Development, validation and use of appropriate assessment tools for certification of entrustable professional activities in community medicine to produce a competent postgraduate: A pilot study.

BACKGROUND: Adoption of competence-based medical education (CBME) is the need of the hour. OBJECTIVES: The objective of the study is to develop and validate appropriate assessment tools for the community medicine entrustable professional activities (EPAs) and to assess the usefulness of the validated tools in the assessment of postgraduate (PG) students. METHODS: An interventional study for 14 months was done in the department of community medicine. After the sensitization of faculty members and PGs, three EPAs were selected through consensus between faculty members and appropriate assessment tools mini-clinical evaluation exercise (Mini-CEX), case-based discussion (CBD), and direct observation of procedural skills (DOPS). Rubrics of milestones were formulated for the selected tools, and the designed tools were validated. These three validated tools were used for the quarterly assessment. RESULTS: The item-content validity index for all three assessment tools was one, while Scale Content Validity Index for Mini-CEX and CBD were 1, and for DOPS, it was 0.87. Three PG students were assessed using the validated tools thrice for the three selected EPAs. The PGs opined that assessment using rubrics made their task-specific, while faculties were quite satisfied with the assessment process as it removed subjectivity. CONCLUSIONS: The developed and selected tools of EPAs were found to have a substantial level of both face validity and content validity. The tools were also found to useful for periodic assessment in workplace settings and acceptable to both PG students and internal/external faculty members.

Prosthetic rehabilitation of large mid-facial defect with magnet-retained silicone prosthesis.

Rehabilitation of maxillofacial defect patients is a challenging task. The most common prosthetic treatment problem with such patients is, getting adequate retention, stability, and support. In cases of large maxillofacial defect, movement of the prosthesis is inevitable. The primary objectives in rehabilitating the maxillofacial defect patients are to restore the function of mastication, deglutition, speech, and to achieve normal orofacial appearance. This clinical report describes maxillofacial prosthetic rehabilitation of large midfacial defect including orbit along with its contents, zygoma and soft tissues including half of the nose, cheeks, upper lip of left side, accompanying postsurgical microstomia and orofacial communication, which resulted from severe fungal infection mucormycosis. The defect in this case was restored with magnet retained two piece maxillofacial prosthesis having hollow acrylic resin framework and an overlying silicone facial prosthesis. The retention of prosthesis was further enhanced with the use of spectacles. This type of combination prosthesis enhanced the cosmesis and functional acceptability of prosthesis.

Photoresponsive block copolymer: synthesis, characterization, and surface activity control.

Amphiphilic block copolymers bearing chromophores are used to achieve photoresponses upon exposure to suitable light, which alter molecular properties, but the photostimulus surface activity control of amphiphilic block copolymers remains to be elucidated. In this work, a series of novel amphiphilic block copolymers consisting of a carboxymethyl betaine monomer (called GLBT) and 4-ethoxy-4'-methacrylamide (EMAAB) with different block ratios have been synthesized using a reversible addition-fragmentation chain-transfer (RAFT) polymerization process. Copolymers were observed to be self-assembled in the aqueous solution above a critical micelle concentration, which was determined by static light scattering measurements and formed vesicles of 120-170 nm in diameter, at different pH values. Copolymers were found to be surface-active at pH 7 but exhibited non-surface activity at acidic and alkaline pH values. After being irradiated with 360 nm UV light, copolymers showed a significant photoresponse both at the surface and in bulk solution as a result of the photoinduced isomerization of azochromophores. The surface property of copolymers was significantly affected by UV irradiation at pH 7, and block copolymers became non-surface-active. The bulk properties changed considerably upon UV exposure where polymer vesicles transformed to micelles as a result of the polarity difference between two azo isomers (cis and trans isomers). All of these transitions were found to be reversible. A new method to control the surface active/nonactive and vesicle/micelle transitions by light and pH has been established by introducing an azobenzene chromophore and GLBT into amphiphlic diblock copolymers.

Accelerated stability and bioassay of a new oral α-ketoglutarate formulation for treating cyanide poisoning.

CONTEXT: Due to several limitations of existing cyanide antidotes, α-ketoglutarate (α-KG) has been proposed as a promising treatment for cyanide. OBJECTIVE: This study reports the accelerated stability and bioassay of a new oral α-KG formulation. MATERIALS AND METHODS: Amber-colored PVDF bottles containing 100 ml of 10% α-KG in 70% sorbitol, preservative (sodium methyl paraben and sodium propyl paraben), sweetener (sodium saccharine), flavor (American ice-cream soda and peppermint) and color (tartrazine), at pH 7.0-8.0 were stored in stability chamber (40 ± 2 °C and 75 ± 5% humidity) for 6 months in a GMP compliant facility. Various physical (pH, color, evaporation, extractable volume and clarity), chemical (identification and quantification of active ingredient) and microbiological (total aerobic count) analyses, together with protection studies were carried periodically in mice. Acute toxicity of the formulation and bioavailability of α-KG were assessed in rats at the beginning of the experiment. RESULTS: No physical changes and microbiological growth were observed in the formulation. After 6 months, α-KG content in the formulation diminished by ∼24% but its protective efficacy against cyanide remained at 5.9-fold. Protection was further characterized spectrophotometrically by disappearance of α-KG spectrum in the presence of cyanide, confirming cyanohydrin formation. Oral LD50 of α-KG formulation in rats was >7.0 g/kg body weight, and did not produce any acute toxicity of clinical significance. Also, an appreciable amount of α-KG was measured in blood. CONCLUSION: As per the guidelines of International Conference on Harmonization, the new α-KG formulation exhibited satisfactory stability, bioefficacy and safety as cyanide antidote.

Ethical Issues in the Planning and the Conduct of Escape Rooms in Medical Education.

Escape rooms in medical education are relatively a novel approach to facilitate critical thinking and decision-making in simulated realistic clinical scenarios among the medical students. The success of escape rooms in the attainment of specified competencies depends on several factors that must be given due consideration for optimizing the overall outcome. Further, there might be multiple ethical concerns that must be given due attention before, during, and after the conduct of such sessions. There is an immense need to integrate ethical considerations while designing and implementing escape rooms in medical schools, as it will aid in the creation of a respectful and encouraging learning atmosphere for the students. In conclusion, escape rooms provide a great learning opportunity for medical students to critically think, engage in teamwork, and learn the art of adaptation depending on the given clinical scenario. However, the successful conduct of such sessions is determined by a wide range of factors, including ethical considerations, and all of them need to be systematically analyzed and measures should be taken to reduce their impact on students.

Employing Escape Rooms in Medical Education to Deliver Engaging and Immersive Learning: Brief Review.

The conventional mode of medical education is delivered using didactic lectures, wherein teachers disseminate the desired information to a large number of students in a structured manner. The purpose of the current review is to explore the scope and need of escape rooms in medical education and identify the potential considerations to be acknowledged while designing an escape room in a medical college for training undergraduate medical students. Escape rooms in principle refer to the learning environments that are interactive and immersive, in the sense that students who are part of these rooms are posed with a puzzle or a challenge or a task that must be solved by them within a defined period of timeframe to eventually escape from the room, which is the ultimate goal of such sessions. The success of escape rooms is determined depending by the way it has been designed, in terms of their ability to engage the involved participants and promote collaboration. In conclusion, the employment of escape rooms in medical education is an innovative teaching-learning method to overcome the limitations of conventional strategies. Acknowledging the merits of escape rooms in the development of critical thinking and teamwork skills, it is the need of the hour that every medical institution must explore the possibility and introduce it within their settings to ensure experiential and long-term learning among medical students.

Serious Games in Medical Education: What it Adds? How to Go about It?

Medical educators have adopted a number of teaching-learning methodologies to make their sessions interactive considering the need for active engagement of students to strengthen the process of learning. One among them is the use of serious games, wherein digital applications are used to enable the attainment of the intended learning objectives. A wide range of serious games can be designed to target different areas in healthcare training, which cumulatively provide a holistic and engaging approach for students to acquire knowledge and develop skills. Owing to the extensive areas and domains in medical education wherein we can use serious games, the benefits attributed to them are immense. The successful introduction of serious games into the medical curriculum depends on several factors and we must adopt a systematic approach to optimize the benefits. In conclusion, the introduction of serious games into medical education can benefit medical students by helping them master multiple skills required for successful clinical practice. Acknowledging the changing landscapes in medical education, there is an immense need that teachers and administrators to explore the possibility of integrating these games into medical schools.

Shifting from Conventional Curriculum to Value-based Medical Curriculum: Narrative Review.

Value-based medical education is essential for the provision of quality-assured patient-centered healthcare services. The purpose of the current review is to explore the need for the adoption of a value-based approach in medical curriculum, identify the merits, devise a stepwise plan for the implementation of a value-based curriculum, and identify the potential concerns and the strategies to overcome them. The implementation of a value-based approach in medical curricula requires a systematic and stepwise approach to ensure the attainment of maximum benefits. However, this implementation can be accompanied by multiple challenges, and we will require the active involvement of medical educators and college administrators to overcome them. The delivery of value-based medical education is expected to prepare the future cohort of healthcare professionals to deliver patient-centered care. This calls for the need to adopt a multipronged approach to ensure that this value-driven teaching is integrated into the existing model of delivery of medical education, as it will significantly improve patient outcomes and well-being.

Integrating Psychological Care Training in Trauma Care for Medical Students: the Need and the Strategies.

Trauma, whether arising from accidents, violence, or medical emergencies, generally has a substantial impact on the lives of victims, their family members, the society, and the healthcare delivery system. The purpose of the article is to justify the need to train medical students in trauma-related psychological care, explore the significance of simulation-based training, and identify coping strategies to augment the resilience of medical students. As healthcare professionals are the ones who are executing trauma care-related interventions, it is essential that medical students are trained to offer psychological care to the victims and family members of trauma to enable healing of both the body and the mind. If medical students learn about psychological care pertaining to trauma, they will be well equipped to handle sudden traumatic events by being more adaptable and resilient. Medical students can be trained in multiple ways to improve their psychological preparedness while delivering trauma care. As a part of the psychological training related to the management of trauma victims, medical students must be trained in developing coping strategies and resilience. In conclusion, facilitating learning among medical students in the psychological aspects of trauma care is a crucial domain for developing competent healthcare professionals. It is a priority to integrate into medical education a comprehensive learning about psychological care that will empower medical students to respond effectively to the complexities of trauma with empathy, resilience, and effective communication.

Transforming Medical Training Through Online Case-Based Learning: Brief Review.

Online case-based learning (CBL) is a pedagogical approach that employs the use of digital platforms and virtual environments to discuss clinical cases with undergraduate medical students. The purpose of the current review is to explore the scope and merits of online case-based learning, development of a plan for designing and implementing online CBL sessions in a medical college for undergraduate medical students. This happens to be an innovative approach as students get an opportunity to discuss and analyze clinical cases by practically applying their theoretical knowledge to clinical practice. Like any teaching-learning method, the effectiveness of online CBL sessions also depends on the efforts taken by educators in the planning stage. As these sessions will be conducted online, the most important consideration is to ensure that students have access to the required technology. As we all know, assessment drives learning, there is a definite need to supplement teaching-learning activities in online CBL sessions with suitable formative assessments. In conclusion, online CBL is an effective pedagogical approach to promote discussion on interesting clinical cases using flexible online platforms. Considering the merits of the method and the fact that technology has become an integral part of medical education delivery, every medical institute must explore its infrastructure to systematically introduce online CBL within the medical curriculum.

Revitalizing Medical Education Delivery through Teacher-Led Curriculum Critiques: A Narrative Review.

A teacher in a medical college is like a compass who has the responsibility and the power to guide budding medical students in their educational journey to become effective and efficient members of the healthcare team. The purpose of the current review is to justify the significance of curriculum evaluation, explore the role of teacher in the capacity of curriculum evaluator, enlist various methods and tools to perform curriculum evaluation, and identify the challenges and suggest potential solutions to overcome them. An extensive search of all materials related to the topic was carried out on the PubMed and Google Scholar search engines and a total of 16 articles were selected based upon their suitability with the current review objectives and analyzed. Keywords used in the search include curriculum evaluation in the title alone only (viz. curriculum [ti] AND medical [ti]; curriculum evaluation [ti] AND methods [ti]; curriculum evaluation [ti] AND approaches [ti]; curriculum evaluation [ti]). A number of strategies can be employed to perform the evaluation of the medical curriculum, ranging from obtaining feedback from medical students at the end of each professional phase to assessing content, teaching methods, assessment, and attainment of learning outcomes. The process of evaluation of medical curriculum by teachers is a complex and challenging one and needs careful planning and execution of different aspects. These identified challenges clearly provide evidence that teachers have to be given the necessary training, resources, and institutional support to enable them to conduct effective medical curriculum evaluation. In conclusion, teachers in their capacity as curriculum evaluators remain the most important stakeholder in ensuring continuous improvement in the quality of education delivered to students. Owing to their in-depth awareness of classroom dynamics, the learning process, and the awareness about unique needs of students, their involvement in curriculum evaluation can ensure alignment between the delivered curriculum and the needs of the society.

Training Undergraduate Medical Students in Shared Decision Making: A Systematic Review.

In the field of healthcare delivery, shared decision making (SDM) refers to a collaborative process, wherein both patients and the healthcare professionals mutually work to make informed and consensus decisions with reference to the kind of medical care that will be administered to patients. The purpose of the current review is to explore SDM in health care, ascertain the role of medical education, and identify the ways to train and assess undergraduate medical students in competencies pertaining to SDM. An extensive search of all materials related to the topic was carried out on the PubMed and Google Scholar search engines and a total of 29 articles were selected based on their suitability with the current review objectives and analyzed. Keywords used in the search include learning resources in the title alone only (viz. shared decision making [ti] AND patient [ti]; shared decision making [ti] AND medical education [ti]; shared decision making [ti] AND assessment [ti]; shared decision making [ti] AND self-assessment [ti]; shared decision making [ti]; shared decision making [ti]). In the domain of medical education, the promotion of SDM essentially will require a multipronged approach to enable its integration into the medical curriculum. However, we must remember that mere teaching-learning methods would not improve it unless they are supplemented with assessment methods, otherwise, we will fail to deliver sustained results. In conclusion, SDM in medical education and healthcare industry represents a transformative shift from the traditional paradigm to a patient-centered approach that empowers both patients and healthcare providers, including budding medical students. The need of the hour is to advocate and encourage structured integration of SDM in the medical curriculum and support the same with periodic assessments.

Strengthening the Process of Mentoring Through Portfolios.

In the field of medical education, mentoring is a form of dynamic relationship that is crucial to facilitating the learning process among medical students and helping them in their professional development. The utility of a portfolio in mentoring is not a mere collection of work samples, rather it is a dynamic tool to ensure the professional and personal growth of medical students, with the help of reflective insights. Portfolio can be used to set goals and track the progress of students over a period of time. Even though mentoring through portfolio has been linked with multiple benefits, there are multiple challenges that must be taken into consideration to enhance the overall utility. In conclusion, mentoring carried out through a portfolio has immense potential to facilitate learning and encourage professional growth. However, considering the presence of multiple challenges, there is an immense need to establish a structured framework for portfolio mentoring and support the same with training and technical support.

Practice makes perfect: The learner-doctor blueprint for proficient physicians.

In the process of producing competent and efficient medical graduates, clinical teaching is an integral component of undergraduate training. Even though clinical training has been linked with multiple benefits and plays a defining role in transforming a medical student into a competent doctor, it has some inherent challenges. The learner-doctor method emphasizes learning by doing and has the potential to counter the identified challenges in the traditional mode of clinical training. The learner-doctor method places emphasis on collaborative learning, wherein students learn by experiential learning and active participation in patient care. This method not only fosters the development of clinical skills but also cultivates critical thinking, teamwork, empathy, and effective communication. A number of activities or strategies must be planned and implemented to ensure that the set objectives of the learner-doctor method are accomplished by the medical institutions. In conclusion, as medical education continues to evolve, the learner-doctor method of clinical training is a dynamic approach to bridging the gap between theoretical knowledge and practical skills. As this method enables medical students to actively engage in patient care and improve their critical thinking, it becomes the need of the hour that every medical institution should explore the opportunity to effectively implement the same in their settings.

Community Health Immersion Programs in Medical Institutions.

Exposure to the local community is crucial and pivotal to deliver contextual learning to medical students and thereby aid in the process of attaining subject-specific competencies. In the field of medical education, community health immersion refers to a set of systematic and immersive educational experiences for medical students to expose them to sociocultural and health-related attributes of the general population. Community health immersion has been linked with multiple merits that are crucial in the making of a competent medical graduate, who is well equipped to deliver patient-centered care. Even though there are multiple benefits to community health immersion nevertheless, its implementation in the community might vary based on institutional support and local community-related factors. There is an immense need to overcome these challenges to ensure optimal benefit, and this will essentially require the adoption of a multipronged approach with the help of all the concerned stakeholders.

Cultural Competency Training of Medical Students among Trauma Patients: Training and Assessment Strategies.

In the field of health care, cultural competency refers to the ability of healthcare professionals to acknowledge, respect, and accordingly respond to the varied needs, beliefs, values, and practices followed by persons and the communities they serve. The purpose of the current review is to explore the role of cultural factors and trauma experience, and identify the strategies that can be employed to train and assess medical students in cultural competency pertaining to trauma patients. An extensive search of all materials related to the topic was carried out on the PubMed and Google Scholar search engines and a total of 21 articles were selected based on their suitability with the current review objectives. Cultural factors play a defining role in determining the experiences of trauma patients, and how these patients and family members perceive, cope, and recover from such traumatic events. To meet the diverse needs of the community, the medical curriculum has to be flexible and must include the component of cultural competency. Like any other domain, medical educators must plan for the assessment of cultural competencies while delivering trauma education, as it will provide insights into the readiness of the students to deliver culturally sensitive and effective care to trauma patients. In conclusion, the inclusion of cultural competency training within trauma care in the medical curriculum carries immense utility as it can help healthcare professionals to effectively communicate and respond to the varied needs of trauma patients, regardless of their cultural backgrounds. This calls for the adoption of a combination of teaching-learning methods and assessment methods by medical educators so that medical students can be empowered to deliver culturally sensitive medical care to trauma patients.

From Likes to Saving Lives: Embracing Social Media's Power to Connect, Learn, and Innovate in Medical Education Delivery.

Social media have become an integral part of human life, because the manner in which we communicate, share information, and network with the external world is changing significantly. The purpose of the current review is to explore the role of social media in transforming medical education, identify the merits and the potential concerns, and propose effective strategies to overcome the identified challenges. Social media have significant potential in strengthening the delivery of medical education and meeting the scenarios emerging out of changing dynamics. The most important aspect of social media is that they have global reach and wide accessibility, and promotes active engagement of students. Similar to any other teaching-learning method, even the use of social media has its own limitations-cum-concerns. We must come out with potential solutions to each one of these problems so that overall acceptance and utilization of social media applications can be optimized. In conclusion, social media in medical education have immense potential to revolutionize learning and provide a platform for collaborative learning and networking. The need of the hour is to do systematic planning, train stakeholders, and establish guidelines for promoting effective engagement while using social media, and thereby keeping pace with the rapidly evolving healthcare landscape.

Exploring Anticancer Properties of Medicinal Plants against Breast Cancer by Downregulating Human Epidermal Growth Factor Receptor 2.

Plants have a history of being employed in managing breast cancer. However, no scientific evidence supports the idea that these plants can effectively reduce the level of HER2 expression. In this study, extracts from 10 medicinal plants were evaluated for their anticancer properties against HER2-positive breast cancer cells through various methods, including the SRB assay, comet assay, annexin V-FITC dual staining, and immunoblotting. All extracts exerted antiproliferative activity against HER2-positive breast cancer cells. Furthermore, Terminalia chebula (T. chebula), Berberis aristata (B. aristata), and Mucuna pruriens (M. pruriens) reduced HER2 expression in tested cell lines. In addition, an increased Bax/Bcl-2 ratio was observed after the treatment. A comparative proteomics study showed modulation in the proteome profile of breast cancer cells after treatment with T. chebula, B. aristata, Punica granatum, M. pruriens, and Acorus calamus. Metabolic profiling of lead plants revealed the existence of multiple anticancer compounds. Our study demonstrates the considerable potential of the mentioned plants as innovative therapies for HER2-positive breast cancer.