Soumendra Sahoo

Finding self-directed learning readiness and fostering self-directed learning through weekly assessment of self-directed learning topics during undergraduate clinical training in ophthalmology

Background: To know the individuals current level of readiness and to manage self-directed learning (SDL) not only help learners but also the instructors. The objectives of this study were to find SDL readiness among 4th year medical student and to analyze the effect of weekly assessment of SDL topics. Methodology: This was a cross-sectional study to analyze the effect of weekly assessment of SDL topics in fostering SDL. The 51 4th year students during a clinical posting in ophthalmology participated for this study. Each recruited student was tested for SDL readiness through the SDL readiness scale (SDLRS) developed by Lucy Guglielmino (1978), which was validated in our local setting and responses were collected from students on the 1st day of the clinical posting. The students chose SDL topics which were assessed on a weekly basis in the form of scenario-based multiple choice questionnaires. Written feedback was collected from each student regarding such activity during their clinical posting, especially to know the actual utilization of SDL hours provided in teaching schedule, satisfaction on the type of questions and motivation for SDL. Results: The mean SDLRS score in male students were 214.15 ± 19.73 and in female 207.95 ± 17.983, which falls under average score as defined in Guglielmino scale. The majority of study population expressed better utilization of SDL study hours because of weekly assessment than when they had no assessment for SDL. Conclusions: Majority of the study population were found to be ready for SDL. The weekly assessment of SDL topics was found to stimulate proper utilization of SDL slots in teaching schedule thereby fostering SDL habits.

Peer-Assisted Learning Activities During Undergraduate Ophthalmology Training: How the Medical Students of Asia Pacific Region Perceive.

ObjectivesThe aims of this study were to identify the attitude of peer tutors (PTs) toward peer-assisted learning (PAL) and to explore the perceived benefits of PAL by PTs and peer learners (PLs). DesignA qualitative and quantitative research study. MethodsThis study involved fourth-year medical undergraduates during their clinical posting in ophthalmology. One PAL session was conducted in each of the 4-week clinical postings. Peer tutors were selected during the first week and were briefed on PAL. Premultiple and postmultiple choice questions were distributed to PLs before and after each PAL session. One focus group discussion was conducted with PLs to explore their perception. Peer tutors were requested to give feedback in the form of structured Likert scale statements with 2 open-ended questions. ResultsA total of 104 students, 6 PTs and 98 PLs, participated in this study. Both tutor and learner groups expressed positive attitudes toward PAL. Peer learners preferred having PAL in a clinical setting. There were some issues related with PAL that emerged from both groups. Success in PAL depends on the teaching ability of PTs. ConclusionsStudents have positive perceptions toward PAL. Most of the students believed PAL was beneficial to them.

Association of Well-Being Index and Cognitive Impairment with Primary Open Angle Glaucoma Patients of Malaysia: A Case-Control Study

The purpose of this study was to determine the association of well-being and cognitive impairment with primary open angle glaucoma (POAG) patients attending a tertiary care hospital in Malaysia. Fifty-four individuals were recruited for study as cases were matched with 60 individuals as the control subjects, and data were collected using the WHO well-being index and the validated 6-item cognitive impairment test dementia test. The results showed that there was no significant association between gender, ethnicity, socioeconomic status and POAG. Patients with POAG had significantly lower well-being index scores (mean 67.93) than the control group (mean 81.60) with P-value < 0.001. Similarly, patients with POAG had a significantly higher score of cognitive impairment (CIT test) (mean 6.15) compared to the control group (mean 0.40) with P-value < 0.001. Consequently, POAG is likely to be associated with higher cognitive impairment and lower well-being index.

Effectiveness of skeleton handouts during ophthalmology theory lectures for undergraduate medical students.

Background: Although lecture handouts are commonly given to students during theory lectures, students’ perception, as well as their performance, can vary depending on the type of handouts they receive for information processing. Methodology: This is a quasi-experimental study involving 6th semester medical students. The study was conducted during theory lectures on ophthalmology. The two types of notes given to the students were comprehensive handout and a skeleton handout, which included some lecture notes but required substantial annotation by the students. Pre-test and post-test in the form of multiple choice questions were conducted before and after the lecture session, respectively. Results: There was a significant difference of mean score of pre- and post-test between skeletal handout (pre = 1.85 ± 1.275, post = 4.85 ± 0.363) and full handout (pre = 1.92 ± 1.09 post = 2.61 ± 0.771) with P < 0.001. However, the students’ responses to questionnaires indicated a strong preference for much detailed handouts as essential to preparation for examinations. Conclusion: The student can improve their performance during examination while working on skeletal handouts during theory lectures in spite of showing a preference for complete handouts.

Posterior Capsule Rupture With/Without Vitreous Loss During Phacoemulsification in a Hospital in Malaysia.

PurposeThis study was undertaken to determine the risk factors and the point at which posterior capsule rupture (PCR) with/without vitreous loss occurred after cataract surgery and the precautions to be taken to avoid it in the future. DesignA retrospective study. MethodsPatients who underwent cataract surgery from January 2011 to December 2012 in a hospital in Malaysia were studied. The data were obtained from the National Eye Database of Malaysia. ResultsOf 80.4% eyes (2519) that had undergone phacoemulsification, it was found that 3.06% (77) of the cases had PCR as one of the complications. The largest number of PCRs happened during cortical removal (35.2%), followed by segment removal (25.4%), cracking (8.5%), and aspiration of the oculoviscodevice (8.5%). It has been found that the rupture most often occurred during cortex removal by consultants, whereas most PCRs occurred during segment removal by specialists. ConclusionsThis study reveals that around 3% of patients had PCR during phacoemulsification. It is important to recognize PCR and presence of vitreous loss intraoperatively to prevent further complications of cystoid macular edema and endophthalmitis.

Formative Assessment of Ophthalmology Problem-Based Learning Tutorials During Undergraduate Medical Training.

PurposeOne of the major challenges lies in the use of strategies to assess students working in small groups. The assessment by tutors and peers, and self-assessment by students appear to be integral parts of problem-based-learning (PBL) tutorials. Our study aimed to analyze the formative assessment scores by students themselves, their tutor and peers during undergraduate ophthalmology tutorials. DesignA cross sectional study. MethodsOne hundred undergraduate students’ self-assessment made during ophthalmology PBL tutorials were compared with that made by their tutor and student peers. At the end of every session, each student and student peers were given an assessment form dealing with criteria like responsibility, information processing, communication, critical analysis and self-awareness. The questionnaires were filled using the 5-point Likert scale. The tutor’s assessment was made using the same criteria. ResultsThere were significant positive correlations between self-assessment and tutor assessment in regard to participation in PBL session (P = 0.01), punctuality for each session (P ⩽ 0.001) and bring new information (P = 0.001). There was a positive correlation between self-assessment and peer assessment regarding active participation (P = 0.02) and bringing new information (P = 0.003). However, there was no significant correlation between the overall scores given by selves and those by peers and the tutor. ConclusionsStudents tended to overrate themselves. The self-assessment scores were generally higher than those given by their tutor and peers. To foster evidence-based practice of ophthalmology, the information acquisition skills need to be improved.

Management of Conjunctivitis in General Practice

This chapter will describe various treatment options for infective conjunctivitis, allergic conjunctivitis, conjunctivitis in immunological disorders and other varieties of conjunctivitis that can be effectively managed in general practice whilst also highlighting various RCTs and systematic reviews on treatment of conjunctivitis. The conjunctiva is a vascularised mucus membrane that covers some anterior portion of the globe and the inner aspects of eye lids. Like all mucous membranes, it also consists of epithelial and stromal layers. The continuum of the epithelial cell layer occurs in one side with epidermis of the lids at the lid margin and with the corneal epithelium at the limbus. Because of this anatomical architecture we call this pouch as conjuctival cul-de sac. The conjunctiva has enormous potential for combating infections mainly because of a) high vascularity b) different types of cells present in conjunctiva initiating and participating in defence inflammatory reactions c) immunopotent cells present in conjunctiva d) enzymatic activity of conjunctiva neutralising many pathogens including viruses. However the conjunctival sac is rarely sterile and is prone to external insult as well as victim of immunological reactions. It has been found that the normal conjunctival flora shares organisms with the skin and respiratory tract. The major organisms found are Staphylococcus, Diptheroids, Anaerobes, Streptococcus, Pneumococcus, Hemophilus, E.Coli etc. However, as most of these potential pathogens are in their dormant stage, they rarely cause infection. Bacterial or infective conjunctivitis is mainly due to organisms of exogenous source. Though many forms of such infections are self-limiting because of barrier function of the conjunctival epithelium, there are exceptions for certain virulent organisms such as N.gonorrhea, Listeria monocytogens ,Corynobacterium diptheriae and the Haemophilus group. These bacteria possess proteolyitic enzymes which damage the parenchymal structure of the conjunctiva. Some conjunctival infections may signify an underlying disease something more sinister such as a systemic disease. In neonates, infective conjunctivitis poses a greater