Effectiveness of problem-based learning strategies compared to conventional anatomy teaching approaches.

Objectives: To determine the effectiveness of problem-based learning compared to conventional teaching strategies, and to determine the impact of sub-disciplines of Anatomy on learning outcomes of the subject. METHODS: The cross-sectional, descriptive study was conducted at Bahria University Health Sciences, Karachi, from August to October 2022, and comprised 1st and 2nd year medical students and 1st year dental students of either gender who were being taught by the hybrid method including both conventional and problem-based learning strategies. Data was collected using a questionnaire circulated through Google Forms. It had close-ended questions that were scored on a Likert scale. Anatomy sub-disciplines explored were gross, embryology and histology. Data was analysed using SPSS 23. RESULTS: Of the 251 subjects, 125(49.8%) were males and 126(50.2%) were females. The overall age ranged aged 18- 23 years. There were 115(45.8%) 1st year medical students, 111(44.2%) 2nd year medical students and 25(10%) 1st year dental students. Among 1st year medical students 60(52.17%), among 2nd year medical students 64(57.6%) and among 1st year dental students 14(56%) respondents favoured problem-based learning compared to conventional methodology. Highly significant results were obtained regarding need of topic revision (p<0.001), whether knowledge of conventional teaching method is enough for understanding the clinical scenarios (p=0.017, whether pictures shown during the problem-based learning sessions were enough for understanding anatomy (p=0.035), relevance of questions in oral structured practical examination (p=0.019) and viva (p=0.002). When the participants were asked regarding the anatomy sub-discipline that required revision for comprehensive learning, 72(28.3%) mentioned gross anatomy. CONCLUSIONS: Students considered problem-based learning to be more inducive in enhancing learning compared to conventional teaching.

Assessment Of Problem-Based Learning In Dental Education And Exploring Barriers To Its Implementation: Theory To Reality.

There are 59 dental colleges in Pakistan out of which 17 are in the public sector and 42 in private. However, only a few use problem-based learning methods, though it is a popular strategy in dental education all around the world. This study aims to assess problem-based learning model in dental education and explore the barriers of its implementation in a private dental college of Karachi. Qualitative case-study approach was employed. The philosophical stance used was critical realism. Qualitative data was collected by participant observation, video recorded observation and video elicited semi-structured in-depth interviews of five faculty members and 15 students. Results showed that students were more interested in interactive sessions while faculty members were in favour of problem-based learning sessions. Thematic analysis was done to generate themes. This research applies reproduction method to explain the necessary and contingent relations and causal powers. Lack of motivation among students and lack of faculty dedication are causal mechanisms of barriers in the implementation of problem-based learning.

Mentor-mentee Relationship Using Video Elicitation Interviews.

OBJECTIVE: To explore aspects that define successful mentor-mentee relationships in medical education from a mentor and mentees' perspective. STUDY DESIGN: Qualitative study. Place and Duration of the Study: Bahria University Health Sciences, Karachi campus, from May to October 2022. METHODOLOGY: Data were collected using observations of mentoring sessions by recording videos, video-elicitation interviews for mentors and focus group discussions for mentees. Mentor Evaluation Tool (MET) questions were used during focus group discussions to gain detailed feedback from mentees on mentors and additional questions were added regarding the mentoring sessions' organisation and environment. During video-elicited interviews with mentors, an interpersonal process recall strategy was used to explore factors that define a mentor-mentee relationship. Video recordings of the mentoring sessions were used as an elicitation tool to guide the interviews. Giorgi's method was used for data analysis. Transcripts of observations by video recordings, video elicitation interviews, and focus group discussions were analysed first separately and then compared and integrated. RESULTS: According to mentors, the true essence of mentoring is mutual respect and confidentiality. Mentees suggested multiple mentors for professional development in different attributes. CONCLUSION: The mentors' commitment to their mentees and the mentees' respect and trust is the foundation of a successful mentor-mentee relationship. KEY WORDS: Mentor, Mentee, Relationship, Mentoring and Medical Education.

Clinical assessment of absence of palmaris longus muscle and its association with ethnicity.

OBJECTIVE: To compare two clinical tests used for assessment of absence of palmaris longus, and to determine the prevalence of the absence of palmaris longus among ethnic groups in a cosmopolitan setting. Methods: The cross-sectional descriptive study was conducted at the Bahria University Health Sciences, Karachi, from April 2021 to May 2022, during which forearms belonging to Sindhi, Punjabi and Urdu-speaking ethnic groups were tested. Assessment of presence or absence of palmaris longus was performed using Schaeffer's and Thompson's tests. Agenesis and association of ethnicity and agenesis were compared. Data was analysed using SPSS 23. RESULTS: Of the 250 subjects, 152(60.8%) were females and 98(39.2%) were males. The overall mean age was 20.4±2.23 years (range: 18-23 years). In terms of ethnicity, 100(40%) subjects each were Punjabis and Urdu-speaking, while 50(20%) were Sindhis. The total forearms assessed were 500. The overall agenesis was 186(37.2%). When the two assessment tests were compared, highly significant differences were noted (p<0.000). Overall agenesis was highest among Sindhis 40%, followed by 38% in Punjabis, and 35% in Urdu-speaking. Significant differences were observed when one-sided palmaris longus absence was compared with two-sided absence (p<0.037). Conclusion: Schaeffer's test had more accuracy compared to the Thompson's test in the determination of palmaris longus agenesis. There were variations in terms of agenesis among the ethnic groups.

Lived experiences of undergraduate medical students after failure in final professional examination: A phenomenology.

The objective of the study is to focus on the actual phenomenon of medical students' exposure to failure. The research aims to highlight the lived experiences of undergraduate medical students after failure in final professional examination, from the student's point of view. Study was conducted in Bahria Medical and dental college Karachi, Pakistan. Interpretative phenomenological approach was used to explore the lived experiences of students who failed in the final professional MBBS examination. Interpretivist and pragmatic research paradigms were used for philosophical explanation of the phenomenon. Semi-structured interviews were conducted for data collection. These interviews were repeated until data saturation was reached. Interviews of participants were initially audio-recorded and then transcribed. Non-verbal communication was transcribed using observation method and following continuum of lexicalisation ranging from symbolic gestures to phrases or words omitted or adapted to enhance thick description and interpretation of latent content analysis. Verbal data was analysed by content analysis, non-verbal and verbal data were integrated, and phenomenological interpretive method was used in this study. Constant reflection on data or parts of data contributed to the understanding of the phenomenon. Data was organised in codes and themes using atlas ti-9. Results showed 16 codes under three themes, i.e. personal, social, and academic factors. Interpretive phenomenological approach applied in this study helped to uncover the complexity of medical students' failure.

Morphological variations in malleus among the male and female.

OBJECTIVE: To determine gender-based morphological variations in malleus. METHODS: The cross-sectional descriptive study was conducted at the Ear-Nose-Throat and Radiology departments of a public-sector hospital in Karachi, from January 20 to July 23, 2021, and comprised subjects of either gender aged 10-51 years who had intact ear ossicles. They were divided into equal male and female groups. After history and a thorough examination of the ear, high-resolution computed tomography scan of petrous temporal bone was done. The images were studied for malleus, to measure the parameters of its head width, length and shape of manubrium, and total length of malleus for possible morphological variations along gender lines. Data was analysed using SPSS 23. RESULTS: Of the 50 subjects, 25(50%) were males with mean width of the head 3.04±0.34mm, mean length of manubrium 4.47±0.48mm, and mean total length of malleus 7.76±0.60mm. The corresponding values in 25(50%) females were 3.00±0.28mm, 4.31±0.45mm and 7.41±0.51mm. The total length of malleus between both genders was significantly different (p= 0.031). The shape of manubrium was straight in 10(40%) males and 8(32%) females, and curved in 15(60%) males and 17(68%) females. CONCLUSIONS: Width of head, length of manubrium and total length of malleus were different in gender terms, but the total length of malleus was significantly different.

Anatomical aberration of palmaris longus agenesis muscle through clinical examination in relation to gender and hand dominance.

OBJECTIVE: To determine the frequency of agenesis of palmaris longus muscle and its association with gender and hand dominance. METHODS: The cross-sectional descriptive study was conducted at the Bahria University Medical and Dental College, Karachi, from March 2021 to November 2021, and comprised medical students of either gender from 1st, 2nd and 3rd year of studies. Clinical examination of palmaris longus was done by using the classic Schaeffer's test, and it was confirmed using the Thompson's test. The agenesis of palmaris longus muscle and its association with gender and hand dominance was also tested. Data was analysed using SPSS 23. RESULTS: Of the 200 participants, 114(57%) were female and 86(43%) were male. The overall age range was 18-23 years. Of the total, 195(97.5%) subjects were right hand dominant and 5(2.5%) were left hand dominant. Agenesis was found in 67(33.5%) subjects with no significant difference in terms of gender or hand dominance (p>0.05). Statistically significant difference (p=0.01) was found related to bilateral agenesis. CONCLUSIONS: Bilateral agenesis was found significantly more in females compared to the males, while palmaris longus agenesis and hand dominance had no significant association.

Online mentoring of medical students during COVID-19 pandemic: Another new normal.

Objectives: To determine the impact of online mentoring sessions on the students during the pandemic time. Methods: The cross-sectional descriptive study was conducted at Bahria University Medical and Dental College, Karachi. The total study duration was 5 months from March 2021 to July 2021. Quantitative research design was used. Categorical data was scored on a three point Likert scale (1= 'Disagree', 2= 'Neutral' and 3= 'Agree'). Frequencies and percentages were calculated to determine the impact of online mentoring. Results: Sixty two percent of 2nd year MBBS students were of the opinion that online mentoring was helpful as compared to 58% 1st year and 50% 3rd year students. Students were anxious while sharing their issues online. A total of 61.66% were eager to have classes on campus as compared to online as learning difficulties were felt in 70%, 77% and 81% of 1st, 2nd and 3rd year classes respectively. Of the 1st year 39%, 2nd year 46% and 3rd year 32% showed relief after the mentoring session but were in favor of face to face sessions. Technical issues were faced by 54% 1st year, 66% 2nd year and 64% 3rd year students. Conclusion: The study suggested that students were overall satisfied with the online mentoring sessions. They do have certain apprehensions like privacy and confidentiality issues but on the whole, they considered this medium as being a powerful one in times of the pandemic.

Association of fetal hydrocephalus with other embryological anomalies: A prenatal ultrasound-based study.

Objective: To determine the incidence of fetal hydrocephalus in pregnant women and to identify the association of fetal hydrocephalus with other embryological anomalies. Methods: This comparative cross-sectional study was conducted on 36 pregnant women at a private ultrasound clinic in Karachi over a period of eight months. The participants were divided into age groups, 21-30 years and 31-40 years. Toshiba APLIO 300 ultrasound machine was used to assess fetal age by measuring biparietal diameter (BPD) and femur length, whereas atrium of lateral ventricle was measured to diagnose fetal hydrocephalus. Results: Twenty-two cases of fetal hydrocephalus were observed in maternal age of 21-30 years with a p-value of 0.011. Severe dilatation of ≥15mm was observed in 85.7% cases in age group of 31-40 years. Cranial anomalies were found in 20 cases with significant results while extracranial anomalies were observed in cases of severe dilatation only. Hydrocephalus was prevalent in male fetuses and was observed in 30 (83.33%) fetuses. Conclusion: Most cases of fetal hydrocephalus were observed in women of younger age (p=0.011). Fetal hydrocephalus of severe type exhibiting ventricular dilatation >15mm was observed in fetuses of male gender.

Comparison of Critical Thinking among undergraduate medical students of Conventional and Integrated curricula in Twin Cities.

Objectives: To compare critical thinking of undergraduate medical students of institutes following traditional and integrated curriculum at Twin cities. Methods: The current cross-sectional study was conducted in medical colleges of Twin Cities from February 2021 till August 2021. Two medical colleges one with conventional and other with integrated mode of curriculum were included. One hundred medical students were selected by simple random sampling from each conventional and integrated medical college. Free critical thinking test tool was used for data collection. The tool was composed of five sections, Arguments, Assumptions, Deductions, Inferences and interpreting information. Data entry and analysis was done by using SPSS version 20. Chi-Square test of independence was run to determine the association of critical thinking with type of curriculum. Independent sample t-test was applied to find out the mean difference in the critical thinking of medical students following the two different curriculums. Results: In current study 200 students were included. Majority were females (n= 155, 77.5%). The overall percentage of good critical thinking was found to be 49%. Majority of the students (n=57, 58.2%) having good critical thinking were found associated with integrated curriculum (p < 0.024, OR= 0.524, 95% CI= 0.3 - 0.92). There was statistically significant difference of critical thinking between institutes following two different curriculum strategies. Total critical thinking score was also found statistically significantly [MD= 5.00, 95% CI, (-1.05-8.96), p<0.013], more with integrated curriculum (133.48±15.6) as compared to conventional curriculum (128.47 ± 11.43). Conclusion: Critical thinking was found high among the students with the integrated curriculum as compared to the conventional.

Distinctive morphometric measurement of frontal sinuses among the female ethnic populations living in Karachi.

OBJECTIVES: To determine uniqueness of frontal air sinuses in female ethnic populations living in Karachi. METHODS: The cross-sectional descriptive study was conducted at the Radiology Department of Jinnah Postgraduate Medical Centre, Karachi, from November 2018 to April 2019, and comprised adult females who were divided into four equal ethnic groups. Frontal sinus X-ray radiography was done using the Water's view. Width, height and area of the right and left frontal sinuses were measured. The radiographs were saved in photograph format and measurements were done using RadiAnt DICOM software. Measurements of height, width and area were noted. Data was analysed using SPSS 23. RESULTS: There were 108 females; 27(25%) in each of the four groups. The overall mean age was 35.14±8.68 years. Variability in terms of width, height and area were noted in both right and left frontal air sinuses (p<0.001). CONCLUSIONS: The width, height and area of right and left frontal sinuses showed variability among female ethnic groups living in Karachi.

Evaluation of C-reactive protein in breast cancer by enzyme linked immunoassay technique.

OBJECTIVE: To explore the serum levels of C-reactive protein in breast cancer patients, and to investigate the relationship between inflammation and progression of breast cancer. METHODS: The case-control study was conducted at Bahria University Medical and Dental College, Karachi, from September 2015 to December 2018, and comprised breast cancer patients in group A and and an equal number of age-matched healthy women in control group B. C-reactive protein levels were evaluated in serum samples using enzyme-linked immunosorbent assay in both the groups and micro ribonucleic acid levels in serum were quantified using real time polymerase chain reaction. Data was analysed using SPSS 16. RESULTS: Of the 170 subjects, 85(50%) were in each of the two groups. C-reactive protein and micro ribonucleic acid expression were significantly different in group A (p<0.001). There was no correlation (r = 0.162, p>0.01) between the tumour markers in group B (p>0.05). CONCLUSIONS: Significantly raised C-reactive protein levels showed there was a link between inflammation and breast cancer.

A CT-Scan review of anatomical variants of sinonasal region and its correlation with symptoms of sinusitis (nasal obstruction, facial pain and rhinorrhea).

OBJECTIVE: To determine the incidence of anatomical variants of sinonasal region and its correlation with symptoms of sinusitis. METHODS: The study was conducted from January-June 2020 at Radiology Department of PNS Shifa Hospital, Karachi. The study involved 50 symptomatic subjects of sinusitis with age ranges from 18-60 years which were prepared for computed tomography of paranasal sinuses. The scans were reviewed for nasal-septum, turbinates, uncinate process, ethmoid air-cells along with other anatomical variants and were correlated with symptoms of sinusitis. RESULTS: Out of 50 subjects, 34 were males and 16 were females with mean age of 42.68±18.22 years. Most common anatomical variants observed were agger nasi cells (64%), deviated nasal septum (56%), and concha-bullosa (46%). Statistically significant correlation existed between bilateral agger nasi cells and nasal obstruction (p=0.017, ρ= -0.336). CONCLUSION: The anatomy of sinonasal region is highly complex. However, anatomical variants can disturb the sinus mucociliary drainage pathway resulting in patient suffering. Therefore, considering the variable anatomy of sinonasal region, CT-PNS is recommended for every subject in order to avoid surgical hazards.

Strategies for improving faculty retention: A mixed-methods study in a private medical university in Karachi, Pakistan.

OBJECTIVE: To determine the strategies that improve faculty retention at a medical university. METHODS: The mixed-method study was conducted at Bahria University Medical and Dental College, Karachi, from August to September 2020, and comprised faculty members of either gender associated either with the university or with Pakistan Navy Station Shifa Hospital. Qualitative component comprised of semi-structured interviews. Quantitative data was collected using the 35-item Faculty Retention Strategies Questionnaire (FRSQ). Data was analysed using SPSS 23. Exploratory factor analysis (EFA) was done to extract the common factors influencing faculty retention. RESULTS: Of the 182 faculty members approached, 101(56%) responded. Of them, 66(65.3%) subjects were females, 35(34.7%) were males, 46(45.5%) were aged <36 years, and 65(65.3%) were working at the university for <5 years. The factors affecting faculty retention were direct communication of departmental head with faculty, timely promotions, feedback on teaching performance to junior faculty, clear employment policies, protected research time, teaching expertise-based promotions, implementing innovative faculty ideas, scholarships for postgraduate faculty, faculty administrative positions, equal junior faculty workloads, transport provision, competitive pay-scale and faculty development workshops. Item mean was 4.143±0.380, Cronbach's alpha was 0.894 and inter-item correlation was 0.223. EFA revealed a 4-factor solution: 'institutional work support', 'faculty development', 'faculty communication' and 'faculty leadership initiative'. CONCLUSION: Implementing these strategies could possibly lead to long-term faculty retention.

Anthropological significance of sexual dimorphism and the unique structural anatomy of the frontal sinuses: Review of the available literature.

Frontal sinuses have unique anatomical features that are distinct to every individual. Radiographic measurement of the frontal sinus is becoming popular in identifying deceased persons in cases where soft tissue remains are not found such as in cases of mass explosions and natural disasters. The aim of this review article is to highlight the significance of employing the method of radiography of frontal sinuses in the process of identification of human bodies. With the use of Pubmed, Medline and Embase, articles on frontal sinus anthropological significance were analyzed from 2015 till 2018. Sexual dimorphism was evident between the two genders. The dimensions are bigger for the males as compared to the females. The left sinus has bigger dimensions as compared to the right frontal air sinus. The reliable use of the radiographic technique is a simple and cost effective method of knowing identity even when the body is severely decomposed.

WhatsApp an informal learning and communication tool: Perception of medical officers working in low resource setting: A Focus Group Discussion.

OBJECTIVE: To assess if WhatsApp communication improves clinical knowledge and to explore the perception of its use among medical officers at a secondary care facility. METHODS: The mixed method study was conducted at the Department of Obstetrics and Gynaecology, Aga Khan Hospital for Women and Children, Kharadar, Karachi, from May to July,2018, and comprised medical officers working at the secondary care facility. All the officers were added to a WhatsApp group with a consultant. Information regarding patient condition and management were exchanged in the form of messages, images related to patient care along with consultant feedback. A pre-test to assess prior knowledge was done followed by a post-test after three months of WhatsApp communication to see improvement in knowledge. To inquire about participant's WhatsApp experience and perception, a focus group discussion was conducted. SPSS 19 was used for data analysis. RESULTS: There were 10 medical officers in the study. A total of 520 communications were recorded. Of them 352(67.6%) were text messages, 117(22.5%) were images followed by 15(2.88%) web links and 36(6.9%) social messages. The pre-test mean score was 29.8±2.65 while the post-test score was 41.3±2.83 with a mean improvement in knowledge of 11.50±2.46 (p<0.0001). The focus group discussion indicated that the participants felt it was a valuable tool for prompt communication and effective patient care, and enhanced their clinical knowledge. CONCLUSIONS: WhatsApp was perceived as an effective tool for good communication as well as for improving clinical knowledge among medical officers working in low-resource setting.

Unfolding the enigma of lamina cribrosa morphometry and its association with glaucoma.

Primary open angle glaucoma (POAG) is worldwide prevalent ailment, affecting millions, and leading irreversible cause of blindness. The treatment strategies revolve around one modifiable factor, elevated intraocular pressure (IOP), despite POAG presenting with normal IOP. Emphasis is put forth in recent past detecting structural elements of glaucoma; lamina cribrosa (LC) is found to be a promising prospect. Morphological alterations of LC are implicated as early sign before onset of glaucomatous optic neuropathy (GON). In this review, the authors explored scientific works from 1976 till 2018 through Google, Google Scholar, PubMed, HEC Digital Library, Springerlink, and PakMedinet in four months' time, extracted structural features of LC, its measurable attributes, fresh innovations employed for in-vivo visualization and clinical signs aiding in establishing diagnosis of glaucoma which will assist as a prophylactic measure against GON. No such work has ever been done in South-East Asia including our country. So LC opens a new horizon for research in Pakistan.

Students perception towards feedback in clinical sciences in an outcome-based integrated curriculum.

BACKGROUND & OBJECTIVE: Feedback has been identified as one of the key strategies for learning in the outcome-based curriculum. Students are more interested in their grades paying little attention to the feedback, may not understand the importance of feedback and its effect on their performance because of their perception, and beliefs. Non-constructive feedback will not result in the improvement of the students' performance. This study aims to explore; student's perception of useful feedback; the purpose of feedback and believes about written feedback. METHODS: This analytical cross-sectional study was conducted from November 2017 to January 2018 at Majmaah University. Students studying in clinical phase were recruited. Data were collected from 121 students by self-structured questionnaire using complete enumeration sampling method. RESULTS: Majority of the students (45.5%) disagreed that the feedback should always contain marks; (49.6%) commented that the tutor did not provide enough constructive feedback. While we ask the purpose of feedback (62.8%), agree with two-way nature of feedback, and it is helpful to find there expected performance. Almost two third (67.8%) of the students believe that limited feedback is the reason for frustration and they did not receive comments for improvement. CONCLUSIONS: Students are aware of the purpose of feedback. Senior students give more value to feedback and in the opinion that feedback provides useful suggestions for future improvement and limited feedback is the reason for frustration. The results highlight the need for more structured feedback mechanism, and there is a need for faculty engagement in training to fill the existing gapes to create an effective educational alliance.

Psychometric analysis of Anatomy MCQs in Modular examination.

OBJECTIVE: To analyze the psychometric indices of Anatomy question items in modular system assessment. METHODS: A quantitative study was done to determine the quality of MCQs and to analyze the performance of 1st year 100 MBBS students. Each module covers different subjects of MBBS curriculum but psychometric analysis was done on the subject of Anatomy only. The assessment results of 3 modules were taken and checked by item analysis to see the mean differences between the modules using ANOVA. Post hoc analysis was determined by using Tukey HSD test. RESULTS: A total of 140 one best (OB) Anatomy MCQ items were calculated for difficulty index, discriminatory index and reliability. Difficulty index was found to be higher in module I when compared with module II and III. Discriminatory index comparatively showed higher results in module II whereas reliability of module III was significantly higher than the other modules. Results were considered to be significant with p value≤ 0.05. CONCLUSIONS: The psychometric analysis of Anatomy MCQs showed average difficulty, good discrimination and reliability.