Radical reform of the undergraduate medical education program in a developing country: the Egyptian experience.

Medical educators are in a continuous quest to close the gap between the needs of medical practice and the rising expectations of the communities in their countries. During the past two decades, competency-based medical education has been evolving as an appealing strategy to close this gap. In 2017, the Egyptian medical education authorities mandated all medical schools to change their curricula to comply with revised national academic reference standards, which changed from outcome-based to competency-based. In parallel, they also changed the timeline of all medical programs for six years of studentship and one-year internship to five years and two years, respectively. This substantial reform involved the assessment of the existing situation, an awareness campaign for the proposed changes and an extensive national faculty development program. Monitoring the implementation of this substantial reform was performed through surveys, field visits and meetings with students, teaching staff and program directors. In addition to the expected challenges, the COVID-19-associated restrictions presented a significant further challenge during the implementation of this reform. This article presents the rationale for and steps of this reform, the challenges faced and how they were addressed.

Alvarado score as an admission criterion in children with pain in right iliac fossa.

BACKGROUND: Acute appendicitis is an important differential diagnosis in children with pain in the right iliac fossa. Some patients have equivocal signs that make the diagnosis difficult. Many patients with suspected acute appendicitis are admitted for observation and finally discharged because they did not have appendicitis. We decided to design this study to investigate whether the Alvarado score could be used by emergency room doctors as a criterion for admission to hospital. PATIENTS AND METHODS: This is a prospective study comprising 350 patients who attended the emergency department with suspected acute appendicitis in the period from May 2007 to April 2009. All patients were scored by Alvarado score in the emergency department before admission. The Alvarado score is based on three symptoms, three signs and two laboratory findings. The decision for admission and surgery was made independent of the score. The diagnosis of patients who underwent appendicectomy was confirmed by both operative findings and postoperative histopathology. RESULTS: We studied the Alvarado scores of 350 patients who presented to the emergency department with pain in the right iliac fossa; their age ranged from 8 to 14 years; 182 patients (52%) operated with the aim to treat acute appendicitis, 168 patients (48%) were discharged without surgical intervention and advised to attend the out-patient clinic after 24 hours for re-evaluation. we have found that patients with a low Alvarado score (less than 6) did not have acute appendicitis. CONCLUSION: Patients with equivocal signs can present a diagnostic challenge and are very often admitted to the surgical department for observation. The Alvarado score can be used as a scoring system that help in taking the decision for admission of cases with suspected acute appendicitis especially by primary healthcare providers.

Pancreatic pseudocysts in Nigerian children

Pancreatic pseudocyst is uncommon in childhood and there is a paucity of literature on its occurrence in Nigeria. This was a retrospective study to highlight the clinical presentation and outcome of management of pancreatic pseudocyst in childhood. Twelve patients were managed in 6 years in 3 hospitals in north-central; Nigeria. There were seven girls and five boys. The median age at presentation was 5.8 years. The patients presented usually with abdominal pain; abdominal mass and fever. There was definite history of trauma in only two patients. Abdominal utrasonography suggested the diagnosis in 10 of the 11 patients examined. Non operative management with ultrasound monitoring was successful in one patient. The others had surgical internal drainage. The procedures performed were cystgastrostomy (7 patients); cystjejunostomy (3 patients) and cyst duodenostomy in one patient. The post-operative period was uneventful in all patients. There was no mortality recorded. The median duration of hospital stay was 8 days. There was no recurrence in three patients available for long term follow up. Pancreatic pseudocyst should be included in the differential diagnosis of abdominal masses in childhood. As is evidenced in this series the prognosis in childhood following prompt surgical intervention is good