Neelam R Dwivedi

Student feedback about the integrated curriculum in a Caribbean medical school

Purpose: Xavier University School of Medicine adopted an integrated, organ system-based curriculum in January 2013. The present study was aimed at determining students’ perceptions of the integrated curriculum and related assessment methods. Methods: The study was conducted on first- to fourth-semester undergraduate medical students during March 2014. The students were informed of the study and subsequently invited to participate. Focus group discussions were conducted. The curriculum’s level of integration, different courses offered, teaching-learning methods employed, and the advantages and concerns relating to the curriculum were noted. The respondents also provided feedback about the assessment methods used. Deductive content analysis was used to analyze the data. Results: Twenty-two of the 68 students (32.2%) participated in the study. The respondents expressed generally positive opinions. They felt that the curriculum prepared them well for licensing examinations and future practice. Problem-based learning sessions encouraged active learning and group work among students, thus, improving their understanding of the course material. The respondents felt that certain subjects were allocated a larger proportion of time during the sessions, as well as more questions during the integrated assessment. They also expressed an appreciation for medical humanities, and felt that sessions on the appraisal of literature needed modification. Their opinions about assessment of behavior, attitudes, and professionalism varied. Conclusion: Student opinion was positive, overall. Our findings would be of interest to other medical schools that have recently adopted an integrated curriculum or are in the process of doing so.

Standardized Patient’s Views About their Role in the Teaching-Learning Process of Undergraduate Basic Science Medical Students

INTRODUCTION Standardized Patients (SPs) are widely used in medical education. SPs have a number of advantages but also have certain limitations. At the institution, SPs have been used since January 2013 for both teaching-learning and assessment during the basic science years of the undergraduate medical program. AIM The present study was conducted to investigate the perception of SPs about various aspects of the program and obtain suggestions for further improvement. MATERIALS AND METHODS A Focus Group Discussion (FGD) was conducted with a group of five SPs during the second week of November 2015. Respondents were explained the aims and objectives of the study and invited to participate. Written informed consent was obtained. The FGD was conducted using a discussion guide and was audio recorded. Various aspects of the SP program at the institution were discussed. Motivation/s for joining the program and suggestions for further improvement were obtained. Transcripts were created after listening to the recordings and were read through multiple times. Similar responses were coded. Items with similar codes were grouped together into themes. RESULTS Three respondents were female while two were male. The major advantage of SPs was their flexibility and ability to present a standardized response to the student. Students become familiar and comfortable with SPs. However, as a SP is simulating an illness s/he may not always be able to do complete justice to the role. The process used by SPs to prepare themselves to portray various diseases was highlighted. The use of SPs both during teaching-learning and assessment was also discussed. Some SPs are trained to provide feedback to students. Most SPs joined the program based on invitations from their friends who were already SPs. Challenges in recruiting SPs in a small island were discussed. Suggestions for further improvement were obtained. CONCLUSION The present study obtained the perception of SPs regarding various aspects of the SP program at the institution. The overall opinion of SPs was positive.

Intraoperative and Immediate Postoperative Outcomes of Cataract Surgery using Phacoemulsification in Eyes with and without Pseudoexfoliation Syndrome

BACKGROUND To compare the intraoperative and immediate postoperative behavior and complications in eyes with pseudoexfoliation (PEX) syndrome with eyes having senile cataract without PEX during cataract surgery using phacoemulsification (PKE). MATERIALS AND METHODS In this prospective study, 68 eyes of 68 patients were divided into two groups: Group 1 (test) comprised 34 eyes with immature senile cataract with PEX and Group 2 (control) included 34 eyes with immature senile cataract without PEX and any coexisting ocular pathology. Phacoemulsification (modern cataract surgery) was performed on both groups through stop and chop technique and comparative analysis of the incidence of intraoperative and immediate postoperative complications was made. RESULTS There was no significant difference in rates of intraoperative complications between PEX (2.9%) and Control (0%) group. The mean pupil diameter was significantly smaller in Group 1 (p<0.001). No eye in either group had phacodonesis. 58.8% of eyes in Group 1 and 29.4% in Group 2 had a harder cataract (nuclear sclerosis) ≥ grade 3 (p=0.017). PKE was performed in all eyes with cataract in both groups. Intraoperative complication (zonular dialysis (dehiscence) was encountered in only 2.9% (1 case) of eyes with PEX. PC (posterior capsule) tear (rent) with vitreous loss was seen in 2.9% eyes of Group 1 and none in Group 2. Postoperatively, IOP (intraocular pressure) and aqueous flare response were comparable between the groups. Significantly higher inflammatory cell response was observed in Group 1 (p=0.014). BCVA (best corrected visual acuity) using Snellen chart with pinhole on postoperative day1 was significantly better in the control group compared to the group with PEX (p=0.027). CONCLUSION Phacoemulsification can be safely performed by experienced hands in cataractous eyes with PEX. The incidence of intraoperative and immediate post-operative complications in eyes with PEX was not significantly different compared to eyes without PEX in our study. Further studies among a larger population are required.

Attitude of Basic Science Medical Students Toward Interprofessional Collaboration.

Purpose: Interprofessional collaboration (IPC) and interprofessional education (IPE) are increasingly emphasized in the education of health professions. Xavier University School of Medicine, a Caribbean medical school admits students from the United States, Canada, and other countries to the undergraduate medical course. The present study was carried out to obtain information about the attitude toward IPC among basic science medical students and note differences, if any, among different subgroups. Methods: The study was conducted among first to fifth semester students during July 2015 using the previously validated Jefferson Scale of Attitudes Toward Interprofessional Collaboration (JeffSATIC). Gender, age, semester, and nationality were noted. Participants’ agreement with a set of 20 statements was studied. Mean total scores, working relationship, and accountability scores were calculated and compared among different subgroups of respondents (p<0.05). Results: Sixty-seven of the 71 students (94.4%) participated. Cronbach’s alpha value of the questionnaire was 0.827, indicating good internal consistency. The mean total score was 104.48 (maximum score 140) while the working relationship and accountability scores were 63.51 (maximum score 84) and 40.97 (maximum score 56), respectively. Total scores were significantly higher among third-semester students and students of Canadian nationality. Working relationship and accountability scores were higher among first and third-semester students. Conclusion: The total working relationship and accountability scores were lower compared to those obtained in a previous study. Opportunities for IPE and IPC during the basic science years should be strengthened. Longitudinal studies in the institution may be helpful. Similar studies in other Caribbean medical schools are required.

Approach to learning of medical students in a Caribbean medical school

There are three main approaches to learning. Deep approach (DA) is an organized one where the emphasis is internal and learners are motivated by the relevance of the syllabus to their personal needs (4). Surface apathetic approach (SAA) is a superficial method of learning where the emphasis is on memorization