Simulated daily readout for maintaining nuclear medicine education in residency training amidst declining case volume: evidence from the COVID-19 pandemic.

BACKGROUND: Simulated daily readout (SDR) is a teaching initiative in radiology and nuclear medicine developed to simulate a resident's experience during periods of case volume reduction. SDR was employed by many training centers during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to evaluate the perception of radiology residents on the effectiveness of SDR. METHOD: The SDR was conducted in the nuclear medicine rotations from 2019 to 2020 during the shutdown of the radionuclide imaging facilities using a combination of strategies including case selection, assignment, reporting and feedback. A brief 8-item questionnaire with Likert scale values was completed by radiology residents who participated in the SDR-based nuclear medicine rotations. RESULTS: Thirty-five of 54 residents returned the questionnaire. The majority of residents affirmed the negative impact of the reduction in case volume on their training experiences and perceived that SDR could alleviate the effects. The SDR strategies perceived as more effective were targeted case selection, in-advanced assignment, verbal interpretation and reporting, and verbal feedback. CONCLUSION: The radiology residents perceived the SDR as an effective tool to preserve their training experiences. The SDR has the potential to be a useful initiative when teaching centers face the threat of declining case volume.

Changes in hepatitis A virus (HAV) seroprevalence in medical students in Bangkok, Thailand, from 1981 to 2016.

OBJECTIVE: This study aimed to determine the seroprevalence of anti-HAV IgG in Thai medical students in 2016 compared with the previous data and to demonstrate the cross-effective strategy to screen HAV seropositivity. RESULTS: Sera from 176 first-year medical students (age 19.07 ± 0.59 years; 50% female) at a university hospital in Thailand were tested for anti-HAV IgG. Data from HAV vaccination records and questionnaires were also collected. HAV seropositivity was unexpectedly high (62.5%, n = 110). 37.5% (n = 66) had an HAV vaccination record. Of these, 60.6% received the full HAV vaccination series, 4.5% received one HAV vaccination, 34.8% did not receive HAV vaccination, and 3.0% had natural HAV immunity. The long-term efficacy of HAV vaccination was at least 97.5% over a mean of 15.55 ± 2.44 years. There was a significant difference in immunity between students with (66.7%) and without (50.9%) vaccination records (P = 0.028). Most of the student's parents had a bachelor's degree or higher (87.9%; n = 272) and above average income (mean 17,000.76 ± 194.22 USD/person/year). Parental education and socioeconomic status influenced vaccination accessibility in these medical students. Screening of vaccination records instead of routine anti-HAV IgG testing is a cost-effective and reliable strategy to determine HAV immunity in medical students in Thailand.

Implementation of hepatitis B vaccine in high-risk young adults with waning immunity.

Universal hepatitis B (HB) vaccination among Thai newborns was initiated in 1992. The first dose of the monovalent HB vaccine was given at birth, then at months 2 and 6 simultaneously with the diphtheria-tetanus-pertussis whole-cell (DTPw) vaccine. In 2008, Thailand replaced the monovalent HB vaccine at months 2 and 6 with a combined DTP-HB given at months 2, 4, and 6, with an added monovalent HB vaccine at month 1 for infants whose mothers were HBV carriers. Despite this rigorous HB vaccination schedule, vaccinated infants who are now adolescents do not possess a protective level of anti-HB surface antigen (anti-HBs) (≥10 mIU/ml). Thus, many young adults may be rendered susceptible to HB infection. Our objective was to determine how HB booster vaccination may benefit high-risk adolescents. We evaluated the serological records of a cohort of medical students (n = 291), which showed that 271 students (93.1%) possessed anti-HBs less than the accepted protective level (<10 mIU/ml) and subsequently received the HB vaccine booster prior to medical school enrollment. We then examined the anti-HB surface antibody (anti-HBs) in 216 individuals six weeks after they were immunized. We found that 61%, 88%, and 94% of individuals with pre-booster anti-HBs of <1 mIU/ml, 1-<3 mIU/ml, and 3-<10 mIU/ml achieved protective anti-HBs, respectively. Post-booster geometric mean titers were 305, 513, and 1,929 mIU/ml in these groups and correlated with pre-booster anti-HBs titers. These data suggest that medical students with known anti-HBs <1 mIU/ml will benefit from 3 doses of HB vaccine at 0, 1, and 6 months. Students with anti-HBs 1-<10 mIU/ml would benefit from an HB vaccine booster without further anti-HBs evaluation.

Residents' Obstacles and Attitudes Toward Research during Residency Training.

BACKGROUND: Many residents often encounter several problems to accomplish their research projects, a requirement to complete medical residency training in Thailand. This study aimed to explore perceived obstacles and attitude of Thai residents toward conducting research. MATERIAL AND METHOD: The questionnaires were distributed among 640 residents at King Chulalongkorn Memorial Hospital from November to December 2014. Structured-questionnaires explored the participants' characteristics, research experience, purpose of conducting research, motivations and perceived barriers to research. Five-pointed Likert scale was used to determine residents' attitude toward research. Descriptive statistical analysis was used. RESULTS: 246 respondents were achieved from 640 residents surveyed, yielding a response rate of 39.7%. The mean age was 28.21 ± 1.60 years and 66.7% was female. Most of them were studying in internal medicine, pediatrics and anesthesiology. Residency year ranged from 1st-4th year and the ratio was 21.5: 20.8:18:1. The purposes to conduct the research were to meet the program requirement (72.4%), to develop research skills (23.6%), and to accrue credentials for future fellowship application (2.4%). While 52.4% pursued research in order to bolster research experience, 12.6% would like to publish and 4.5% would like to present in the international conference, as high as 39.8% had not motivation. Perceived barriers were limited statistical knowledge, inadequate time and, difficulty formulating research topic. In addition, 50.6% were assigned research topics from advisors. Most of the residents agreed that conducting research enhanced inquiry-based learning and enabled them to better understand research methodology. Nevertheless, they thought that researching was complicated, time-consuming, and tedious. CONCLUSION: Most residents were motivated to conduct research projects but perceived obstacles and negative attitude might erode their motivation for research.

Phenytoin toxicity in two-month-old Thai infant with CYP2C9 gene polymorphism--A case report.

Phenytoin is one of the most well established and most effective antiepileptic medications for the treatment of focal seizures. In our clinical practice, it has proven difficult to maintain therapeutic phenytoin levels in infants less than three months of age. Incidence of phenytoin toxicity in infants is very rare. The cytochrome P450 super family plays an important role in phenytoin metabolism, especially CYP2C9 and CYP2C19. In this case report, we profiled a two-month-old Thai infant who developed phenytoin toxicity resulting from CYP2C9 gene polymorphism.

Assessment of preclinical students' academic motivation before and after a three-day academic affair program.

BACKGROUND: Medical students' motivation is an important driving factor for academic performance, and therefore medical teachers and educators are often highly interested in this topic. This study evaluated the impact of an academic affair program upon preclinical year medical students' motivation to study. DESIGN AND METHODS: An intervention study was conducted using a pretest-posttest study design. A total of 296 preclinical year medical students who had just passed their first year and were about to attend their second year at the Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, participated in the study. The intervention comprised of dialogues for personality development, pictorial expression in groups, as well as small group lectures delivered by senior students giving information on how to prepare for the forthcoming classes. Students' academic motivation was measured before and after the intervention program, applying the transculturally translated Academic Motivation Scale (AMS). Cronbach's alpha of Thai version AMS was 0.8992. The average scores in seven scales of AMS were compared between the pre- and posttest results, using the Wilcoxon signed-rank test. The differences were confirmed by using the multivariate analysis of variance. RESULTS: Students' academic motivation increased after participation in the three-day academic program. There was also a significant increase in introjected extrinsic motivation, which can enhance the students' self-esteem and feeling of self-worth (P<0.001). Moreover, intrinsic motivation toward accomplishment increased significantly (P<0.001). This is related to the enjoyment of passing academic milestones, and a step ahead of autonomous motivation. Amotivation level declined significantly (P<0.001). The change of academic motivational constructs before and after the intervention was altogether significant (P=0.036, multivariate analysis of variance). CONCLUSION: After experiencing a three-day intervention, the new students' motivation advanced along the continuum of self-determination toward autonomous motivation. Therefore, it is considered to be worthwhile conducting an academic intervention to catalyze the evolution of preclinical year medical students' academic motivation. Moreover, educators and faculties should evaluate the impact of interventions in evidence-based approaches to secure both controlled and autonomous types of motivation.