ABSTRACT
Formative assessment, described as "the process of appraising, judging or evaluating students' work or performance and using this to shape and improve students' competence", is generally missing from medical schools of Pakistan. Progressive institutions conduct "formative assessment" as a fleeting part of the curriculum by using various methods that may or may not include feedback to learners. The most important factor in the success of formative assessment is the quality of feedback, shown to have the maximum impact on student accomplishment. Inclusion of formative assessment into the curriculum and its implementation will require the following: Enabling Environment, Faculty and student Training, Role of Department of Medical Education (DME). Many issues can be predicted that may jeopardize the effectiveness of formative assessment including faculty resistance, lack of motivation from students and faculty and paucity of commitment from the top administration. For improvement in medical education in Pakistan, we need to develop a system considered worthy by national and international standards. This paper will give an overview of formative assessment, its implications and recommendations for implementation in medical institutes of Pakistan.
Subject(s)
Education, Medical, Undergraduate , Educational Measurement , Adult , Curriculum , Humans , Knowledge of Results, Psychological , Pakistan , Students, MedicalABSTRACT
AIM: To find a non-invasive strategy for detecting choledocholithiasis before cholecystectomy, with an acceptable negative rate of endoscopic retrograde cholangiopancreatography. METHODS: All patients with symptomatic gallstones were included in the study. Patients with abnormal liver functions and common bile duct abnormalities on ultrasound were referred for endoscopic retrograde cholangiopancreatography. Patients with normal ultrasound were referred to magnetic resonance cholangiopancreatography. All those who had a negative magnetic resonance or endoscopic retrograde cholangiopancreatography underwent laparoscopic cholecystectomy with intraoperative cholangiography. RESULTS: Seventy-eight point five percent of patients had laparoscopic cholecystectomy directly with no further investigations. Twenty-one point five percent had abnormal liver function tests, of which 52.8% had normal ultrasound results. This strategy avoided unnecessary magnetic resonance cholangiopancreatography in 47.2% of patients with abnormal liver function tests with a negative endoscopic retrograde cholangiopancreatography rate of 10%. It also avoided un-necessary endoscopic retrograde cholangiopancreatography in 35.2% of patients with abnormal liver function. CONCLUSION: This strategy reduces the cost of the routine use of magnetic resonance cholangiopancreatography, in the diagnosis and treatment of common bile duct stones before laparoscopic cholecystectomy.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Cholangiopancreatography, Magnetic Resonance , Choledocholithiasis/diagnosis , Decision Support Techniques , Gallstones/diagnosis , Liver Function Tests , Adult , Aged , Algorithms , Chi-Square Distribution , Cholecystectomy, Laparoscopic , Choledocholithiasis/diagnostic imaging , Choledocholithiasis/surgery , Female , Gallstones/diagnostic imaging , Gallstones/surgery , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Patient Selection , Predictive Value of Tests , Prospective Studies , Risk Assessment , Risk Factors , Ultrasonography , Unnecessary Procedures , Young AdultABSTRACT
OBJECTIVE: To determine the serum leptin levels in cord blood of Pakistani newborns and to ascertain the relationship between serum leptin and anthropometric parameters i.e. birth weight, length and OFC. STUDY DESIGN: A cross-sectional study. PLACE AND DURATION: Lady Dufferin Hospital and Ziauddin Hospital, Karachi from 1999 to 2000. PATIENTS AND METHODS: Leptin concentration was measured in 110 newborns of mothers of normal antenatal history from venous cord blood, using Active Elisa Kit (DSL-10-23100). Samples were selected according to availability. RESULTS: Mean birth weight, length and occipitofrontal circumference (OFC) were 3.0+/-0.4 kg, 48.7+/-2.3 cms and 33.1+/-0.8 cms, respectively. Mean serum leptin levels was 10.0+/-7.5 ng/ml. Serum leptin levels were found to be positively correlated with birth weight (r=0.16, p=0.04), and OFC (r=0.33, p<0.01), whereas no significant relationship was found with length of the babies. CONCLUSION: The reported results suggest that leptin may play role in newborns body weight and energy expenditure as in adults and children.
