Knowledge and Practice on Injection Safety among Primary Health Care Workers in Kaski District, Western Nepal

Background: Unsafe injection practice can transmit various blood borne infections. The aim of this study was to assess the knowledge and practice of injection safety among injection providers, to obtain information about disposal of injectable devices, and to compare the knowledge and practices of urban and rural injection providers. Methods: The study was conducted with injection providers working at primary health care facilities within Kaski district, Nepal. Ninety-six health care workers from 69 primary health care facilities were studied and 132 injection events observed. A semi-structured checklist was used for observing injection practice and a questionnaire for the survey. Respondents were interviewed to complete the questionnaire and obtain possible explanations for certain observed behaviors. Results: All injection providers knew of at least one pathogen transmitted through use/re-use of unsterile syringes. Proportion of injection providers naming hepatitis/jaundice as one of the diseases transmitted by unsafe injection practice was significantly higher in urban (75.6%) than in rural (39.2%) area. However, compared to urban respondents (13.3%), a significantly higher proportion of rural respondents (37.3%) named Hepatitis B specifically as one of the diseases transmitted. Median (inter-quartile range) number of therapeutic injection and injectable vaccine administered per day by the injection providers were 2 (1) and 1 (1), respectively. Two handed recapping by injection providers was significantly higher in urban area (33.3%) than in rural areas (21.6%). Most providers were not aware of the post exposure prophylaxis guideline. Conclusion: The knowledge of the injection providers about safe injection practice was acceptable. The use of safe injection practice by providers in urban and rural health care facilities was almost similar. The deficiencies noted in the practice must be addressed.

Challenges in shifting to an integrated curriculum in a Caribbean medical school / 보건의료교육평가

No abstract available.

Initiating small group learning in a Caribbean medical school / 보건의료교육평가

No abstract available.

Student feedback about the integrated curriculum in a Caribbean medical school / 보건의료교육평가

PURPOSE: Xavier University School of Medicine adopted an integrated, organ system-based curriculum in January 2013. The present study was aimed at determining students' perceptions of the integrated curriculum and related assessment methods. METHODS: The study was conducted on first- to fourth-semester undergraduate medical students during March 2014. The students were informed of the study and subsequently invited to participate. Focus group discussions were conducted. The curriculum's level of integration, different courses offered, teaching-learning methods employed, and the advantages and concerns relating to the curriculum were noted. The respondents also provided feedback about the assessment methods used. Deductive content analysis was used to analyze the data. RESULTS: Twenty-two of the 68 students (32.2%) participated in the study. The respondents expressed generally positive opinions. They felt that the curriculum prepared them well for licensing examinations and future practice. Problem-based learning sessions encouraged active learning and group work among students, thus, improving their understanding of the course material. The respondents felt that certain subjects were allocated a larger proportion of time during the sessions, as well as more questions during the integrated assessment. They also expressed an appreciation for medical humanities, and felt that sessions on the appraisal of literature needed modification. Their opinions about assessment of behavior, attitudes, and professionalism varied. CONCLUSION: Student opinion was positive, overall. Our findings would be of interest to other medical schools that have recently adopted an integrated curriculum or are in the process of doing so.

Designing and conducting a two day orientation program for first semester undergraduate medical students / 보건의료교육평가

No abstract available.

Medical humanities: developing into a mainstream discipline / 보건의료교육평가

No abstract available.

Small group effectiveness in a Caribbean medical school's problem-based learning sessions / 보건의료교육평가

PURPOSE: The Tutorial Group Effectiveness Instrument was developed to provide objective information on the effectiveness of small groups. Student perception of small group effectiveness during the problem base learning (PBL) process has not been previously studied in Xavier University School of Medicine (Aruba, Kingdom of the Netherlands); hence, the present study was carried out. METHODS: The study was conducted among second and third semester undergraduate medical students during the last week of September 2013, at Xavier University School of Medicine of the Netherlands. Students were informed about the objectives of the study and invited to participate after obtaining written, informed consent. Demographic information like gender, age, nationality, and whether the respondent had been exposed to PBL before joining the institution was noted. Student perception about small group effectiveness was studied by noting their degree of agreement with a set of 19 statements using a Likert-type scale. RESULTS: Thirty-four of the 37 (91.9%) second and third semester medical students participated in the study. The mean cognitive score was 3.76 while the mean motivational and de-motivational scores were 3.65 and 2.51, respectively. The median cognitive category score was 27 (maximum score 35) while the motivation score was 26 (maximum score 35) and the de-motivational score was 12 (maximum score25). There was no significant difference in scores according to respondents' demographic characteristics. CONCLUSION: Student perception about small group effectiveness was positive. Since most medical schools worldwide already have or are introducing PBL as a learning modality, the Tutorial Group Effectiveness Instrument can provide valuable information about small group functioning during PBL sessions.

Students' perception of the learning environment at Xavier University School of Medicine, Aruba: a follow-up study / 보건의료교육평가

Xavier University School of Medicine admits students mainly from the United States and Canada to the undergraduate medical program. A previous study conducted in June 2013 used the Dundee Ready Educational Environment Measure to measure the educational environment and impact of different teaching and learning methods in the program. The present study aims to obtain information about students' perceptions of changes in the educational environment, which underwent modifications in teaching and learning, in January 2014. Information was collected about the participants' semester of study, gender, nationality, and age. Students' perceptions of the educational environment were documented by noting their degree of agreement with a set of 50 statements grouped into five categories. Average scores were compared among different groups. The mean total and category scores were compared to those of the 2013 study. Sixty of the sixty-nine students (86.9%) who enrolled in the undergraduate medical program participated in the survey. The majority were male, aged 20-25 years, and of American nationality. The mean+/-SD total score was 151.32+/-18.3. The mean scores for students' perception in the survey categories were perception of teaching/learning (38.45), perception of teachers (33.90), academic self-perceptions (22.95), perception of atmosphere (36.32), and social self-perception (19.70). There were no significant differences in these scores among the different groups. All scores except those for academic self-perception were significantly higher in the present study compared to the previous one (P<0.05). The above results will be of particular interest to schools that plan to transition to an integrated curriculum.

Students' perception of the learning environment at Xavier University School of Medicine, Aruba / 보건의료교육평가

PURPOSE: The learning environment at Xavier University School of Medicine (XUSOM), Aruba has not been previously studied. Hence, the present study was carried out using the Dundee Ready Education Environment Measure (DREEM) to obtain student perceptions about the learning environment and compare the same among different subgroups of respondents. METHODS: The questionnaire was administered to undergraduate medical students in their first to fifth semester during the first two weeks of June 2013. The students' perceptions were evaluated by noting their degree of agreement with a set of 50 statements using a Likert-type scale. The mean overall score and the scores of subcategory were calculated and compared among different respondents (P<0.05). RESULTS: Seventy-three of the 86 students (84.9%) completed the questionnaire. The overall mean+/-SD score was 131.79+/-22.86 (maximum score 200). The mean+/-SD score for students' perception of teaching/learning was 31.99+/-6.23 (maximum score, 48), while the score for students' perceptions of teachers was 30.05+/-5.54 (maximum score, 44). The mean+/-SD scores for students' academic self-perception, students' perception of the atmosphere, and students' social self-perception were 21.88+/-5.11 (maximum score, 32), 30.92+/-8.59 (maximum score, 48), and 16.96+/-4.71 (maximum score, 28), respectively. There were no differences in scores according to the respondents' personal characteristics. CONCLUSION: The student responses about the learning environment at the institution were positive. We plan to obtain regular student feedback as the curriculum becomes progressively more student-centered and integrated.

Assessment of structured physical examination skills training using a retro-pre-questionnaire / 보건의료교육평가

PURPOSE: The effectiveness of physical examination skills (PES) training is very rarely assessed using the "post-then-pre" approach. In this study, a retro-pre-questionnaire was used to study the effect of structured physical examination skills training (SPEST) imparted to second-year undergraduate medical students. METHODS: KIST Medical College (KISTMC) affiliated to Tribhuvan University Nepal admitted its first batch of MBBS students in November 2008. The university curriculum recommends the involvement of Medicine and Surgery Departments in PES training, but the methods for teaching and assessment are not well defined. KISTMC has made training more structured and involved the Medicine, Surgery, Gynaecology and Obstetrics, Orthopaedics, ENT, Ophthalmology, Paediatrics, and Family Medicine Departments. SPEST includes the teaching/learning of basic PES for 210 minutes once a week for 28 weeks. Self-assessment is done by using a retro-pre-questionnaire at the end of the last session of training, and these data are analysed using SPSS. RESULTS: Out of 100 students, 98 participated in the objective structured clinical examination (OSCE); 82 completed the retro-pre-questionnaire. Forty-six skills representing various systems were selected for inclusion in the retro-pre-questionnaire from among the many skills taught in different departments. The average perceived skills score (maximum score, 46x4=184) before training was 15.9 and increased to 116.5 after training. The increase was statistically significant upon the application of a paired t-test. CONCLUSION: The students perceived that their level of skills improved after the training. The retro-pre- instrument seems to be useful for assessing the learners' self-reported changes in PES after training if a large number of skills need to be assessed. However, it should be noted that although a retro-pre-questionnaire may reveal valuable information, it is not a substitute for an objective measure or gold standard.

Self-financing students in private medical schools / 보건의료교육평가

No abstract available.

Taking medical humanities forward / 보건의료교육평가

No abstract available.

Book review: Basics in medical education / 보건의료교육평가

No abstract available.

Undergraduate medical education in Nepal: one size fits all? / 보건의료교육평가

No abstract available.

Conducting correlation seminars in basic sciences at KIST Medical College, Nepal / 보건의료교육평가

KIST Medical College is a new medical school in Lalitpur, Nepal. In Nepal, six basic science subjects are taught together in an integrated organ system-based manner with early clinical exposure and community medicine. Correlation seminars are conducted at the end of covering each organ system. The topics are decided by the core academic group (consisting of members from each basic science department, the Department of Community Medicine, the academic director, and the clinical and program coordinators) considering the public health importance of the condition and its ability to include learning objectives from a maximum number of subjects. The learning objectives are decided by individual departments and finalized after the meeting of the core group. There are two student coordinators for each seminar and an evaluation group evaluates each seminar and presenter. Correlation seminars help students revise the organ system covered and understand its clinical importance, promote teamwork and organization, and supports active learning. Correlation seminars should be considered as a learning modality by other medical schools.

Student feedback about The Skeptic Doctor, a module on pharmaceutical promotion / 보건의료교육평가

Pharmaceutical promotion is an integral part of modern medical practice. Surveys show that medical students have a positive attitude towards promotion. Pharmaceutical promotion is not adequately taught in medical schools. A module based on the manual produced by Health Action International was conducted for second year medical students at KIST Medical College, Lalitpur, Nepal. Student feedback on various aspects of the module was obtained using a semi-structured questionnaire. Eighty-six of the 100 students (86%) provided feedback about the module. Forty-five (52.3%) were female and 39 (45.3%) were male. Participant feedback about the module was positive. Small group work and role plays were appreciated, and the ratings of the module and the manual were satisfactory. Respondents felt pharmaceutical promotion will play an important role in their future practice and that the module prepared them to respond appropriately to promotion and select and use medicines properly. The module further developed on issues covered during pharmacology practical and majority felt the module was of relevance to Nepal. Students appreciated the module though there were suggestions for improvement. The module should be considered during the years of clinical training (third and fourth years) and internship and in other medical schools.

Feedback on and knowledge, attitude, and skills at the end of pharmacology practical sessions / 보건의료교육평가

Concern has been raised about inadequate pharmacology teaching in medical schools and the high incidence of prescribing errors by doctors in training. Modifications in pharmacology teaching have been carried out in many countries. The present study was carried out using a semi-structured questionnaire to obtain students' perceptions of their knowledge, attitudes, and skills with regard to different subject areas related to rational prescribing at the end of two-year activity-based pharmacology practical learning sessions in a private medical school in Nepal. The effectiveness of the sessions and strengths and suggestions to further improve the sessions were also obtained. The median total knowledge, attitude, skills and overall scores were calculated and compared among different subgroups of respondents. The median effectiveness score was also calculated. Eighty of the 100 students participated; 37 were male and 43 female. The median knowledge, attitude, and skills scores were 24, 39, and 23, respectively (maximum scores being 27, 45, and 36). The median total score was 86 (maximum score being 108). The effectiveness score for most subject areas was 3 (maximum 4). The strengths were the activity-based nature of the session, use of videos and role-plays, and repeated practice. Students wanted more sessions and practice in certain areas. They also wanted more resources and an internet connection in the practical room. The skills scores were relatively low. The immediate impact of the sessions was positive. Studies may be needed to assess the long term impact. Similar programs should be considered in other medical schools in Nepal and other developing countries.

Medical humanities in Nepal - snakes and ladders

In the last decade there has been a quantitative growth in medical schools in Nepal, a developing country in South Asia. Medical Humanities [MH] uses disciplines traditionally termed as the humanities in the pursuit of medical educational goals. The subject is slowly developing in Nepal. Sessions have been conducted at Manipal College of Medical Sciences, Pokhara and KIST Medical College, Lalitpur. In this article the authors examine inhibitory factors [snakes] and facilitating factors [ladders] for the development of the subject in Nepal

Medical education and medical educators in south Asia- a set of challenges

South Asia has vast unmet health needs especially in rural areas. Community-based medical education can partly address these needs and can serve to introduce students to a number of community health problems. Climate change has the potential to produce major challenges for health and food security in South Asia. Medical students should be taught about climate change and methods to tackle its impact on health. The pharmaceutical industry in South Asia aggressively promotes their products. Disease mongering is becoming more common in South Asia. Educational initiatives to sensitize students regarding promotion are common in developed countries. In Nepal, an educational initiative critically looks at the industry's promotional tactics. Similar initiatives are required in other medical schools. The nature of the doctor-patient relationship is changing. An increasing demand for patient autonomy and for their involvement in therapeutic decisions is seen. Access to the internet and internet sources of health information is increasing. Medical schools should address these issues as well. Medical Humanities modules and courses in communication skills are required. Research can play an important role in alleviating the health problems of South Asia. Students should be taught the basics of scientific research and student research should be strongly encouraged. This is a review article