Assessment of first-year medical students' perceptions of teaching and learning through team-based learning sessions.

Team-based learning (TBL) is an emerging teaching and learning strategy being employed in medical schools. The College of Medicine at Alfaisal University has adopted a TBL approach as an instructional method for first-year medical students. The aim of the present study was to describe the TBL method employed at Alfaisal University College of Medicine and to assess first-year medical students' perceptions of this learning modality for the anatomy- and physiology-based blocks/courses in organ systems form of curriculum. A five-point Likert scale questionnaire was structured based on Kirkpatrick's theory and assessed three major domains: reaction, learning, and behavior. Confirmatory factor analysis (CFA) and Cronbach's α-coefficient tests were used to assess the validity and reliability of the construct, respectively. CFA showed an adequate validity of the survey and Cronbach's α revealed an acceptable internal uniformity (0.69). A total of 185 respondents rated reaction, learning, and behavior toward introduction of TBL as 3.53 ± 1.01, 3.59 ± 1.12, and 3.57 ± 1.12, respectively. Excellent students rated TBL highly in all major domains compared with borderline students (reaction, behavior, and learning domains with P values of <0.049, <0.035, and <0.031, respectively). Students who had prior teamwork experience rated TBL higher in terms of their learning experience compared with those who were rarely involved in team work. This study demonstrated that Alfaisal University first-year medical students perceived TBL positively as a teaching and learning strategy for functional anatomy, and prior involvement in teamwork and academic performance correlates with higher ratings of TBL.

Feasibility of combining oncology surgery with bariatric surgery; a two-patient case series of sleeve gastrectomy with cytoreductive surgery and HIPEC.

Patients with an oncologic disease requiring cytoreductive surgery and hyperthermic intraperitoneal chemotherapy may also present with morbid obesity. In some patients, it may be possible to offer bariatric surgery such as sleeve gastrectomy in combination with their cancer resection to treat both diseases concurrently. Two such cases are described where sleeve gastrectomy was done alongside the primary oncologic surgery in the same procedure. Our patients had long-term follow-ups and their overall outcomes were favorable. They achieved remission and acceptable levels of weight loss over their several years of follow-up appointments. The added benefit of bariatric surgery may decrease long-term morbidity and mortality in carefully selected patients. More studies are indicated to fully understand the risks of benefits of this combined procedure in order to offer it on a wider scale.

Two Unusual Presentations of Presacral Schwannoma; A Case Series.

INTRODUCTION: Schwannomas are benign tumors that arise from the Schwann cells of nerve fibers. They commonly occur in the head and neck, mediastinum and extremities. However, they are extremely rare to be found in the pelvis. CASE PRESENTATION: We report two cases of pelvic presacral schwannomas found in our hospital. The first case is a 50 years old lady who was seen in the outpatient clinic complaining of pelvic heaviness. Investigations were done including Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) which showed a solid mass in the presacral area. Biopsy was taken, and results came back as schwannoma. The patient underwent exploratory laparotomy and total tumor resection. The second case is a 19 years old gentleman who was referred from a local hospital to our hospital for further evaluation of an asymptomatic left retroperitoneal pelvic mass. The mass was found incidentally after a Road Traffic Accident. The patient underwent exploratory laparotomy and total tumor resection. In the two cases, specimen histopathology report came back positive for schwannoma and patients were doing fine in the post-operative period with no signs of recurrence till this date. CONCLUSION: Due to the few cases in the literature, the diagnosis of presacral schwannoma is challenging. Some patients presented with vague symptoms like pelvic heaviness as seen with the patient in the first case, and some presented completely asymptomatic as seen with the patient in the second case. In symptomatic and asymptomatic cases, surgical excision is the mainstay of treatment of these tumors.

Laparoscopic intrapancreatic accessory splenectomy: A case report of recurrent immune thrombocytopenia in a 33 years old male patient after 6 years of splenectomy.

INTRODUCTION: Intra-pancreatic Accessory Spleen (IPAS) is a rare benign abnormality of splenic embryology that should be considered in any patient with recurrence of immune thrombocytopenia (ITP). The case demonstrates that remission could be achieved if an IPAS is correctly identified and safely removed. CASE PRESENTATION: We report a 33-years-old male patient who presented with chronic ITP relapsed 3 years post initial splenectomy. The patient presented with severe thrombocytopenia requiring steroids and intravenous immunoglobulin (IVIG). DISCUSSION: IPAS can be identified using enhanced CT scan along with Tc-99m sulfur colloid scintigraphy. Our patient underwent CT scan of abdomen and pelvis and was found to have an IPAS originating from the tail of the pancreas which was subsequently removed laparoscopically. The patient was then tapered off steroids and was followed up regularly and found to have acceptable platelet levels and no symptoms for 30 months post-surgery. CONCLUSION: The diagnosis of IPAS can be non-invasively made by an experienced radiologist with the recent advancement of medical imaging. Recognizing IPAS as a possible cause of ITP recurrence, and using minimally invasive approach can be performed safely and lead satisfactory outcomes.