Tools for measuring curriculum integration in health professions' education: a systematic review.

BACKGROUND: Curriculum integration is an important educational concept widely implemented by various educational institutions, particularly within the healthcare field. Its significance lies in enhancing the preparation of future healthcare professionals. The assessment of these integrated curricula is imperative to guarantee their effectiveness. Consequently, the aim of this systematic review is to delve into existing literature, with the goal of identifying instruments designed to assess the extent of curriculum integration in health professions' education. METHODS: A comprehensive search was conducted to identify peer-reviewed papers and grey literature describing the development, validation, or use of instruments measuring the degree of integration in a curriculum. Eight databases were searched: PubMed, Scopus, Google Scholar, CINAHL Ultimate, Web of Science, Cochrane, ProQuest Central and EMBASE. Grey literature was also included. Titles, abstracts, and full text screening was conducted. Data extraction was done using a data extraction tool developed by our research team. RESULTS: The search resulted in the identification of 2094 references. After the removal of duplicates and title and abstract screening, 16 articles were deemed suitable for inclusion in this systematic review. Twenty-two instruments were extracted from these articles. The identified instruments assessed either integration attributes, perceptions about the integrated curriculum characteristics, process and outcomes, or curriculum integration level. Two of the instruments were focused on assessing horizontal integration (Basic Science Curriculum Assessment Instrument and the integration characteristic tool). In addition, one instrument was developed to assess integration within a single session only, while other instruments assessed curriculum integration level. Two of the integration instruments (The Session Integration Tool and Integration Ladder Questionnaire) provided scales for calculating integration levels. Validation of the integration assessment instruments was infrequent, with only 9 of 22 instruments validated for their psychometric properties. CONCLUSION: Our findings reveal the existence of diverse instruments designed to assess the extent of curriculum integration within health professions' curricula. The majority of identified instruments were focused on participants' perceptions towards the attributes of the integrated curriculum, and a significant number of these tools lacked validation.

Implementation and evaluation of a preceptor educational development programme involving the health cluster colleges at Qatar University.

BACKGROUND: 'The Practice Educators' Academy Programme' is an innovative educational intervention developed following a preceptor-focussed needs assessment. The primary aim of this study was to evaluate the programme's effect on self-efficacy and knowledge amongst multi-disciplinary clinical preceptors who precept students across the Health Cluster in Qatar University. The secondary aim was to assess the preceptors' satisfaction with the programme's comprehensiveness, appropriateness, and relevance. METHODS: This is a longitudinal study, with the same participants followed at different time points (i.e., pretest-posttest interventional design). The sample size was calculated to represent 10% of the sample expected for the main study, utilising a stratified convenience sampling technique. Preceptor self-efficacy was assessed using the Preceptor Self-Efficacy Questionnaire, a validated 21-item questionnaire. Preceptor knowledge was assessed through a 25-item multiple-choice question test. Satisfaction with programme content and delivery was assessed through a 14-item questionnaire with open comments. RESULTS: Thirty pretest-posttest respondents for the PSEQ assessment, and 26 pretest-posttest respondents for the knowledge assessment were appropriately matched and analysed. Participation in the self-efficacy questionnaire resulted in a statistically significant increase in their posttest median score (pretest-to-posttest: 3.3-to-3.6, p = 0.001). Participation in the knowledge assessment resulted in a statistically significant increased posttest mean score (pretest-to-posttest: 10.2-to-15.7, p < 0.001). Participants indicated high levels of satisfaction with the programme (average score = 4.42/5). CONCLUSIONS: Our findings suggest the programme is effective as demonstrated through a significant improvement in preceptors' self-efficacy and knowledge. Recommendations for future iterations include placing greater focus on active learning strategies, and inter-disciplinary interactions.

Health educators' professional agency in negotiating their problem-based learning (PBL) facilitator roles: Q study.

BACKGROUND: University educators are expected to cope with emerging situations and complex issues in teaching and learning, and this requires them to be agentic and proactive. While professional agency of health educators has not been investigated adequately, this study explores health educators' perception of their enactment of professional agency in the PBL facilitation process in a postpandemic context. METHODS: Forty PBL facilitators from medical and dental programs in Qatar University participated in the study during the fall semester of 2021, after resuming in-person PBL sessions. To collect and analyse data both qualitatively and quantitatively, Q methodology was employed. A 33-statement Q-set was established based on a proposed theoretical framework of professional agency in PBL facilitation, which included three dimensions-intrapersonal, action, and environment. RESULTS: Q factor analysis identified five significantly different viewpoints regarding how PBL facilitators perceive their professional agency sources, namely, (1) institutional resources, (2) policy guideline, (3) making efforts to improve support for students, (4) beliefs on PBL effectiveness, and (5) agentic actions. While four of the viewpoints were positive, participants with the second viewpoint reported negative perceptions and described lack of interest in facilitation work. All three dimensions of the framework were addressed and indicated complexity and interrelatedness of agency enactment. Consensus was observed regarding the need for more professional learning activities for faculty involved in PBL facilitation as source of professional agency. DISCUSSION: The results revealed a high variation of participants' perceptions of professional agency enactment throughout the three dimensions, indicating the need for establishing a common understanding of PBL facilitation work in a given context. For practical implications, further institutional efforts are required to support professional learning for PBL facilitation in a postpandemic context. Alternate approaches highlighting enforcement of agentic actions in all dimensions of intrapersonal values, stance and action taking, and active interactions with students, colleagues, and institutional environments are crucial. Q methodology provides new conceptual and empirical insights to explore the subjectivity of actors in health education.

Assessment of Educational Needs and Design of a Preceptor Development Program for Health Professional Education Programs in Qatar.

INTRODUCTION: Experiential learning is the backbone of many health care professional education programs; however, the quality of learning is profoundly dependent on the skills and experiences of clinical preceptors. This study was conducted at Qatar University Health Cluster (Colleges of Pharmacy, Medicine, and Health Sciences) with the primary objective of identifying the educational needs of preceptors to design and review an educational professional development program. METHODS: This study adopted a mixed-methods approach and was conducted in three stages: (1) assessment of preceptor educational needs, (2) designing of the Practice Educators' Academy program, and (3) revision and refinement of the designed program. The needs' assessment was conducted at all the three colleges through a validated survey and focus groups comprising of preceptors, students, and clinical faculty members. The sample included 209 survey respondents and 11 focus group sessions. RESULTS: The results yielded five key themes and a variety of individual preferences, which were used to design a five-module face-to-face two-day interactive workshop. For the revision of the designed program, the syllabus was shared purposively with selected scholars and experts in the area of health professions education, and their feedback was collected and critically examined. Furthermore, the refinement of the program was performed on the basis of this feedback, resulting in the revised and representative program being ready for piloting. DISCUSSION: A preceptor development program on experiential teaching and learning skills was successfully designed and revised with the needs of the clinical preceptors at its core. Preceptors' skills development can advance health care outcomes by preparing competent health professional graduates.

Construct Validity of an Instrument for Assessment of Reflective Writing-Based Portfolios of Medical Students.

PURPOSE: Assessment of reflective writing for medical students is challenging, and there is lack of an available instrument with good psychometric properties. The authors developed a new instrument for assessment of reflective writing-based portfolios and examined the construct validity of this instrument. METHODS: After an extensive literature review and pilot testing of the instrument, two raters assessed the reflective writing-based portfolios from years 2 and 3 medical students (n=135) on three occasions. The instrument consists of three criteria: organization, description of an experience and reflection on the experience. We calculated the reliability of scores using generalizability theory with a fully crossed design and two facets (raters and occasions). In addition, we measured criterion validity by testing correlations with students' scores using other assessment methods. RESULTS: The dependability (Φ) coefficient of the portfolio scores was 0.75 using two raters on three occasions. Students' portfolio scores represented 46.6% of the total variance across all score comparisons. The variance due to occasions was negligible, while the student-occasion interaction was small. The variance due to student-rater interaction represented 17.7%, and the remaining 27.7% of the variance was due to unexplained sources of error. The decision (D) study suggested that an acceptable dependability (Φ = 0.70 and 0.72) can be achieved by using two raters for one and two occasions, respectively. Finally, we found moderate to large effect-size correlations between students' scores in reflective writing-based portfolios and communication skills (r = 0.47) and PBL tutorials (r = 0.50). CONCLUSION: We demonstrated the presence of different sources of evidence that support construct validity of the study instrument. Further studies are warranted before utilizing this instrument for summative assessment of students' reflective writing-based portfolios in other medical schools.

Measuring medical students' professional competencies in a problem-based curriculum: a reliability study.

BACKGROUND: Identification and assessment of professional competencies for medical students is challenging. We have recently developed an instrument for assessing the essential professional competencies for medical students in Problem-Based Learning (PBL) programs by PBL tutors. This study aims to evaluate the reliability and validity of professional competency scores of medical students using this instrument in PBL tutorials. METHODS: Each group of seven to eight students in PBL tutorials (Year 2, n = 46) were assessed independently by two faculty members. Each tutor assessed students in his/her group every five weeks on four occasions. The instrument consists of ten items, which measure three main competency domains: interpersonal, cognitive and professional behavior. Each item is scored using a five-point Likert scale (1 = poor, 5 = exceptional). Reliability of professional competencies scores was calculated using G-theory with raters nested in occasions. Furthermore, criterion-related validity was measured by testing the correlations with students' scores in written examination. RESULTS: The overall generalizability coefficient (G) of the professional competency scores was 0.80. Students' professional competencies scores (universe scores) accounted for 27% of the total variance across all score comparisons. The variance due to occasions accounted for 10%, while the student-occasion interaction was zero. The variance due to raters to occasions represented 8% of the total variance, and the remaining 55% of the variance was due to unexplained sources of error. The highest reliability measured was the interpersonal domain (G = 0.84) and the lowest reliability was the professional behavior domain (G = 0.76). Results from the decision (D) study suggested that an adequate dependability (G = 0.71) can be achieved by using one rater for five occasions. Furthermore, there was a positive correlation between the written examination scores and cognitive competencies scores (r = 0.46, P < 0.01), but not with the other two competency domains (interpersonal and professionalism). CONCLUSIONS: This study demonstrates that professional competency assessment scores of medical students in PBL tutorials have an acceptable reliability. Further studies for validating the instrument are required before using it for summative evaluation of students by PBL tutors.

Morphology of Anterolateral Ligament of the Knee: A Cadaveric Observation with Clinical Insight.

Background. The morphology and function of anterolateral ligament (ALL) of the knee are not clearly understood even today with all the sophisticated techniques available. There have been differing descriptions of the ALL of the knee in literature, and not all of them have been named or described clearly. Aim. The present study was undertaken to provide a clear structure/relationship description on ALL. Materials and Methods. We used 24 formalin-fixed cadaveric limbs. Knee regions of the all the limbs were neatly dissected and the ALL was exposed. Its proximal and distal attachments were traced carefully. Middle portion of ALL was removed and processed for histological analysis. Results. ALL was found in one right knee (4.16%). It extended distally from the lateral femoral condyle to the lateral tibial plateau margin. Its attachment on the tibial plateau was located between head of the fibula and Gerdy's tubercle. A strong connection was identified between the ALL and the periphery of the middle third of the lateral meniscus. Histological analysis of ALL confirmed the presence of true ligamentous structure in it with dense connective tissue and plenty of fibroblasts. Conclusion. The prevalence of ALL in different populations along with its clinical significance has been discussed in detail in this paper.

Generalisability theory analyses of concept mapping assessment scores in a problem-based medical curriculum.

CONTEXT: In problem-based learning (PBL), students construct concept maps that integrate different concepts related to the PBL case and are guided by the learning needs generated in small-group tutorials. Although an instrument to measure students' concept maps in PBL programmes has been developed, the psychometric properties of this instrument have not yet been assessed. OBJECTIVES: This study evaluated the generalisability of and sources of variance in medical students' concept map assessment scores in a PBL context. METHODS: Medical students (Year 4, n = 116) were asked to construct three integrated concept maps in which the content domain of each map was to be focused on a PBL clinical case. Concept maps were independently evaluated by four raters based on five criteria: valid selection of concepts; hierarchical arrangement of concepts; degree of integration; relationship to the context of the problem, and degree of student creativity. Generalisability theory was used to compute the reliability of the concept map scores. RESULTS: The dependability coefficient, which indicates the reliability of scores across the measured facets for making absolute decisions, was 0.814. Students' concept map scores (universe scores) accounted for the largest proportion of total variance (47%) across all score comparisons. Rater differences accounted for 10% of total variance, and the student × rater interaction accounted for 25% of total variance. The variance attributable to differences in the content domain of the maps was negligible (2%). The remaining 16% of the variance reflected unexplained sources of error. Results from the D study suggested that a dependability level of 0.80 can be achieved by using three raters who each score two concept map domains, or by using five raters who each score only one concept map domain. CONCLUSIONS: This study demonstrated that concept mapping assessment scores of medical students in PBL have high reliability. Results suggested that greater improvements in dependability might be made by increasing the number of raters rather than by increasing the number of concept map domains.

Lecturing skills as predictors of tutoring skills in a problem-based medical curriculum.

PURPOSE: Recruitment of tutors to work in problem-based learning (PBL) programs is challenging, especially in that most of them are graduated from discipline-based programs. Therefore, this study aims at examining whether lecturing skills of faculty could predict their PBL tutoring skills. METHODS: This study included evaluation of faculty (n=69) who participated in both tutoring and lecturing within particular PBL units at the College of Medicine and Medical Sciences (CMMS), Arabian Gulf University, Bahrain. Each faculty was evaluated by medical students (n=45±8 for lecturing and 8±2 for PBL tutoring) using structured evaluation forms based on a Likert-type scale (poor to excellent). The prediction of tutoring skills using lecturing skills was statistically analyzed using stepwise linear regression. RESULTS: Among the parameters used to judge lecturing skills, the most important predictor for tutoring skills was subject matter mastery in the lecture by explaining difficult concepts and responding effectively to students' questions. Subject matter mastery in the lecture positively predicted five tutoring skills and accounted for 25% of the variance in overall effectiveness of the PBL tutors (F=22.39, P=0.000). Other important predictors for tutoring skills were providing a relaxed class atmosphere and effective use of audiovisual aids in the lecture. CONCLUSION: Predicting the tutoring skills based on lecturing skills could have implications for recruiting tutors in PBL medical programs and for tutor training initiatives.

Occurrence of the retromolar foramen in dry mandibles of South-eastern part of India: a morphological study with review of the literature.

The retromolar foramen (RMF) is a rare anatomical structure situated in the retromolar fossa behind the third molar tooth. When it is present, the foramen is connected with the mandibular canal and is believed to transmit neurovascular structures that provide accessory source to the mandibular molars and the buccal area. Reports from the literature show that the presence of RMF could pose a challenge in complete blockage of the inferior alveolar nerve during mandibular surgeries. We report the incidence of retromolar foramen from ninety-four dry mandibles of south-eastern part of Karnataka State, India. The foramen was observed in 11 mandibles out of 94 included in the study (11.7%). In three mandibles, the foramen was present bilaterally (3.2%) and in three it was on the left side (3.2%) and in five it was on the right side (5.3%). For the first time, we also measured the dimensions of the retromolar area and distance of the foramen from third molar tooth to understand its risks during the surgical extraction of the lower third molar tooth. A thorough review of the literature has also been done to compare the present findings with the studies reported from the various populations.

Genetic polymorphism of the glutathione S-transferase M1 and T1 genes in three distinct Arab populations.

Deletion polymorphisms for the glutathione S-transferase (GST) gene are associated with increased risk of cancer, and are implicated in detoxifying mutagenic electrophilic compounds. GST Polymorphic variants were reported for different populations. The aim of this study was to investigate the frequencies of GSTM1 and GSTT1 null genotypes among Bahraini, Lebanese and Tunisian Arabs. GST genotyping was done by multiplex PCR-based methods. Study subjects comprised 167 Bahrainis, 141 Lebanese and 186 Tunisians unrelated healthy individuals. GSTM1 deletion homozygosity of 49.7%, 52.5% and 63.4% were recorded for Bahraini, Lebanese and Tunisians, respectively. Among Bahrainis, the prevalence of GSTT1 null homozygotes was 28.7%, while in higher rates were seen in Lebanese (37.6%) and Tunisians (37.1%). Our results indicate that there are no major differences in allelic distribution of GSTM1 and GSTT1 genes between the three Arab populations investigated except between Bahrainis and Tunisians regarding the allelic distribution of GSTM1 gene (P=0.013). Combined analysis of both genes revealed that 14.4% of Bahrainis, 16.3% of Lebanese and 21.0% of Tunisians harbor the deleted genotype of both genes. This is the first study that addresses GST gene polymorphism in Bahraini and Lebanese Arabs, and will help genetic studies on the association of GSTM1 and GSTT1 polymorphisms with disease risks and drug effects in Arab populations.

The prevalence of absence of the palmaris longus muscle in the Bahraini population.

Absence of the palmaris longus muscle has been well documented in several populations at a prevalence rate ranging between 2.2 and 63.9% which varies according to race, sex, and side of the body. There is little documentation of the prevalence of absence of this muscle from populations in the Arabian Gulf region. We examined 1,043 subjects, 3-85 years old, from the Kingdom of Bahrain for the presence or absence of the palmaris longus muscle using the conventional test for the presence of this muscle. Statistical analyses investigated the association of muscle absence with sex, hand dominance, and laterality. The palmaris longus muscle was absent in 36.8% of subjects. Bilateral absence (19%) was more common than unilateral absence (17.9%) with preponderance in female subjects. The muscle was absent more often on the left side than the right (P = 0.003). In the right upper limbs the muscle was absent in female subjects more than male subjects (P = 0.031). This study reaffirms that there is population variation in the frequency of absence of the palmaris longus muscle. The tendon of the palmaris longus bifurcated at the wrist in 7.1% of subjects, with male subjects showing this feature more frequently than female subjects in the right hand (P = 0.037) and the left hand (P = 0.030). This has not been reported before. The clinical significance of our findings is discussed.

Distribution of four HIV type 1-resistance polymorphisms (CCR5-Delta32, CCR5-m303, CCR2-64I, and SDF1-3'A) in the Bahraini population.

Allelic differences of chemokine (C-C motif ) receptor 5 (CCR5) and CCR2, as well as the ligand for the chemokine receptor CXCR4, stromal-derived factor (SDF-1), are known to suppress HIV-1 transmission and to be involved in delay in HIV-1 disease progression. The aim of our study was to investigate the frequencies of four mutations that confer resistance to HIV-1: CCR5-Delta32, CCR5-m303, CCR2-64I, and SDF1-3'A among Bahrainis. We have studied the DNA polymorphisms in 304 unrelated healthy Bahraini individuals without any known history of HIV-1 infection or AIDS symptoms. The CCR5-Delta32 mutation was detected by PCR analysis, while the CCR5-m303, CCR2-64I, and SDF1-3'A mutations were detected by PCR-restriction fragment length polymorphism (PCR-RFLP) tests. Allele frequencies and the fit to the Hardy-Weinberg equilibrium were evaluated using the Arlequin population genetics application. The frequencies of the CCR5-Delta32, CCR2-64I, and SDF1-3'A alleles were 2.8%, 8.9%, and 26.5%, respectively. No mutant alleles were detected for the CCR5-m303 mutation in 304 individuals. We estimated the risk of AIDS onset (relative hazard), computed from the three-locus genotype data. This is the first report of these four mutations conferring resistance to HIV-1 in the Bahraini population. The presence of the CCR5-Delta32 allele among Bahrainis may be attributed to the admixture with people of European descent. The CCR2-64I allele and especially the SDF1-3'A allele are predominant in the Bahraini population and may be associated with resistance to fast HIV-1 infection in Bahrainis, and thus their genotyping can be used for prognosis in HIV-infected individuals.

Deep fascia on the dorsum of the ankle and foot: extensor retinacula revisited.

This study revisits the anatomy of the deep fascia over the distal leg, ankle, and dorsum of the foot. The arrangement of the deep fascia in these regions was recorded in 14 lower limbs of adult cadavers using photographs and drawings. The fascial layer from all three sites was subsequently removed in toto, and serial thickness measurements were made along its entire length. In addition, fiber disposition was studied under polarized light, and sections were stained to demonstrate collagen. The arrangement of deep fascia is complex. A common and novel finding at all levels is a crisscross, lattice-like arrangement of fibers. There was little evidence of the clearly defined sturdy band of the superior extensor retinaculum (SER) or of the Y-shaped inferior retinaculum (IER) commonly illustrated in topographical anatomy texts. The SER is a complex area with several thickenings commencing about 3 cm proximal to the tip of the lateral malleolus and gradually increasing to reach a maximum of 270 microm about 5 cm above the malleolus, then gradually returning to original thickness, about 9 cm above the malleolus. Fibers crossing diagonally to each other are a feature of the region. The IER characteristically has two forms: either a cross-shaped band (9 specimens) or a thickened "node" with small extensions radiating toward the malleoli (5 specimens), located about 1-2 cm distal to the lateral malleolus and centred over the common tendon of extensor digitorum where it has maximum thickness (430 microm). The deep fascia is thickened and firmly attached over both malleoli and to the tarsals and metatarsals along both borders of the foot. In general, the deep fascial structures were thicker in males than those in females.

Teaching styles of tutors in a problem-based curriculum: students' and tutors' perception.

This study compared the self-rated with student-rated teaching styles of PBL tutors. We also examined the relationship between teaching styles of tutors' and students' evaluation of tutor effectiveness in tutorials. The study included 48 tutors and 276 medical students. Tutors, and students' were given a teaching style inventory with a 5-point scale consisting of 21 items that comprise four domains of teaching styles (facilitative, collaborative, suggestive and assertive). In addition, quantitative and qualitative evaluations of tutor effectiveness by students were analyzed. Tutors perceived themselves in the facilitative-collaborative end of the spectrum of styles In contrast, students perceived tutors as less 'facilitative-collaborative' and more 'suggestive-assertive' than tutors self-ratings (p < 0.001). In addition, the difference in perception between students and tutors ratings in the facilitative-collaborative domains was more evident as students progressed in the PBL curriculum. The students' ratings of the effectiveness of tutors correlated more strongly with facilitative-collaborative than with suggestive-assertive domains of teaching styles. However, other tutor attributes such as establishing rapport with students, providing academic help for them and having content expertise were considered important criteria of an effective tutor. We conclude that there is a mismatch between students' and tutors' perceptions about teaching styles of tutor. Tutor attributes other than teaching styles are important determinants of an effective tutor.

Population variation in the incidence of the medial (hamate) facet of the carpal bone lunate.

Studies on the wrist joint have shown two types of the carpal bone lunate. In type II lunate there is a facet on the medial side of the lunate for articulation with the proximal pole of the hamate; such a facet is absent in type I lunate. Type II lunates have different kinematics, are more prone to clinically relevant degenerative changes in the hamato-lunate joint and are an uncommon cause of ulnar-sided wrist pain. Ninety plain radiographs showing postero-anterior views of the wrist (52 right and 38 left wrists) were studied in a population of Malays from Malaysia (mean age 48 years; age range 23 to 67 years) to determine the incidence of type I and type II lunates. Our findings were compared with those in other reports in the literature. In Malays, only 24 wrists (26.7%) showed a type II lunate compared to a reported incidence of 50% or more in populations from the Western world. Such a low incidence of type II lunate has not been reported before and may represent a genetic variation in Malays. Consequently, osteoarthritis of the hamate or lunate may play a less significant role in causing ulnar-sided wrist pain in Malays. In conclusion, the prevalence of type II lunate might vary in different population groups and further studies could be necessary to confirm this observation.

The angiotensin type 1 receptor antagonist valsartan attenuates pathological ventricular hypertrophy induced by hyperhomocysteinemia in rats.

INTRODUCTION: Clinical and experimental studies have reported the role of homocysteine in ventricular hypertrophy. Activation of the renin-angiotensin system mediated by angiotensin II type 1 (AT1) receptor has also been suggested to contribute to the pathogenesis of ventricular hypertrophy. There are also reports suggesting the affect of angiotensin II (Ang II) on cardiac hypertrophy is mediated by hyperhomocysteinemia. However, there is limited information on the mechanisms of the possible relationship between homocysteine and Ang II in ventricular hypertrophy. In this study we tested the hypothesis that hyperhomocysteinemia induced ventricular hypertrophy and remodelling may be mediated through activation of Ang II AT1-receptors in rats. METHODS: This study was conducted on control non-treated rats (n=13), methionine-treated rats (1.5 mg/kg/day, n=18) and methionine plus oral AT1 antagonist (valsartan, 30 mg/kg/day, n=13) treated rats for 56 days. Systolic blood pressure (SBP) was determined in rats at baseline, 28 and 56 days. Echocardiography was also performed in all rats after eight weeks, and blood samples were obtained for determination of plasma tHcy. Rats were then sacrificed for histopathological and biochemical assessment of cardiac structure. RESULTS: The SBP in the methionine-treated rats was significantly higher compared with controls and significantly lower compared with the methionine-valsartan group at 28 and 56 days (p<0.001). In addition, left ventricular wall thickness (LVWT) in the methionine-valsartan group (4.36+0.11 mm) was significantly lower compared with the methionine group (5.0+0.23 mm, p=0.03). Furthermore, cardiac collagen to total protein ratio was significantly lower in the methionine-valsartan group (2.19+0.11%) compared with the methionine group (2.64+0.08%, p=0.026). Fractional shortening (FS) was not significantly different between groups. CONCLUSION: Results from this study suggest that hyperhomocysteinemia-induced hypertension and ventricular hypertrophy in rats are mediated, at least partly; by Ang II activation of AT1-receptors.

Student-led tutorials in problem-based learning: educational outcomes and students' perceptions.

The aim of this study was to examine the effectiveness of using students as tutors in a problem-based learning (PBL) medical curriculum. Ninety-one third-year medical students were divided into ten tutorial groups. The groups were randomly allocated into student-led tutorials (SLT) (five groups, n = 44 students) and faculty-led tutorials (FLT) (five groups, n = 47 students). Outcome measurements included assessment of students' performance in tutorials individually and as a group, end-unit examinations scores, assessment of tutoring skills and identifying students' perceptions about peer tutoring. Student tutors were perceived better in providing feedback and in understanding the difficulties students face in tutorials. Tutorial atmosphere, decision-making and support for the group leader were better in SLT compared with FLT groups. Self-assessment of student performance in SLT was not different from FLT. Student scores in the written and practical examinations were comparable in both groups. However, SLT groups found difficulties in analysis of problems presented in the first tutorial session. We conclude that the impact of peer tutoring on student performance in tutorials, group dynamics, and student achievement in examinations is positive overall. However, student tutors require special training before adopting this approach in PBL programs.