Trends in medical education from traditional to integrated system: valued by first year MBBS students at a private medical college of Peshawar

Introduction: Rehman Medical College Peshawar implemented a new modular integrated hybrid curriculum and modern mode of teaching strategies since its inception in 2010. The present study aimed to explore the viewpoints of students about the usefulness of the principles of integrated medical curriculum and teaching strategies and evaluation methods adopted

Material and Methods: A survey of first year MBBS students was conducted in 2011 using self-administered questionnaire which included quantitative and qualitative parts. Enough space was provided for the qualitative response. The qualitative part of the study entailed in self-response open ended format. Universal sampling approach was employed. Quantitative data analysis were done using SPSS version 15.0 while qualitative data were manually analyzed

Results: Fifty-eight students [58%] completed the questionnaires. Regarding the usefulness of integrated medical curriculum of basic medical subjects, 36 [62.1%] found it very useful, 15 [25.8%] found it useful. For preference of teaching methods, 50[87.7%] found small group format [SGF] very useful; also 34[58.6%] found large group format [LGF] very useful and 15[25.9%] found it useful; 30[51.7%] reported that mini-seminars are useful whereas 21[36.2%] students found self-directed learning [SDL] useful. Students' responses to the end of lesson examination were evaluated; 32[55.2%] students were in favor of these exams; 38[65.5%] were in favor of end of week evaluation while 49[84.5%] were in favor of end of module examinations. Similarly 41[70.7%] supported mid-term; 38[65.5%] favored inclusion of medical research in the undergraduate curriculum. Most of the students were in favor of current system with small reservations. According to them the current system should be continued with improvement in areas like; decrease in end of lesson exam, teacher student relationship, availability of reading materials, strict follow up of lesson plan

Conclusion: Majority of students prefer the new modular integrated system of teaching. A few areas of the previous system are still popular and may be continued by integrating them in suitable places in the new system. Based on evidence, diversity of teaching and evaluation method is a good thing and to be encouraged. The strategy [SGF] that promotes interaction is likely to be the most effective

Breast disease: causes for delays in presentation

It has been observed that patients with breast disease may delay consulting a doctor. The results are disastrous for patients ultimately diagnosed with malignant breast disease. This study is an observation of the factors which affect the time interval between symptom recognition in breast disease and medical consultation. All patients with breast disease presenting to the outpatient department of our unit between November 2003 and November 2005 and ultimately admitted were included in the study. They were divided into two groups based on whether they presented before or after 6 months of symptom recognition. They were interviewed about factors which had brought them to the hospital. Factors responsible for delays in presentation were also inquired about. Of the 133 patients with breast lumps, 51 [38.5%], presented within, and 82 [61.7%], beyond 6 months of noticing the swelling. Various factors which might have played a role in the delay to seek advice included poverty [52.4%], belonging to remote areas [44.9%], wrong beliefs and fears [67%], lack of education [58.5%] and shyness [18.3%]. Factors responsible for delays in seeking medical advice among patients with breast disease must be targeted to result in earlier presentation. This is especially important in breast cancer which is a curable disease in the early stages

Clinical aspects of primary hyperparathyroidism

We present 4 cases of primary hyperparathyroidism presenting with pathological fracture. All of them were females with age range of 26-37 years. The average time for which they remained symptomatic before diagnosis was made is 2 years. Ultrasound abdomen showed renal calculi in all. Serum calcium was in the normal range in 2 of the cases. Serum PTH assay was elevated and Para-thyroid Scinti-scan was positive in all cases. Bilateral neck exploration was the procedure carried out on all of them. Parathyroid adenoma was the underlying cause in all the cases as confirmed on histopathology