The positive impact of introducing modified directed self-learning using pre-small group discussion worksheets as an active learning strategy in undergraduate medical education.

BACKGROUND: Directed self-learning (DSL) is an active learning approach where the learners are provided with predefined learning objectives and some facilitation through the learning process in the form of guidance and supervision. It can help establish a strong foundation for autonomous and deep learning. OBJECTIVE: The aim of this study was to introduce a modified form of DSL to second-year undergraduate medical students using pre-small group discussion (pre-SGD) worksheets. The authors intended to evaluate its effectiveness through theme assessment and investigate students' perceptions using a feedback questionnaire. METHODS: This was an analytical cross-sectional study. Modified DSL (MDSL) was introduced to 96 second-year undergraduate medical students in two themes. Students were divided randomly into two groups. One group was exposed to traditional DSL (TDSL), and the other was introduced to MDSL using pre-SGD worksheets for the first theme. Groups were reversed for the second theme. The activity was followed by a theme assessment, which was scored for research purpose only. The scores of this assessment were compared, and perceptions of the students were gathered using a validated questionnaire. Data were analyzed using IBM's statistical package of social sciences (SPSS) version 22. RESULTS: The comparison of theme assessment scores revealed statistically significant difference (P = 0.002) in median scores between control TDSL and experimental MDSL groups. The percentage of students scoring ≥80% in theme assessment was significantly higher in the experimental group compared to the control group (P = 0.029). This strategy was well perceived by the students in terms of acceptability and effectiveness as depicted by a high degree of agreement on the Likert-scale. CONCLUSION: Modified DSL resulted in significant improvement in academic performance of undergraduate medical students. MDSL was also well perceived as an active learning strategy in terms of acceptability, effectiveness, and comparison with TDSL. [Figure: see text].

A clinical account of Pakistani children suffering from congenital adrenal hyperplasia.

The objective of the endeavour was to study the clinical presentation, diagnosis, and management of paediatric patients suffering from congenital adrenal hyperplasia and understand the issue in the light of available published data on the disease in Pakistan through a systematic analysis of researches. From an analysis of five-year retrospective data on congenital adrenal hyperplasia in patients of paediatric age group from a tertiary care centre in the capital of Pakistan and the available published Pakistani literature on CAH, it was concluded that the resultant deficiency of cortisol, aldosterone, and a rise in adrenal androgens is responsible for the symptomatology observed in the disease. Particularly, the presence of ambiguous genitalia makes the disease a difficult problem to tackle, especially in complex social conditions such as in Pakistan. The country not only lacks statistical data on the disease but also the diagnostic machinery making the problem two fold. It is only through maintaining an efficient disease registry and the introduction of neonatal screening programme that we might start grappling the crux of the issue.

Perceptions of students regarding innovative approaches introduced in nutrition and metabolism module at Shifa college of medicine.

Objective: To assess the perceptions of 2nd year medical students regarding certain approaches introduced in the course of Nutrition and Metabolism module. METHODS: The descriptive study was conducted at the Shifa College of Medicine, Islamabad, Pakistan, in December 2020, and comprised all 2nd year medical students who completed the Nutrition and Metabolism module in which new components had been added, including introduction to community nutrition, school visits, Islamic perspective of nutrition, journal club and e-posters. Data was collected using a questionnaire based on the modified Dundee Ready Education Environment Measure, and had 5 categories with a total of 25 questions that were scored on a 5-point Likert scale. Data was analysed using SPSS 22. RESULTS: Of the 100 students, 65(65%) were females and 35(35%) were males. The overall mean age was 20.5 ± 0.5 years. The total mean score was 74.68±2.53. Mean score for student's perception of learning was 38.17±0.17, student's perception of teachers 9.27±0.18, student's academic self-perceptions 12.1±0.11, student's perceptions of atmosphere 9.03±0.03 and student's social self-perceptions 6.11± 0.01. Conclusion: The perceptions medical students about innovations were positive, showing an encouraging attitude in terms of learning approach and outcome.

Feasibility of video assessment of operative skills in FCPS vascular surgery.

Objective: To explore the feasibility of assessment of operative skills of FCPS vascular surgery trainees based on video recordings of the surgical procedures with a view to introduce it in the curriculum. Methods: This qualitative study was carried out from 9th April 2021 - 15th July 2021 at Shifa Tameer e Millat University, Islamabad, Pakistan. It is a qualitative study based on constructivist grounded theory. Semi structured interviews of 16 participants, including five vascular surgical trainees, six vascular surgical consultants/supervisors/examiners, and five medical educationists were conducted, recorded and transcribed. Open and axial coding method was employed to identify recurring themes. Results: Six themes could be identified. (1) There was consensus among participants on deficiency in current assessment of surgical skills. (2) Most participants believed that this is a useful method, although four out of 16 participants believed that current methods were sufficient. (3) There was a unanimous opinion that its purpose should be initially formative assessment and later for summative assessment. (4) It was suggested that it is practical with logistic support; it can be made part of trainee's record to be reviewed later; maybe by independent observers. (5) Participants believed that the logistic issue in term of equipment and trained manpower will be a challenge in implementing this mode of assessment. Other barriers included medicolegal and ethical issue and acceptability by the stake holders. (6) Participants also suggested remedies for the barriers. Conclusion: Video review of surgical procedures can improve assessment of operative skills of trainees provided it is used as formative tool initially with a need to overcome logistics, medicolegal and cultural barriers.

Does the Implementation of Flipped Classroom Model Improve the Learning Outcomes of Medical College Students? A Single Centre Analysis.

OBJECTIVE: To assess the perspectives of the first year and second year MBBS students of College, regarding the effectiveness of flipped classroom learning as compared to the traditional mode of teaching. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Shifa College of Medicine, Islamabad, Pakistan, from August to September 2021. METHODOLOGY: This descriptive study was conducted on all first and second year MBBS students in College after informed consent. A self-developed questionnaire formulated after a thorough literature search, with 16 questions was given. Quantitative data was collected after ethical approval and was analysed using SPSS version 22. Percentages and mean were calculated for descriptive analysis whereas qualitative data was analysed through thematic analysis Results: Out of the 156 responders, 61% students believed that flipped classroom buttressed a better understanding of study objectives, 24% stated that it didn't make much of a difference whereas 15% had a negative response in this respect. The majority (90%) reckoned that learning beforehand fostered better discussions and made the whole learning process much easier. Seventy-five percent believed that it has improved their grades. Although, some students did point out that sometimes meandering through various study sources consumed a lot of their time but overall they held a satisfactory opinion of flipped pedagogy (85%). CONCLUSION: The students enrolled in the study asserted the usage of flipped classrooms as a likeable and preferable teaching method in medical institutions. Not only it engaged students in active learning and helped them improve their grades but also enabled them to sharpen cognitive and presentation skills, which are the prime objects of undergraduate pedagogy. KEY WORDS: Flipped classroom, Medical education, Medical students, e-learning.

Trends of congenital hypothyroidism and inborn errors of metabolism in Pakistan.

BACKGROUND: Metabolic disorders are heterogeneous group of genetic disorders that are responsible for significant neonatal and infant morbidity and mortality worldwide. In developing countries like Pakistan where infant mortality is high current population based studies are unable to gauge contribution of metabolic disorders in causing mortality and morbidity. It is essential to address this gap by a review of available scattered Pakistani data related to metabolic disorders specifically congenital hypothyroidism and inborn error of metabolism to calculate probable burden of these disorders. MAIN BODY: Unfortunately currently in Pakistan newborn screening which identifies these illnesses at birth as a preventive strategy are not available. For current review data was collected through a systematic search of published articles (including data related to screening in certain subgroups of patients admitted to pediatric/neonatal intensive care units, patients with developmental delay/mental retardation). CONCLUSION: The primary aim of this review was to get an estimate of the disease burden in the Pakistani population as true prevalence of Congenital Hypothyroidism and Inborn Errors of Metabolism in Pakistan is not available. This systematic review will help us to identify the rough idea about the scale of problem in Pakistan.

Congenital hypothyroidism: Diagnosis and management of patients.

Congenital hypothyroidism (CH) is a neonatal endocrine disease with an incidence of 1:2000 to 1:4000 worldwide. Much remains to be known about the nature of this specific condition and the effective treatment of less severely-affected babies. We retrospectively reviewed the data for patients who were diagnosed with congenital hypothyroidism. So for a total of fifteen patients medical record files were thoroughly evaluated. Three (20%) patients were diagnosed with congenital hypothyroidism alone while 12(80%) patients were diagnosed with other disorders along with congenital hypothyroidism but all received treatment for congenital hypothyroidism. A high percentage 6 (40%) of uncertain or unclear cases suggested new genetic aetiologies that still need to be explained. Such cases need further exploration especially less severely affected patients so to avoid complications. It may be useful to identify the genetic aetiology accurately for dyshormogenic, familial, or syndromic forms of CH.

Clinical biochemistry teaching: use of peer debriefing by Pendleton's rule as an instructional tool.

OBJECTIVE: To explore the effectiveness of peer debriefing in practical sessions of undergraduate medical students in Pakistan. METHODS: The cross-sectional quasi-experimental study was conducted from November 2016 to October 2018 at Shifa College of Medicine, Islamabad, Pakistan, and comprised second year medical students who were randomly divided into two groups. Group A was delivered skill sessions of Nutrition and Metabolism module through facilitator-led demonstration, while Group B was delivered skill sessions through peer debriefing using Pendleton's method. All the students were assessed in formative integrated practical exam. A focus group discussion followed by interviews was subsequently arranged for recording the perception of students regarding the effectiveness of peer debriefing as an instructional tool for skill sessions. Data was analysed using SPSS 21. RESULTS: Of the 84 subjects, 39(46.4%) were in Group A and 45(53.6%) were in Group B. Group B results were statistically significant for total cumulative scores and scores for the station of calculating body mass index (p<0.05). No significant difference was found in terms of general physical exam and counselling (p>0.05). Thematic analysis showed that students found the process of peer debriefing as fun, more interactive, time-consuming yet organized and less stressful. Students considered peer debriefing as an effective tool for learning skill sessions. CONCLUSIONS: Peer debriefing approach can be a useful instructional strategy to deliver skill sessions. It increases students' participation and thus effectively promotes learning.

Analysis of clinical and biochemical spectrum of Wilson disease patients.

BACKGROUND AND AIMS: Wilson disease (WD) is autosomal recessive disorder of copper metabolism. Wilson disease patients usually suffer from hepatic or neuropsychiatric complications. The symptoms appear between ages five to 35 but it can vary from two years to 72 years. MATERIALS AND METHODS: Study was carried out from June 2008 to November 2010. This study included nine families with eleven cases of WD to determine clinical presentation, diagnostic findings (including laboratory results) and liver histology. It included 11 patients who presented with hepatic manifestations and/or Neuropsychiatric manifestations and/or family history suggesting features of WD. Patients with hepatitis B and C and those with history of taking antipsychotic drugs were excluded from the study. Patient's data was included in a well designed performa. Liver function test, serum ceruloplasmin, serum copper, 24 hour urinary copper, blood complete picture were analyzed. Quantitative data such as age, hemoglobin etc were expressed as mean with ± SD and quantitative variables such as sex, movement disorders, hepatic involvement etc were expressed as frequency and percentage. RESULTS: There were five male and six female patients with evidence of various manifestations here (i) hepatic in which they had only liver dysfunction (ii) hepatic and neurological (iii) neurological. The mean age of presentation was 8.7±3.92 years (range 4-19 years) and 45% were male patients. Decreased serum ceruloplasmin, enhanced 24-h urinary copper excretion and signs of chronic liver damage were confirmed in all patients and Kayser-Fleischer rings (KF rings) in 72% of patients. In severe WD patients, serum prothrombin activity was less than 50%, serum ceruloplasmin were low and serum copper levels were high than those in non-severe WD patients. High degree of suspicion leads to early treatment with good outcome. CONCLUSIONS: The WD is rare but important cause of chronic liver disease. Clinical and biochemical analysis in cases of patients with unexplained liver disease with high degree of suspicion can lead to early treatment with good outcome.