Drawing is an important tool to learn context-based histology in an integrated undergraduate medical curriculum.

Objectives: To determine if learning histology by drawing is superior to learning by looking through a microscope only. Methods: Second year MBBS students were divided by simple random sampling into Groups A and B. Each group comprised 50 students. This mixed-methods study was conducted in an 8-week module. For the first 4 weeks, students in Group A learned histology by drawing, whereas Group B learned by seeing the text and microscopic images. For the last 4 weeks, groups were swapped by crossover design. The impact of learning by drawing was assessed by multiple choice question (MCQ) test I and test II at the end of 4 and 8 weeks, respectively. Statistical analyses of the data were conducted with SPSS version 23. The scores obtained in test I and test II were analyzed by the independent samples t-test. The paired samples t-test was applied to scores obtained by the same subject when they learned with drawing and no drawing strategies. To assess the impact of drawing on learning histology, a focus group study was conducted in six participants selected by purposive sampling. Responses to the semi-structured interview questions were analyzed by qualitative research techniques of coding, categorizing, and generation of themes. Results: The independent samples t-test showed that there was no statistically significant difference in the mean scores obtained by Groups A and B in test I and test II. However, there was a statistically significant difference when the subject learned histology by drawing compared to no drawing, as shown by the paired samples t-test. The results from the focus group study revealed that drawing had a positive impact on knowledge retention and understanding the basic concepts of histology for its application in the clinical context. Conclusion: Drawing-based learning in histology helps with the application of basic knowledge in the clinical context.

Paradigm shift in medical education due to the COVID-19 pandemic: guidelines for developing a blended learning curriculum in medical education.

Background: The coronavirus disease 2019 (COVID-19) pandemic has transformed the world's economy, health and education in a blink of an eye. Almost 1 billion learners have been affected across the globe. This has resulted in a paradigm shift to blended learning. Therefore, it was felt necessary to provide practical guidelines for the development of blended curriculum in medical education. It would help to overcome the challenges faced due to unprecedented transformation of medical education on account of pandemic. Methods: Guidelines based on personal experience of the authors and literature search were developed using the complex adapted blended learning system (CALBS) framework. Seven experts developed these guidelines using the nominal group technique. The consent form and literature for CABLS framework was shared with experts. The experts developed the guidelines independently during phase one of the technique. After a given time, phase 2 started with moderator mediated discussion about the individual guidelines developed by the experts. After discussion and mutual consensus four types of guideline ideas were developed. During the third phase the experts ranked the guideline ideas on a scale of 1 to 5. The guideline idea that ranked highest was selected as a final guideline for developing a blended learning curriculum. Results: The group consensus resulted in developing seven guidelines for a blended course or curriculum in medical education. These guidelines are based on a conceptual framework supplemented by expert's own personal experience and current evidence from literature. Conclusions: These guidelines would provide a comprehensive and systematic approach to develop a blended learning curriculum in medical education.

Coping strategies adopted by medical residents in dealing with work-related stress: a mixed-methods study.

BACKGROUND: This study was carried out to identify and explore the difference in coping strategies for dealing with stress; adopted by medical residents in surgical and nonsurgical specialties. METHODS: A mixed methods approach, was chosen for this study. In phase one (quantitative); data were collected by a web-based survey, using a structured questionnaire. This survey was carried out in five major teaching hospitals of Rawalpindi & Muzaffarabad in 2020. Purposive sampling was done and data were analysed using SPSS, recording frequencies and major trends. In phase two (qualitative); six focus group discussions were carried out with 24 participants, using semi-structured questions and prompts. Convenient sampling was done from the cohort of phase 1. These focus group discussions, explored the various coping strategies adopted by medical residents. Later, the data were analysed manually for development of codes, sub-themes and themes. RESULTS: Out of 250 (100%) participants, 146 (58%) participants responded to the online survey. Surgical residents had a higher response rate (60%, n = 87) than nonsurgical residents. Moreover, female participation (54%, n = 79) was greater than male participation (46%, n = 67). The Mann-Whitney U test was statistically significant only for seeking medical advice to cope with stress (P = .029). There was no statistically significant difference found between the coping strategies, employed by medical residents. In focus group discussions, female involvement was more (58% n = 14) than their counterparts. Four main themes were developed after data analysis: self-regulation, tailor-made strategies, educational focus and support system. Finally, minor differences were obtained qualitatively; like, socializing is preferred by surgical residents whereas, spiritualism is chosen by nonsurgical residents. CONCLUSION: Quantitatively, no significant differences were found between the coping strategies of medical residents, against work-related stress. However, minor differences were obtained qualitatively due to difference in job demands and level of burnout between these two specialities.

Is behaviourism really dead? A scoping review to document the presence of behaviourism in current medical education.

Behaviourism is the underpinning learning theory of many teaching and assessment tools utilised to enhance the effectiveness of learning. Feedback, reinforcements, motivation, learning outcomes and objectives are a few among many which are implied by the medical teachers while teaching both basic and clinical sciences to students. The claim of behaviourism being redundant or dead is not based on realities. The behaviourist approach is and will remain the most powerful theory to be implied in educational processes for gaining successful outcomes.

Challenges for implementing WFME standards for accreditation in health professions education in low and middle-income countries: A scoping review.

OBJECTIVE: The accreditation standards developed by the World Federation of Medical Education (WFME) are acknowledged as regulatory mechanism for quality assurance of medical education programmes. The scoping review was planned to collect all the literature for identification of the barriers affecting the implementation of quality curriculum defined by WFME. METHODS: The literature was searched in electronic databases for relevant peer-reviewed studies over the last ten years. The search terms used were, `challenges of WFME accreditation', `barriers to accreditation', `challenges to accreditation in healthcare system', `hindrances to WFME accreditation standards', and `barriers to WFME standards', in PubMed, ERIC, PsycINFO databases, and in Google Scholar for grey literature. After screening and assessing for eligibility, 922 publications were retrieved and only 19 articles were included in study. The QualSyst appraisal tool was used to appraise the quality of studies. Data was synthsized to present the findings. RESULTS: The themes identified after data synthesis broadly described the barriers to implementation in various domains of WFME standards. The themes were social and political support, process of curriculum development, involvement of students in curricular planning, organizational setup, infrastructure, technical issues/ management of curriculum. The social and political support referred to leadership and governance, a prime barrier to address. Similarly, organizational setup, infrastructure and technical issues should also be looked for apart from students and curriculum. CONCLUSIONS: The scoping review will inform and lay the foundation for more empirical studies on quality improvement in health professional education, particularly in low and middle-income countries.

Morphometric localisation of pterion for lateral neurosurgical planning and approach.

OBJECTIVE: To localise pterion, as a safe landmark, on dry skulls, for performing various neurosurgical procedures. To analyse the variation in the type and location of pterion among Pakistani male population. METHODS: This cross sectional study was conducted form August 2018 to May 2019 on 50 dry skulls obtained from The anatomy departments of different medical colleges of Rawalpindi and Islamabad. Shape of the pterion was noted and different measurements of the pterion from the two reference points, frontozygomatic suture and superior border of zygomatic arch, were recorded. Mean differences between the right and left sides were compared using SPSS version 23. RESULTS: The pattern of pterion suture was sphenoparietal in 47 skulls, 2 skulls had epipteric type and 1 skull had a stellate type of pterion. The mean distance of pterion, on the right side, from posterolateral aspect of frontozygomatic suture was 2.490±0.596cm, 1.485±0.497cm, 2.922±0.697cm measured as horizontal, vertical and direct respectively. The mean horizontal, vertical and direct frontozygomatic measurements on the left side were 2.265±0.574cm, 1.395±0.548cm, 2.717±0.665cm respectively. The mean frontozygomatic horizontal and direct measurements were significantly greater on the right side as compared to the left side (p value 0.001). The mean distance from superior border of zygomatic arch to the centre of pterion on the right and left sides were 3.744±0.444cm and 3.644±9.473 respectively. CONCLUSIONS: The findings of the study provided important information regarding the probability of type and location of pterion in Pakistani males for lateral skull neurosurgical planning, especially when CT scan facility is not available.

Cranial CT scan evaluation of morphological variations and location of pterion in Pakistani male population for lateral neurosurgical approach.

OBJECTIVE: To determine the morphological variations and location of pterion in Pakistani male population. METHODS: This retrospective observational study was carried out in the Department of Radiology, Shifa International Hospital from December 2018 to June 2019. The sample size was calculated by Open Epi web-based calculator. Fifty-three cranial CT scans with slice thickness of 0.5mm; consecutive scans of males were randomly selected. The patients with no craniofacial fracture and ages from 25 to 45 years were included. The dataset was obtained from Toshiba Aquilion One, 360-slice MDCT. The images were imported into the imaging software PACS (WFM), and analyzed in maximum intensity projection mode with three dimensional multiplanar reconstruction viewers. Measurements were taken in lateral projections of skull in Frankfurt plane, as horizontal and vertical distance from the posterolateral margin of frontozygomatic suture to center of pterion. Vertical distance from the superior border of zygomaticotemporal arch to the center of pterion. The morphological types were also recognized. RESULTS: The type of pterion on right side was 94.3% sphenoparietal 5.6% epipteric whereas left side was (90.5%) sphenoparietal (3.7%) epipteric, (3.7%) stellate type, (1.8%) frontotemporal type. The mean horizontal and vertical frontozygomatic measurements on right side were 2.23 ± 0.22cm and 1.25±0.219 cm respectively. The same measurements on the left side were 2.27-±0.25 cm and 1.226-±0.22 cm respectively. The mean zygomaticotemporal measurements on the right and left sides were 3.45 ±0.29cm and 3.44 ±0.25 cm respectively. The mean distance on right and left side of skull was statistically insignificant. CONCLUSION: The study provides useful data for position and location of pterion for safe neurosurgical procedures via pterion. Moreover, the knowledge about different morphological types of pterion help the radiologist to differentiate between a fracture line and normal morphological variety.

Wound healing in rat skin subjected to loud noise stress; a light microscopic study.

OBJECTIVE: To determine the effect of loud noise stress on wound healing in a skin tissue. METHODS: The randomised control trial was conducted at the Department of Anatomy, College of Physicians and Surgeons Pakistan Regional Centre, Islamabad, from September 2007 to September 2008. The study comprised 240 male Sprague Dawley rats who were randomised into control group A and experimental group B. Each group comprised 120 animals. Main groups were further subdivided into four subgroups of 30 animals each. After induction of local anaesthesia a linear full thickness skin incision paravertebral to thoracic spine was made. The experimental group B was exposed to loud noise stimulus. The animals were decapitated 1, 3, 5 and 7 days after surgery. Histological data was collected in the incisional space of the wound. Polymorpho-nuclear leukocytes, macrophages, fibroblasts and blood vessels, were analysed quantitatively, whereas re-epithelialisation and content of collagen fibres in the incisional space were analysed qualitatively. RESULTS: Macrophages were decreased initially 3 days after surgery and were increased 5 and 7 days after surgery in the experimental subgroups. Similarly, blood vessels and fibroblast were significantly decreased in experimental subgroups 3 days after surgery, but were increased significantly in experimental subgroups 7 days after surgery. Nothing significant was found regarding re-epithlialisation and collagenisation of wound. CONCLUSION: Loud noise stress affects the important cells involved in the healing of the wound. Therefore, it is expected to have an impact on the stages of wound healing.

Quantitative analysis of macrophages in wound healing of rat skin subjected to loud noise stress.

BACKGROUND: Factors affecting skin wound healing have always been a central consideration in medical practice. Loud noise is biological stressor affecting the body systems at various levels. The present study was taken to study the effect of loud noise stress on the macrophages during wound healing process in male rat skin. METHOD: One hundred and eighty male Sprague Dawley rats were randomly divided into control group-A and experimental group-B. Each group comprised 90 animals. Control and experimental groups were further subdivided into three subgroups of 30 animals each, corresponding to the day of sacrifice of animals, i.e., day 3, 5 and 7 after surgery. After induction of local anaesthesia a linear full thickness incision paravertebral to thoracic spine was made on the dorsum of rat. The experimental group B was exposed to loud noise stimulus (recorded noise of aero planes and gun fire) set at 97dBA to 102 dBA with a sound level meter. The animals were decapitated on day 3, 5 and 7 after surgery. Tissue was processed for paraffin embedding and stained by Hematoxylin and Eosin and Mallory's trichrome stain. Data was collected for the incisional space of the wound. Quantitative data of number of macrophages was analysed by Student's' test for the detection of any significant differences between the mean number in the experimental and control groups. All the quantitative data was expressed as means ± SE. A p-value of ≤ 0.05 was considered statistically significant. RESULTS: In this study macrophages were decreased statistically significantly at day 3 after surgery and thereafter increased significantly on day 5 and 7 after surgery in the experimental subgroups as compared to their match control subgroups. CONCLUSION: These results show that loud noise stress affects the cells (macrophages) involved in the healing of the wound therefore it is expected to have impact on the stages of wound healing.