Has the inclusion of a longitudinally integrated communication skills program improved consultation skills in medical students? A pilot study.

BACKGROUND: Evidence highlights a lack of communication skills in doctors leading to dysfunctional consultations. To address this deficit, a private medical college instituted curricular reforms with inclusion of a longitudinal communication skills program. A pilot study was undertaken to evaluate the effectiveness of this program by comparing the consultation skills of medical students of this college with a medical college without a communication skills program. METHODS: A 4-station Objective Structured Clinical Examination (OSCE) was conducted in the third and final year. Mann-Whitney U-test was used to compare the difference in the distribution between OSCE stations total and construct scores. RESULTS: At the end of the third year, 21 (31.34%), students of the study site (medical college 1 [college with integrated longitudinal communication skills program]) and 31 (46.26%) students from the comparison site (medical college 2 [comparable college without communication skills program]) consented. Medical college 1 achieved a significantly higher overall mean total station score of 68.0% (standard deviation [SD] =13.5) versus 57.2% (SD = 15.4) (P < 0.001). Significantly higher mean scores were achieved on three stations. At the end of the final year, 19 students (29.3%) from medical college 1 and 22 (34%) students from medical college 2 consented. The difference in overall mean total station score reduced from 9.2% to 7.1% (70.2) (SD = 13.7) versus 63.1 (SD = 15.2) (P = 0.004). The mean scores of both colleges decreased in "Patient presenting with Hepatitis C Report" station (P values 0.004 and 0.775) and in "Patient Request for Faith Healing Therapy in Diabetes Mellitus" station (P values 0.0046 and 0.036), respectively. CONCLUSION: Longitudinal communication skills in an undergraduate curriculum positively impacted consultation skills. Community-based training and faculty development are required to develop effective patient-centered consultation skills.

Pattern of perfusion defects seen in ischemic heart disease patients on technetium (Tc99m) tetrofosmin scanning.

BACKGROUND: Cardiovascular disease is common cause of death in developed as well as developing countries. The most common cause of Ischemic Heart disease is narrowing of coronary arteries, a process called as atherosclerosis. The objective of the present study is to determine the pattern of ischemic changes detected by technetium tetrofosmin (Tc99m). METHODS: Sixty five patients presenting as known or suspected ischemic heart disease over a period of two years (December 1995 to December 1998) at Ziauddin Hospital were included in the study. Each patient underwent Tc99m tetrofosmin stress and rest studies. Tetrofosmin study was performed according to one day protocol. RESULTS: By segmental analysis (five segment per patient), 35 patients had perfusion defects by SPECT Tc99m tetrofosmin imaging. Out of 95 perfusion defects, reversible ischemia and mixed defects were more common in inferior wall and fixed defect in left ventricular apex. CONCLUSION: Reversible ischemia and mixed defects were more common in inferior wall and fixed defect in left ventricular apex.

The frequency of shisha (waterpipe) smoking in students of different age groups.

OBJECTIVE: To determine the frequency of waterpipe smoking in students of different age groups. STUDY DESIGN: Cross-sectional survey. PLACE AND DURATION OF STUDY: Karachi, Pakistan, from February 2012 to February 2013. METHODOLOGY: The subjects were divided into two age groups. Group-I comprised of 13 - 17 years old randomly selected students from O' Level schools in Karachi and group-2 included 23 - 27 years old undergraduate and postgraduate students again randomly selected from various institutions in Karachi. A questionnaire was filled with prior consent, basic education on waterpipe smoking was given, and all the questions of the survey form were explained to the subjects according to context. RESULTS: In group-1, 39% students smoked waterpipe. Most students had been smoking waterpipe for the last 2 years. In group-2, 48% individuals smoked waterpipe, majority of smokers indulged in the last 5 years and among them, most were falling within the last 2 years. CONCLUSION: The frequency of waterpipe smoking in teenage students was 39% and older students for 48%. Social and recreational use of waterpipes is widespread among both groups despite being acknowledged by majority as a health hazard.