Effects of a curriculum integrating critical thinking on medical students’ critical thinking ability in Iran: a quasi-experimental study / 보건의료교육평가

Purpose@#Improving physicians’ critical thinking abilities could have meaningful impacts on various aspects of routine medical practice, such as choosing treatment plans, making an accurate diagnosis, and reducing medical errors. The present study aimed to measure the effects of a curriculum integrating critical thinking on medical students’ skills at Tehran University of Medical Sciences, Iran. @*Methods@#A 1-group pre-test, post-test quasi-experimental design was used to assess medical students’ critical thinking abilities as they progressed from the first week of medical school to middle of the third year of the undergraduate medical curriculum. Fifty-six participants completed the California Critical Thinking Skills Test twice from 2016 to 2019. @*Results@#Medical students were asked to complete the California Critical Thinking Skills Test the week before their first educational session. The post-test was conducted 6 weeks after the 2 and half-year program. Out of 91 medical students with a mean age of 20±2.8 years who initially participated in the study, 56 completed both the pre- and post-tests. The response rate of this study was 61.5%. The analysis subscale showed the largest change. Significant changes were found in the analysis (P=0.03), evaluation (P=0.04), and inductive reasoning (P<0.0001) subscales, but not in the inference (P=0.28), and deductive reasoning (P=0.42) subscales. There was no significant difference according to gender (P=0.77). @*Conclusion@#The findings of this study show that a critical thinking program had a substantial effect on medical students’ analysis, inductive reasoning, and evaluation skills, but negligible effects on their inference and deductive reasoning scores.

Effects of a curriculum integrating critical thinking on medical students’ critical thinking ability in Iran: a quasi-experimental study / 보건의료교육평가

Purpose@#Improving physicians’ critical thinking abilities could have meaningful impacts on various aspects of routine medical practice, such as choosing treatment plans, making an accurate diagnosis, and reducing medical errors. The present study aimed to measure the effects of a curriculum integrating critical thinking on medical students’ skills at Tehran University of Medical Sciences, Iran. @*Methods@#A 1-group pre-test, post-test quasi-experimental design was used to assess medical students’ critical thinking abilities as they progressed from the first week of medical school to middle of the third year of the undergraduate medical curriculum. Fifty-six participants completed the California Critical Thinking Skills Test twice from 2016 to 2019. @*Results@#Medical students were asked to complete the California Critical Thinking Skills Test the week before their first educational session. The post-test was conducted 6 weeks after the 2 and half-year program. Out of 91 medical students with a mean age of 20±2.8 years who initially participated in the study, 56 completed both the pre- and post-tests. The response rate of this study was 61.5%. The analysis subscale showed the largest change. Significant changes were found in the analysis (P=0.03), evaluation (P=0.04), and inductive reasoning (P<0.0001) subscales, but not in the inference (P=0.28), and deductive reasoning (P=0.42) subscales. There was no significant difference according to gender (P=0.77). @*Conclusion@#The findings of this study show that a critical thinking program had a substantial effect on medical students’ analysis, inductive reasoning, and evaluation skills, but negligible effects on their inference and deductive reasoning scores.

[Study of evidence based medicine in residents of selected Medical Sciences Universities of Tehran]

Background: Nowadays, development and influence of technology in medical information and emergence of the extensive information have provided opportunity for the development of applying evidence-based medicine as a reasonable framework for decision making in medicine and it has attracted attention due to its importance. Aim of this study was to determine awareness, attitude, ability and facilities of evidence-based medicine in medical residents

Materials and methods: In this study, 40 residents of hospitals of selected Medical Sciences Universities of Tehran were included in the study with proportional stratified random sampling in 2013. Data collection instrument was a researcher-made questionnaire including 5 parts, such as demographic specifications and four criteria of awareness, attitude, evidence-based performance and its executive facilities. Validity of questionnaire was determined through content validity and internal consistency of the questions through Cronbach's alpha of 0.71. Data were analyzed by SPSS software

Results: Awareness of residents about evidence-based medicine was medium. Physicians had negative attitude toward evidence-based medicine. Ability of evidence-based medicine was undesirable and physicians sometimes had access to facilities of evidence-based medicine

Conclusion: Results showed that residents had low awareness with evidence-based medicine. Therefore, there is need for systematic education for awareness and execution of evidence-based medicine among residents

Toward evidence-based diagnosis in developing countries: the use of likelihood ratios for robust quick diagnosis

Evidence-based medicine [EBM], a relatively new paradigm for clinical practice, stresses the use of research evidence in diagnostic evaluations and therapeutic interventions. Financial and instrumental scarcities in developing countries require clinicians to visit patients under time constraints, especially in outpatient clinical settings. In this situation, clinicians need diagnostic approaches that reduce both diagnostic time and errors. This article discusses what EBM can do to help physicians in this regard. For quick history taking and physical examination, all physicians utilize certain [key pointers] [signs or symptoms or paraclinical tests that influence the pretest estimation of the disease prevalence]. EBM emphasizes that these key pointers are nothing but signs or symptoms with significant likelihood ratios. Likelihood ratios are a practical means of interpreting clinical tests; physicians can derive likelihood ratios from critically appraised studies. The use of clinical tests with sizeable likelihood ratios and with likelihood ratios for key pointers from independent body systems may significantly decrease both diagnostic time and errors. EBM could be a significant aid to physicians in the developing world

Comparison of desmopressin [DDAVP] tablet and intranasal spray in the treatment of central diabetes insipidus

Desmoperssin is the drug of choice for treatment of central diabetes insipidus and most commonly it is used as intranasal spray. In this study, efficacy and side effects of oral desmopressin was compared with the intranasal spray. This study was before -after clinical trial on 14 outpatients [9 F, 5 M, age 14 -50 Y] with central diabetes insipidus who had been treated with intranasal spray of desmopressin previously. Weight, pulse rate and blood pressure [sitting -standing], biochemical profile, serum electrolytes, 24h urine volume, specific gravity of urine and LFT was measured before and after 1 month study. Starting dose for each patient was one oral tablet of DDAVP [0.1 mg] per 8 hours. Paired Samples T-Test was used for data analysis. No clinically significant changes were found as regard to weight, pulse rate, blood pressure, blood chemistry, electrolyte and urinalysis. Single reported adverse effect was headache [43%] in tablet group and dyspnea [7%] in spray group. Both dosage forms were able to control diurnal polyuria and nocturnal polyuria. The antidiuretic dose - equivalence ratio for intranasal to oral desmopressin was 1: 18. Spray was superior in terms of rapid onset of action and duration of antidiuretic action in 100% and 78% of cases [not significant], respectively. Tablets were more available and much more easily consumed as reported by patients, in 86% [P=0.0006]. Treatment with tablets offers a good alternative to the intranasal route, especially in patients with chronic rhinitis or common cold and similar conditions