Perceptions of specialist doctors of the ability of doctors with colour vision deficiency to practise their specialty safely.

Some doctors with severe congenital colour vision deficiency (CCVD) may experience difficulty in colour discrimination that can affect their decision-making. In the absence of evidence-based guidelines, learners with CCVD are arbitrarily debarred from specialising in some disciplines. This cross-sectional, anonymous, questionnaire-based study asked specialists from all over the country if doctors with CCVD should avoid specialising in their respective disciplines. Of 218 responses, 80 (36.7%) said they should avoid it, citing colour discrimination as critical. The 32 (14.7%) participants who were unsure and 106 (48.6%) who said that CCVD would not be a problem gave reasons that mirrored those in the literature: the degree of deficiency is variable; experience helps; automation, history-taking, close observation, good illumination, contrast, touch, and peer-corroboration can reduce dependency on colour. Awareness of the deficiency and finding ways to compensate for it during training may mitigate errors and safeguard patients. Instead of blocking people with CCVD from admission to some specialties, specialists should consider these findings and support learners who are aware of their deficiency and still wish to specialise in a particular discipline.

Student performance during the medical course: role of pre-admission eligibility and selection criteria.

BACKGROUND: Marks scored in class XII determine the eligibility to apply to a medical course in India; selection is through an entrance test. Some students do poorly in the medical course. We assessed the eligibility and selection criteria as predictors of in-course performance. METHOD: This cross-sectional study included marks in class XII and in each professional examination, and the Delhi University Medical-Dental Entrance Test (DUMET) rank for five batches of medical students. Students were grouped as those who passed professionals in the first attempt and those who did not. Unpaired t-test and Mann-Whitney U test compared class XII marks and mean DUMET scores between the two groups; ROC analysis determined class XII cut-off marks above which no student failed a professional. RESULTS: Students who passed a professional in the first attempt had higher marks in class XII (p0.001). DUMET rank, however, was comparable for the two groups (p>0.05 each). Above a cut-off of 77.8% (in physics, chemistry and biology) students were significantly likely to never fail any professional. CONCLUSION: Prior academic achievement is a useful measure of in-course performance; however, the current eligibility cut-off results in poor in-course performance by some students. The DUMET is a poor predictor of performance. There is need to reform eligibility and selection criteria to admit students who will do well in the medical course.

Barriers to acceptance of intervention among patients with trachomatous trichiasis or entropion presenting to a teaching hospital.

PURPOSE: To determine the barriers to therapeutic intervention in patients with trachomatous trichiasis or entropion. METHODS: Prospective study over one year in 60 patients with trachomatous trichiasis or entropion presenting to a teaching hospital. The outcome measure was reported barriers to uptake of intervention using a questionnaire. The data were analysed using chi-square and Fisher's exact tests. Patient characteristics were correlated with barriers using univariate and multivariate analysis. RESULTS: The major barriers (operative in > 60% of patients) were illiteracy (66.7%), ignorance regarding treatment (65.0%), and fear of surgery (63.3%). Duration of symptoms in 43 females and 17 males ranged from 0.5 to 240 months (mean 30.2 +/- 45.82). Females reported significantly more barriers (average 5.8 +/- 1.88) than males (average 4.6 +/- 1.97; p = 0.03). Shorter duration was significantly related to perceived expense (p = 0.008). Patients aged =55 years more often cited young children as a barrier (p = 0.02). CONCLUSIONS: Encouraging patients who have undergone intervention to share their experiences with community members, providing intervention in patients' villages, community involvement with patients who live alone and making gender-sensitive medical programmes might be useful in reducing the fear of surgery and enhancing awareness and uptake of intervention. Future studies must identify barriers in their regions so that attempts can be directed to overcoming them so as to reduce the blinding and non-blinding burden of trachoma.

Health-related quality of life in patients with trachomatous trichiasis or entropion.

PURPOSE: To determine the health-related quality of life in patients with trachomatous trichiasis or entropion, before and after intervention. METHODS: A prospective, case-control, interventional study. Health-related quality of life was evaluated in 60 patients with trachomatous trichiasis or entropion, before and after intervention, and 60 age- and gender-matched controls without trichiasis or entropion, using the WHOQOL-Bref questionnaire. Thirty patients and controls had vision < 6/18, while 30 had vision = 6/18 in the better eye. The WHOQOL-Bref assesses four domains of quality of life: physical health (1), psychological health (2), social relationships (3), and environment (4). Domain scores of patients and controls and of patients before and after intervention were compared using Student's t-test. Patient characteristics were correlated with domain scores using Pearson's correlation. RESULTS: Quality of life was poorer than that of controls in domains 1 and 2 for patients with vision < 6/18 in the better eye (p < 0.001, p = 0.001, respectively), and in domains 1, 2 and 4 for patients with vision = 6/18 (p < 0.001, p < 0.001, p = 0.01, respectively). Scores improved after intervention in all domains except domain 3, even though vision did not improve. CONCLUSIONS: Patients with trachomatous trichiasis or entropion suffer in the physical, psychological and environmental domains of health-related quality of life even when vision is normal. Timely intervention is essential not only to prevent corneal blindness but also to reduce the suffering caused by the non-visual symptoms. Future studies must identify barriers to therapeutic intervention, and attempts should be directed at overcoming them so as to reduce the non-blinding burden of trachoma.