Varna Taranikanti

Anatomy Practical Examinations: How Does Student Performance on Computerized Evaluation Compare with the Traditional Format?.

Practical examinations in anatomy are usually conducted on specimens in the anatomy laboratory (referred to here as the “traditional” method). Recently, we have started to administer similar examinations online using the quiz facility in Moodle™. In this study, we compare student scores between two assessment environments viz. online and traditional environments. We hypothesized that regardless of the examination medium (traditional or online) overall student performance would not be significantly different. For the online medium, radiological images, prosected specimens, and short video clips demonstrating muscle action were first acquired from resources used for teaching during anatomy practical classes. These were optimized for online viewing and then uploaded onto Moodle learning management software. With regards to the traditional format, actual specimens were usually laid out in a circular stream. Identification tags were then attached to specific spots on the specimens and questions asked regarding those identified spots. A cohort of students taking practical examinations in six courses was studied. The courses were divided into three pairs with each pair credit‐weight matched. Each pair consisted of a course where the practical examination was conducted online and the other in the traditional format. There was no significant difference in the mean scores within each course pair. In addition, a significant positive correlation between score in traditional and online formats was found. We conclude that mean grades in anatomy practical examination conducted either online or in the traditional format were comparable. These findings should reassure teachers intending to use either format for their practical examinations. Anat Sci Educ.

Idiopathic Granulomatous Mastitis: Diagnostic strategy and therapeutic implications in Omani patients

OBJECTIVES Idiopathic granulomatous mastitis (IGM) is a rare benign disorder of the breast whose aetiology is controversial, and is often misdiagnosed clinically and radiologically as mammary malignancy; as a result, it may be incorrectly treated. Although no standard treatment is available for this chronic disease, surgery with or without corticosteroids has been tried with controversial results. This study discusses the clinical presentation, diagnosis, management, recurrence, and follow-up data of IGM with a review of relevant literature. METHODS From 2009-2012, the Breast Unit at Sultan Qaboos University Hospital, Oman, conducted a clinical study on 20 patients with breast lumps. Their clinical and radiological examinations were indeterminate, and a diagnosis of granulomatous mastitis was established only by histopathology. RESULTS The majority of the patients were cases of unknown aetiology, who presented with a unilateral breast mass. A few patients had a mass with an abscess, along with axillary lymphadenopathy. A total of 4 patients were suspected of malignancy using radiology. In all patients, sterilised pus was sent for culture and sensitivity. Microscopy showed the characteristic pattern of granulomatous inflammation. All patients were treated with antibiotics for 6 weeks, and the mean follow-up period was 15 months (11-33 months). All patients had complete remission with no further recurrence. CONCLUSION This single largest study of cases of IGM in Oman highlights the pitfalls in diagnosing this non-neoplastic disease of unknown aetiology and uncertain pathogenesis. It emphasises IGMs excellent response to antibiotics, which is crucial, as IGM is a disease which is notoriously difficult and controversial to treat.

Implementing a modified team-based learning strategy in the first phase of an outcome-based curriculum – Challenges and prospects

Background: Team-based learning (TBL) is an innovative form of collaborative learning. The aim of TBL is to create a motivational context in which students become accountable for their learning. Aim: Student attendance at didactic lecture sessions in our school is usually poor. A modified TBL approach in lieu of lectures was undertaken for the first time in a large class (150 students). This communication reports on the challenges of its implementation in our setting and preliminary data on its effects on student performance. Method: Using computer-based evaluation followed by an in-class activity, a modified TBL approach was implemented over two semesters during an introductory basic science course. Data on student performance, student motivation and faculty reflection were collected and analysed. Results: This strategy had significantly enhanced students’ class attendance. They performed better on the built-in TBL assessment (IRAT) compared to standard in-course tests. Besides content mastery, TBL approach could also instill useful attitudinal outcomes such as self-directed learning. Conclusions: The TBL strategy is a viable and refreshing alternative to the usual didactic faculty engagement with the teaching process. Students appear to do better in tests built-in within TBL as compared to stand-alone in-course tests.

“Between a Rock and a Hard Place” : The discordant views among medical teachers about anatomy content in the undergraduate medical curriculum

The last two decades of medical education have been marked by a persistent push towards curricular reform. Anatomy as a discipline, the unshakable foundation of medical teaching for hundreds of years, has been at the centre of this development. Although it is widely agreed that for doctors to be competent, they need an adequate knowledge of anatomy underpinning medicine, there is much less agreement over the quantity required, and who should decide and define it. Many clinicians feel medical students are being under-trained in this basic medical science before reaching the clinical stages. Professional accreditation boards advocate the reduction of factual information in undergraduate medical courses. Anatomists complain of a progressive erosion of the time allocated to the subject. Caught in the midst of this controversy is the student of anatomy who is left bewildered and confused about what is required from him to become a safe and competent health professional. The way forward might, first, be for medical schools to facilitate discussions between students, anatomy professors, and clinicians to bring these divergent perspectives into alignment. Second, the anatomists need to re-invent themselves in two principal frameworks: first, to present the subject in the context within which it will be utilised by the student, and second to employ the overwhelming learning tool of today, i.e. technology, in their teaching and assessment of the subject.

Assays for drug resistant tuberculosis in high burden countries

Jessica Minion and colleagues have done a systematic review and meta-analysis to assess the accuracy of microscopic-observation drug susceptibility (MODS) and thin layer agar (TLA) in rapid screening of multidrug resistant (MDR) tuberculosis. However, the studies included in the investigation did not include those from countries that are most burdened by MDR tuberculosis. According to a WHO report that mapped the distribution of MDR tuberculosis cases, 27 countries account for about 85% of the estimated cases of multidrug resistance among new cases of tuberculosis. China and India have the most cases, whereas incidence of MDR tuberculosis in the USA is decreasing rapidly. In a country such as India, where about 42% of the population is below the poverty with the authors of published works, who were generally responsive. Grey literature refers to data that is not formally published in easily accessed sources, such as conference abstracts. Intervention studies that are published in grey literature are more likely to have negative results than those published in journals, and failure to include these sources signifi cantly aff ects the results of systematic reviews of interventions. It is not known if a similar bias applies to studies of diagnostic accuracy or prognosis from grey literature. We did not systematically search for unpublished studies, and this might be an additional limitation of our study.

Modifiable and Non-modifiable Risk Factors for Colon and Rectal Cancer

Colorectal cancer (CRC) is the world’s third most common cancer. Before the twentieth century, CRC was relatively uncommon; however, the incidence has risen dramatically especially in the last 50 years. Several risk factors have been proposed, including the adoption of westernized diet, obesity, and physical inactivity. The majority of colorectal cancer continues to occur in industrialized countries. According to the recent studies, CRC is associated with several modifiable and non-modifiable risk factors. These risk factors involve CRC history in first-degree relative, inflammatory bowel disease, consumption of red meat, fruit, and vegetables, cigarette smoking, body mass index to overall population, race, gender, personal habit of alcohol consumption and smoking, ethnicity diabetes, and physical activity. Here we review the key evidence for the role of different risk factors and their effect on CRC prevention and progression.

Metastatic Invasive Lobular Carcinoma of the Breast Masquerading as a Primary Renal Malignancy = ورم الكلية قد يكون مؤشرا لإنتشار سرطان الثدي الحويصلي

Breast cancer is known to metastasise to different organs in the body, but an initial presentation of breast cancer with loin pain secondary to a metastatic renal mass is extremely rare. We report a 58-year-old woman who presented with recurrent left loin pain due to a metastatic deposit of invasive lobular carcinoma of the breast. The detection of a renal mass on computed tomography led to the assumption of a renal pelvic malignancy. The diagnostic dilemma posed by the detection of a breast mass during staging and the usefulness of immunohistochemistry in the confirmation of diagnosis are discussed.