Simple moulage for improving simulation for objective structured clinical examinations in undergraduate dermatology courses.

BACKGROUND: Objective structured clinical examination (OSCE) is being increasingly used as an assessment tool for undergraduate dermatology courses. One of the practical difficulties in conducting OSCEs in dermatology is getting patients with typical skin lesions which can be used for the whole group to ensure uniformity of assessment. We present a study on the use of simple moulage techniques to create uniform and standardized skin lesions for OSCEs in dermatology. METHODS: As a first step, the dermatology faculty in our department chose the clinical conditions which could be covered by using moulages. The main criteria considered were the importance of the condition to the exam blueprint, ease of making and resistance to handling (should not require frequent retouching). Moulages were created on volunteers after taking consent and the same were used in OSCEs s for a group of 5th-year students (N = 102). Difficulty and discrimination indices were compared between the stations using the moulage and the other stations. Qualitative feedback was obtained regarding the same from both the faculty and the students. RESULTS: There was consensus among the faculty and the majority of the students that the lesions were clearly recognizable. As far as other psychometrics were concerned, average difficulty and discrimination of the stations using the moulage were good (average difficulty index-0.78 and average discrimination index-0.68) and compared favorably with the other stations (average difficulty index-0.77 and average discrimination index-0.57). LIMITATIONS: Limited number of stations included, lack of detailed item analysis and lack of feedback from the simulated patients were the main limitations in this study. CONCLUSION: For most common skin conditions creating moulages to simulate the corresponding lesions is an easy procedure and can be an effective tool to standardize dermatology OSCEs for undergraduates, especially in resource-poor settings.

Computer assisted Objective structured clinical examination versus Objective structured clinical examination in assessment of Dermatology undergraduate students.

BACKGROUND: The assessment of dermatology undergraduates is being done through computer assisted objective structured clinical examination at our institution for the last 4 years. We attempted to compare objective structured clinical examination (OSCE) and computer assisted objective structured clinical examination (CA-OSCE) as assessment tools. AIM: To assess the relative effectiveness of CA-OSCE and OSCE as assessment tools for undergraduate dermatology trainees. METHODS: Students underwent CA-OSCE as well as OSCE-based evaluation of equal weightage as an end of posting assessment. The attendance as well as the marks in both the examination formats were meticulously recorded and statistically analyzed using SPSS version 20.0. Intercooled Stata V9.0 was used to assess the reliability and internal consistency of the examinations conducted. Feedback from both students and examiners was also recorded. RESULTS: The mean attendance for the study group was 77% ± 12.0%. The average score on CA- OSCE and OSCE was 47.4% ± 19.8% and 53.5% ± 18%, respectively. These scores showed a mutually positive correlation, with Spearman's coefficient being 0.593. Spearman's rank correlation coefficient between attendance scores and assessment score was 0.485 for OSCE and 0.451 for CA-OSCE. The Cronbach's alpha coefficient for all the tests ranged from 0.76 to 0.87 indicating high reliability. LIMITATIONS: The comparison was based on a single batch of 139 students. Such an evaluation on more students in larger number of batches over successive years could help throw more light on the subject. CONCLUSIONS: Computer assisted objective structured clinical examination was found to be a valid, reliable and effective format for dermatology assessment, being rated as the preferred format by examiners.

Measuring medical students' empathy using direct verbal expressions.

PURPOSE: Empathy is an important trait in physicians and a key element in the physician-patient relationship. Accordingly, one of the goals in medical education is developing empathy in students. We attempted to practically assess medical students' empathy through their direct verbal expressions. METHODS: The medical students' empathy was measured using the modified Pencil-and-Paper Empathy Rating Test by Winefield and Chur-Hansen (2001). The students took 15 minutes or so to complete the scale, and it was then scored by one of two trained evaluators (0 to 4 points for each item, for a total score of 40). The subjects were 605 medical students, and the data were analyzed using descriptive analysis, independent t-test, and one-way analysis of variance in SPSS version 21.0. RESULTS: The students' empathy scores were low (mean, 12.13; standard deviation, 2.55); their most common responses (78.6%) registered as non-empathetic. Differences in empathy were observed by gender (female students>male students; t=-5.068, p<0.001), school system (medical school>medical college; t=-1.935, p=0.053), and academic level (pre-medical 1 year < other years; t=-4.050, p<0.001). CONCLUSION: Our findings lead us to the significant conclusion that there is the need for empathy enhancement training programs with practical content.

Teaching of leprosy: current challenges.

In the context of declining leprosy endemicity worldwide, keeping the interest in knowledge and expertise in leprosy alive has been a matter of concern. Approaching the problem only in primary care, without the proper integration with other levels of care in the health system fails to account for the complexity of the disease. Training professionals to work at different levels of health care is a current challenge. The objective of this review was to look for experiences related to the teaching of leprosy both in undergraduate courses in the field of health sciences and in training programs for professionals who work in patient care. We highlight the role of the dermatologist in the management of control programs, diagnosis and treatment of the disease, as well as in the continuous education of other health professionals.

Teaching of leprosy: current challenges

In the context of declining leprosy endemicity worldwide, keeping the interest in knowledge and expertise in leprosy alive has been a matter of concern. Approaching the problem only in primary care, without the proper integration with other levels of care in the health system fails to account for the complexity of the disease. Training professionals to work at different levels of health care is a current challenge. The objective of this review was to look for experiences related to the teaching of leprosy both in undergraduate courses in the field of health sciences and in training programs for professionals who work in patient care. We highlight the role of the dermatologist in the management of control programs, diagnosis and treatment of the disease, as well as in the continuous education of other health professionals.

Validation of a computer based objective structured clinical examination in the assessment of undergraduate dermatology courses.

Many teaching centers have now adopted objective structured clinical examination (OSCE) as an assessment method for undergraduate dermatology courses. A modification of the standard OSCE in dermatology is computer based or electronic OSCE (eOSCE). We attempted to validate the use of a computer-based OSCE in dermatology in a group of fifth year medical students. The scores of the students in the computer-based OSCE showed a strong positive correlation with the scores on the clinical presentation (Pearson's co-efficient - 0.923, P value <0.000, significant at the 0.01 level) and a good correlation with overall scores of the student (Pearson's co-efficient - 0.728, P value <0.000, significant at the 0.01 level), indicating that this is a reliable method for assessment in dermatology. Generally, the students' feedback regarding the methods was positive.

Computer Assisted Objective Structured Clinical Examination: a useful tool for dermatology undergraduate assessment.

BACKGROUND: Dermatology is a minor subject in undergraduate medical curriculum in India. The dermatology clinical postings are generally poorly attended, and the clinical acumen of an average medical graduate in this specialty is quite low. AIMS: To develop and implement Computer Assisted Objective Structured Clinical Examination (CA-OSCE) as a means of end of dermatology posting evaluation. Also, to assess its effectiveness in improving the motivation, attendance and learning of undergraduate students with respect to their visual recognition skills and problem solving ability. METHODS: We designed and introduced CA-OSCE as a means of end of posting assessment. The average attendance and assessment scores of students undergoing CA-OSCE were compiled and compared using 'independent t test' with the scores of previous year's students who had undergone assessment with essay type questions. RESULTS: The average attendance and average assessment scores for the candidates undergoing CA-OSCE were found to 83.36% and 77.47%, respectively as compared to 64.09% and 52.07%, respectively for previous years' students. The difference between the two groups was found to be statistically significant. Student acceptability of the technique was also high, and their subjective feedback was encouraging. CONCLUSION: CA-OSCE is a useful tool for assessment of dermatology undergraduates. It has the potential to drive them to attend regularly as well as to test their higher cognitive skills of analysis and problem solving.

A study of knowledge, attitude and practices regarding leprosy among undergraduates and interns of a medical college and hospital from rural India.

Leprosy is an Infectious disease caused by Mycobacterium leprae and acquired through droplet infection. India has been carrying the 2/3rd global leprosy burden. Inadequate or incorrect information and knowledge about the disease and its treatment are the root causes of many stigmas and inhibitions prevalent in the various sections of the community. The present study was undertaken to assess the knowledge, attitude and practices (KAP) regarding leprosy among undergraduates (final year medical students) and interns of Rural Medical College and Pravara Rural Hospital, Loni, Maharashtra, India. It is heartening to note that most of students and interns had good knowledge about regimens, counselling and were willing to work in leprosy. There were, however, misconceptions about several aspects of diseases which were more in case of final year students compared with interns. Significant improvementin the knowledge of interns in comparison offinal year MBBS students was mostly noted on the aspects like transmission of leprosy, involvement of ulnar nerve in the leprosy, immunological relevance, use of vaccine, treatment of leprosy affected person and leprosy associated stigma. This positive change in attitudes as well as knowledge highlight the requirement of proper training and clinical exposure of medical students and important role of internship. There is need to focus on important aspects (such as cardinal signs, public health aspects and definitions, infectivity, misconception about marriage in which insignificant changes were observed.

Research as a tool for the teaching of epidemiology.

At a medical school in India, undergraduates have been given the opportunity to volunteer to conduct research as a means of improving their knowledge and understanding of epidemiology. First-year clinical students have conducted case-control studies with emphasis on methodological detail. Second-year students have been involved in community-based epidemiological studies. At the intern level, projects related to social factors in health and disease and to health administration have been encouraged. This initiative has been largely welcomed by the students and has yielded highly encouraging results.

PIP: Starting in 1985, at the Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India, modifications concerning teaching community medicine and epidemiology were introduced. Students were encouraged to conduct epidemiological investigations for better understanding of the subject. First-year students were free to participate in a hospital-based case control study involving 3-7 students over a period of 6-8 months. 5 projects were completed between 1990 and 1992 pertaining to risk factor analysis in oral cancers, protein-energy malnutrition, myocardial infarction, birth asphyxia, and cervical carcinoma. Methodology included objectives, review of the literature, definitions, questionnaires, and statistical methods. Faculty members monitored progress. Each student made a presentation to a gathering of 1st- and 2nd-year students and answered their questions. 2nd-year students undertook projects in community medicine lasting 2 months during vacation. Each student had a separate project of value for planning urban and rural field practice areas. Between 1987 and 1992, field studies were carried out on immunization coverage and mothers' knowledge about child immunization; the prevalence of caries among preschool children; cultural and economic factors affecting pregnancy; the epidemiology of cataract; blood pressure and hypertension; the nutritional status of preschool and school-age children; and drug compliance by leprosy patients. Case school studies were also undertaken on risk-factor analysis of low birth weight; factors affecting the acceptance of tubectomy; and treatment-seeking behavior among patients with cervical carcinoma. Similar public presentations were made. Interns were invited to assist in difficult subjects. A hospital study was completed by 2 students on injections given unnecessarily to children aged under 5 years. 111 out of 149 1st- year students questioned stated that they had gained knowledge and skills. Benefits reported included improved thinking, communication, statistical knowledge, understanding of human behavior, and a social view on health and disease.