A comparison between peer-assisted learning and self-study for electrocardiography interpretation in Thai medical students.

INTRODUCTION: Peer-assisted learning has been shown to be an effective teaching and learning method. However, this technique has not been proven in Thai medical school. We aimed to compare the effectiveness of peer-assisted learning and self-study in interpreting an electrocardiogram in Thai medical students. METHODS: This is a prospective, randomized controlled trial, conducted in Chonburi teaching hospital, a community hospital affiliated with Chulalongkorn University. All medical students from the fourth and fifth years, a total of eighty students, were randomly assigned to two groups of peer-assisted learning (PAL) and self-study (SS) via stratified randomization done by computer-generated randomization. The two groups were matched for sex and grade point average. In the PAL group, teaching was performed by the fourth and fifth year medical students. We conducted five weekly study sessions. Different topics of electrocardiogram interpretation were assigned to tutors for teaching. SS group would separately study the same topic on their own. Constructed response questions were used to assess the students at the beginning as a pre-test and after a five-week session as a post-test. Online self-assessment was delivered to students one month after the study. RESULTS: Mean pre-test and post-test score was put into the analysis and compared across groups using t-test. No significant difference in pre-test score was observed between the two groups in the same academic year. There was a significant difference between the mean post-test score between the fourth year PAL and SS groups. Also, the mean difference score in the fourth year PAL group was higher than the fourth year SS group. However, in the fifth year group, there was no significant difference between the PAL and SS groups in the mean post-test score and mean difference score. CONCLUSION: In conclusion, peer-assisted learning is an interesting method to improve understanding and interpreting skills of basic ECG better than self-study in the early clinical year medical students.

Perception of educational environment among medical students in Thailand.

OBJECTIVES: To examine the perception of educational environment among clinical year students in Thailand using Dundee ready education environment measure (DREEM) and identify factors associated with the DREEM scores. METHODS: A total of 2,467 fourth- to sixth-year students from 34 teaching hospitals nationwide responded to a Thai version of DREEM questionnaire. Data on each student's sex, year of study, size of teaching hospitals and GPAX were collected. Mean total DREEM scores and subscales were calculated and then compared across groups using t-test and one-way ANOVA. RESULTS: The overall student perception on educational environment was 'more positive than negative,' with the mean total DREEM score of 131.1 (SD=17.4). Similar findings were observed in all subscales. Mean total DREEM scores were lower in medium-size than small- and large-size teaching hospitals 129.9 (SD = 18.1), 131.9 (SD = 17.5) and 131.6 (SD=16.4) respectively (F (2,2422)=3.21, p=0.04). Sex and years of study was associated with certain DREEM subscales. CONCLUSIONS: Clinical year medical students in Thailand were satisfied with their academic learning environment, with varying perceptions across different size of teaching hospitals. Repeat assessment of educational environment of medical schools over time is needed for monitoring changes after specific educational interventions being applied.

Transcatheter closure of atrial septal defect in a patient with cor triatriatum sinister and atrial septal defect.

Cor triatriatum sinister is a rare congenital heart disease and rarely found in adults. The authors describe an asymptomatic 20-year old man presenting with heart murmur by check up. Transthoracic and transesophageal echocardiogram demonstrate atrial septal defect (ASD) secundum 26 mm and cor triatriatum sinister with 20 mm of fenestration. Transcatheter closure of ASD using Occlutech Figulla(R) device was successfully performed without complications. Echocardiogram post procedure demonstrate good position of device without obstruction of blood flow, no residual shunt and residual 12 mm of fenestration of cor triatriatum.

N-terminal pro brain natriuretic peptide and cardiac function in doxorubicin administered pediatric patients.

OBJECTIVE: Assess the use of N terminal pro brain natriuretic peptide (NT-pro BNP) to early diagnose ventricular dysfunction in doxorubicin-administered children. MATERIAL AND METHOD: Fifty-five cancer patients who received accumulative dose of doxorubicin <300 mg/m2 (group 1), 49 cases with accumulative dose > or = 300 mg/m2 (group 2) and 52 cases as a control group (group 3) were included in the study. Electrocardiogram, chest roentgenogram, echocardiogram, and serum NT-pro BNP were studied. RESULTS: At age 1-10 years, there were significantly higher NT-pro BNP in group 2 than group 1 (384 +/- 291 vs. 92.2 +/- 89 pg/ml; p = 0.001), and than group 3 (79 +/- 92 pg/ml; p = 0.001). Patients with NT-pro BNP level > 1 SD of the control group were more likely to have abnormal > or = 2 echocardiographic parameters of left ventricular diastolic dysfunction than patients with NT-pro BNP < or = 1 SD (OR = 3.8, 95% CI 1.18-12.5). Patients in group 2 were more likely to have abnormal > or = 2 parameters of left ventricular diastolic dysfunction than patients in group 1 (OR = 2.8, 95% CI 1.07-7.7) and more likely to have NT-pro BNP >1 SD than group 1 (OR = 8, 95% CI 1.96-38.4). There were association of NT-pro BNP > 1 SD, accumulative dose of doxorubicin > or = 300 mg/m2, and early left ventricular diastolic dysfunction by echocardiogram. CONCLUSION: Serum NT-pro BNP > 1 SD has a high probability to diagnose early doxorubicin-induced cardiomyopathy in patient 1-10 years old.