Development and standardization of Indian Alcohol Photo Stimuli (IAPS) for cue-reactivity paradigms in patients with alcohol use disorder.

Background: The availability of appropriate alcohol-related stimuli is a crucial concern for the evaluation and treatment of patients with alcohol dependence syndrome. The study aimed to standardize alcohol-related images with cultural relevance to the Indian setting. Methods: We produced an extensive database of 203 pictures, the Indian Alcohol Photo Stimuli (IAPS), portraying different categories and types of alcoholic beverages, after removing the confounding effects of low-level stimulus parameters (e.g. brightness and blurriness). Thirty patients with alcohol dependence syndrome, currently abstinent, rated each image on visual analog scale (VAS) ranging from 0 (no craving) to 10 (extreme), to determine how typical the stimuli served as craving-relevant stimuli. Results: The mean VAS scores across beverages (ordered from highest to lowest) were whiskey >rum >beer >wine >vodka. Repeated-measures analysis of variance (ANOVA) showed a significant difference in mean VAS scores across beverages (F = 2.93, df = 2.9/86.3, P = 0.039, Greenhouse-Geisser corrected); the effect size for the difference was small (ηp2 = 0.092). A post hoc Bonferroni shows significantly higher VAS scores with whiskey compared with vodka (P = 0.029), whereas the scores were similar across other beverages. A two-way repeated-measures ANOVA for interaction between type of alcoholic beverages and activity was not significant (F = 2.67, df = 2.6/76.6, P = 0.061, Greenhouse-Geisser corrected). Conclusions: We created a standardized alcohol-related image database for studying cue-reactivity paradigms in individuals with alcohol use disorder (AUD). Further research is needed to validate the impact of image features on cue reactivity.

Tangible impact of patient communication modules on medical students and interns.

Attitude, ethics, and communication are key attributes in the doctor-patient relationship and to strengthen these qualities, the National Medical Commission, the body that regulates medical education and medical professionals in India introduced a course called Attitudes, Ethics and Communication (AETCOM) in the undergraduate medical curriculum. The objective of this study was to ascertain the perceptible qualitative influence of the modules in communication in the AETCOM course and to obtain feedback on its implementation. In this cross-sectional study, the attitude of medical students in all stages of training including internship was first explored using a Communication Skills Attitude Scale. Out of 27 modules in AETCOM course, five modules named foundations of communication deal with communication, and they are taught from the first to final professional years of training. After introducing communication modules in AETCOM for all professional years, feedback was collected from interns who had completed training in all modules. The interns provided feedback with a validated scale and two focused group discussions. Additionally, feedback from faculty involved in teaching AETCOM was analyzed. There was a significant increase in the positive attitude scores in the final year and internship compared to the first year. Eighty percent of the interns agreed that communication modules in AETCOM were useful and that they equipped them with the communication skills required for actual practice during their internship. Faculty agreed that these modules motivated the students to acquire communication skills. However, faculty also felt that these modules alone may not be sufficient to learn communication skills.NEW & NOTEWORTHY In the current study, we have assessed the attitude of medical students toward learning communication skills in all stages of their training. The novelty of our study is that communication modules were formally introduced for the first time into the medical curriculum and feedback was obtained from a cohort of interns who completed training in all modules in communication from AETCOM. The feedback from faculty and students provided us with concepts to improvise these modules.

Cognitive function and heart rate variability in open and closed skill sports.

OBJECTIVES: The differences in sporting environments between open and closed skill sports impose unique demands on athletes' cognitive and motor capabilities. Our study aims to investigate and compare cognitive function and Heart Rate Variability (HRV) among individuals involved in different sports, namely basketball, swimming, and a sedentary non-sports group. MATERIALS AND METHODS: The study consisted of three groups, namely basketball players, swimmers, and sedentary individuals, with each group comprising twenty-six participants. HRV was assessed with the help of PowerLab. Cognition was assessed using the Ebbinghaus Memory Procedure Test (EMT), Go/No-Go Task (GNG), Color Stroop task, Trail Making Test (TMT), and Letter Cancellation test (LCT). RESULTS: The results of the Multivariate Analysis of Covariance (MANCOVA) analyses indicated that there was significance between the groups. However, no significant differences were observed between swimmers and basketball players in cognitive functions and HRV measures. Overall, the sport group outperformed the sedentary group. Specifically, basketball players and swimmers completed LCT and TMT faster than the sedentary group (p = 0.044 and p < 0.001 for basketball players, p = 0.002 and p = 0.001 for swimmers). Additionally, basketball players took fewer trials in EMT (p = 0.013) and less time (p = 0.026) compared to the sedentary group. CONCLUSION: The results of the study indicate that sports training, regardless of sport type, positively impacts overall cognitive function. However, no significant differences were observed in cognitive task performance and HRV measures between open and closed skill sport players. These findings suggest that sports can enhance cognitive functions, regardless of the sport played.

Simulated patient videos to supplement integrated teaching in competency-based undergraduate medical curriculum.

The competency-based undergraduate medical curriculum in the preclinical years requires clinical topics to be taught using a linker clinical case for students to appreciate the clinical application of basic sciences. The objective of this study was to evaluate student and faculty satisfaction regarding the construct and delivery of an aligned and integrated curriculum that involved the use of linker clinical cases. We aimed at evaluating the perceptions and performance of students when paper cases were supplemented with a simulated patient (SP) video. This interventional study was conducted by inviting 250 medical students from the first professional phase from the 2020-2021 batch. Integrated modules were prepared for two clinical conditions: myocardial infarction (MI) and nephrotic syndrome (NS). The topic NS was taught with a paper-based case while the topic MI was supplemented with an SP video. Feedback from students and faculty was collected using a newly developed and validated questionnaire and focused group discussions. The students performed significantly better in the assessment conducted after the topic MI compared to NS. The majority of the students (80%) expressed a preference for the video to understand the clinical relevance when compared to the paper case. Overall, the students (83-87%) expressed satisfaction with integrated teaching sessions using clinical cases. Using linker clinical cases in an aligned and integrated preclinical curriculum allowed students to interrelate the subjects and apply them to clinical contexts. The SP videos prepared from an authentic setting facilitated learner engagement with a better understanding of the clinical relevance of the basic sciences.NOTE & NOTEWORTHY In this study, we have introduced linker cases to teach clinical correlation of basic sciences for integrated modules in the competency-based undergraduate medical curriculum. The novelty of our study is the inclusion of simulated patient video that was internally prepared and validated to supplement linker clinical paper cases in integrated modules.

Enhancing our ability to diagnose cardiac valve disease by applying a graphical educational game.

Objectives: This study aimed to compare a newly designed graphical educational game (GEG) with a case-based learning (CBL) exercise and to enhance our ability to apply physiological knowledge of the cardiac cycle to diagnose cardiac valvular diseases among preclinical medical students. Methods: In this interventional study, first-year undergraduate medical students were randomly assigned to a GEG group (n = 42) and a CBL group (n = 37). The GEG group involved shading cardiac cycle graphs and pressure-volume loops while the CBL group worked on two cases of cardiac valve diseases. A multiple-choice question (MCQ) test was then used to assess conceptual understanding of the cardiac cycle. After brief exposure to murmur auscultation on a simulator manikin, the groups were assessed in a simulator manikin test for their ability to diagnose cardiac valve disease. Median MCQ scores and mean scores in the simulator test were then compared using the Mann-Whitney U test. The student's perspectives of the GEG and simulation session were acquired on a 5-point Likert scale questionnaire. Results: The GEG group had significantly higher median MCQ scores (p < 0.001) and mean simulator test scores (p < 0.001) when compared to the CBL group. Moreover, 91% of students agreed that the GEG helped them to clarify concepts, and 88% agreed that the concepts and knowledge gained through the GEG helped them to diagnose valve disease in the manikins. Conclusion: The GEG was positively received by students and was more useful than the CBL in enhancing the application of cardiac physiology concepts and improving diagnostic ability in a simulated clinical setting.

Student perceptions towards online learning in medical education during the COVID-19 pandemic: a mixed-methods study.

BACKGROUND: This mixed-methods study was undertaken to ascertain undergraduate medical students' perceptions of remote learning following the COVID-19 restrictions. 545 students participated in this study. METHODS: Data was collected using a validated questionnaire and four focus group discussions. RESULTS: Regarding recorded lectures, the quantitative findings indicated that they were important during online learning and the qualitative findings explained that the recorded lectures enabled individual students to pace and customize their learning. The majority of the students agreed that recorded lectures were relevant to their learning, though they watched less than 50% of recorded lectures. Qualitative findings described procrastination as the rationale for not watching the videos. The online live lectures had a relatively higher percentage of contribution towards learning in comparison with instructor recorded video lectures. Students were more engaged with live lectures, and 63.3% of respondents agreed. Qualitative findings confirmed the opportunities for interacting with peers and better clarification of doubts by teachers during live lectures. CONCLUSIONS: Online learning with recorded and live lectures provided continuity in medical education during the COVID-19 pandemic. When compared to recorded video lectures, synchronous live lectures were regarded as superior by students largely due to the opportunity to directly communicate with the instructor and receive quick feedback.

A combined stimuli presentation for assessing facial emotion related N170, N250 and visual mismatch negativity in neuropsychiatric disorders.

Event-related potential (ERP) is a useful approach to assess the neurophysiological correlates of facial emotion processing. Previous studies examined the facial emotion recognition (FER) related ERPs (N170, N250, visual MisMatch Negativity) individually using ERP specific paradigms. This approach can be time-consuming and may not resemble real-life scenarios where an individual must process multiple stimuli simultaneously. The aim of the study was to assess the utility of a combined paradigm when compared to individual paradigms to measure N170, N250 and visual MisMatch Negativity (vMMN) in healthy controls (HC), utilizing emotion stimuli standardized in the Indian population. Further, the combined paradigm was examined in patients with schizophrenia (SCZ) to detect the differences in ERPs compared to HC. Within paradigms, ERPs showed higher amplitudes for emotion compared to neutral stimuli suggesting that the paradigms were able to detect valence associated with emotional stimuli. The combined paradigm was able to elicit decipherable peaks of N170, N250 and vMMN similar to individual paradigms. ERP data quality as assessed by analytic Standardized Measurement Error (aSME) showed a satisfactory aggregate score of above 2 for all the three paradigms. Combined paradigm approaches to record ERPs in neuropsychiatric conditions has the advantage of reducing the time required for task administration, avoiding practice effects, better subject cooperation and participation.

One-month long foundation course for newly joined Indian medical undergraduates: Faculty and students' perspective.

BACKGROUND: A one-month long foundation course has been introduced at the entry-level for first-year MBBS (Bachelor of Medicine and Bachelor of Surgery) students in the medical institutions across India from 2019. Therefore, the present study is aimed at describing the experience of implementing a one-month long foundation course conducted for the Competency-based Undergraduate Medical Curriculum (CBUC) of Indian Medical Graduate as per the guidelines from the National Medical Commission (NMC) (erstwhile Medical Council of India, MCI). We have evaluated the student and faculty perceptions towards the effectiveness of the program. METHODS: The foundation course had six modules Orientation, Skills, Field visit to Community Health Centre, Professional Development including Ethics, Sports and Extracurricular activities, Computer Skills, and Language enhancement program. Regular feedback wascollected from students (N = 250) and teachers (N = 26) involved in the Foundation course using a semi-structured questionnaire. The program's overall feedback was also obtained at the end of the course, using a validated questionnaire. The quantitative findings were expressed in frequency and percentage. The qualitative observations (reflections of students and faculty) were subjected to thematic. RESULTS: The students and faculty appreciated the one-month long foundation course. The course's defined objectives were met as indicated by most students (98.4%) and faculty (75%). The course seemed to be useful for students to embark on a formal MBBS curriculum. It also exposed them to new knowledge and practices, as indicated by the feedback. Thematic analysis of the students' and faculty's reflections was carried out and two themes were identified, i.e., 'strengths' and 'challenges.' The Foundation Course Committee will work out appropriate remedial measures to overcome the challenges in the future sessions for subsequent batches. CONCLUSIONS: The one-month-long foundation course was found to be beneficial for newly joined students to get introduced and adjusted to higher education systems' demands. Also, the challenges faced during the program needs to be addressed with suitable remedial measures while implementing for subsequent batches. This effort will ensure a smooth conduct of the foundation course for the future batches of medical undergraduates and make the program more effective.

Impact of readiness assurance process and faculty feedback on individual application exercises: a model for continuous assessment in physiology.

This study is aimed at the implementation of a continuous assessment model in physiology for a large-enrollment classroom with 250 students. The readiness assurance process (RAP) and immediate feedback elements from team-based learning (TBL) methodology were adopted to test their ability to guide students to solve applications exercises individually. Three continuous assessments in physiology (CAPs) were conducted with the RAP to include individual (iRAT) and group readiness assurance tests (gRAT). Immediate feedback was provided with faculty-student discussion (FSD), and the individual application exercises (iAE) were designed to be answered individually. Each CAP was subjected to three types of experimental manipulation in subgroups created out of 250 students. The intervention began with iRAT for all three subgroups. The sequence of iRAT, gRAT, FSD, and iAE varied between subgroups within a CAP. In a cross-over study design, each subgroup of students was subjected to all three intervention types over three CAPs. The subgroup completing iAE after RAP and FSD showed higher scores than the subgroup with RAP alone. One hundred eight-two students (82.35% response rate; 101 women and 81 men) responded to the questionnaire. The majority of students (87.4%) felt that doing iRAT and gRAT at the beginning helped them to solve iAE better. Most of the students (86.8%) responded that they received useful feedback and clarification during the discussion with the teacher after the gRAT. In conclusion, the administration of iRAT first followed by gRAT and immediate feedback from faculty seem to be beneficial to prepare students to tackle application-based exercises.

Predictive performance of traditional and novel lipid combined anthropometric indices to identify prediabetes.

BACKGROUND AND AIMS: Diabetes mellitus is one of the critical public health challenges in the Indian healthcare scenario. Novel anthropometric indices are promising surrogate markers to detect prediabetes compared to the traditional anthropometric indices that only reflect gross obesity. Thus, the authors aim to analyse the potential of three novel lipid combined anthropometric indices in predicting prediabetes in the Asian Indian population. METHODS: We conducted an age and gender-matched case-control study to identify the predictors of prediabetes. Prediabetes was diagnosed as per the American Diabetes Association (ADA) guidelines 2010. The traditional anthropometric measurements including waist circumference (WC), waist to hip ratio (WHR) and body mass index (BMI) were executed using standardised methods. Fasting lipid profile was obtained and using standardised formulas, the novel lipid combined anthropometric indices such as lipid accumulation product (LAP), visceral adiposity index (VAI) and triglyceride glucose index (TyG index) were derived. TyG related indices such as triglyceride glucose-waist circumference (TyG-WC) and triglyceride glucose-body mass index (TyG-BMI) were also calculated. RESULTS: The novel lipid combined anthropometric indices LAP, VAI, TyG index, TyG-WC and TyG-BMI were significantly higher in subjects with prediabetes of both the genders (p < 0.05). During receiver operating characteristic (ROC) curve evaluation, TyG index (AUC = 0.802) was the superior predictive measure in males, while in females, TyG-WC (AUC = 0.767) was the best among all the markers. CONCLUSION: TyG index and TyG-WC seem to be a superior indicator of prediabetes in the Asian Indian population in comparison with other anthropometric indices to screen prediabetes.

Application of Case-Based Readiness Assurance Process as a Model for Case-Based Pedagogy and Collaborative Learning in Physiology.

The preclinical phase of the undergraduate medical curriculum has to embed clinically relevant learning experience to bridge basic sciences with clinical disciplines. Student-centric educational methods like the readiness assurance process of team-based learning promote active learning. In this study, we report our implementation of the case-based readiness assurance process (CBRAP) as a case-based strategy for introducing early clinical exposure in the preclinical phase of the undergraduate medical curriculum in India. Four CBRAPs with individual and group readiness assurance tests (IRAT and GRAT) were conducted in four different systems taught in physiology (hematology, muscle physiology, cardiovascular physiology, and renal physiology). The multiple-choice questions for CBRAP were specifically designed to test application and problem-solving by incorporating clinical vignettes with pathophysiology and lab findings. This study was designed to involve all 250 students from the first professional year. The GRAT scores were significantly more than mean IRAT scores in all four CBRAPs (p value < 0.001). The GRAT scores in the second, third, and fourth CBRAPs were significantly better than the GRAT score of the first CBRAP (p value < 0.001). The GRAT scores correlated significantly with mean IRAT in three out of four CBRAPs and with the highest IRAT in two out of four CBRAPs. Based on the student feedback of CBRAP and other case-based strategies, it was found that students preferred CBRAP and the majority of students reported that discussion of CBRAP questions with team members was useful. In conclusion, innovative case-based teaching methods with active student involvement can be incorporated in the preclinical curriculum for improving learning outcomes.

Body composition analysis, anthropometric indices and lipid profile markers as predictors for prediabetes.

OBJECTIVES: To compare different anthropometric indices, Body composition analysis and lipid profile markers in terms of their ability to predict prediabetes (PD). METHODS: We enrolled 83 subjects with PD and 84 normoglycemic subjects who were matched for age and gender. The diagnosis of prediabetes was done according to the American Diabetes Association (ADA) criteria. All subjects were aged between 30-55 years of age and visited the outpatient department of tertiary care hospital. Anthropometric and lipid profile measurements were obtained. Analysis of body composition was done using Bodystat 1500MDD Instrument. Backward logistic regression was performed for detecting the predictors of PD. A receiver operator characteristic curve (ROC) with area under curve (AUC) was utilized for the accuracy of the predictors of PD. RESULTS: Comparison of anthropometric measurement and body composition analysis parameters between the two groups showed that Waist circumference (WC), Body mass index, Body Fat% were significantly higher whereas Extracellular water and Dry lean weight in percentage (ECW% and DLW%) were found to be lower in PD (p< 0.05). Higher triglyceride (TG) levels and lower high-density cholesterol (HDL-C) with high TG/HDL-C were seen in subjects with PD. Backward logistic regression analysis found the combination of Body Fat % with WC, TG, ECW% and DLW% as strong predictors of PD. In ROC analysis, ECW% (AUC = 0.703) was the most predictive measure, followed by WC (AUC = 0.702). CONCLUSION: This study demonstrated that estimation of Body Fat % combined with waist circumference, Extracellular water and Dry lean weight in percentage are valuable in screening and diagnosis of prediabetes. Plasma levels of TG in lipid profile measurements can also serve as an additional marker for prediction of prediabetes.