Need Assessment for Updating the MBBS Curriculum 2012 of Bangladesh.

Curriculum is the road map of any course and an instrument for developing the competencies of the human resources. The MBBS curriculum in our country was last updated in 2012 during the period of Millennium Development Goals (MDGs). Since then it has been under implementation in different government, non-government and Army medical colleges in association with different universities. "Health Professional for a New Century" now asks for a transformation of the education to strengthen the health systems for meeting the challenges of the 21st century. Curriculum reform is an important issue in transformative education and need assessment is the first and essential task to review and update any curriculum. The objective of the study was to assess the need to review and update the MBBS curriculum 2012 of Bangladesh. Review and updating of MBBS curriculum was organized by Centre for Medical Education (CME) and supported by World Health Organization (WHO). CME, DGHS, Dean offices, MOH&FW, BM&DC and all the government and non-government medical colleges were involved in this activity. Duration of study was 7 months from April 2019 to October 2019. Data were collected from academic councils of 102 medical colleges through structured questionnaire and through FGD with teachers and interns. Around 90(88.2%) academic councils agreed and 12(12%) disagreed about the appropriateness of existing four phases of MBBS curriculum. About 80(84.2%) academic councils agreed with 1.5 years duration of Phase I, 84(88.4%) agreed with one year duration of Phase II, 84(94.4%) agreed with one year duration of Phase III and 77(84.6%) agreed with 1.5 years duration of Phase IV. The study suggested the subjects for 2nd phase are, Pharmacology 74(84.1%), Pathology 53(60.3%), Forensic Medicine 46(52.3%), and for 3rd phase are Community Medicine 60(69.8%), Microbiology 54(62.8%). The study revealed that the subjects of overloaded contents are, Anatomy - 24(50%), Community Medicine - 35(72.9%) and Pathology - 19(39.6%). The study suggested incorporation of organized teaching-learning for behavioral science, communication skills, ethics and development of attitude by most of the academic councils. The study suggested that the increased duration of ambulatory care (outdoor/emergency) teaching. The study revealed around 84(83.2%) academic councils recommended that Single Best Answer (SBA) type of questions should be included in MCQ part for all subjects along with multiple true-false response and around 82(81.2%) academic councils recommended that Structured Essay Question (SEQ) should be included in written part along with Short Answer Question (SAQ). The study revealed that 58(58.6%) academic councils recommended that carry-on system should not be in Phase I and 53(53.5%) academic councils opined to introduce grading system in MBBS course. Most of the academic councils agreed about the appropriateness of existing four phases of MBBS curriculum. The subjects for 2nd phase are, Pharmacology - 84.1%, Pathology - 60.3%, Forensic Medicine - 52.3%, and for 3rd phase are Community Medicine - 69.8%, Microbiology - 62.8%. Most of the participants are in favour of the present curriculum components, grading system for assessment but not the carry-on system in Phase I. The study recommended for national level consultations involving the concerned persons for finalization of the MBBS curriculum.

Extrapulmonary tuberculosis in surgical specimens.

Tuberculosis is a very common lesion in surgical specimen in our country. This study was designed to explore the distribution of extrapulmonary tuberculosis (EPTB) in various organs through examination of surgical specimens. A total of 103 specimens were diagnosed as tubercular lesion by histological evaluation in the department of pathology, Mymensingh Medical College and a private laboratory during the period from January 1997 to August 1998. Out of 103 cases 36 were male and 67 were female (M: F = 1:1.8) and their age ranged from 4-75 years (median age 28 years). The lesions were distributed as follows: lymphnode 86 (84.9%), intestine 9 (8.7%), bone 2 (1.9%), epididymis 2 (1.9%), fallopian tube 1 (0.97%), pharynx 1 (0.97%) tonsil 1 (0.97%) and nasal mucosa 1 (0.97%). Out of 86 cases of tubercular lymphadenitis, 61 (89.7%) were cervical, 6 (6.8%) were mesenteric and 1 (1.5%) was inguinal. Sixty nine percent clinically diagnosed cases were consistent with histological findings (18 out of 26). This study reveals, in our locality, EPTB is very common in early adulthood with female preponderance. Cervical lymph node is very common sites for EPTB.

Evaluation of 500 cases of Pap's test in Mymensingh.

Papaniculaou test (Pap's test) is a screening test for cervical pre-malignant and malignant lesions. A total of 500 cases of Pap's smear were examined in a private laboratory in Mymensingh during the period from May, 1997 to April 1998. The aim of the present study was to find out the patterns of cytologically detected lesions in these cases. The age of the case range from 17 to 65 years. Majority of the cases was in the age group of 21-30 years (53%). The pattern of cytologically detected lesion was as follows: within normal limit 13.8% (69), Chronic non-specific inflammation 82.8% (414), inflammation associated with Tricomonus vaginalis 1.6% (8), candidiasis 3.2% (16), Herpes simplex 0.6% (3), low grade squamous cells of undetermined significant (ASCUS) 0.6% (3), low grade squamous intraepithelial lesion (LSIL) 1.2% (6), high grade squamous intraepithelial lesion (HSIL) 0.6% (3), squamous cell carcinoma (SCC) 0.2% (1) and squamous metaplasia 1.4% (7).

Tuberculous prostatitis--a case report.

Tuberculous prostatitis is a rare condition. A 55 years-old man admitted into a surgery unit of Mymensingh Medical College Hospital with features of prostatism. After clinical examination and investigations, it was diagnosed as a case of benign enlargement of prostate (BEP) and surgery was decided to do. During exploration a large cystic cavitation found in prostate and the intact median lobe taken out for histopathological examination, which revealed tuberculous granuloma. The patient had no evidence of past or present pulmonary tuberculosis. He was treated with anti-tubercular chemotherapy and responded well. No such case is found reported in Bangladesh yet in through medline search database. So, the case is reported here.

Pulsed electromagnetic fields for the treatment of bone fractures.

The effectiveness of electrical stimulation and Pulsed Electro Magnetic Field (PEMF) stimulation for enhancement of bone healing has been reported by many workers. The mechanism of osteogenesis is not clear, therefore, studies look for empirical evidence. The present study involved a clinical trial using low amplitude PEMF on 19 patients with non-union or delayed union of the long bones. The pulse system used was similar in shape to Bassett's single pulse system where the electric voltage pulse was 0.3 mSec wide repeating every 12 mSec making a frequency of about 80 Hz. The peak magnetic fields were of the order of 0.01 to 0.1 m Tesla, hundred to thousand times smaller than that of Bassett. Among the 13 who completed this treatment schedule the history of non-union was an average of 41.3 weeks. Within an average treatment period of 14 weeks, 11 of the 13 patients had successful bone healing. The two unsuccessful cases had bone gaps greater than 1 cm following removal of dead bone after infection. However, use of such a low field negates Bassett's claim for a narrow window for shape and amplitude of wave form, and justifies further experimental study and an attempt to understand the underlying mechanism.