Perspectives of Teachers at Medical Colleges Across India regarding the Competency based Medical Education Curriculum – A Qualitative, Manual, Theoretical Thematic Content Analysis

Background: Competency-based medical education (CBME) curriculum has been implemented in India since 2019 with a goal to create an “Indian Medical Graduate” (IMG) possessing requisite knowledge, skills, attitudes, values, and responsiveness. Objectives: To explore teachers’ perceptions across India at medical colleges on the newly implemented competency-based medical education curriculum. Methods: This was a qualitative cross?sectional study conducted among teachers working at medical colleges across India, between February and April 2022 (n = 192). The data collection was done using Google forms online survey platform on teachers’ perception regarding CBME, its specific components, and perceived bottlenecks. We analyzed this qualitative data using manual, theoretical thematic content analysis following the steps endorsed in Braun and Clarke’s six-phase framework. Results: The majority of the teachers (64.1%) have positively responded to the CBME curriculum’s implementation. However, it came with a caution that the curriculum should continuously evolve and adapt to regional demands. The foundation course, early clinical exposure, and the family adoption program were the specific components of CBME curriculum over which the teachers raised concerns. The need for additional teachers in each department (department-specific teacher or faculty per hundred students ratio to be worked out) and the need for enabling faculty preparedness through adequate training was highlighted. Concerns were also raised regarding implementing CBME with teachers without a medical background (especially in preclinical departments). Conclusion: It is the need of the hour for the curriculum to incorporate a systematic feedback mechanism built into the system, though which such critical appraisals can be meaning collated and acted upon, to ultimately evolve, thereby creating an “Indian Medical Graduate” for the needs of todays’ society.

Impact of COVID-19 pandemic on medical education

Background: Medicine is one of the few academic disciplines that cannot be taught in the distance education mode. Hands-on practice for clinical skills and competency is critical in medical education. Although this pandemic has offered new learning modes such as teleconsultation, videoconferencing, virtual simulations, and digital podcasts, how much actual knowledge transfer and skill gain will be achieved, is unanswered. Aims and Objectives: The present study has been planned to understand the impact of COVID on medical education and to identify the factors which promoted or hindered learning during COVID-19 pandemic. Materials and Methods: This cross-sectional study was conducted among 261 willing MBBS students from various colleges of Tamil Nadu after obtaining Institutional Ethical committee clearance using a pre-validated structured online questionnaire through Google form link in online social platforms through “Voluntary opt in” method of sampling. Results: About 22.6% of the study participants were affected by COVID-19. About 46% of the participants family members suffered from COVID and all of them accepted that it significantly affected their academics. About 71.6% experienced anxiety/depression. About 93.5% were addicted to social media during class hours. About 88.1% welcomed “flipped/blended learning”. More than 90.8% reported that they missed skill-based learning/Primary health care training. About 80.8% positively felt that they got more duration for preparing exams. About 89.3% found that practical exams were challenging. Conclusion: Not only have we witnessed the importance of having a robust health-care system, but the pandemic has created a critical need to transform various aspects of medical education especially to a model of blended learning of online and offline methods to enable a better academic environment so as to reflect the changing medical landscape.

Comparison of high-resolution manometry parameters among type II diabetes patients and normal volunteers

Background: Gastrointestinal (GI) autonomic neuropathy and reflux esophagitis are common in chronic diabetics. To gauge the adequacy of peristalsis, high-resolution esophageal manometry is considered as a reliable test. Aim and Objective: To compare the GI symptoms and high-resolution manometry parameters between type II diabetes patients and normal volunteers. Materials and Methods: This comparative study was conducted on 35 known type II diabetes mellitus patients (hemoglobin A1c [HbA1c] levels ?6.5%) and 35 normal volunteers between the age group of 35 and 70 years. Sociodemographic details, drug history, disease duration, and GI symptoms were elicited among the study participants. HbA1c and High-resolution manometry were measured for all the participants. Results: The frequency of epigastric pain (31.48%), heartburn (34.28%), pharyngeal irritation (31.43%), and loose stools (37.14%) were significantly higher in the diabetics. Significant difference (P < 0.05) was observed in mean basal expiratory pressure (MBEP) and mean basal inspiratory pressure (MBIP) values between diabetics and controls. There was a positive significant correlation between esophagogastric junction contractile integral and MBIP (r = 0.557), MBEP (r = 0.583), Median Integrated Relaxation pressure (r = 0.410). Conclusion: Hyperglycaemia seems to be an independent risk factor for gastroesophageal reflux disease (GERD). Obesity significantly increments the occurrence of GERD in diabetics. Strict adherence to preventive measures such as weight reduction, diet management, glycaemic control will have a great impact on the occurrence of GERD in diabetics.

Association Of Risk Factors Of Cerebral Palsy – A Matched Case Control Study

Background: Cerebral palsy (CP) is one of the leading causes of childhood disability worldwide. The exact etiology of CP is poorly understood, but many risk factors are related to problems during pregnancy, labor, and delivery. The age and sex-matched control study were done to evaluate the association of perinatal risk factors with the development of CP among children in a rural area. Methods: The study was conducted in the Division of Physical Medicine and Rehabilitation (PMR). Seventy clinically diagnosed CP children as cases and 70 children without CP as controls were included. Information regarding perinatal risk factors was collected from the parents of the children. Data were collected and statistically analyzed by using the Mc-Nemar chi-square test. Results: The study results suggested that children with male sex (53%) had a higher incidence of CP compared to female (47%) children. Spastic diplegia (60%) was the most common subtype of CP. The significant ‘p’ value (< 0.01) reveals that all the perinatal risk factors are associated with the development of CP. Conclusion: This study concluded that spastic diplegia was the most common subtype of CP. The perinatal risk factors such as preterm, low birth weight, birth asphyxia, and neonatal seizures had a significant association with the development of CP.

Comparison of efficacy between levosalbutamol and levosalbutamol-ipratropum nebulization in mild to moderate childhood asthma

Background: The objective of the study was to compare the efficacy between levosalbutamol and ipratropium combination over levosalbutamol nebulisation in reversing airflow obstruction and improve oxygenation, evaluated using the pulmonary asthma score, SaO2, and PEFR in mild and moderate asthma.Methods: A prospective, randomized, study was performed in RMMCH pediatric emergency department. Children between 6 and 12 years of age who presented with mild to moderate asthma exacerberations were enrolled in the study. They were randomly allocated into two different groups: one nebulised with levosalbutamol alone and another with addition of ipratropium bromide to levosalbutamol. Baseline Peak expiratory flow rate and Final absolute values or change from baseline 60-120 minutes after the inhalation are measured. Patients were evaluated using the pulmonary score.Results: After treatment there is improvement in the mean pulmonary asthma scores and PEFR percentage in A+B group than A group, but it is not statistically significant (p value >0.05). There is statistically significant improvement in pulmonary asthma score and PEFR in each of the groups after nebulisation and pulmonary asthma score has a sensitivity of 66.7% and 65.6% in diagnosing severity of asthma in relation to PEFR.

Role of probiotic for impetigo in children

Back ground: Impetigo is the most common bacterial infection in children. This acute, highly contagious infection of the superficial layers of the epidermis is primarily caused by Staphylococcus aureus or Streptococcus Pyogenes. The Objective of this study is to find out the role of probiotic among children suffering from impetigo. Materials and methods: This was a prospective, randomized, single-blinded interventional study, conducted in Paediatric OPD, Dermatology OPD and Paediatric Ward in Rajah Muthiah Medical College and Hospital for a period of 6 months. A total of 50 patients were enrolled in the study as per the inclusion criteria. They were treated with probiotic (50 million spores of Lactobacillus sporegenes, Streptococcus faecalis 30 million spores, Clostridium butyricum 2 million spores, Bacillus mesentericus 1 million spores) twice daily for 5 days. As a conventional treatment, Azithromycin 10 mg/kg/day once a day for 5 days given along with probiotic. Microbiological examination of pus from the first swab was used to prepare smears and was stained by Gram’s method. The pus from the second swab was inoculated on blood agar and Mc Conkey’s agar. Results: Bacteriological response and the clinical response were highly significant from baseline to the fifth day of treatment with probiotic along with azithromycin. Conclusion: The result of our study explores a new possibility in the horizon of treatment of impetigo. Since the adverse effects caused by probiotic are minimal and tolerable, it could be further exploited for the treatment of other inflammatory or immune conditions that are refractory to treatment with current chemotherapeutic agents.

Proximal Tibia Bone Graft: An alternative Donor Source especially for Foot and Ankle Procedures

Bone graft is essential in various orthopaedic procedures. Among the many donor sites for harvesting autologous bone graft, the iliac crest has been the most commonly used. However, for foot and ankle procedures the proximal tibia has gained popularity as an alternative donor site due to its anatomic proximity to the primary surgical site. In this article we evaluated the possible complications associated with harvesting proximal tibia bone graft. Our study showed the low incidence of morbidity in harvesting proximal tibia bone graft, thereby providing a good alternative donor for foot and ankle procedures.

Efficacy of Euphorbia splendens and Leonotis nepetaefolia on aflatoxin producing fungi Aspergillus flavus and Aspergillus parasiticus.

Efficacy of three different concentrations (5, 10 and 15 mg/ml) of dry flower powder of E. splendens and L. nepetaefolia was tested on the growth of aflatoxin-producing toxigenic strains of fungi A. flavus (NCBT 101) and A. parasiticus (NCBT 128) in Sabouraud dextrose agar medium (SDA). Maximum (75%) inhibition of growth of A. flavus was seen at 15 mg/ml concentration of E. splendens flower dry powder, while A. parasiticus showed 50% inhibition of growth at 10 and 15 mg/ml concentrations. Total inhibition (100%) of growth of A. flavus was seen at 10 and 15 mg/ml for L. nepetaefolia and maximum (75%) inhibition of growth was seen for A. parasiticus at 15 mg/ml concentration. Bioassay with groundnut seeds soaked with different concentrations of flower extract proved that both fungi were incapable of infecting the seeds at 10 and 15 mg/ml of L. nepetaefolia flower extracts.

Pleural involvement by Salmonella senftenberg: a report of two cases.

Non-typhoidal serovars of salmonella are an unusual cause of pleuropulmonary infections. We report two patients with empyema caused by Salmonella senftenberg. One patient had associated diabetes and gall bladder carcinoma, and infection was acquired in hospital. Both patients responded well to parenteral antibiotics.

High frequency ventilation: basic concepts and clinical application.

High frequency ventilation (HFV) is a mode of therapy that improves gas exchange with pressure fluctuations much lower than that required for conventional ventilation. HFV is efficacious in the "rescue" management of infants with respiratory failure. Although each HFV system has functional characteristics that are design related, it now appears that when used with similar treatment strategies and within functional limitations, similar outcomes can be achieved. Ideally, the clinician or the operator should be familiar with the basic concepts of different high frequency ventilators to achieve maximal benefits from using these devices in infants with respiratory failure.

Acute respiratory distress syndrome complicating typhoid fever.

We report a case of a young female patient with typhoid fever whose clinical course was complicated by hypotension, thrombocytopenia, encephalopathy and acute respiratory distress syndrome (ARDS). She recovered with prompt mechanical ventilatory support. ARDS in typhoid fever has generally proved to be fatal in reported cases.

Acute respiratory distress syndrome following nitrogen dioxide exposure.

A young laborer was accidentally exposed to toxic nitrogen dioxide fumes following an accidental explosion at work place. He developed acute respiratory distress within few hours of exposure and manifested with severe hypoxemia and permeability edema. Assistance with mechanical ventilation and corticosteroid therapy could be instituted only after 24 hours of exposure. He had shown remarkable recovery and could be weaned off after seven days. At three weeks after discharge, his lung function tests were normal.