Early clinical exposure in medical education: the experience from Debre Tabor University.

BACKGROUND: The idea of early clinical exposure in Ethiopian medical schools is a young concept. Old and newly established universities across the nation are shifting towards incorporation of early clinical exposure (ECE) in their curricula. Debre Tabor University introduced ECE in undergraduate medical education from inception. This study generated evidence on students' experience and academic leaders' reflection on early clinical exposure implementation. OBJECTIVE: This study was carried out to investigate medical students' perception towards early clinical exposure and its implementation process by instructors in undergraduate medical education at Debre Tabor University. METHOD: A cross-sectional survey design that combines quantitative and qualitative methods was conducted in 2021. We asked fifth year medical students (42) to complete a self-administered questionnaire on 5-point Likert scale. The data were supplemented by semi-structured interview with 6 purposively selected academic leaders on the factors that facilitate or impede early clinical exposure implementation. The quantitative data were entered and analyzed using SPSS 20 to compute frequency, median and interquartile range. The qualitative data were analyzed thematically. RESULTS: The study findings suggest that early clinical exposure (ECE) has a positive impact on the development of students' professional knowledge, problem-solving skills, motivation, active learning, and community orientation. Specifically, 64.3% of the surveyed students believed that ECE was effective in constructing their professional knowledge, while 52.4% felt that it improved their problem-solving skills and facilitated constructive/active learning. Additionally, 57.1% of students reported that ECE improved their motivation and 50% noted that it facilitated community orientation. The study also identified several barriers to the implementation of ECE, with the heavy workload being the most commonly mentioned (78.6%). Other challenges included a loose linkage between academic and healthcare institutions (59.5%) and a lack of orientation on the implementation process (35.7%). Academic leaders reflected that ECE was beneficial in familiarizing students with the clinical environment, but staff commitment was crucial for its successful implementation. The study also found that heavy workload, lack of assessment dedicated to ECE on the curriculum, and poorly oriented staff about the program impeded its implementation. CONCLUSION AND RECOMMENDATIONS: The findings of this study suggest that early clinical exposure was beneficial learning method. Teachers' commitment to their roles with adequate preparation, and the contribution of curriculum in providing the learning objective and cases for each session were factors that facilitate effective implementation of ECE. Heavy workload and poor orientation about the program could impede ECE implementation.

Perforated ileum as the initial presentation of Crohn's disease, a case report.

INTRODUCTION: The perforation of the bowel as the first presentation of inflammatory bowel disease is a rare occurrence reported in about 0.15-3 % of the literature and is especially unusual in young patients <30 years of age. It is a serious event with most of the perforations occurring on the ileum. This article describes a unique case of a 20-year-old female patient who presented with perforated ileum due to Crohn's disease as an initial presentation operated at a private surgical center. CASE PRESENTATION: We present a case of a previously asymptomatic 21-year-old female presenting with intestinal perforation secondary to Crohn's disease for the first time. The patient presented with crampy abdominal pain and frequent bilious vomiting of 3 days duration. She also had a high-grade fever and abdominal distension. WBC was 24,000 and an abdominal CT scan showed perforation of the bowel consistent with Crohn's Disease. Ruling out other etiologies perforated viscous secondary to query Crohn's Disease was entertained and laparotomy revealed 2 × 2 cm perforation on the anti-mesenteric border of the terminal ileum. The perforated segment was resected primary anastomosis was performed. Following surgery, the patient was discharged symptom-free and linked to the Gastroenterology unit after a biopsy confirmed Crohn's disease. She was started on Prednisolone and Azathioprine exactly a month after her surgery. Her 6-month follow-up is smooth. CONCLUSION: Presentation of bowel perforation as an initial feature of Crohn's Disease is a rare phenomenon. Adequate resuscitation followed by emergency laparotomy with primary resection and anastomosis could be life-saving for a hemodynamically stable patient.

Ileo-sigmoid knotting in a female Ethiopian patient, a case report.

INTRODUCTION: Ileo-sigmoid knotting is a very rare cause of bowel obstruction. The diagnosis can be challenging and may not be suspected pre-operatively. A high index of suspicion, especially in areas of the "sigmoid belt" region, can be helpful. CASE PRESENTATION: A 40-year-old ethnic Amhara female patient presented with symptoms and signs of bowel obstruction. She presented in shock and after resuscitation, laparotomy revealed gangrenous ileum twisted around the sigmoid colon ('ileo-sigmoid knotting'). The gangrenous ileal segment was resected, with end-to-end ileo-ileal anastomosis. The patient had a smooth postoperative course and was discharged on the 4th post-operative day. CONCLUSIONS: Twisting of the ileum around the sigmoid colon is pathognomonic of ileo-sigmoid knotting. Prompt resuscitation and surgical intervention in the shocked patient with an acute abdomen and evidence of intestinal obstruction could be life-saving.

The practice of foreign body removal from the ear, nose, and upper esophageal in children in Ethiopia: A retrospective descriptive study.

BACKGROUND: Ear, nose, and upper esophageal foreign body (FB) impaction in children is a common emergency in-hospital service. There are no clear guidelines regarding the management of ingested FBs. This study aimed to determine the FB in terms of type, anatomic site, management outcome, and associated complications. METHODS: Retrospective study of children with ear, nose, and upper esophageal FB managed under general anesthesia (GA) at operating room of Wolkite Hospital in the southern part of Ethiopia between January 2019 and February 2021. Data were collected from the medical chart of the patients using a prepared checklist. The parameters included were age, sex, FB anatomic site, type, management outcome, and associated complications related to FB or procedure modalities. RESULTS: A total of 169 (31.4%) study subjects were required GA for the removal of FBs. The mean age was 4.45 ± 3.20 years. Under 5 years old children comprises 61.5% of total cases. The most common anatomic site of FB impaction was in the ear 97 (57.4%). The most commonly found type of FB was cereals or seeds, which constituted 102 (60.35%). The complication rate was 18.35%. Epistaxis was the commonest complication (6.51%) from the nose while canal abrasion (5.92%) was common from the ear. CONCLUSION: Ear, nose, and upper esophageal FBs were found more frequently in younger children. The ear was the most common anatomic site of FB impaction followed by the nose and upper esophageal. The most common type of FB was cereals or seeds. LEVEL OF EVIDENCE: 4.

Hydatid cyst of the foot: a case report.

BACKGROUND: Hydatid cyst is rarely located in soft tissues. This case of a hydatid cyst over the plantar surface of our patient's foot is one of the rarest presentations. CASE PRESENTATION: This is a case report of a 22-year-old Somali who presented with a lump over the plantar surface of his foot of 1-year duration. The diagnosis of hydatid cyst was made intraoperatively from the typical appearance of a hydatid cyst. The cyst was completely excised. No local recurrence has been detected to date. CONCLUSIONS: The rare location and uncommon incidence made the initial diagnosis of hydatid cyst of the foot difficult. Detection of the typical germinal membrane can guide the diagnosis of hydatid cyst in rare locations that are found incidentally.