heads of seven undergraduate medical colleges in the twin cities of Rawalpindi and Islamabad in Pakistan

Material and Methods: Principals of seven undergraduate medical colleges in one city were given a brief questionnaire to fill which was followed by interviews. The data from the questionnaire was analyzed using SPSS-21 and the data from the interviews was analyzed using NVivo 11. Themes obtained were studied in detail for analysis and interpretation

Results: The study determined that while the learning environment in different medical colleges is neither uniform nor optimal, most institutional heads have similar opinions about major factors contributing to the learning environment and face more or less similar difficulties. Curriculum emerged as the most important factor contributing to the learning environment. Lack of resources and shortage of academic staff were the main difficulties identified. Improved standards of student and faculty selection and better coordination between the colleges and the affiliated teaching hospitals were two of the important recommendations

Conclusion: Lack of resources, shortage of the academic staff along with the curriculum issues were identified as the major factor contributing towards the learning environment

Course enjoyment and learning style of participants of a distance learning program in health professions education [HPE]

Objective: To identify and relate enjoyment levels of various components of MCPS-HPE course and the learning styles of the course participants followed by explanation of the reasons for enjoyment, non-enjoyment and how enjoyment factors can be enhanced

Study Design: Mixed method sequential study

Place and Duration of Study: College of physicians and surgeons, Pakistan, Regional Center, Lahore from January 2013 to April 2014

Material and Methods: Learning style of MCPS-HPE course participants of 2011-13 batch was identified through Kolb's Learning Style Inventory version 3.1; and participant's perception of the most enjoyable areas in the contact sessions and assignment completion were sought on two respective survey forms followed by structured interviews

Analysis of the quantitative data was performed using SPSS version 19. [Framework method] was used for the manual analysis of qualitative data

Result: Learners identified social interaction, team work, knowledge construction, active learning and self-efficacy as enjoyable while cognitive overload, disruptions in learning, and deadlines as factors impeding enjoyment. Acquiring learning skills, contextual simplified learning, addressing disruptions and promoting active learning and proactive mentorship were suggested as measures for improving enjoyment level. Predominantly our participants were convergers who enjoyed the course more than those with other learning styles. Conclusion: Team work along with experiential learning improves learners' self-efficacy and enthusiasm. Ensuring contextual learning and proactive mentoring can address negative impact of cognitive overload, inappropriate facilitator's attitude and deadlines on course enjoyment while taking into account various learning styles

Comparison of learning anatomy with cadaveric dissection and plastic models by medical students

The purpose of this study at Army Medical College was to assess differences in learning of students from cadaveric dissection or plastic models; and explore their perceptions about efficacy of various instructional tools used during the gross anatomy practical time. Two phase mixed methods sequential study. This study was conducted at anatomy department Army Medical College, Rawalpindi, Pakistan over a period of three weeks in July 2013 after approval from the ethical review board. Quantiative phase 1 involved 50 second year MBBS students, selected through non probability convenience sampling,They were divided into two groups of 25 students. Group A covered head and neck gross anatomy dissection course through cadaveric dissection and group B using plastic models. At the end of course MCQ based assessment were conducted and statistically analyzed for both groups. In qualitative phase 2, two focus group discussions [FGD] with 10 second year MBBS students were conducted to explore students' perspectives about and their preferences of various instructional tools used during the gross anatomy practical time. The FGDs were audio taped, transcribed, and analyzed through thematic analysis. The results of a post test of group A was 24.1 +/- 4.26 and group B 30.96 +/- 6.23 [p = 0.024]. Focus group discussions generated three themes [Learning techniques used by students during gross anatomy practical time; Preferred learning techniques; and Non-preferred learning techniques]. Students prefered small-group learning method over completely self-directed studies as the study materials were carefully chosen and objectives were clearly demonstrated with directions. Cadaveric dissection and didactic teachings were not preferred. Students exposed to models performed better in gross anatomy examination than those who learned through cadaveric dissection

Student's perception of labor room learning environment

To assess the quality of the labor room educational environment as perceived by the final year medical students and to explore students7 justifications for rating the environment in a certain way. Mixed method sequential. Sir Ganga Ram hospital Lahore, Pakistan from Nov 2011 to Oct 2012. During stage 1, one hundred and fifty two final year students completed the modified post graduate environment measure [PHEEM] survey after completion of their maternity duty from November 2011 till October 2012 and Institutional Ethical Review Board's approval. Stage 2 involved semi-structured focus group discussions [FGD] for in depth enquiry to explore students' reasons for rating their learning environment in a certain way after ensuring confidentiality and anonymity to study participants. The mean overall score for labor room educational environment, as rated by students was 65.98, implying 47.8% satisfaction, indicating plenty of problems in learning environment. Mean total scores for autonomy, teaching and social support was 20.5, 28.9 and 16.5. Satisfaction with regard to autonomy, teaching and social support was 20.5/48 [42.7%], 28,9/56 [51.6%] and 16.5/32 [51.5%] respectively. The patterns that emerged from FGD were lack of teaching protocol, inappropriate supervision and feedback, enormous workload and unenthusiastic teachers. Skill learning, authentic real life experience and team work were motivating factors while poor accommodation, sanitation, catering facilities and humiliating attitude of paramedic staff were demotivating factors for learning. Labor room rotation provides an excellent real time practical skill learning opportunity in an environment with plenty of problems. In order to make labor room duty a worthwhile learning experience, all detrimental aspects, as pointed out in this study, can be addressed to enhance students' learning

Developing professionalism: dental students' perspective

To explore the undergraduate dental students' insight of their professionalism development through Focus Group Discussions [FGD]. Constructivist approach using qualitative phenomenological design. Fatima Memorial Hospital, College of Dentistry, Lahore, from April to June 2011. Four FGDs of 1st year [8 students], 2nd year [6 students], 3rd year [6 students] and 4th year [6 students] enrolled in Bachelor of Dental Surgery [BDS] program were conducted to explore how they have developed various elements of professionalism namely altruism, accountability, excellence, duty and service, honor and integrity, and respect for all; and how professionalism can be further developed in them. The FGDs were audio taped, transcribed and analyzed through thematic analysis. Triangulation of themes and trends were done through content analysis by relating to their respective frequency of quotes. Data verification was done through audit by second author. Role models and social responsibility were the main reasons in the students' professionalism development thus far with personal virtues and reasons; religion; and punishment and reward contributing to a lesser degree. Training contributed least but was deemed most in furthering professionalism. Excessive workload [quota] and uncongenial educational environment were considered detrimental to the cause. Formal planning and implementation of professionalism curriculum; selection of students with appropriate attributes; control of hidden curriculum, including effective role models, good educational and working environments will foster professionalism among dental students maximally

Dentists perceptions about practices, undergraduate training and training needs of local anesthesia

The objective of this study was to assess dentists perceptions about safety and efficacy of their practices; their undergraduate training; and training requirements about local anesthesia [LA]. A prospective, questionnaire-based survey of 181 dentists from Lahore and Karachi was carried out. The questionnaire was designed to collect information about general dentists perceptions about their salient local anesthesia practices, the level of training provided to them at under-graduate level and the training needs at different levels of professional careers. Sixty eight percent of the participants did not aspirate during inferior alveolar nerve block LA injections. Training in important LA nerve block injections was not provided to the majority of participants at the undergraduate level. Most of the participants felt that improvement in training of LA at under-graduate, post-graduate and continuing professional development levels were needed. Serious shortcomings in the practice and training of safe and effective LA were noticed in this survey. In accordance with the need felt by the survey participants for improved teaching and training of LA, the curriculum for local anesthesia training should be revised and implemented

Diagnosis of temporomandibular disorders based on research diagnostic criteria

The Research diagnostic criteria for Temporomandibular Disorders [RDC/TMD] is a tool used by International RDC/TMD Consortium [A Designated Network of the International Association for Dental Research], to diagnose and categorize TMD patients. The aim of the present study was to investigate the frequency of TMD in undergraduate dental and medical students based on RDC/TMD; and its relation with depression and somatization. 37 male and 48 female dental and medical students from FMH College of Medicine and Dentistry, Lahore, Pakistan were evaluated. A clinical physical diagnosis [Axis I] and pain related disability and psychological status [Axis II] were assessed using a questionnaire and clinical examination on RDC/TMD protocol. Seventeen students diagnosed with TMD showed significantly higher incidence in females [p=0.003]. Maximum number of TMD was in internal derangement group, followed by pathosis and muscle disorder groups. Significantly higher TMD incidence was noted in; participants [p = 0.00, Likelihood ratio = 10.80] with Axis II than those without Axis II. Significant TMD participants showed somatization than those without TMD [p = 0.000, Likelihood ratio = 12.04]. A comparatively lower incidence of TMD in young adults, with much higher prevalence in females was found. Disc displacement was the commonest Axis I diagnosis. TMD patients showed greater RDC/TMD Axis II

Odontogenic cervical necrotizing fasciitis

Two cases of cervical necrotizing fasciitis, secondary to dental infection, are presented. It is a potentially life-threatening severe mixed infection with rapidly progressive inflammation and necrosis of the fascia, muscle and fat. Laboratory and CT features are described. CT scan was also useful for progress monitoring during the treatment. Both cases were complicated by mediastinitis with pleural effusions. A successful non-fatal outcome was achieved following multiple surgical interventions, aggressive culture based antimicrobial therapy, multi-specialty approach and intensive supportive care of the patients

Ameloblastoma of the jaw: Enucleation with immediate cancellous Bone graft

Two cases of mandibular ameloblastomas were treated by enucleation, peripheral ostectomy and immediate iliac crest cancellous bone grafting to the residual bony defect. In the opinion of the authors extensive resection of the mandible in all ameloblastomas is over treatment. The tumour can be eradicated completely by conservative treatment in many cases of mandible without causing a continuity defect