Standard setting of objective structured practical examination by modified Angoff method: A pilot study.

Background.The undergraduate curriculum at our institution is divided system-wise into four blocks, each block ending with theory and objective structured practical examination (OSPE). The OSPE in Physiology consists of 12 stations, and a conventional minimum score to qualify is 50%. We aimed to incorporate standard setting using the modified Angoff method in OSPE to differentiate the competent from the non-competent student and to explore the possibility of introducing standard setting in Physiology OSPE at our institution. Methods. Experts rated the OSPE using the modified Angoff method to obtain the standard set cut-off in two of the four blocks. We assessed the OSPE marks of 110 first year medical students. Chi-square test was used to compare the number of students who scored less than standard set cut-off and conventional cut-off; correlation coefficient was used to assess the relation between OSPE and theory marks in both blocks. Feedback was obtained from the experts. Results. The standard set was 62% and 67% for blocks II and III, respectively. The use of standard set cut-off resulted in 16.3% (n=18) and 22.7% (n=25) students being declared unsuccessful in blocks II and III, respectively. Comparison between the number, who scored less than standard set and conventional cut-off was statistically significant (p=0.001). The correlation coefficient was 0.65 (p=0.003) and 0.52 (p<0.001) in blocks II and III, respectively. The experts welcomed the idea of standard setting. Conclusion. Standard setting helped in differentiating the competent from the non-competent student, indicating that standard setting enhances the quality of OSPE as an assessment tool. Natl Med J India 2016;29:160–2

Exploring attributes of effective teachers - student perspectives from an Indian medical school.

Introduction: Attributes of an effective teacher is a passionate area of research for medical educators. Teaching at Melaka Manipal Medical College (MMMC), Manipal University, India, is assessed periodically as a part of the institution’s program evaluation process. The present study was undertaken to determine the highly rated attributes of a medical teacher, as felt by three batches (preclinical, para-clinical and clinical batch) of medical students at MMMC. Methods: A questionnaire focusing on twelve attributes of effective teaching was developed and administered to three batches of students. Students were requested to select the five most important attributes from the questionnaire and rank them accordingly as 1st, 2nd, 3rd, 4th and 5th. The responses were analyzed using cross tabulation and percentages of the grades provided by the participants were reported for each of the batch. Results: The ability of a teacher to motivate and inspire students was rated to be the best attribute of an effective teacher. Students also felt that defining objectives and clarifying concepts was an important quality that medical teachers should possess. The importance of being an effective communicator was also emphasized. Discussion: The present study underpins the need for a healthy teacher-student relationship in medical schools. Communication with international students in an Indian scenario may be a challenging task, keeping in mind the diverse cultural background of students. Probing qualities that students identify with an effective teacher may help us respond to these challenges.

Impact of note-taking on cognition during lectures.

Background: At Melaka Manipal Medical College (MMMC) (Manipal Campus), Manipal University, India, lectures form an important part of the Bachelor of Medicine and Bachelor of Surgery (MBBS) curriculum. The faculty of the Department of Physiology at MMMC uses both blackboard and PowerPoint for delivering lectures. Students are given the freedom to note down from the PowerPoint slides the content taught during a lecture. The present study was undertaken to explore the impact of note taking on students’ learning and also to determine students’ perceptions regarding the advantages and disadvantages of note taking. Methods: During a respiratory physiology lecture (Lecture 1) using PowerPoint, students were allowed to take down notes. Lecture 1 was followed by an examination (Test 1). During another lecture (Lecture 2), students were not allowed to take down notes, but were asked to listen only. This was followed by an examination (Test 2). Scores of Test 1 and Test 2 were compared using paired t test. Results and Conclusion: The mean score for Test 1 was found to be significantly higher (p <0.001) compared to that of Test 2. The present study revealed that note-taking during the lecture facilitated student learning by helping them to recall better. The conscious management of the note-taking activity is more than just taking down notes, but involves concentration during the lecture and understanding the concepts.

Enhancing active learning in microbiology through case based learning: Experiences from an Indian medical school.

Background: Case-based learning (CBL) is an interactive student-centered exploration of real life situations. This paper describes the use of CBL as an educational strategy for promoting active learning in microbiology. Materials and Methods: CBL was introduced in the microbiology curriculum for the second year medical students after an orientation program for faculty and students. After intervention, the average student scores in CBL topics were compared with scores obtained in lecture topics. An attempt was also made to find the effect of CBL on the academic performance. Student and faculty perception on CBL were also recorded. Results: In a cross sectional survey conducted to assess the effectiveness of CBL, students responded that, apart from helping them acquire substantive knowledge in microbiology, CBL sessions enhanced their analytic, collaborative, and communication skills. The block examination scores in CBL topics were significantly higher than those obtained for lecture topics. Faculty rated the process to be highly effective in stimulating student interest and long term retention of microbiology knowledge. The student scores were significantly higher in the group that used CBL, compared to the group that had not used CBL as a learning strategy. Conclusion: Our experience indicated that CBL sessions enhanced active learning in microbiology. More frequent use of CBL sessions would not only help the student gain requisite knowledge in microbiology but also enhance their analytic and communication skills.

Integrated practical examination: a novel approach to evaluate undergraduate medical students in physiology practices.

Background: The development of a reliable and valid method to assess laboratory exercises in preclinical sciences is a challenging task. The use of different assessment methods helps assess various aspects of clinical competence. Integrated Practical Examination (IPE) was thus incorporated as an assessment tool in physiology at Melaka Manipal Medical College (Manipal Campus), India aiming to test a wide range of practical skills and to improve the validity of our practical examinations. Methods: Three batches of first year medical students were tested by IPE which included two components: objective structured practical examination (OSPE) and performance exercise (PE). Scores of each student of the study sample in PE and OSPE in the 4th block were analysed. Results and conclusion: Analysis of student scores in the examinations revealed that student performance in PE was better than that in OSPE for all three batches. The correlation coefficients between the marks on OSPE and PE were found to be poor for all three batches. There was a significant difference in the mean scores on OSPE for all three batches (P value=0.014). There was also a significant difference in the mean scores on PE for all three batches (P value=0.013). Analysis of student scores also exposed some of the deficiencies of PE and OSPE. Students have differing strengths and weaknesses and each component of IPE thus tests different aspects of knowledge, understanding and abilities.

Quadruple therapy for initial eradication of Helicobacter pylori in peptic ulcer: comparison with triple therapy.

BACKGROUND: Quadruple therapy appears to be more effective than standard triple therapy in the management of patients with Helicobacter pylori infection who harbor drug-resistant organisms. No data are available on the relative efficacies of triple and quadruple drug regimens from India. METHODS: Consecutive patients with peptic ulcer and H. pylori infection were randomized to receive lansoprazole 30 mg twice daily along with either amoxycillin (500 mg four times daily) and clarithromycin (500 mg twice a day) (Group A), or tri-potassium dicitrato bismuthate (120 mg four times daily), metronidazole (400 mg thrice daily) and tetracycline (500 mg 4 times daily) (Group B) for 10 days. Presence of H. pylori infection was looked for using an in-house urease test and histology before starting treatment, and 30 days after completion of treatment. RESULTS: Twenty-nine of 35 patients in Group A and 24 of 33 in Group B had eradication of infection (82.8% and 72.7% by intention-to-treat analysis, and 87.9% and 85.7% by per protocol analysis, respectively; p = ns). Side-effects occurred in 4 (12%) and 5 (18%) patients in Groups A and B, respectively (p = ns); discontinuation of drugs was required in two patients in group B. CONCLUSIONS: Quadruple therapy for initial treatment of H. pylori infection does not offer any advantage over standard triple therapy in Indian patients.

The bone marrow in Hodgkin's disease--a two year study.

A total of forty bone marrow trephine biopsies and aspirates were studied from thirty five patients suffering from Hodgkin's disease during the two year period 1994 and 1995. Of these twenty five were at the time of diagnosis of the disease and fifteen after treatment. The biopsies were studied for incidence of involvement as well as associated findings in both the positive and negative biopsies. A comparison of the trephine biopsy with marrow aspirate with respect to yield of positivity was made. Five patients (20%) at the time of diagnosis and two (13.33%) after treatment showed involvement of the marrow. None of the seven corresponding aspirates were positive for involvement showing that biopsies were superior to aspirates in detecting marrow infiltration in Hodgkin's disease. Suppression of the marrow, fibrosis and lymphocytic aggregates were the other findings in positive biopsies. Eosinophilia and myelosuppression were notable changes in the negative biopsies. One biopsy also showed granulomas. The probable significance of these findings are also discussed.

Standard dimensions for cis N-methyl peptide unit and flexibility of cis peptide units.

The mean dimensions of the cis N-methyl peptide unit have been arrived at by analysing the crystal structure data on compounds containing such units. These dimensions can be used as standard in conformational studies on cyclic peptides. While the bonds meeting at C are almost coplanar, those meeting at Ν show a slight pyramidal disposition. A comparison of the dimensions of the normal and N-methylated cis peptide units show that there are perceptible differences in the parameters connected with N. In addition, the flexibility of the cis peptide unit has been analysed by studying the distribution of the parameters in different classes of compounds such as cyclic di, tri and higher peptides. The salient features are: (i) The angle CαCN in cyclic dipeptide and the angle CδNCα in higher peptides tend to be lower, when the peptide unit is associated with a prolyl residue; (ii) in cyclic tripeptides the internal angles viz., CαCN and CNCα are significantly larger thereby increasing the intra-annular space; (iii) the bond Cα-C is distinctly shorter when it occurs in cyclic dipeptides. The results lead to the conclusion that the cis peptide unit takes up a need-based flexibility in its dimension.

Fixed eruption due to rifampicin.

Cutaneous side effects due to Rifampicin are rare (less than 5%). We report an urticarial type of fixed eruption due to Rifampicin. Fixed eruption due to Rifampicin is not reported earlier.