Critical performance analysis of rotating resident doctors in Iraq.

The present study was undertaken to evaluate the competence of rotating residents in handling clinical problems, falling under the purview of the major clinical disciplines, which they come across during their routine work. Three hundred and one rotating residents (55% of the total) who graduated in June 1981 from the four universities of Iraq, namely, Mustansiryia, Basrah, Mosul and Baghdad, and were currently undergoing their residency posting in the various hospitals of Iraq were selected for the study. Two approaches were used to assess the level of competence: first, on the basis of the resident's responses to fifty simulated patient-management problems and, secondly, their critical performance in patient care adjudged by their respective supervisors. A minimum passing level (MPL) was fixed for patient management problems (PMP). The score for the consultant's observations could range from -70 to +100 to represent the very poor and the very good performance. Only 2% of the residents were found to have reached the minimum pass level of competence taking their overall performance in the various disciplines. No significant variation in performance was observed in relation to the university of graduation. None of the residents could reach the MPL in the case of obstetrics and gynaecology. In the case of medicine and medical emergency the findings were almost similar. The residents put up a much better performance in orthopaedics and paediatrics (45.0% and 27.5% respectively). According to the supervisors' assessment nearly two-thirds of the residents secured at least 50% of the maximum score. The study underscores the need to redefine our educational objectives specifically, with aim of developing competences at a defined level in the learner befitting the needs of the health system through a competency-based curriculum.

Community medicine.

It has become increasingly apparent that traditional medical education serves badly the need of many developing countries to provide effective health care for widely dispersed and often poor communities. This article describes a training programme developed in Iraq to provide final-year medical students with stimulating practical experience in community health care.

A measure of community health needs and actions in a rural area of Iraq. The Abu-al-Khasib experience.

A longitudinal enquiry was carried out among randomly selected households in four villages in Abu-al-Khasib district of Iraq, to study health needs as perceived by the community and actions people take when the need arises. Almost three-quarters of the spells of sickness as perceived by the community were among mothers and children. Most of the morbidity was found to be within the scope of preventive services at the local health centre level. Health centre services were underutilised. Only half of the spells of sickness were reported to the local health centres for medical care; a reason for this phenomenon is the emerging preference for care at the hands of clinical specialists. The action the community takes when a health need arises depends on their perception and this is determined by rapid social and educational development. The need to increase demand for normal care, especially that of mother and child, is stressed; this care may be strengthened through introduction of a domiciliary component.

The prevalence of sickle cell disease in Abu-AL-Khasib district of southern Iraq.

At attempt was made to estimate the prevalence of sickle cell disease among the primary school children in Abul-al-Khasib district of southern Iraq which is known for a relatively high prevalence. Examination of 706 children in the age group of 10 to 12 years from 10 out of 20 schools randomly chosen in four villages of Abu-al-Khasib showed an overall prevalence rate of 16% as compared to 2.5% seen in a control population of 525 children belonging to five urban schools in Basrah. Sickle cell trait was evident in 13.3% of the cases. Sickledex was used for initial testing and those showing positive sickling phenomenon were confirmed by cellulose acetate haemoglobin electrophoresis. The need for introducing early screening measures as well as marriage/genetic counselling as part of the overall health and welfare services in stressed.

Profile of the medical student and his outlook on medical education--the Basrah experience.

The aim of the study was to obtain the students' views on the current system of medical education with focus on training and evaluation in the College of Medicine, University of Basrah, Iraq. The data were gathered by circulation of a questionnaire to students belonging to all the classes (1 to 6 years). An attempt was made to look for trends in student responses and attitudes over the years. National service, i.e., joining the national health care system, appears to be the dominant motive among the first- and second-year students in choosing the profession. Though the practice of general clinical disciplines at the basic doctor's level are preferred, general practice per se does not seem to be popular. An apparent dislike for certain curricular subjects was observed which was more evident among students who had to pass an examination in that subject during the particular year. Lectures and dictation of notes are rated low. A good majority of students consider their active participation in the learning-teaching process as something highly useful. Though examinations are not generally liked, the students showed their preference for periodical tests as compared to a single annual examination. Students generally do not prefer assessment based on problem solving exercises. Little use is made of the library and there is hardly any student-teacher contact outside the classroom. The study has brought out the need for greater emphasis on self-directed learning. The relevance of the students' views in educational planning are highlighted in the discussion.

Demographic and health characteristics of a rural Iraqi population.

The population of 2 representative villages in Abu-al-Khasib field practice area of the College of Medicine, Basrah in Southern Iraq was surveyed during 1979 for baseline information relating to demographic and health characteristics. The total population covered was 3399. Women of child bearing age together with children under 15 years of age accounted for 68% of the population. The birth rate was 49 and death rate, 14.5 per 1000. Nearly 10% of the morbidity was evident among women of child bearing age. The enquiry revealed a general awareness concerning the existing health care facilities available in the area. Local health centres were utilised mainly for treatment of childhood illnesses. Only 12% of the mothers used them for care during pregnancy.

The prevalence of diabetes mellitus in a rural community in Iraq.

A survey was undertaken to estimate the prevalence of diabetes mellitus in a rural community in Iraq. Blood-sugar estimations after glucose-loading were performed on a sample of a village population 15 + years. 4.8% had diabetes and a majority of them had symptoms referable to their diabetic state. Diabetes was totally unknown among this rural population before the survey.