Stages of Concern of Medical Faculty toward Adoption of Competency-based Medical Education in India: A Multicentric Survey.

Context: Currently, a major curricular reform in the form of competency-based medical education (CBME) curriculum is being rolled out across all medical colleges in India. However, it is important to find out and address the concerns of faculty regarding various aspects of this new curriculum. Aim: To analyze the concerns of the faculty members of medical colleges in India in response to the changes emerging from the adoption and implementation of the new curriculum through the concerns-based adoption model by applying the stages of concern (SoC) questionnaire. Methodology: A multicentric, cross-sectional quantitative study involving faculty members currently working in medical colleges and with more than 2 years of teaching experience was conducted using SoC questionnaire (SoCQ). The questionnaire was delivered as Google Form. Results: Of the 744 faculty participants, 41.1% (306) of faculty belonged to the 31-40 years age group followed by the 41-50 years age group (267, 35.9%). Respondents rated their level of concern differently among the seven SoC - percentile scores were highest in Stage 0- awareness (94) and least in Stage 4- consequences (59). An appreciably higher percentile scores were seen at the consequences stage (63 vs. 54), collaboration stage (80 vs. 68), and refocusing stage (77 vs. 69) in those faculty members who were trained in curriculum implementation support program (CISP) compared to the untrained group. However; the SoCQ profiles of CISP trained and untrained faculty were very much similar. SoCQ profiles of holders of advanced training in medical education and non-holders were also the same. Conclusion: Almost after 2 years of well-planned introduction of the CBME curriculum in India, the generalized faculty profile is still suggestive of interested but non-user type for the adoption of CBME. However; compared to untrained faculty, CISP trained faculty is more concerned about the impact of CBME on students, collaborating with colleagues for its proper implementation and exploring more benefits from the implementation of CBME, indicating that more hand-holding is required for faculty development beyond CISP.

Transformational learning for health professionals through a Theatre of the Oppressed workshop.

Theatre of the Oppressed (TO) is a powerful participatory tool for communities to examine their struggles against oppression. The healthcare community has problems inherent to complex, unequal power equations, and TO may be a useful means to understand and respond to their struggle. A 3-day workshop on TO was facilitated by the authors in the Himalayan Institute of Medical Sciences (HIMS) in Dehradun, India, in August 2017. The workshop culminated in the 'Forum Theatre', which included five short plays, each depicting a struggle due to real-life oppression faced by one or the other participant. The audience (about 200 invited members of the HIMS community) chose one play depending on the struggle with which they identified most. That play was 'forumed': spectators were invited to replace the struggling person and demonstrate how they would handle the oppression. Over the next week, participants reflected on the workshop through a structured online questionnaire. The feedback (n=16/27 participants; response rate 59.3%) was subjected to descriptive statistics and to qualitative analysis. The highest average Likert score (out of a maximum of 5) was given to the following items: TO engages senses and emotions (4.6±0.50), can help inculcate ethical behaviour (4.4±0.81), identifies conflict (4.4±0.51), and resolves issues of attitude, behaviour, communication, diversity and empathy (4.4±0.73). The Forum Theatre was reported to be a means to "express emotions and opinions and to simultaneously gather the same from others"; "make people push their own limits"; "bring out social problems in public"; "examine the root causes behind lived experience"; "provide context for understanding and for exploring alternatives"; and "convert thoughts to action." In conclusion, TO is an engaging activity that identifies conflict; participants' initial reactions suggest that it may initiate change in the ABCDE attributes (attitude, behaviour, communication, diversity, ethics and empathy) of medical professionals.

Asynchronous versus Traditional Teaching for MBBS Undergraduate Students-Effectiveness and Students Perspectives - A Pilot Study.

BACKGROUND: Traditional lectures continue to be one of the common ways of teaching practiced in medical schools across India. However, there are many other effective ways of teaching in large groups and lately e-learning modules, which can be synchronous, asynchronous, or blended, have been used to complement face-to-face interactions. E-assignments have been effectively used to engage students into meaningful learning. AIM: The aim of the study is to compare asynchronous teaching with traditional teaching in terms of student perspectives and learning. MATERIALS AND METHODS: After taking ethical clearance from the Institutional Ethics Committee, the study was conducted involving 66 student volunteers from MBBS 2nd year. All the students were subjected to a pretest on the topic - "low backache" prior to the intervention. The students were then divided into two groups: Group A and Group B of 33 students each. Group A was taught by traditional lecture method, while Group B was given an e-assignment on the topic for which no face-to-face interaction was done earlier. The students from both the groups were then subjected to a posttest followed by feedback. RESULTS: Analysis of covariance, considering the pretest score as a covariate, revealed that the two groups were comparable to begin with P = 0.632. After the intervention, posttest mean scores improved significantly (P < 0.001) within each group, for both the groups, but there was no significant difference in posttest scores on intergroup comparison (P = 0.507). Student feedback brought to light that 85% of the students felt that the traditional lecture method followed by e-learning would be of a great benefit to them. CONCLUSION: Although no single method emerged as superior over the other, student feedback revealed that 90% of the students graded e-module as either satisfactory to good. Most felt that lecture followed by e-modules will help them to learn better.

Role of concept map in teaching general awareness and pharmacotherapy of HIV/AIDS among second professional medical students.

OBJECTIVE: Medical students as future doctors will play an important role in caring for HIV-infected patients. This study assessed and evaluated the existing level of knowledge of MBBS students about HIV/AIDS given through lecture delivery methods and by use of concept map (CM). MATERIALS AND METHODS: This study was carried out on 150 professional MBBS students of tertiary care hospital. A pretest was conducted by giving 10 multiple choice questions (MCQ) of general awareness and 15 questions regarding pharmacotherapy of HIV/AIDS. In between pre- and post-test, a session of 1-week integrated teaching module was organized. After completion of integrated teaching, 2 h session of CM on general awareness and pharmacotherapy of HIV/AIDS was taken. A posttest was conducted using MCQs and problem-based question (PBQ) to assess the effect of integrated teaching and CM on their knowledge about HIV/AIDS. Feedback was also taken from the students to regarding their views about CM. RESULTS: There was a significant increase in student's score in MCQ test after integrated teaching than pretest (P < 0.05). There was also significant improvement in PBQ score after CM than that of after integrated teaching (P < 0.05). Students' perception about the effectiveness of CM was positive. CONCLUSION: CM can make a significant improvement in the knowledge of medical students and were motivated and developed interest in the subject.

Introducing structured viva voce examination in medical undergraduate pharmacology: A pilot study.

OBJECTIVE: Viva voce examination is an important tool of evaluation in medical examinations marred by high subjectivity. Gross subjectivity in viva voce assessment can be reduced by structuring it. MATERIALS AND METHODS: The marks obtained in theory and viva voce (traditional viva voce examination [TVVE]) of I sessional, II MBBS students were compared and a huge disparity was identified. A structured viva voce examination (SVVE) was then proposed and experimented as an objective and standardized alternative. Sets of equitable question cards for SVVE were prepared, each having eight questions with two parts each, arranged successively with increasing difficulty, domains of learning, and appropriate marks. The percentage variation in scoring in viva versus theory marks was calculated for both TVVE and SVVE, and students were grouped as Group I (+100 to +51%); Group II (+50 to -50%); Group III (-51 to -100%); Group IV (-101 to -150%); Group V (-151 to -200%); and Group VI (< -200%) variation, as? inappropriate, appropriate, inappropriate, erroneous, more erroneous and most erroneous respectively. Student's feedback on the SVVE was also obtained. RESULTS: In TVVE (n = 128), the students distributed were:none,17.2%, 23.4%, 22.7%, 11.7% and 25% in Group I, II, III, IV, V, and VI in contrast to SVVE (n = 107) as 7.5%, 57.9%, 19.6%, 6.5%, 5.6%, and 2.8%, respectively. Marked disparity of TVVE was annulled with SVVE. Student's feedback was quite encouraging with 83% overall acceptability and almost 66% preferred SVVE. CONCLUSION: SVVE was more realistic as compared to TVVE. Most of the students favored this approach.

Poetry in teaching pharmacology: Exploring the possibilities.

OBJECTIVES: To explore poetry as a tool for active learning in linking knowledge and affective domains and to find if correlating learning with imagination can be used in "assessment for learning." MATERIALS AND METHODS: After taking a conventional lecture on Asthma, a creative writing assignment in the form of poetry writing was given to the students. Different triggers were given to the students to channelize their thought pattern in a given direction that was linked to specific areas of academic relevance. Students were asked to reflect on this learning experience and the faculty was asked to evaluate the student assignment on a 5-point Likert scale. RESULTS: Most student groups scored well in the "overall assessment" of creative assignments and were rated as good or fair by the faculty. Students reflections were very informative and revealed that more than 90% of the students liked the exercise and many were too exuberant and liberal with emotional reactions that breathed positive. Around 5% students found the exercise average and another 5% found it very childish. CONCLUSION: Poetry writing turned out to be like a simulation exercise that linked academic knowledge, creativity, and the affective domain in an assumed scenario, rehearsed in free locales of mind. The metaphorical transition embedded in its subtle creation helped assess deeper understanding of the subject and the logical sequence of thought pattern.

A double-blind, randomized, controlled trial to compare the efficacy and tolerability of fixed doses of ropinirole, bupropion, and iron in treatment of restless legs syndrome (Willis-Ekbom disease).

BACKGROUND: We aimed to compare the efficacy of fixed doses of bupropion and ropinirole and iron alone for the treatment of restless legs syndrome (RLS) and to look for the tolerability of these medications. MATERIALS AND METHODS: Patients diagnosed with RLS were randomly divided into three groups with thirty patients in each group (Group A: Bupropion [300 mg/day], Group B: Ropinirole [0.25-0.5 mg/day], and Group C: Oral iron [150 mg elemental iron] along with folic acid [500 µg]). Each participant was then assessed for severity of RLS, as well as RLS-related quality at the baseline, and thereafter, every 14th day till 6 weeks based on the International Restless Legs Scale (IRLS) severity rating scale and Restless Legs Syndrome Quality of Life (RLSQoL) Questionnaire, respectively. RESULTS: IRLS scores differed significantly from baseline visit to last (F = 4.85; P = 0.01). The interaction between the time x treatment group was significant (F = 10.37; P < 0.001) showing an improvement with the therapy in all the groups. Pair-wise comparison depicted that ropinirole group differed from other two groups in IRLS score (F = 7.06; P = 0.001), which were comparable to each other. Regarding quality of life of these cases, within each group scores differed among all the four visits (F = 5.12; P = 0.002). Unlike IRLS, there was no significant difference among the RLSQOL scores between groups at any point of time (F = 1.2; P = 0.28). CONCLUSION: RLS severity decreased across time in all three groups; however, the ropinirole treatment was better than the bupropion and iron-folate therapy. Moreover, RLS-related quality of life although improved among all groups, it was comparable among three groups.

Selective Serotonin Re-uptake Inhibitors (SSRIs) Induced Weight Changes: A Dose and Duration Dependent Study on Albino Rats.

INTRODUCTION: Selective Serotonin Re-uptake Inhibitors (SSRIs) are the most significant and safe drugs among the antidepressants. Fluoxetine is the prototype drug of SSRIs. Various clinical studies showed that SSRI causes change in body weight in patients. This study was conducted to know the extent of weight change with different doses for different durations. AIM: The aim of this study was to find out whether fluoxetine causes weight gain or weight loss, and to deduce the comparative weight change after intraperitoneal injection of fluoxetine for different duration and doses. MATERIALS AND METHODS: Present study was conducted on 72 adult (36 males and 36 females) albino rats, in 3 phases of 2 weeks, 4 weeks and 12 weeks duration. Each phase consisted of 24 (12 males and 12 females) albino rats. These 24 rats were further randomly subdivided into 4 Groups of 6 albino rats each (3 males & 3 females). Group 1(Control) received normal saline (vehicle). Rest 18 rats of each phase were experimental rats, of Group 2, Group 3 and Group 4 (6 rats each). Group 2, group 3 and group 4 experimental rats received 10mg/kg, 20 mg/kg and 40mg/kg of intraperitoneal injection of fluoxetine respectively. All rats were weighed on each day for growth monitoring. Data was subjected to statistical analysis (Mean, standard deviation and Student's t-Test). RESULTS: All experimental group rats which received fluoxetine showed decrease of body weight. Rats which received high doses of fluoxetine could not tolerate the drug for more than two weeks and died due to excessive body weight loss, loose stools and muscle twitching. CONCLUSION: Present study conclude that SSRIs can cause weight change in the form of decrease of body weight. This property of SSRIs can be used clinically by prescribing these drugs to obese psychiatric patient without any fear of withdrawal of drug.

Premature ejaculation - dose and duration dependent effect of fluoxetine: a histological study on seminal vesicle of albino rats.

INTRODUCTION: Fluoxetine is a prototype drug of Selective Serotonin Reuptake Inhibitors. Its active demethylated metabolite has a half life of 7-10 d. Fluoxetine is used to treat depression and is also prescribed in premature ejaculation. AIM: In the present study dose and duration dependent effects of Fluoxetine on histology of seminal vesicle of the albino rats were observed. MATERIALS AND METHODS: The present study was conducted on 36 adult male albino rats. Fluoxetine was administered intraperitoneally for 2 wk, 4 wk and 12 wk with mild (10mg/kg/day), moderate (20mg/kg/day) and severe doses (40mg/kg/day). Histological slides of Seminal vesicle were prepared and stained with Hematoxylin and Eosin stain. RESULTS: On examination through the light microscope, the proliferation of primary, secondary and tertiary villi, increased crypt/alveoli, increased thickness of lamina propria, decreased epithelial cell height, metaplasia, changes in the amount of luminal eosinophilic secretory material in the form of scanty secretion in lumen of seminal vesicle. CONCLUSION: Low doses for long duration and high doses for short duration of Fluoxetine produce histological changes in seminal vesicle of albino rats.

Translation and validation of restless leg syndrome quality of life questionnaire in Hindi language.

BACKGROUND: Restless legs syndrome (RLS) itself as well as the problems that are secondary to RLS may worsen the quality of life. AIM: The aim of this study is to translate and validate the Restless Legs Syndrome Quality of Life (RLS-QOL) questionnaire in Hindi language. SETTINGS AND DESIGNS: Patients attending psychiatry OPD and sleep clinic in a tertiary care teaching hospital. MATERIALS AND METHODS: Thirty four consecutive patients of RLS and twenty nine control subjects were included in the study. Permission for translation and validation of RLS-QOL questionnaire scale was obtained. Translation was done according to the guidelines provided by the publisher. After translation, the final version of the scale was applied in both the groups to find the reliability and validity. STATISTICAL ANALYSIS: SPSS, version 17.0 was used for the analysis. Independent sample t test was used to compare age. Chi-square test was applied to compare non-parametric variables. Pearson's and Spearman's correlations were used to find out the correlation between parametric and non-parametric items, respectively. Reliability analysis was done by using Cronbach's alpha. RESULTS: Among the RLS subjects, mean Insomnia Severity Index (ISI) score, International Restless Legs Syndrome Severity Rating Scale (IRLS) score and Computed Score of RLS-QOL questionnaire were 25.43 (7.39), 12.7 (8.34) and 29.8 (8.39), respectively. A statistically significant difference was observed between both the groups on all these scores (ISI: t= -11.2, P<0.001, 95% CI= -22.62 to -15.76; IRLS: t = -8.1, P< 0.001, 95% CI =-15.81 to -9.58; RLS-QOL: t =-19.07, P<0.001 with 95% CI = -32.69,- 28.83). A significant correlation between ISI and RLS-QOL (r² = 0.59; P< 0.001) was seen. Most of the items also showed good correlation with each other. Internal consistency done by Cronbach's alpha showed good correlation (0.85). CONCLUSION: Hindi version of the Restless Legs Syndrome Quality of Life (RLS-QOL) questionnaire is a valid and reliable tool for the assessment of the quality of life in patients with RLS.

Modulation of pain perception by ramipril and losartan in human volunteers.

The angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are a well known entity and have been used in therapeutics for various indications like hypertension, myocardial infarction and CHF. However, there is a renewed interest in these compounds in terms of their effects on pain perception in animals as well as in human beings. They have yielded contradictory results, showing hyperalgesia in some studies but analgesia in others. Hence this study was undertaken to evaluate the effect of Ramipril (an ACE-I) and Losartan (an ARB) on pain perception in human volunteers using cola caps and handcuff of sphygmomanometer. A total of 30 healthy, normotensive individuals with no previous history of intake of analgesics during or 4 weeks prior to the study were selected after an informed consent. The first group received a single dose of placebo, the second group received Ramipril (2.5 mg) & the third group received Losartan (50 mg). Pain perception threshold (the point at which an individual first experiences pain) and the maximum tolerated pain were assessed using the above method. The control group showed no significant changes in pain threshold, but the group receiving either Ramipril or Losartan showed a decline in threshold for maximum tolerated pain. Only Ramipril and not Losartan decreased the pain perception threshold. Our study revealed that single dose treatment of healthy volunteers with Ramipril and Losartan may cause algesia as early as after ingestion of the first dose and further studies are needed to study their long term effects on pain perception.

Doping droops.

Drug abuse is a major concern in the athletic world. The misconception among athletes and their coaches is that when an athlete breaks a record it is due to some "magic ingredient" and not because of training, hard work, mental attitude and championship performance. The personal motivation to win in competitive sports has been intensified by national, political, professional and economic incentives. Under this increased pressure athletes have turned to finding this "magic ingredient". Athlete turns to mechanical (exercise, massage), nutritional (vitamins, minerals), pharmacological (medicines) or gene therapies to have an edge over other players. The World Anti-Doping Agency (WADA) has already asked scientists to help find ways to prevent gene therapy from becoming the newest form of doping. The safety of the life of athletes is compromised with all forms of doping techniques, be it a side effect of a drug or a new technique of gene doping.