Creation of Virtual Patients for Undergraduate and Postgraduate Medical Education: An Experience from Pakistan.

OBJECTIVE: To create virtual patients as an educational tool to determine their feasibility and effectiveness in clinical problem solving. STUDY DESIGN: Cross-sectional study. Place and Duration of the Study: The Aga Khan University Hospital, Karachi, from 2018 to 2021. METHODOLOGY: Prototype virtual patients were developed at the Aga Khan University Hospital, Karachi, for medical trainees. Articulate Storyline 360 software was used for creating clinical encounters. Undergraduate students and postgraduate trainees were selected using purposive sampling to practice on these virtual patients (VPs). They were asked to provide feedback on the construction and usefulness of virtual patients as a learning modality. RESULTS: Two VPs were created and used. The geriatric VP was used for the assessment of final-year students. Twenty-five students gave detailed feedback after completion. Most (90%) agreed that the VP provided realistic scenarios and improved clinical reasoning. Almost five identified the need to improve navigational instructions. The pediatric VP for postgraduate trainees was well received. Almost 90% reported that it facilitated learning and improved knowledge and clinical reasoning. There was a 30% increase in post-test scores, supporting it as an adjunct resource for clinical learning. CONCLUSION: Virtual patients can be easily created using local disease patterns to make learning more contextual. They enhance clinical reasoning and decision-making in a safe learning environment.   Key Words: Medical education, Virtual patients, e-learning.

Anxiety Disorders: Flying Under the Radar of Mental Health.

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Effectiveness of Simulation-based Clinical Skills Training for Medical Students in Respiratory Medicine: A Pilot Study.

OBJECTIVE: To assess the effectiveness of high-fidelity simulation-based medical education (HF-SBME) in teaching and learning respiratory clinical examination in medical students. STUDY DESIGN: Quasi-experimental pilot study. PLACE AND DURATION OF STUDY: The Aga Khan University, Karachi, from November 2018 to January 2020.   Methodology: This study was conducted amongst third year medical students at the University. Students were assigned to intervention (IG) or control groups (CG). The IG underwent training for the respiratory clinical examination on a high-fidelity simulator mannequin, while the CG received the conventional practice session on standardised patients. Students were assessed on their respiratory clinical examination skills in five domains, and each domain was scored between 1-3 points (poor=1, fair=2, good=3) for a maximum composite score of 15. Feedback on use of SBME was also obtained from students. RESULTS: There were no statistically significant differences in demographics for the CG (n=41) and IG (n=40). Composite score for control and intervention groups was not significantly different (CG: 12.9 ± 1.89 vs. IG: 12.0 ± 2.35; p=0.067). However, a greater percentage of CG students were rated good in all five domains, with the difference being statistically significant for ability to correlate findings with clinical history (CG: 87.8% vs. IG: 67.5%; p=0.028). CONCLUSION: Although medical students perceived HF-SBME as a beneficial teaching modality, it did not translate into improved performance. More research is required to determine the utility of HF-SBME in a developing country, like Pakistan. Key Words: Simulation, High-fidelity, Medical education, Developing country, Clinical skills.

Health literacy in Pakistan: Exploring new ways of addressing an old challenge.

Pakistan continues to struggle with low health literacy that often results in late presentation of disease, poor adherence to treatment and meagre understanding of wellness and disease prevention. In a country burdened by diseases of the developing and the developed world, with poor healthcare infrastructure and low literacy levels improving healthcare literacy could have major influence on health and wellness of our masses. Utilising our rapidly expanding mobile technology and media for dissemination of health information is a viable solution. Public service announcements for media and health information apps for mobile technology can be developed by the government, health sector and media partnership. A systematic, multi-level targeted approach to health literacy would allow health seekers the opportunity to understand and comprehend disease prevention, symptomatology and treatment.

Mimicking rashes: Use of moulage technique in undergraduate assessment at the aga khan university, Karachi.

BACKGROUND: The use of simulated patients in student assessment is supported by the Best Evidence Medical Education and U.S. Agency for Healthcare Research and Quality, and it provides a safe and effective alternative to real patients in many situations. To assess the validity and feasibility of moulage technique-where a cosmetically constructed rash is used on simulated patients-two dermatologic rashes were developed using moulage simulation on standardized patients at Aga Khan University Hospital for 3rd year medical summative Objective Structured Clinical Examination (OSCE). METHODS: Checklists for cases that focused on history taking of a skin rash were developed. These also included a description and identification of lesions, differential diagnosis, and basic management. Cases were first reviewed and approved by the Educational Committee and a dermatologist content expert. Stations were piloted to assess validity and feasibility. Simple nontoxic materials were used to develop the rash by faculty familiar with moulage simulation. RESULTS: Sixty-four students were assessed on a Herpes Zoster case and 32 students on a Herpes Simplex case in morning and afternoon sessions. The total mean score obtained at all OSCE stations was 64.82 ± 10.22. Mean scores on the morning and afternoon dermatology stations were 62.72 ± 9.74 and 69.03 ± 9.98, respectively. Face validity for both stations was established through input of content experts. The internal reliability as measured by Cronbach's alpha between the checklist items on the morning and afternoon stations was acceptable at 0.60 (20 items) and 0.65 (18 items), respectively. DISCUSSION: The use of moulage technique to develop dermatologic lesions on simulated patients may be utilized for student assessment.

The case for family medicine in Pakistan.

The specialty of Family Medicine enjoys a special position in the medical practice of the West, serving as one of the key primary care specialties. Family physicians act as providers of first contact catering to the medical needs of the entire family in all aspects of preventive, curative and rehabilitative stages of illness and to health maintenance. The growth of this specialty, however, has lagged behind in Pakistan for various reasons. Having both a high burden of communicable and non-communicable diseases in Pakistan; family physicians should form the frontline force in dealing with these health issues. Several success stories of Family Medicine forming the base of medical services have been noted, validating its presence and propagation. The World Health Organisation also supported this in its 2008 report that discusses primary care for all. Growth of family practice needs to be encouraged at both undergraduate and postgraduate levels to ensure adequate training and provision of quality of medical care to our society. The need of the hour is that both medical institutions and the government develop policies to strengthen Family Medicine and incentivise family practice in rural and urban settings to cater to the needs of society at large.

Polypharmacy in elderly: a cautious trail to tread.

Polypharmacy has now increasingly come into focus as the recipient of healthcare in old age worldwide. In elderly it is associated with frequent adverse drug reactions (ADRs) and drug-drug interactions resulting in significant morbidity. Geriatrics is still an emerging specialty in South Asia, especially in Pakistan, where multiple reasons for polypharmacy exist. An extensive literature review of articles using key words like 'polypharmacy,' 'elderly' was conducted. The recently updated Beers Criteria of classification of inappropriate drugs in the elderly was reviewed in detail. Articles of relevance to polypharmacy and evaluation of guidelines for appropriate interventions to minimise inappropriate drug prescribing were also reviewed. Commonly prescribed drugs like psychotropic, cardiovascular, nonsteroidal anti-inflamanatory drugs (NSAIDs) and oral hypoglycaemics can cause significant adverse events when prescribed to the elderly. Primary care physicians may use evidence based non-pharmacological interventions which may be appropriate to use in selected cases. Drugs can affect quality of life and morbidity in the elderly. A basic understanding of ageing physiology and pharmacology along with a step-wise approach to prescribing in the elderly maybe helpful in minimising iatrogenic complications of commonly used drugs in this age group.