Complementing theory with practice to enhance Students' learning.

BACKGROUND: Combining cognitive skills teaching related to the techniques leads to better understanding in a skill training course; but still there a substantial disagreement in curriculum on such combinations. This study aims to help guide the designers in making the outline of instructional plan for a Clinical Skills Module (CSM) for the undergraduates. Objectives were to assess performance of students on a clinical skill after training by two different models of (hands-on only or with cognitive skills) instructions and explore their perception on the employment of educational strategies through Focus Group Discussions (FGD) through a Sequential mixed method study design: (1) Quantitative (Pre- and post-assessments and comparing their results (2) Qualitative (Exploration of perspectives through constructivist approach using qualitative phenomenological design) The study was conducted during the month of September, 2015 at Rabigh Medical College, King Abdul Aziz University, Jeddah. METHODS: Students entering fourth year were randomized to two groups to participate in pre-post OSCE using global rating scale and their scores were compared. The examiners were kept blinded to the randomization of students undergoing two separate training methods. The test group (group A) was trained for both procedural as well as cognitive skills whereas the control group (Group-B) was trained only with hands-on practice. Later their perception about the addition of cognitive skills to improve of procedural skills was explored through focus group discussions. The recorded audio tapes of FGDs were transcribed and analysed thematically. Triangulation of themes and trends was achieved by relating the content analysis to the relevant frequency of quotes. Auditing of the data verification was done by all the authors separately.. RESULTS: A total of 42 students completed both pre- and post-tests. As a result, student performance in OSCE significantly increased from pre- to post-test (p<0.001) in both the groups; on the other hand no statistically significant difference was found in the pre- and posttest scores between groups A and B (p=0.108). Five themes (1) advantages, (2) disadvantages of combining theory with practice, (3) time balance in teaching a skill, (4) training on skills, (5) skillsassessment, were found prevalent on thematic analysis of the FGDs. CONCLUSIONS: Students' ability to grasp the procedural skills was not significantly different when they acquire the cognitive skills in addition to the practical sessions. Students were more convinced to adopt combination of the two in the learning of procedural skills.

Validity of resistive index for the diagnosis of malignant ovarian masses.

OBJECTIVE: To evaluate the validity of resistive index (RI) in conjunction to the morphological appearances. METHODS: Prospective cross sectional survey of 37 females with adnexal masses was selected through non probability sampling admitted in Obstetrics units, in a private hosital from January 2009 to March 2010. All women underwent transabdominal and transvaginal ultrasound and ovarian masses were characterized as probably benign or possibly malignant on the basis of their sonographic appearance. The RI was calculated in every case and threshold RI of 0.40 was used to differentiate benign from malignant lesions. Later pathologic proof was obtained in every case. Validity of the RI was calculated considering the histopathology as gold standard. RESULTS: Out of these 37 masses, 19 were morphologically benign and pathology revealed the same results. The RI was less than 0.4 in 3 of these cases. Eighteen lesions were morphologically either malignant (or indeterminate). On pathologic examination, 7 were benign 2 were nonneoplastic masses and 9 were malignant neoplasm. The RI was greater than 0.4 in 8 of these cases and was less than 0.4 in only 2 of the eight lesions. Sensitivity of the RI was 18.18% in diagnosing the malignancy whereas the specificity was only 84.61%. Positive predictive value of RI to differentiate benign from malignant lesions was only 33.33% and negative predictive value was 70.96%. Thus the accuracy of the RI was 64.86% with precision of only 33.33%. CONCLUSION: Resistive index may improve specificity in characterizing malignant ovarian lesions on ultrasound but it can be misleading.

Misoprostol for the purpose of mid-trimester termination of pregnancy: a comparative study with prostaglandin F2 alpha.

OBJECTIVE: To compare the efficacy of misoprostol verses prostaglandin F2alpha (PGF2alpha) in the medical management of termination of mid-trimester pregnancy due to medical reasons. METHODS: This experimental study was conducted in Obstetrics and Gynaecology Department, Bahawal Victoria Hospital, Bahawalpur for a period of 6 months from April 2005 to September 2005. Time interval between induction with misoprostol or PGF2alpha and expulsion of foetus, number of tablets of misoprostol used and total dose of injection PGF2alpha used for termination of pregnancy as well as the complications experienced with both drugs. Fifty patients of 18-35 years of age were randomly selected who presented to Gynaecology and Obstetrics outdoor with mid-trimester foetal loss or congenitally malformed foetus incompatible to life, confirmed on ultrasonography. These women were randomised to receive either intravaginal misoprostol or extra-amniotic PGF2alpha. RESULTS: Ninety-six percent of cases were managed successfully with Misoprostol as compared to 92% where PGF2alpha was tried (p > 0.5). Mean induction to expulsion duration for misoprostol and PGF2alpha were 9.02 +/- 4.57 and 16.04 +/- 6.22 hours respectively (p < 0.5). Complications profile was low especially in cases of PGF2alpha and only one case experienced significant haemorrhage. CONCLUSION: Misoprostol and PGF2alpha were found to be of same success rate but former was found to be more efficacious in terms of induction to expulsion duration.