Exploring the usage of learning resources by medical students in the basic science stage and their effect on academic performance.

BACKGROUND: The United States Medical Licensing Examination (USMLE) step 1 is one of the two examinations written after completion of the first two years (basic science stage) of medical school to be eligible to apply for residency training in the USA. A huge number and types of study materials are available to prepare for the exam which might confuse students choosing a resource. We investigated learning resources being used by the third and fifth-semester medical students and their association with academic performance. We also compared learning resources and exam scores of high-performing and low-performing students. METHODS: Data collection was done using structured (quantitative study) and semi-structured (qualitative study) questionnaires during a face-to-face interview. This article is about the quantitative part which was designed as a correlational study. Single factor one-way analysis of variance (ANOVA), Pearson correlation coefficient test, T-test, and Fisher's exact test were used to analyze the data. RESULTS: About half of all students used three or more commercial resources dealing with the same content. A weak negative correlation was observed between the number of commercial resources and the exam scores, especially when the number of these resources was three or more (r = -0.26). The mean exam score of textbook users was statistically significantly higher than the mean score of textbook non-users (p = 0.01). The usage of textbooks was statistically significantly higher in the cohort of top performers in comparison to the rest of the students (p = 0.006). In addition to less usage of textbooks, the mean number of review books was higher in the group of weakest students (2.84 versus 3.7; p = 0.75). CONCLUSIONS: Most students did not use professional textbooks and about half used too many commercial review resources. While the former fact was significantly associated with poor academic performance, the later fact had weak negative correlation with exam score. Pedagogical interventions are urgently needed to make the right type of learning resources available by making professional textbooks more USMLE-oriented and helping the students choose the best and right number of resources for optimum academic performance. By fulfilling the observed needs of the students in this way, they might feel empowered because of self-determination which will motivate studies.

Morphological Study of Hashimoto Thyroiditis in Fine Needle Aspiration Cytology Specimens.

Background: Hashimoto thyroiditis is an autoimmune disease which is diagnosed based on well-defined clinical and cytological criteria. Purpose: The objective of this research is to study cytomorphological features in patients of Hashimoto thyroiditis and compare the findings with other studies. Literature on morphology of multinucleated giant cells was found to be lacking, and this study has focused on the number and morphology of these cells in this study. Material and Methods: FNAC was done in patients who met the clinical diagnostic criteria of Hashimoto thyroiditis formulated by "Japan Thyroid Association" and smears were analyzed by light microscopy. Data analysis was done by XLSTAT in Microsoft Excel 2010. The Wilcoxon Signed Rank Test was done to analyze the data on multinucleated giant cells. The null hypothesis was that the median of the population of differences between the paired data of small and large giant cells is zero. Results: A total of 26 patients were included in a period of one year. Contrary to observations in other studies, multinucleated giant cells were found in most participants. The Wilcoxon Signed Rank Test proved that small multinucleated giant cells were significantly more common than large multinucleated giant cells in Hashimoto thyroiditis; P value (two-tailed) being <0.0001 at significance alpha of 0.05. This study has also revealed that a few patients with Hashimoto thyroiditis can have large and very large multinucleated giant cells in a small number. Data on other cytomorphological features were no different than in other studies. Conclusion: The presence of multinucleated giant cells in 92.3% of patients in this study is far higher than in other studies which can have important diagnostic implications. Few large multinucleated giant cells can be present in a small number in a few patients as in Hashimoto thyroiditis.

Comparing Standard Setting Methods for Objective Structured Clinical Examinations in a Caribbean Medical School.

BACKGROUND: OSCE are widely used for assessing clinical skills training in medical schools. Use of traditional pass fail cut off yields wide variations in the results of different cohorts of students. This has led to a growing emphasis on the application of standard setting procedures in OSCEs. PURPOSE/AIM: The purpose of the study was comparing the utility, feasibility and appropriateness of 4 different standard setting methods with OSCEs at XUSOM. METHODS: A 15-station OSCE was administered to 173 students over 6 months. Five stations were conducted for each organ system (Respiratory, Gastrointestinal and Cardiovascular). Students were assessed for their clinical skills in 15 stations. Four different standard setting methods were applied and compared with a control (Traditional method) to establish cut off scores for pass/fail decisions. RESULTS: OSCE checklist scores revealed a Cronbach's alpha of 0.711, demonstrating acceptable level of internal consistency. About 13 of 15 OSCE stations performed well with "Alpha if deleted values" lower that 0.711 emphasizing the reliability of OSCE stations. The traditional standard setting method (cut off score of 70) resulted in highest failure rate. The Modified Angoff Method and Relative methods yielded the lowest failure rates, which were typically less than 10% for each system. Failure rates for the Borderline methods ranged from 28% to 57% across systems. CONCLUSIONS: In our study, Modified Angoff method and Borderline regression method have shown to be consistently reliable and practically suitable to provide acceptable cut-off score across different organ system. Therefore, an average of Modified Angoff Method and Borderline Regression Method appeared to provide an acceptable cutoff score in OSCE. Further studies, in high-stake clinical examinations, utilizing larger number of judges and OSCE stations are recommended to reinforce the validity of combining multiple methods for standard setting.

Procrastination among basic science undergraduate medical students in a Caribbean medical school.

This article was migrated. The article was marked as recommended. PURPOSE: The study was conducted to study procrastination behavior among basic science undergraduate medical students using the previously validated procrastination assessment scale students (PASS). Frequency of and reasons for procrastination were compared among different subgroups of respondents. METHODS: The study was conducted during the first two weeks of February 2017 using PASS. Gender, nationality and semester of study of the respondents were noted. PASS explores areas of and frequency of procrastination, reasons for procrastination and interest in changing the behavior. The frequency of procrastination, fear of failure, risk aversiveness, laziness and rebellion against control scores were compared among different subgroups using appropriate statistical tests. RESULTS: A total of 107 students (84.9%) participated in the study. The mean frequency of procrastination score was 32.9 (maximum score 60). The score was significantly correlated with the respondents' gender. With regard to the percentage of students who nearly always or always procrastinated on a task, the percentages with regard to completing assignments, studying for exams, completing reading assignments, academic administrative tasks, attendance tasks and school activities in general were 25.2, 19.7, 25.2, 19.6, 18.7 and 17.7. The mean score for 'fear of failure' and 'aversiveness of task' as described by Solomon and Rothblum was 2.29 and 2.83. The mean scores for fear of failure, risk taking, and laziness were 26.17, 13.76 and 14.32. The median rebellion against control score was 6. Risk taking score was higher among respondents of other nationalities compared to Americans. CONCLUSIONS: Procrastination was regarded as a greater problem with regard to studying for exams and completing reading assignments and preparing for problem-based learning sessions. Only 42% of students were interested in attending a program to overcome procrastination. Similar studies among students during the clinical years are required. A study correlating self-reported procrastination with behavior can be carried out. Procrastination can also be studied in other offshore, Caribbean medical schools.

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.

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.

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.

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.

Skin tumorigenic potential of benzanthrone: prevention by ascorbic acid.

Benzanthrone (BA) exposed occupational workers have been found to exhibit toxicological manifestations in the skin, thus it is quite likely that long term exposure may lead to skin tumorigenicity. Thus, attempts were made to elucidate the tumor initiating and promoting potentials of pure (PBA) and commercial benzanthrone (CBA). Additionally, the preventive role of ascorbic acid (AsA) was also assessed. PBA showed tumor initiating activity while CBA demonstrated tumor initiating as well as promoting activities in two-stage mouse skin tumor protocol. Further, prior treatment of AsA to PBA and CBA followed by twice weekly application of 12-o-tetradecanoyl phorbal myristate acetate (TPA) resulted into delayed onset of tumor formation and similarly single application of 7,12-dimethylbenz [α] anthracene (DMBA) followed by twice weekly application of AsA and CBA showed an increase in the latency period. Thus, AsA showed a protective effect against CBA promoted skin tumor. Furthermore, the topical application of CBA significantly increased the levels of xenobiotic enzymes. The animals topically treated with AsA along with topical application of CBA, restored all the impairment observed in enzyme activities. Thus, this study suggested that AsA can be useful in preventing PBA and CBA induced skin tumorigenicity.

Ferrite-silica-insulin nanocomposites (FeSINC) for glucose reduction.

Proteins find a more stable environment upon encapsulation in a silica host, because of the polymeric silica frame that grows around the macromolecule and protects them from denaturation. Silica-insulin nanocomposite (SINC) and ferrite-coated SINC (FeSINC) was prepared by polyelectrolytic condensation of silica precursor on insulin and they were studied for their ability to control glucose levels. SINC was prepared by acid-base-catalyzed polymerization in the presence of insulin at room temperature by a modified Stober's process. FeSINC nanoparticles were prepared by coprecipitation of both ferric and ferrous salts on the bovine insulin loaded silica nanoparticle. The presence of ferrite coating in FeSINC was identified using a vibrating sample magnetometer and quantified from XRF study. The intermolecular interactions in these nanocomposites were studied by FTIR and Raman spectroscopy. An in vivo study indicated that FeSINC was biologically active in reducing glucose levels as compared to SINC.

Nanoferrite embedded magnetocochleate microstructures to encapsulate insulin macromolecules.

A fused lipid microstructure embedded with ferrite nanoparticles, a magnetocochleate, was prepared and used to encapsulate insulin by making use of the lipid phase transition from the fluidic lamellar phase to the gel phase at pH 2. The magnetocochleate obtained by tuning the hydrophilic headgroup hydration of phosphatidylserine in the presence of ferrite encapsulates a larger amount of insulin. Enhanced encapsulation of insulin in between the fused lipid bilayer indicates that the magnetocochleate has potential as a delivery vehicle for an active pharmaceutical incipient. In particular, protein macromolecules like insulin are target incipients, because these fused microstructures protect insulin from the action of enzymes and from pH changes, which is necessary to maintain its bioactivity. Microscopic and spectroscopic investigations of these fused microstructures were done to understand the internal microstructure and encapsulation of protein. Freeze fracture transmission electron microscopy revealed the gel-like phase of fused lipid bilayers and the presence of ferrite in magnetocochleate. Confocal micro-Raman, high performance liquid chromatography (HPLC) studies confirmed the presence of ferrite and insulin within the lipid microstructures. Differential scanning calorimetry (DSC) and Fourier transform infrared resonance (FTIR) studies substantiate the state of lipid in these fused microstructures. In vivo subcutaneous activity was studied in a rat model, and the positive result obtained there signifies the promising potential of magnetocochleates in subcutaneous delivery of macromolecules.