A Paradigm Shift in Assessment of Scientific Skills in Undergraduate Medical Education.

The General Medical Council's publication 'Outcomes for Graduates' places emphasis on doctors being able to integrate biomedical science, research and scholarship with clinical practice. In response, a new paradigm of assessment was introduced for the intercalated Bachelor of Science program at Imperial College School of Medicine in 2019. This innovative approach involves authentic "active learning" assessments analogous to tasks encountered in a research environment and intends to test a wider range of applied scientific skills than traditional examinations. Written assessments include a "Letter to the Editor", scientific abstract, and production of a lay summary. A clinical case study titled "Science in Context" presents a real or virtual patient, with evaluation of current and emerging evidence within that field. Another assessment emulates the academic publishing process: groups submit a literature review and engage in reciprocal peer review of another group's work. A rebuttal letter accompanies the final submission, detailing how feedback was addressed. Scientific presentation skills are developed through tasks including a research proposal pitch, discussion of therapies or diagnostics, or review of a paper. A data management assignment develops skills in hypothesis generation, performing analysis, and drawing conclusions. Finally, students conduct an original research project which is assessed via a written report in the format of a research paper and an oral presentation involving critical analysis of their project. We aspire to train clinicians who apply scientific principles to critique the evidence base of medical practice and possess the skillset to conduct high-quality research underpinned by the principles of best clinical and academic practice. Assessment drives learning, and active learning has been demonstrated to enhance academic performance and reduce attainment gaps in science education. We therefore believe this strategy will help to successfully shape our students as future scientists and scholars as well as clinical practitioners and professionals.

A conceptual model for students' satisfaction with team-based learning using partial least squares structural equation modelling in a faculty of life sciences, in the United Kingdom.

PURPOSE: Students' satisfaction is an essential element in higher education. This study aimed to identify paths and predictive power of students' satisfaction during team-based learning (TBL) activities in the faculty of life sciences using partial least squares structural equation modelling (PLS-SEM). METHODS: In 2018-2019, at the University of Sussex (Falmer, UK), 180 life science students exposed to TBL were invited to participate in the study. Team-Based-Learning-Student-Assessment-Instrument was used. A conceptual model was developed for testing six hypotheses. H1: What was the effect of TBL on student satisfaction? H2: What was the effect of lectures on student satisfaction? H3: What was the effect of TBL on accountability? H4: What was the effect of lectures on accountability? H5: What was the effect of accountability on student satisfaction? H6: What were the in-sample and out-of-sample predictive power of the model? The analysis was conducted using the PLS-SEM approach. RESULTS: Ninety-nine students participated in the study giving a 55% response rate. Confirmatory tetrad analysis suggested a reflective model. Construct reliability, validity, average extracted variance, and discriminant validity were confirmed. All path coefficients were positive, and 5 were statistically significant (H1: ß=0.587, P<0:001; H2: ß=0.262, P<0.001; H3: ß=0.532, P<0.001; H4: ß=0.063, P=0.546; H5: ß=0.200, P=0.002). The in-sample predictive power was weak for Accountability, (R2=0.303; 95% confidence interval [CI], 0.117-0.428; P<0.001) and substantial for Student Satisfaction (R2=0.678; 95% CI, 0.498-0.777; P<0.001). The out-of-sample predictive power was moderate. CONCLUSION: The results have demonstrated the possibility of developing and testing a TBL conceptual model using PLS-SEM for the evaluation of path coefficients and predictive power relative to students' satisfaction.

Perception of team-based learning using the team-based learning student assessment instrument: an exploratory analysis within pharmacy and biomedical students in the United Kingdom.

PURPOSE: This study aimed to evaluate students' perception of team-based learning (TBL) amongst a cohort who was exposed to this methodology for the first time at an university in the United Kingdom . METHODS: Between November and December 2018, 26 first year Master of Pharmacy and 90 second year B.Sc. Biomedical Science students of School of Life Sciences, University of Sussex, United Kingdom were invited to participate and requested to complete a questionnaire that contained quantitative and qualitative questions. The quantitative component was based on the team-based-learning student assessment instrument (TBL-SAI) instrument. It additionally contained questions about key student characteristics. RESULTS: The response rate was 60% (70/116), 74% (n=52) were females and 26% (n=18) males. The percentage of agreement in the TBL-SAI suggested a favourable response to TBL. The overall mean score for the TBL-SAI was 115.6 (SD 5.6) [maximum score: 140] which was above the threshold of 102, thus suggesting a preference for TBL. Statistically significant differences were not found according to demographics characteristics. Students who predicted a final result of ≥70% strongly agreed that TBL help improve their grades. Some students highlighted issues with working in teams and only 56% of students agreed that they could learn better in a team setting. CONCLUSION: This study shows that students exposed to TBL for the first-time favour several aspects of it. However, more focused strategies including team-building exercises activities and expert facilitation skills could potentially tackle resistance to working in teams.

Correlation of Symphysiofundal Height and Abdominal Girth with the Incidence of Hypotension in Cesarean Section Under Spinal Anesthesia using Bupivacaine with Fentanyl as Adjuvant: A Clinical Study.

BACKGROUND AND AIMS: A decreased lumbosacral subarachnoid space volume is a major factor in cephalad intrathecal spread of local anesthetic in term parturients due to compressive effect of the gravid uterus. The aim of this study was to assess the relationship of symphysiofundal height (SFH) and abdominal girth (AG) with the incidence of hypotension and the highest level of sensory blockade. SETTINGS AND DESIGN: This study was a prospective observational study. MATERIALS AND METHODS: Ninety parturients under the American Society of Anesthesiologists physical status class II within the age range of 20-30 years, weighing between 60 and 65 kg, and height between 150 and 155 cm were studied, and the SFH and AG of all parturients had been measured just before spinal anesthesia. Hyperbaric bupivacaine 9 mg with 12.5 µg intrathecal fentanyl was administered for subarachnoid block. The incidence of hypotension and the highest level of sensory block were assessed. STATISTICAL ANALYSIS: Correlation analysis (Spearman's rank test) was applied to analyze the data, and P < 0.05 was considered to be statistically significant. RESULTS: The incidence of hypotension was higher with increasing SFH (16.9% with SFH of 30-35 cm, 78.37% with SFH of 36-40 cm; correlation coefficient ρ =0.338) and with increasing AG (5.3% with AG between 85 and 89 cm, 35.7% with AG 90-94 cm, 62.8% with AG 95-99 cm; ρ =0.341), and both were statistically significant (P < 0.001). There was a statistically significant correlation between increasing SFH and maximum sensory block achieved (ρ =0.157, P < 0.001). There was increased level of sensory blockade with increased AG but was not statistically significant (ρ =0.011, P = 0.32). CONCLUSION: In term parturients undergoing cesarean section under spinal anesthesia, the SFH has a significant positive correlation with the incidence of hypotension and ascent of spinal anesthesia. AG also has a positive correlation with the incidence of hypotension but is not significant with the ascent of spinal anesthesia.

The Effect of Single-dose Intravenous Dexamethasone on Postoperative Pain and Postoperative Nausea and Vomiting in Patients Undergoing Surgery under Spinal Anesthesia: A Double-blind Randomized Clinical Study.

BACKGROUND: The use of neuraxial anesthesia has dramatically increased. Acute postoperative pain is an undesirable outcome that can delay functional recovery for patients undergoing surgery. Nausea and vomiting in the postoperative period occurs in 20%-30% of the patients and together are the second-most common complaint reported (pain is the most common). Efficacy of glucocorticoids for reducing pain and inflammation after surgery is being explored. Glucocorticoids are strong anti-inflammatory agents, which can be used for a short-time postoperative pain control in various surgeries. Dexamethasone is a glucocorticoid with little mineralocorticoid effect commonly used perioperatively to reduce postoperative nausea and vomiting (PONV) and has a beneficial role in postoperative analgesia. Dexamethasone has also an antiemetic effect, in addition to its anti-inflammatory and analgesic effects. AIM: The main purpose of this study is to evaluate the effect of administration of single-dose intravenous (i.v.) dexamethasone on postoperative pain and PONV in patients undergoing surgery under spinal anesthesia. SETTINGS AND DESIGN: A double-blind randomized clinical study was performed in our institute between November 2014 and October 2015 after obtaining clearance from the ethical committee. MATERIALS AND METHODS: A double-blind randomized clinical study was performed on 60 patients posted for surgery under spinal anesthesia. Patients were randomly assigned into two groups: A (study: 2 ml [8 mg] dexamethasone) and B (control: 2 ml saline). In both the groups, variables such as mean arterial blood pressure (MAP), heart rate (HR), respiratory rate, severity of pain (based on visual analog scale), and other symptoms such as nausea and vomiting were recorded at different time points during the first 24 h after surgery. Statistical methods using Student t-test (two-tailed, independent) and Fischer's exact test were used for analyzing the data. RESULTS: Between-group comparisons indicated significant differences in terms of severity of postoperative pain and PONV (P < 0.001), MAP (P = 0.063), and HR (P = 0.071), which in the study group were lower than the control group. CONCLUSION: i.v. dexamethasone is efficient in reducing postoperative pain, requirement of rescue analgesia on the first postoperative day, and incidence of PONV with no significant changes in vital signs.

Evaluation of a rapid immunochromatographic test in the diagnosis of dengue fever.

Serology is the mainstay of diagnosis in Dengue virus infection. Various rapid tests for antibody detection have been developed. They can prove to be important diagnostic tools especially in the field set up due to technical simplicity. We evaluated a Rapid immunochromatographic assay The rapid test was performed on acute phase sera collected from patients suspected to be suffering from Dengue fever/DHF. These samples were then tested by Dengue Duo Capture ELISA and compared The rapid test showed a good sensitivity for the detection of secondary dengue infection and thus can be a good screening tool.

Bacterial counts from hospital doctors' ties are higher than those from shirts.

Doctor ties are often contaminated with bacteria, and it has been suggested that they should not be worn. We have compared bacterial counts from the ties and shirt pockets of 50 doctors. Counts were higher (P = .002) from ties that were rarely, if ever, cleaned than from shirts that were washed every 2 days or more frequently. The results support the need for further research on unwashable clothing of hospital staff.