Empowering health professions educators: enhancing curriculum delivery through customized e-tutorial training on fundamental digital tools.

Introduction: In the dynamic landscape of education, the fusion of technology and learning, commonly termed "technology-enhanced learning" (TEL), has emerged as a transformative phenomenon. This study focuses on the imperative integration of TEL in medical education, recognizing the diverse digital literacy levels of adult learners. The exploration introduces the innovative E-Portal training program, designed to empower health professions educators with essential skills for proficiently employing digital tools in instruction. Methodology: A dedicated team of medical educationists conducted a thorough investigation into E-curriculum design and delivery, employing the Moodle Learning Management System as the foundation for the E-Portal training program. The training, spanning crucial stages such as course design, content delivery, self-paced teaching, and quality assessment, facilitated participant progression at individual paces, unlocking subsequent steps upon meeting stipulated prerequisites. A pre-training questionnaire gauged participants' comprehension of distance learning, e-learning, synchronous and asynchronous teaching, and self-directed study. Subsequent focus group discussion post-training generated rich insights into participants' experiences, reflections, and identified challenges. Results: The results illuminate participants' limited adeptness with e-learning terminology, successful assimilation of components and functionalities, and heightened confidence in online teaching practices. However, discerned challenges during implementation, such as technical hurdles and engagement issues, highlight the multifaceted nature of TEL integration. While the E-Portal training positively impacted preparedness, participant feedback advocates for improvements in assessment tools, technical training provisions, and exploration of alternative Learning Management Systems. Discussion and conclusion: Study emphasizes the ongoing need for diverse training methodologies across Learning Management Systems, acknowledging the evolving nature of education and technology. This study underscores the transformative role of a tailored E-Portal training program in seamlessly integrating digital tools into medical education. The comprehensive insights provided contribute to a nuanced understanding of the advantages, obstacles, and potential avenues for enhancement in curriculum delivery through technology-enhanced learning, thereby propelling the field forward.

Investigating the internal structure of multiple mini interviews-A perspective from Pakistan.

BACKGROUND: Healthcare professionals require many personal attributes in addition to cognitive abilities and psychomotor skills for competent practice. Multiple Mini- Interviews are being employed globally to assess personality attributes of candidates for selection in health professions education at all level of entry; these attributes are namely, communication skills, critical thinking, honesty, responsibility, health advocacy, empathy and sanctity of life. Considering the high stakes involved for students, faculty, institutions and the society, rigorous quality assurance mechanisms similar to those used for student assessment must be employed for student selection, throughout the continuum of medical education. It is a difficult undertaking as these psychological constructs are difficult to define and measure. Though considered to yield reliable and valid scores, studies providing multiple evidences of internal structure especially dimensionality of Multiple Mini-Interviews are sparse giving rise to questions if they are measuring a single or multiple constructs and even if they are measuring what they are purported to be measuring. OBJECTIVE: The main objective is to provide statistical support of the multi-dimensional nature of our Multiple Mini Interviews, hypothesized a-priori, through CFA. Another objective is to provide multiple evidences for the internal structure. Our study highlights the link between content and internal structure evidences of the constructs, thus establishing that our Multiple Mini Interviews measure what they were intended to measure. METHOD: After securing permission from the Institutional review board, an a-priori seven factor-model was hypothesized based on the attributes considered most essential for the graduating student of the institution. After operationally defining the attributes through extensive literature search, scenarios were constructed to assess them. A 5-point rating scale was used to rate each item on the station. A total 259 students participated in the multiple mini interviews over a period of three days. A training workshop had been arranged for the participating faculty. RESULTS: The reliability coefficient using Cronbach's alpha were calculated (range from 0.73 to 0.94), Standard Error of Measurement (ranged from 0.80 to1.64), and item to station-total correlation ranged from 0.43-0.50 to 0.75-0.83. Inter-station correlation was also determined. Confirmatory factor analysis endorsed the results of Exploratory factor analysis in the study revealing a seven model fit with multiple indices of Goodness-of-fit statistics such as Root mean square error of approximation (RMSEA) value 0.05, Standardized root mean square residual (SRMR) value with less than 0.08. All these indices showed that model fit is good. The Confirmatory factor analysis confirmed the multi-dimensional nature of our MMIs and also confirmed that our stations measured the attributes that they were supposed to measure. CONCLUSION: This study adds to the validity evidence of Multiple Mini-Interviews, in selection of candidates, with required personality traits for healthcare profession. It provides the evidence for the multi-dimensional structure of Multiple Mini interviews administered with multiple evidences for its internal structure and demonstrates the independence of different constructs being measured.

Negative faculty role modelling - is it a reflection of deteriorating societal values?

BACKGROUND: Negative faculty role modelling is an area of growing concern especially due to its implications on medical professionalism. The study aims to explore the impacts of negative role modelling on professionalism of medical students in the context of Pakistan. METHODS: This qualitative study is part of a larger study exploring impacts of role modelling on professionalism of students. It is based on Constructivist Grounded Theory involving six semi-structured interviews with clinical faculty and three focus group discussions with 22 students. Initial, focused, selective coding and thematic analysis was used to find the core category. RESULTS: Three overarching categories were developed: traits observed with negative role models; impact of negative role modelling; factors promoting negative role modelling. Subcategories of impacts included negative impact on professionalism, emotional impact, and its paradoxical positive impact. Negative role modelling, a manifestation of declining professionalism, was attributed to deteriorating societal values; further compounded by the lack of required mechanisms by institutions and the regulatory authority at their respective levels. CONCLUSIONS: In the absence of a strong moral platform at societal level, the burden of responsibility rests with the faculty and more importantly with institutions and regulatory bodies to discourage negative role modelling and educate students to recognize, reflect on and avoid negative behaviours and adopt strong professional values.

Development and validation of a questionnaire about hidden curriculum in medical institutes: A pilot study.

The goal of the current study was to develop and validate a questionnaire that would reveal characteristics of medical hidden curricula. It is an extension of the qualitative research that was done by researchers on hidden curriculum, and a second part of the qualitative was the creation of a questionnaire by a panel of experts. Using both exploratory factor analysis (EFA) and the quantitative portion, the questionnaire was verified. The sample size was 301, and the participants, who were from medical institutes, were both genders and between the ages of 18 and 25. First, a thematic analysis of the qualitative portion was used to create a 90-item questionnaire. The validity of the questionnaire's content was certified by the expert panel. A 39-item questionnaire was subsequently created after the items that overlapped and the items that did not represent the particular theme were eliminated. After that, we validated the survey. A total of 39 high-loading components made up the six variables of EFA, which explained 62% of the variance. The 33-item questionnaire, from which six items were deleted, was found to have satisfactory psychometric qualities. As a result, the accountability of faculty and students in curricula and extracurricular activities combined with equal opportunity is one factor, communication and relationships with stakeholders combined with evidence-based reforms and implementations are the second factors, and student-centeredness and empowerment as the third main factor of the hidden curriculum are all considered to be important factors. All these three main constructs were collectively used to measure hidden curricula in medical institutes.

Transforming professional identity of medical teachers in Pakistan by a certificate program in health professions education: a thematic analysis of reflective essays.

Introduction: A teacher's professional identity development is a dynamic and continuous process that requires rigorous, longitudinal, faculty development initiatives which are designed to work on individual professional growth. Impact of such programs must be evaluated by qualitative means to identify the process of change; The purpose of our study was to investigate whether and how our thoughtfully designed 6-month certificate program has transformed the professional identity of medical teachers. Methods: The study was conducted in National University of Medical Sciences, Pakistan using thematic analysis, wherein a weekly task of guided reflective writing, on Moodle, was given. Data was analyzed in six phases to achieve credibility and transferability. Results: By analyzing 202 reflective writings, seven subthemes were identified which manifest transformation in certain aspects of identity of participants and grouped under three major themes. The seven subthemes represent transformative journey of participants and include recognizing millennial learners' dilemma, identifying learning gaps and overcoming barriers, discovering a newer version of self, alternative frame of thinking, transforming traditional classroom, conducive learning environment and Community of Practice. Three major themes identified were Awareness, Modeling and Socialization which represent three processes bringing transformation in participants. Conclusion: Our faculty development program has transformed certain aspects of professional identities of medical teachers by incorporating informal teaching strategies of experiential learning, professional socialization, reflections, and role modeling. Participants' beliefs and practices on teaching were challenged by giving a disorienting dilemma of millennial learners and learning theories. They underwent critical discourse with professional peers and mentors in community of practice, reflected on their traditional teaching practices, acquired new insight, underwent self-discovery, and introduced digitalization and interactive learning strategies within their classrooms.

Pachypodol attenuates Perfluorooctane sulphonate-induced testicular damage by reducing oxidative stress.

Perfluorooctane sulfonate (PFOS) is an endocrine disruptor chemical (EDC) with potentially adverse effects on the male reproductive system. Pachypodol (5,4'-dihydroxy-3,7,3'-trimethoxyflavone) is a promising flavonoid isolated from Pogostemon cablin (Blanco) Benth that shows a broad range of pharmacological properties. However, the potential curative effects of pachypodol on testicular toxicity are not available until now. Therefore, this research was proposed to examine the efficiency of pachypodol against PFOS-induced testicular toxicity in adult male rats. The experiments were conducted on Sprague-Dawley rats (n = 48), which were equally distributed into four groups: control, PFOS (20 mg/kg), PFOS + Pachypodol (20 mg/kg + 10 mg/kg respectively), and Pachypodol (10 mg/kg). After 56 days of treatment, testes were excised by slaughtering rats, weighed, and stored till further analysis. The estimated parameters include biochemical markers, spermatogenic indices, hormonal and histopathological profiles. PFOS exposure disturbed the biochemical profile by altering the antioxidant/oxidant balance. For instance, it decreased the activities of catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), and glutathione reductase (GSR) while increasing the concentration of reactive oxygen species (ROS) and level of thiobarbituric acid reactive substances (TBARS). PFOS intoxication also led to a notable decline in viability, motility, epididymal sperm count, and the number of HOS coiled-tail sperms, whereas the higher level of abnormality in the head, mid-piece, and tail of sperms were observed. Besides, it lowered luteinizing hormone (LH), follicle-stimulating hormone (FSH), and plasma testosterone. In addition, PFOS exposure led to histopathological damages in testicles. However, pachypodol treatment potently alleviated all the illustrated impairments in testes. Conclusively, our results demonstrate the promising free-radical scavenging activity of pachypodol, a novel phytochemical, against the PFOS-instigated testicular dysfunctions.

Capacitive and Conductometric Type Dual-Mode Relative Humidity Sensor Based on 5,10,15,20-tetra Phenyl Porphyrinato Nickel (II) (TPPNi).

(1) Background: A quest for a highly sensitive and reliable humidity monitoring system for a diverse variety of applications is quite vital. Specifically, the ever-increasing demand of humidity sensors in applications ranging from agriculture to healthcare equipment (to cater the current demand of COVID-19 ventilation systems), calls for a selection of suitable humidity sensing material. (2) Methods: In the present study, the TPPNi macromolecule has been synthesized by using a microwave-assisted synthesis process. The layer structure of the fabricated humidity sensor (Al/TPPNi/Al) consists of pair of planar 120 nm thin aluminum (Al) electrodes (deposited by thermal evaporation) and ~160 nm facile spin-coated solution-processable organic TPPNi as an active layer between the ~40 µm electrode gap. (3) Results: Electrical properties (capacitance and impedance) of sensors were found to be substantially sensitive not only on relative humidity but also on the frequency of the input bias signal. The proposed sensor exhibits multimode (capacitive and conductometric) operation with significantly higher sensitivity ~146.17 pF/%RH at 500 Hz and 48.23 kΩ/%RH at 1 kHz. (4) Conclusions: The developed Al/TPPNi/Al surface type humidity sensor's much-improved detecting properties along with reasonable dynamic range and response time suggest that it could be effective for continuous humidity monitoring in multi environmental applications.

Evaluating the impact of faculty development programme initiative: Are we really improving skills in MCQ writing?

A series of seven workshops were conducted in 2018, at the National University of Medical Sciences and its affiliated institutes, to evaluate the effectiveness of a three-hour workshop in improving faculty competence in developing high quality test items. Participants' satisfaction was evaluated with a post-workshop feedback questionnaire. A self-made structured questionnaire was required to be filled as a pre-test and post-test assessment. Paired t-test was applied and difference in mean scores of responses was evaluated. A total of 141 faculty members were trained. The training session led to high satisfaction in all elements of workshop, significant improvements in boosting confidence in item writing skills (p=0.001), recognising parts of MCQs (p=0.001), identifying item writing flaws (p=0.001), and levels of Millers pyramid and blooms taxonomy (p=0.001). Training sessions of short duration are effective in improving faculty competence in writing high quality test items, if hands-on experience is built-in and effective feedback is provided.

Administration of Vaccine Preservative Thimerosal Produces Impairment in Rat Liver

Abstract The present research was planned to analyze the toxic effects of thimerosal on rat liver. Mercury and mercury compounds are universally known toxicants for animals and humans. Thimerosal is widely used in the vaccines as a preservative which contains 49.6% mercury. Twenty-four adult male albino rats were distributed into four groups (n=6). The first group was considered as a control group. While, second, third and fourth groups were intoxicated with 0.5, 10 and 50 µg/kg thimerosal (i.m.) respectively. After 30 days, rats were slaughtered to analyze the liver tissues. The results of the experiment exposed that thimerosal instigated significant (p<0.05) increase in alanine transaminase (ALT), alkaline phosphatase (ALP) and aminotransferase (AST) levels. Catalase (CAT), superoxide dismutase (SOD), peroxidase (POD) activities and Glutathione (GSH) and protein levels were significantly (p<0.05) reduced. Furthermore, significant increases in Hydrogen peroxide (H2O2), thiobarbituric acid reactive substances (TBARS) level and DNA damage was observed. Histopathological study revealed severe damages, e.g. fatty alterations, deterioration of lobular structure and degeneration of nuclei in hepatic tissues of thimerosal treated rats. Results of present investigation revealed that thimerosal induces hepatotoxicity at different levels.

Real-Time Label-Free Kinetics Monitoring of Trypsin-Catalyzed Ester Hydrolysis by a Nanopore Sensor.

Trypsin is an important proteolytic enzyme in the digestive system and its activity is a major indicator for evaluating diseases such as chronic pancreatitis. Here, we present a novel label-free method to detect trypsin kinetics using a nanopore technique. A mutant α-hemolysin (M113R)7 protein nanopore equipped with a polyamine decorated ß-cyclodextrin (am7ß-CD) was employed as a sensing platform for the real-time monitoring of the process of trypsin enzymatic cleavage of a substrate Nα-benzoyl-l-arginine ethyl ester (BAEE) at the single molecule level. Significantly, this sensor can exclusively respond to the current modulation caused by the product and prevent interference from the substrate, thus improving detection sensitivity, and it provides a new scheme to detect enzyme activity for cleaving small molecules.

Effect of solvent polarity and extraction time on in vitro antioxidant properties of Brassica oleracea Convar Capitata Var L. seeds.

Effect of solvent polarity and extraction time on antioxidant properties of Brassica oleracea seeds was optimized by response surface methodology using central composite design. A significant linear negative effect of solvent polarity on total extractable components (TEC), total phenolic acids (TPA), linoleic acid reduction capacity (LARC) and hydroxyl radical scavenging capacity (HRSC) and significant positive effect on iron chelating activity (ICA), reducing power (RP) and (DPPH RSC). Linear effect of solvent polarity on total antioxidant activity (TAOA) was also found to be positive but not significant. Significant linear negative effect of extraction time was observed on ICA and HRSC. Only RP was found to be significantly increased with increase in extraction time. Quadratic effect of solvent polarity was found to be negative on TAOA, DPPH RSC and HRSC. However, quadratic effects of both variables were found to be positive on TEC, TPA, ICA and LARC. The polarity dependent increase in TAOA indicates the extraction of phytochemicals with comparatively stronger antioxidant properties in polar solvents. The decrease in antioxidant properties in response to increase in extraction time may be attributed to the time dependent loss of antioxidant activity of extracted compounds.

Relationship between Student Performances in Non-Cognitive Skills in Multiple Mini Interview and Integrated Practical Examination.

OBJECTIVE: To investigate the relationship between the performances of students in non-cognitive skills in Multiple Mini Interview (MMI) and Integrated Practical Examination (IPE) of the first year of medical school. STUDY DESIGN: Cross-sectional observation study with statistical support. PLACE AND DURATION OF STUDY: Shifa College of Medicine/Shifa Tameer-e-Millat University, Islamabad between December 2015 and March 2016. METHODOLOGY: Student performance in communication skills, domain of the 8-station Multiple Mini Interview, was compared with their scores in communication skills in the first Integrated Practical Examination taken at the end of first block. Descriptive statistics were calculated for student demographics, scores in communication skills in MMI as well as IPE. Pearson's Correlation was calculated to investigate the relationship between the two scores. A p-value of <0.05 was taken as significant. RESULTS: The mean score in MMI was 130.38 ±9.90 as compared to a score of 79.96 ±19.74 in the IPE. This relationship has a statistically significant (p<0.001) positive correlation, with a Pearson's correlation of 0.52. CONCLUSION: Student performance shows a positive correlation in non-cognitive skills between Multiple Mini Interview and Integrated Practical Examination.

Optimization of extraction yield and antioxidant properties of Brassica oleracea Convar Capitata Var L. leaf extracts.

Effects of extraction time and solvent polarity on antioxidant properties of Brassica oleracea leaves were optimized by response surface methodology using a central composite design. Five extraction times (12, 24, 36, 48 and 60h) and solvent polarities (dipole moment - hexane: 0.0, diethyl ether: 2.80, ethyl acetate: 4.40, methanol: 5.10 and water: 9.0D) were selected for optimization. Response surface analysis of data showed a significant increase (p<0.05) in extract yield and antioxidant potential, based on total phenolic acids, reducing abilities and free radical scavenging capacities, in response to an increase in extraction time and solvent polarity. The optimal response was obtained using relatively polar solvents (4.40-9.00D) and prolonged extraction times (50-60h). This suggests that most of the phytochemical constituents of B. oleracea leaves are polar and possess strong antioxidant potential.

Exploring the trustworthiness and reliability of focus groups for obtaining useful feedback for evaluation of academic programs.

BACKGROUND: At Shifa College of Medicine, evaluation is an integral part of the curriculum. We used focus groups as a tool to obtain in-depth information regarding students' experience with the new integrated, system- based curriculum. The purpose of this study was to explore the usefulness of focus groups in identifying important issues for curriculum improvement and to explore the trustworthiness and representativeness of data obtained through this strategy. METHODS: In 2012, we used focus groups to seek feedback from students regarding their experience with the integrated curriculum. One course of each of the three preclinical years was selected for this purpose. Three parallel focus groups were conducted for each selected course. Each focus group was audio recorded, and the moderator and a volunteer student took additional notes during the session. The audio recordings were transcribed and data obtained from the three sources were analyzed, coded, and categorized independently by three investigators. Both manifest and latent themes were identified, using an inductive approach. Final agreement on themes was reached by comparison of the independently done thematic analysis by the three researchers. Reliability of data was established by comparing responses from the three parallel focus groups of each course. Trustworthiness of inferences was ensured by multiple coding, audit trail and member checking with focus group participants who reviewed the themes for validity. RESULTS: Most of the data on students' perceptions of their courses from each of the parallel groups were in agreement: Similar themes were seen within groups of the same class as well as across the three preclinical years. CONCLUSION: Focus groups can be a useful tool for collecting trustworthy and reliable information through a process that promotes interaction among student participants. They can support quantitative data from students and be used to support curriculum reform.

Formative assessment in undergraduate medical education: concept, implementation and hurdles.

Formative assessment, described as "the process of appraising, judging or evaluating students' work or performance and using this to shape and improve students' competence", is generally missing from medical schools of Pakistan. Progressive institutions conduct "formative assessment" as a fleeting part of the curriculum by using various methods that may or may not include feedback to learners. The most important factor in the success of formative assessment is the quality of feedback, shown to have the maximum impact on student accomplishment. Inclusion of formative assessment into the curriculum and its implementation will require the following: Enabling Environment, Faculty and student Training, Role of Department of Medical Education (DME). Many issues can be predicted that may jeopardize the effectiveness of formative assessment including faculty resistance, lack of motivation from students and faculty and paucity of commitment from the top administration. For improvement in medical education in Pakistan, we need to develop a system considered worthy by national and international standards. This paper will give an overview of formative assessment, its implications and recommendations for implementation in medical institutes of Pakistan.

Working toward decreasing infant mortality in developing countries through change in the medical curriculum.

BACKGROUND: High infant and maternal mortality rates are one of the biggest health issues in Pakistan. Although these rates are given high priority at the national level (Millennium Development Goals 4 and 5, respectively), there has been no significant decrease in them so far. We hypothesize that this lack of success is because the undergraduate curriculum in Pakistan does not match local needs. Currently, the Pakistani medical curriculum deals with issues in maternal and child morbidity and mortality according to Western textbooks. Moreover, these are taught disjointedly through various departments. We undertook curriculum revision to sensitize medical students to maternal and infant mortality issues important in the Pakistani context and educate them about ways to reduce the same through an integrated teaching approach. METHODS: The major determinants of infant mortality in underdeveloped countries were identified through a literature review covering international research produced over the last 10 years and the Pakistan Demographic Health Survey 2006-07. An interdisciplinary maternal and child health module team was created by the Medical Education Department at Shifa College of Medicine. The curriculum was developed based on the role of identified determinants in infant and maternal mortality. It was delivered by an integrated team without any subject boundaries. Students' knowledge, skills, and attitudes were assessed by multiple modalities and the module itself by student feedback using questionnaires and focus group discussions. RESULTS: Assessment and feedback demonstrated that the students had developed a thorough understanding of the complexity of factors that contribute to infant mortality. Students also demonstrated knowledge and skill in counseling, antenatal care, and care of newborns and infants. CONCLUSIONS: A carefully designed integrated curriculum can help sensitize undergraduate medical students and equip them to identify and address complex issues related to maternal and infant mortality in underdeveloped countries.