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INTRODUCTION: Script concordance test (SCT) is an innovative tool to teach and assess the clinical reasoning skills of medical students. It is the key aspect of clinical competency that enables the medical graduates to progress from novice to practicing general practitioner. SCT was used the first time in pharmacology to inculcate clinic reasoning skills in medical students by focusing on the topic of pharmacotherapy. METHODS: A SCT with a total of 18 questions, with 15 questions having 3 items each, one having four items and two questions having two items each was administered to 170 second year undergraduate medical students in the subject of pharmacology to assess the clinical reasoning skills. It was an interventional study conducted using convenience sampling technique with a sample size of 170. Aggregate scoring method was used to do the scoring obtained from the answers given by 10 expert-panel members in the field of pharmacology, which were used as an answer key to do the final scoring of the students. Descriptive statistics were computed using Students t test. SCT conduct included a small-group feedback session to the students post-SCT. A feedback questionnaire was administered to the students one week after the feedback session. Reliability of the SCT and feedback questionnaire was checked by calculating Cronbach alpha through Siegle reliability calculator. Content validity of the test as well as feedback questionnaire was done by the panel of experts included in the study. RESULTS: Though the mean score of the students (27.68±4.59) was significantly lower than the expert panel (40.91±3.52), students were highly satisfied as they expressed that SCT enhanced their perceived clinical reasoning skills (median value=5) and critical thinking (median value=4). The Cronbach alpha for the test was 0.76. The students were also highly satisfied with the feedback given by the teachers after the SCT (median value=4). CONCLUSION: SCT enhances critical thinking and clinical reasoning skills of the students, as reported by them. With the conduct of feedback session post-SCT, it can be used as assessment for learning tool and can be well used in a para-clinical subject of pharmacology.
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BACKGROUND: Antiepileptic drugs (AEDs) adversely affect bone health and there are reports describing association of alternations of bone and mineral metabolism in epileptic patients. OBJECTIVES: This study was undertaken to evaluate the bone profile (bone mineral parameters and bone mineral density [BMD]) of patients with epilepsy and compare them to their age-, gender-, and socioeconomic status-matched healthy controls in a community. MATERIALS AND METHODS: This was a nested case-control study conducted in fifty individuals, which included 25 cases (age above 18 years and on AEDs for at least 3 years) for which 25 controls were selected from the same community. Bone mineral parameters (serum calcium, proteins, phosphorous, alkaline phosphate, parathyroid hormone, and Vitamin D) and BMD were measured. RESULTS: There was significant hypocalcemia (P = 0.003), hypoproteinemia (P = 0.014), hyperparathyroidism (P = 0.048), and increased levels of serum alkaline phosphatase (P = 0.019) in cases as compared to controls. The difference was insignificant in the serum levels of Vitamin D and phosphorous among both the groups. Vitamin D was significantly low in female patients as compared to males (P = 0.043). There was no significant difference in BMD at the lumbar spine and femur neck among both the groups. Mean duration of epilepsy was longest in patients with osteoporosis (23.6 years), and increasing duration of epilepsy was associated with reduction in age- and sex-corrected total BMD mean Z-score anteroposterior spine. There was negative correlation between cumulative drug load and T-score of patients with epilepsy. CONCLUSION: Patients on long-term AED treatment have altered bone profile as evident from biochemical parameters and reduced BMD. There is a need for more extensive research and that too on a larger sample size.
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BACKGROUND: Multiple choice questions (MCQs) are a common method of assessment of medical students. The quality of MCQs is determined by three parameters such as difficulty index (DIF I), discrimination index (DI), and distracter efficiency (DE). OBJECTIVES: The objective of this study is to assess the quality of MCQs currently in use in pharmacology and discard the MCQs which are not found useful. MATERIALS AND METHODS: A class test of central nervous system unit was conducted in the Department of Pharmacology. This test comprised 50 MCQs/items and 150 distracters. A correct response to an item was awarded one mark with no negative marking for incorrect response. Each item was analyzed for three parameters such as DIF I, DI, and DE. RESULTS: DIF of 38 (76%) items was in the acceptable range (P = 30-70%), 11 (22%) items were too easy (P > 70%), and 1 (2%) item was too difficult (P < 30%). DI of 31 (62%) items was excellent (d > 0.35), of 12 (24%) items was good (d = 0.20-0.34), and of 7 (14%) items was poor (d < 0.20). A total of 50 items had 150 distracters. Among these, 27 (18%) were nonfunctional distracters (NFDs) and 123 (82%) were functional distracters. Items with one NFD were 11 and with two NFDs were 8. Based on these parameters, 6 items were discarded, 17 were revised, and 27 were kept for subsequent use. CONCLUSION: Item analysis is a valuable tool as it helps us to retain the valuable MCQs and discard the items which are not useful. It also helps in increasing our skills in test construction and identifies the specific areas of course content which need greater emphasis or clarity.
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D-penicillamine interferes with elastin and collagen metabolism and produces several cutaneous and multi-systemic side-effects. We present two cases of Wilson's disease who on long-term penicillamine therapy developed drug-induced degenerative dermopathy manifesting as skin fragility over pressure sites and cutis laxa-like changes.
