Interactive Quiz-Based Anatomy Teaching for Medical Undergraduate Students.

BACKGROUND: Anatomy is one of the most volatile subjects and needs the learner to understand and retain a lot of information and terms. It is thus very important to continuously upgrade the methodology from the traditional didactive to interactive teaching to make the student an active learner and engage him in the learning process to categorize and analyze anatomical facts and knowledge. AIMS AND OBJECTIVES: The study was done to compare the learning outcomes and perception of medical students towards didactic lectures and interactive quiz-based lectures in anatomy. METHODOLOGY: The study was conducted amongst the 200 Year 1 medical undergraduate students enrolled in the Department of Anatomy at Dr. Ram Manohar Lohia Institute of Medical Sciences, located in Lucknow, India. The 200 students comprised 120 males (60%) and 80 females (40%). The mean age of male students was 19.67 years and of females was 19.52 years. The students were divided into two groups of hundred students each by a method of convenience sampling. Students of group I were taught by an interactive quiz-based lecture and group II by a traditional didactic lecture. A pre- and post-test were conducted for both groups and feedback for both methods was taken by using a pre-validated feedback form based on a 5-point Likert scale. RESULTS: On statistical analysis, it was found that in the post-test the performance of group I taught by the interactive quiz-based study was better as compared to group II taught by traditional didactive teaching, but was not statistically significant (p=0.233, p>0.05). The feedback from students revealed that 45.9% of them strongly agreed and 44.9% agreed with the fact that quiz-based lectures are better than routine lectures. CONCLUSIONS: Results of the present study clearly indicate that the introduction of quiz-based anatomy teaching for undergraduate medical students was well received and appeared to improve their learning outcomes in the form of increased attention and participation during class and would lead to better retention of the topics taught during interactive lectures. To the best of our knowledge, no previous study has been done to document the efficacy of quiz-based teaching for the subject of anatomy.

Gross Anatomy Teaching for Medical Undergraduates Through Computer-Based Simulation: Introduction and Evaluation of Effectiveness.

Background Cadaveric teaching has been the gold standard for gross anatomy instruction through the ages and across the geographic spectrum, but with issues of availability faced in many medical schools, there is a need to look for other options. Digital tools like virtual dissectors that simulate the cadaver have been around for some years now, but their acceptability to the teachers and students and effectiveness need to be validated in the settings where applied. Aim To evaluate the acceptability, feasibility and effectiveness of using computer-based simulation tools for teaching gross anatomy via online mode to undergraduate medical students. Methodology A prospective crossover randomized controlled study was conducted online on 200 (120 males (60%) and 80 females (40%), Year 1 medical undergraduates (mean age males: 19.67 years and females: 19.52 years), wherein two broad topics of head and neck region were taught by didactic lectures delivered online via Zoom. Dissection videos were prepared for both cadaveric and computer-based simulation teaching. Groups were divided by random allocation and pre- and post-tests and feedback surveys were conducted online. Results A significant increase from pre- to post-test scores was found in both cadaveric and computer-based simulation techniques. However, more change was found in the computer technique as its t-value was more than the cadaveric technique. The feedback from the students was that the computer-based simulation teaching method gave them a good insight into 3D understanding of the human body, increased understanding of relations of body structures and capacity to grasp surface anatomy. Conclusion The study concluded that teaching gross anatomy through computer-based simulation techniques is acceptable to both the students and faculty. The study also concluded that it is an effective and feasible method that can be used to complement cadaveric teaching to revisit areas already dissected and for quick revision.

Appendectomy in Management of Malrotation of Gut is it Necessary?

Introduction: Malrotation is a congenital anatomical anomaly that affects the normal positioning of the intestines. Traditional management of malrotation, as described by Ladd, consists of detorsion of the volvulus if present, division of Ladd's bands, widening of the mesenteric root, proper positioning of the small and large bowels, and a prophylactic appendectomy. This study was done to determine whether appendectomy should be an integral part of the Ladds procedure or if it can be avoided. Materials and Methods: This retrospective observational study was conducted in one pediatric surgical unit in the tertiary care center of North India. All the cases of malrotation of the gut managed from January 2008 to December 2018 were reviewed. The details of the patients were recovered from the electronic data recording system of the hospital and manual operation theater records. The cases that have a follow-up of <5 years were not included in the study. The details were charted in an Excel Sheet for the analysis. No statistical test was performed because there was no event in patients in whom prophylactic appendectomy was not done. Results: The data analysis revealed that a total of 66 malrotation patients were managed during this period, those who fulfilled the inclusion criteria. Among 66 cases included in the study, in 41 cases, prophylactic appendectomy was done, whereas in the rest 25, prophylactic appendectomy was not done. During the follow-up, none of the patients in whom the appendix was preserved presented with signs or symptoms related to appendicitis or any other complications. Conclusion: Ladds procedure without appendectomy can be performed in view of the potential use of the appendix in the future, and with the fact that in the current era of advanced medicine, appendicitis can be diagnosed early due to the advancement of imaging and better record keeping.

Assessing the Role of Internal Motivation and Extrinsic Factors on Online Undergraduate Medical Teaching in a Resource-Poor Setting During Covid-19 Pandemic in North India: An Observational Study.

PURPOSE: The unprecedented academic environment brought by the COVID-19 pandemic led to the evolution of online teaching as an ineluctable tool for education and training. To ensure that the undergraduate teaching curriculum does not become another victim of the virus, online teaching was started in most medical schools. The undergraduate students enrolled in our institution hail mostly from rural areas and small townships with limited internet connectivity and accessibility due to poor socioeconomic status. This study highlights the students' perception of and motivation towards online classes in respect to internet connectivity and accessibility during COVID-19 pandemic. Since online teaching is essentially a student-centered learning approach, the motivational level of students plays an important role in making teaching protocols effective. METHODS: A prospective qualitative and quantitative assessment of perceptions of 498 medical undergraduate students from 1st, 2nd and 3rd year of Dr. Ram Manohar Lohia Institute of Medical Sciences, Vibhuti Khand, Gomti Nagar, Lucknow, Uttar Pradesh, India was done using validated online questionnaires and anonymous voluntary feedback during the government-imposed lockdown from March 2020 to November 2020. RESULTS: On evaluation of 260 responses received, it was found that the majority of students were motivated to attend the online classes but external factors like internet connectivity and household environment were affecting their motivation on a daily basis and thus decreasing the motivation levels. Validity of feedback by Cronbach's alpha was 0.907 and Pearson coefficient between internet connectivity and motivation factors was 0.419 (p-value <0.001). CONCLUSION: The extrinsic factors of internet connectivity and household environment hamper the motivation of students to attend online classes; this should be considered as an important factor to enable the desired student-led learning as mandated by competency-based medical education.

Is multiple session of intralesional bleomycin mandatory for complete resolution of macrocystic lymphatic malformation?

BACKGROUND: Intralesional bleomycin scelro-therapy has become a favored line of treatment for macrocystic lymphatic malformations. However the need for multiple sessions is a drawback associated with this treatment modality. Our aim is to document whether multiple session of intra- lesional sclero-therapy is necessary for complete resolution of cystic lymphatic malformation. METHOD: Intralesional bleomycin under Ultrasound guidance was used for macrocystic lymphangioma at concentration of 3mg/ml but not exceeding the total dose (1mg/kg) body weight for single session or cumulative dose of 5mg/kg. In all cases intralesional sclerosant (ILS) was installed under proper aseptic precaution in operation theatre in general anesthesia or sedation depending on the site or size of lesion and age of the patient. Age of patients at the time of enrolment in study ranged from 3 months to 18 years. Clinical examination was the main stay of diagnosis which was supplemented by USG and/or computed tomography. Compression of the lesion site was done for few hours wherever it was possible after the ILS session. RESULT: A total of 21 patients included in our study. The age ranged from 3 months to 18 years. Male to female ratio was 8:13. The most common site of involvement was neck and axilla followed by anterior chest wall and nape of the neck. Complete resolution after single session was observed in 90.5% cases where as surgery was required in 9.5% case. Major complication was observed in one patient, who had intralesional bleeding which was managed conservatively. Transient pain and fever was observed in 23.8% of cases. Only two patient required surgical intervention where one had persistent subcutaneous fibrotic nodule and other one did not respond to ILS. CONCLUSION: Intralesional bleomycin is an effective treatment for macrocystic lesion, and complete resolution may be achieved by single session of ILS if proper principle are followed.

External Drainage of Giant Infantile Choledochal Cyst before Definitive Repair: Is it Worth?

Infantile Choledochal Cysts (IFCC) usually present with jaundice, acholic stool and abdominal lump or abdominal distension. If the surgical intervention is delayed, they rapidly progress to liver fibrosis which is considered to be irreversible if progressed to cirrhosis. We present the data of four cases (aged one month to seven months) of IFCC presented with cholangitis managed in one surgical unit in last two years. In one case, cholangitis was treated with prolonged antibiotic course before definitive repair whereas in rest, external drainage of cyst was done in addition to intravenous antibiotic to treat cholangitis. All the infants had features of cholangitis at time of presentation. Total leucocyte count ranged from 18x1000/UL to 30.6x1000/UL. Total bilirubin level at presentation ranged from 8.2 mg/dl to 18 mg/dl and Prothrombin time (INR) ranged from 1.33 to 1.9. Hepatic fibrosis was observed in all cases but cirrhosis was observed in only one case. There was no mortality but one patient had postoperative complication with prolonged hospital stay. External drainage helps in early recovery from cholangitis and better optimization of liver function. It also delays further progression to liver fibrosis by relieving the biliary outflow obstruction while waiting for definitive repair.