The effectiveness of online team-based learning in introduction to medical ethics education for medical students at a medical college of Nepal: a pilot study.

BACKGROUND: The effectiveness of online classes is always a concern, and it can be overcome by opting for active learning strategies like team-based learning (TBL). This study was conducted to find out the effectiveness of online TBL as an active learning strategy. We also aimed to explore the satisfaction and perception of students toward TBL. METHODS: This is a mixed-method study conducted among 29 third-year Bachelor of Medicine and Bachelor of Surgery (MBBS) students of Gandaki Medical College using purposive sampling method in the duration of January to September 2021. Three two hours online TBL sessions were used for teaching introduction to medical ethics. The individual readiness assurance test (IRAT) scores were compared to the group readiness assurance test (GRAT) scores to evaluate the effect of TBL through cooperative learning. Learner reactions and satisfaction of students towards TBL were assessed using a validated questionnaire comprising of a five-point Likert scale. An open-ended question asking the participants to describe their overall experience of the TBL sessions was also included to explore their perceptions towards TBL. The data were collected using Google form and exported to Microsoft Excel and the quantitative data were then analyzed using Statistical Package for Social Sciences (SPSS) version 16.0. To check the normal distribution of the data, Kolmogorov Smirnov and Shapiro-Wilk test were used. Non-parametric tests were used for the non-normally distributed data. P value of < 0.05 was regarded as significant. Thematic analysis was conducted for the qualitative data. RESULTS: The median GRAT scores were significantly higher (p = 0.006 in TBL 1 and 0.001 in TBL 2) than IRAT scores. Learner reactions toward TBL sessions were positive as shown by the mean scores which were in the range of 3.59 to 4.66. Five themes were generated from the codes: "effective learning method", "positive experience", "gained knowledge", "expression of gratitude" and "the way of conduction of the sessions". CONCLUSION: Online TBL in medical ethics was effective as a teaching learning tool in our setting. The students were satisfied with the learning process and rated the learning strategy positively.

Unnatural Deaths among Autopsy Cases Brought at Tertiary Care Hospital of Western Nepal during COVID-19 Pandemic Period: A Descriptive Cross-sectional Study.

INTRODUCTION: The outbreak of COVID-19  as changed patterns of mortality in different setups. The rate of suicide has increased in some countries during the pandemic while the overall death rates  have decreased. The study was conducted with objective to find out the prevalence of unnatural deaths among the autopsy cases brought at tertiary care hospital during COVID-19 pandemic period. METHODS: This is a descriptive cross-sectional study using the records of the medico legal autopsies conducted from 24th March 2020 to 23rd August 2020 during the COVID-19 pandemic in Pokhara Academy of Health Sciences. Ethical approval was taken from Institutional Review Committee of Pokhara Academy of Health Sciences (Reference number 28.2077/78). Whole sampling method was used. Records which were available were included in the study whereas those cases whose complete records were not available were excluded. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 188 deaths studied at the autopsy during the COVID-19 pandemic period, the prevalence of unnatural deaths was 147 (78.19%) (71.04-85.33 at 95% Confidence Interval). Among these deaths, 109 (74.14%) were males and 38 (25.85%) were females. Suicide was the most common manner attributing to 78 (53.06%) of the unnatural deaths. CONCLUSIONS: The prevalence of suicide was more than those demonstrated by earlier observations in similar settings before the pandemic period. Suicidal deaths were more common during the COVID 19 pandemic. This is an indicator of frustration of the people and necessary steps have to be taken to decrease such deaths in similar conditions to come.

Risk Perception and Hesitancy Toward COVID-19 Vaccination Among Healthcare Workers and Staff at a Medical College in Nepal.

PURPOSE: The study was conducted to explore the perception of healthcare workers and staff towards the risk of COVID-19 vaccination and to study vaccine hesitancy amongst them. METHODS: A total of 266 healthcare workers working in a medical college in Nepal were studied using a questionnaire consisting of three sections: demographics, experiences and perception of COVID-19, and COVID-19 vaccine safety. Data were analyzed using IBM SPSS version 26. The total perception score was calculated by noting respondent's agreement with a set of eleven statements using a Likert-type scale. Non-parametric tests (Mann-Whitney U and Kruskal-Wallis) were used for analysis (p<0.05). RESULTS: Altogether, 13.9% of respondents had been diagnosed COVID-19 positive prior to the survey. Many considered themselves to be at increased risk of contracting COVID-19. Only over one third (38.3%) were willing to be vaccinated. The most common reason for refusal/hesitancy was concern about vaccine safety. The median (interquartile range) total perception score was 36 (4) (maximum possible score=55). The score was significantly higher among those who had been diagnosed COVID positive, those who perceived the pandemic as being moderate or severe and among those willing to be vaccinated. CONCLUSION: Addressing doubts related to vaccine safety and providing more data on the safety of vaccine may be helpful in overcoming hesitancy.

Study on the effectiveness of online classes for undergraduate medical and dental students of Gandaki Medical College during COVID 19 pandemic period in Nepal

Introduction: Pandemic situation of COVID 19 had an impact on medical education globally leading to cancellation of lectures, laboratory exercises, clinical postings and exams. To continue with the academic program, the online classes are started in different academic streams in large scale. This came with challenges and new learning opportunities for medical students and potential to adopt some changes. The objective of this study is to find out the effectiveness of online classes for medical and dental students of Gandaki Medical College (GMC) during COVID 19 pandemic period in Nepal with questionnaire based survey distributed to the students attending the online classes. Materials and Method: This is a descriptive cross sectional questionnaire based online survey. The questionnaires were distributed to the undergraduate medical and dental students of GMC, Pokhara, Nepal. Result: Amongst the students who responded, majority 205 (98.1%) were attending online classes. The device used by most of the student to attend the classes was smart phone 156 (74.6%). The strength of internet of the students was good in 41 (19.6%) and satisfactory in 99 (47.40%). The internet was disturbed by electricity cut down as responded by 66(31.6%) students. Almost 140 (67%) of the respondents rated the online classes were interactive and 124(59.33%) rated the classes were not disturbing. Despite the classes being interactive and non-disturbing, 162(77.51%) of respondents rated that the online classes were not effective. The online classes with one to 51 number of students showed good interactions as compared to classes with 51 to 100 number of students (p<0.01). There was no differences seen in the effectiveness in online classes between these medical and dental students (p=0.414). Conclusion: Good numbers of students had participated in online classes in medical and dental streams at GMC. The students faced problems in internet connectivity due to electricity cut down. The online classes were not that effective as class room classes. In country like Nepal, various factors affecting the online education should be looked upon to make the online learning effective.