Medical curriculum reform at the Mona Campus of the University of the West Indies: responding to change - Poster abstract

The Faculty of Medical Sciences on the Mona Campus of the University of the West Indies is currently undertaking a thorough review of the undergraduate medical degree programme in order to improve its aims and objectives, its overall structure, flow and relevance. This paper reports on the rationale, method and progress of the review. The specially appointed Working Group took several factors into consideration in commencing the review. These included the need to identify an essential core of knowledge and skills in view of the burgeoning of medical knowledge, the need to give new emphasis to attitudinal attributes and the need to strengthen the teaching of ethics and the behavioural sciences. The Group intends to create a more student-centred approach to teaching and learning in the new curriculum. In laying the groundwork for the review, a compilation of the present courses conducted in the MBBS programme was first prepared. A foundation document containing agreed aims of the MBBS programme and ideal qualities of the new graduate was then drafted and approved by the Faculty Board. This document was used as a guide in creating a draft outline of a modular, systems-based curriculum. A number of ideas were drawn from curricula recently introduced in medical schools in Australia, the United Kingdom, and the United States of America. Consultation with Faculty representatives from Barbados and Trinidad campuses and with student representatives was done at a two day retreat. Course co-ordinators are now being appointed to oversee the design of the various systems-based modules and further consultation is planned before final implementation of the curriculum.(AU)

Motivation for and concerns about entering a medical programme: a Caribbean perspective

OBJECTIVE: To determine the motivation for and concerns about studying medicine, and future career plans of students of Faculty of Medical Sciences, University of the West Indies (UWI). DESIGN AND METHODS: A cross-sectional survey that included year 1 medical students at both the Mona and St. Augustine medical schools of the UWI was conducted. A self-administered questionaire containing structured questions on demographics and family background, motivation for and concerns about studying medicine and future career preferences held by students at entrance into the course of study, was used to collect the data. RESULTS: A total of 228 students took part in the study, 103 from Mona and 125 from St. Augustine. Seventy-three percent of the students were between 18 and 22 years of age with 61 percent being females and 39 percent males. The students gave the highest rating to those motives best described as people-oriented. These included interest in relations between health, well-being and society and caring for and working with people. The female students scored significantly higher than the males for most of those motives. However, males rate the social prestige/status motive significantly higher than females. The greatest concern of the students was fear of failure. Surgical specialities (43 percent), family medicine (38 percent) and paediatrics (34 percent) were the top choices of the students for future specialty. However, significantly more males chose surgery while more females chose obstetrics.(AU)

The challenge of designing a database for auditing surgical in-patients

Surgical audit is imperative in modern practice, particularly in the developing world where resources are limited and efficient allocation important. The structure, process and outcome of surgical care can be determined for quality assurance or for research. Improved efficiency and reduction of morbidity and mortality are additional goals which may be accomplished. However, computerization, medical staff cooperation and the availability of dedicated staff are among the hurdles which may be encountered. We report the challenge of designing and establishing a database for auditing surgical inpatients in a developing country and the difficuties which were encountered.(AU)

Tomorrows doctors - an early profile of our students

In planning for the training of medical personnel in a well ordered health service, it is important to determine the profile of those persons who enter the course of training and what effect, if any, this programme has on their subsequent choice of speciality. Work on this issue elsewhere indicates that the best time to begin gathering information about these factors is at the time of entry to medical school and before students are swayed by the course and by the opinions of their peers and teachers. This study was designed to explore why persons seek to become doctors and what factors influence different sub groups to select different specialities. It sets out to answer the following questions: 1) What are the motivational factors influencing the students to study medicine? 2) What demographic and family background factors are related to these motivational factors? 3) What influence do these motivational factors have on future choice of speciality? A longitudinal study of all medical students from their first year in a 5-year curriculum was begun on the Mona and St. Augustine campuses by administration of a questionnaire at the start of the first year of study. This included structured questions on demographics, the motivation for making the decision to study medicine and the present choice of speciality. Confidentiality of the information collected will be assured by using student's identification numbers. This paper reports the preliminary data from one of the campuses. It focuses on motivational factors, speciality choices and concerns of the students about pursuing the medical programme at the UWI. It is hoped that this information and the results of longitudinal follow-up will help the Faculty to shape decisions about selection criteria for entrants and for designing and implementing the new curriculum (AU)

Auditing early operative mortality in a developing country

This study examined patient deaths occurring in the critical first 24 hours after operation in order to identify those patients in whom different management decisions might have improved survival outcomes. During a 36 month period commencing January 1, 1994, information collected prospectively on all patients operated on by the general surgery, orthopaedic, neurosurgery, cardiothoracic and genitourinary services at the University Hospital of the West Indies (UHWI) was examined. Data for all patients who died within 24 hours of the operative procedure were retrieved and these patients comprised the study group. Confirmation was obtained as to the completeness of this group and the causes of death from the hospital's autopsy records. 37 patients met the study criteria and the hospital and autopsy records of all were examined. These deaths were divided into three groups: high risk (patients in extremis), medium risk (seriously ill but with reasonable chance of survival) and low risk (not expected to have any serious problem during or immediately after operation). Nine patients were deemed to be at high risk, seventeen at medium risk and eleven were placed in the low risk group. In the high risk group, the majority were trauma cases in whom the findings at operation showed that survival was not in fact possible. Among the medium risk patients there were six severe injuries and a similar number had serious cardiac disease. It was in those cases assessed as being of low risk that there was most cause for concern. The identification and documentation of this group may offer a widely applicable means of assessing and comparing the quality of perioperative surgical care.(AU)

The dying patient: teaching doctors to care

This article discusses the question of teaching doctors the humanistic components of caring for the dying. The difficulties of learning in the affective domain are compounded by the modern social attitude to death, which serves to distance the caregiver from the dying patient at the time of his greatest need. Values and attitudes can be taught. Experiential learning, supported by group discussion, is an accepted and available strategy but ethical decision-making is best taught by example and suitable attitudes can only be developed by teachers who have emotionally accepted their own mortality. Unfortunately, there is a shortage of teachers, with the right attitudes and skills, who will serve as suitable role models for our students.

The dying patient: teaching doctors to care

This article discusses the question of teaching doctors the humanistic components of caring for the dying. The difficulties of learning in the affective domain are compounded by the modern social attitude to death, which serves to distance the caregiver from the dying patient at the time of his greatest need. Values and attitudes can be taught. Experiential learning, supported by group discussion, is an accepted and available strategy but ethical decision-making is best taught by example and suitable attitudes can only be developed by teachers who have emotionally accepted their own mortality. Unfortunately, there is a shortage of teachers, with the right attitudes and skills, who will serve as suitable role models for our students. (AU)

The prevalence of seat belt use in Jamaica: an observational study

An observational cross-sectional survey showed that 21.1 percent of private motor vehicle drivers and 13.5 percent of front seat passengers voluntarily wore seat belts in Kingston, Jamaica, where there is no law requiring this. Rear passenger utilisation was not examined. Compared to males, females were significantly more likely to wear seat belts when driving but not as front seat passengers. Of all motor vehicles examined 10.1 percent were not equipped with seat belts. The oldest group of vehicles were mostly not fitted with seat belts. Drivers of older vehicles were significantly less likely to use seat belts even when the vehicles were equipped with belts. Implementation of legislation can reduce mortality, morbidity and costs from road traffic accidents which are relatively frequent in Jamaica. Male drivers, drivers of older vehicles and all passengers may require specific targeting in an educational and enforcement campaign should legislation, which is highly desirable, be implemented

Chemical burns as assault injuries in Jamaica

A three-fold greater incidence of chemical burn injuries in Jamaican hospitals, compared to burn centers in other industrial countries, underscores the problem of the use of common chemicals for assault weapons in this country. With the increased availability of guns for personal use, many Jamaicans learned the value of carrying household chemicals such as sulphuric acid from batteries or sodium hydroxide obtained from cleaning supplies. Chemical carried in a container, such as one might carry mace, afforded a means of defence among the lower socioeconomic groups who could not afford handguns. The use of dangerous chemicals for defensive weapons has extended to the use of chemicals for assault. The pattern of chemical injury differs significantly from most reports in the literature in both prevalence and aetiology. This review was prepared to examine these injuries with a view to planning strategies for prevention. (AU)

The prevalence of seat belt use in Jamaica: an observational study

An observational cross-sectional survey showed that 21.1 percent of private motor vehicle drivers and 13.5 percent of front seat passengers voluntarily wore seat belts in Kingston, Jamaica, where there is no law requiring this. Rear passenger utilisation was not examined. Compared to males, females were significantly more likely to wear seat belts when driving but not as front seat passengers. Of all motor vehicles examined 10.1 percent were not equipped with seat belts. The oldest group of vehicles were mostly not fitted with seat belts. Drivers of older vehicles were significantly less likely to use seat belts even when the vehicles were equipped with belts. Implementation of legislation can reduce mortality, morbidity and costs from road traffic accidents which are relatively frequent in Jamaica. Male drivers, drivers of older vehicles and all passengers may require specific targeting in an educational and enforcement campaign should legislation, which is highly desirable, be implemented (AU)

Factors influencing doctors' knowledge and prescribing habit concerning antimicrobial drugs: issues emerging from a pilot study - abstract

Although many antimicrobial drugs are available in Jamaica, hitherto no surveys have been done to assess doctors' knowledge and usage of these drugs. The authors report on a pilot study of this kind carried out at the Spanish Town Hospital. Thirty-three of 39 doctors on staff were available and completed a questionnaire which enquired about knowledge of certain older and newer antimicrobials, sources from which doctors were first introduced to the drugs

Dermatofibrosarcoma protuberans: a 10 year clinicopathological review of an uncommon tumour

A review of dermatofibrosarcoma protuberans diagnosed at the University hospital of the West Indies over a 10-year period revealed 23 cases. The mean age of the patients was 36.3 years. There were 13 females and 10 males. The trunk was the most common site. The clinical diagnosis was commonly missed. The results of this study are compared with those from other countries (AU)

Chemical burns in Jamaica - an urban social problem - abstract

A ten-year survey of admissions for acute burn injury was undertaken in eight hospitals in Jamaica for the period January 1981 to December 1990. Of 4,234 burn admissions, 562 or 13 percent were due to chemical injury and almost half of these resulted from interpersonal violence. More than 80 percent of these patients were admitted to four hospitals situated in urban regions of high population density (AU)

We asked them and they told us: victims' views of the first surgical clerkship - abstract

This study was undertaken to obtain the views of the students concerning the effectiveness of the first clerkship in surgery. A short anonymous questionnaire was handed to each student at the end of their ten-week clerkship immediately following the multiple choice examination. Completed forms were collected before the students left the examination room. Four hundred and sixty-three questionnaires were returned and analysed from the five graduating classes 1988 - 1992. Three hundred and forty of these responded to the section asking for comments or criticisms of the clerkship. These were broken down into five main areas - organisation, evaluation, course content, teaching and teachers. While the majority of the students felt that the clerkship was well organised, three main areas of discontent were evident. It was felt that teaching should be more patient-oriented, that teachers were too frequently unavailable and that the present curriculum clash with the pathology/microbiology programme adversely affected the rotation. In addition, almost a quarter felt that time spent in the operating theatre was a poor learning experience. Based on the results presented to the lecturers in the department, the clerkship has been modified and a new questionnaire designed and administered. The new data are being stored in a computer database and being made available to the organisers of the clerkship on an on-going basis (AU)

Penetrating injuries of the heart

This study represents a review of 33 patients seen at the Kingston Public Hospital, Jamaica, with penetrating cardiac injuries over a 7-year period from 1982 to 1989. Male patients between the ages of 12 and 30 years accounted for more than 80 per cent of cases. A history of syncope associated with haemodynamic instability were the predominant clinical features on presentation. The clinical triad of raised central venous pressure, muffled heart sounds, and low blood pressure levels was present in 33 per cent of the patients with cardiac tamponade. Pulsus paradoxus was not a significant diagnostic sign. Most of the injuries were stab wounds to the left anterior chest. The most commonly injured heart chamber was the right ventricle (48 per cent). Pericardiocentesis was no helpful in making the diagnosis and was only performed as a resuscitative measure in unstable patients prior to thoracotomy. Cardiorrhaphy was performed in the majority of patients through a left anterior lateral thoracotomy with median strnotomy being used only for suspected hilar injuries. A high index of suspicion in patients with penetrating thoracic trauma with expeditious thoracotomy will result in the greatest salvage rate (AU)

Penetrating injuries of the heart - abstract

This study represents a review of 33 patients seen at the Kingston Public Hospital, Jamaica, with penetrating cardiac injuries over a 7-year period from 1982 to 1989. Male patients between the ages of 12 and 30 years accounted for more than 80 per cent of cases. A history of syncope associated with haemodynamic instability were the predominant clinical features on presentation. The clinical triad of raised central venous pressure, muffled heart sounds, and low bloodpressure was present in 33 per cent of the patients with cardiac tamponade. Plus paradoxus was not a significant diagnostic sign. Most of the injuries were stab wounds to the left anterior of the chest. The most commonly injured heart chamber was the right ventricle (48 per cent). Pericardiocentesis was not helpful in making the diagnosis and was only performed as a resuscitative measure in unstable patients prior to thoracotomy. Cardiorrhaphy was performed in the majority of patients through a left anterior lateral thoracotomy with median sternotomy being used only for suspected hilar injuries. A high index of suspicion in patients with penetrating thoracic trauma with expeditious thoracotomy will result in the greatest salvage rate (AU)

Visceral complications of electrical burn injury: a report of two cases and review of the literature

Two patients with high voltage electrical injury involving the trunk are presented. Both injuries were complicated by visceral damage; and one patient died from sepsis secondary to bowel perforation. The rarity of this complication is examined in light of the pathophysiology of electrical injury; and its management is discussed with reference to previously published reports on this condition. (AM)

Student perception of the first surgical clerkship - abstract

This study was undertaken in order to obtain the student view of the first surgical clerkship whereas, previously, only student performance had been assessed. It was begun in 1985 and covers graduating classes 1988 to 1990. A simple anonymous questionnaire consisting of two sections was handed to each student at the end of this ten-week clerkship, immediately after the Multiple-choice paper. The completed forms were collected as the students left the examination room. Two hundred and fifty-nine questionnaires were collected and analysed. The majority of respondents felt that the clerkship was well organised and that members of staff were generally willing to teach. Nearly one-quarter found the operating theatre experience to be poor, but the majority (67 percent) felt it had been useful. One hundred and sixty-one students responded to the section which asked for comments and criticisms of the rotation. Three main areas of discontent were identified, viz., teachers were sometimes unavailable, the teaching should have a stronger patient orientation and the clash with the pathology/microbiology programme which affected the rotation adversely (AU)