Faculty's perspective on skill assessment in undergraduate medical education: Qualitative online forum study.

BACKGROUND: India is at the nascent stage of competency-based medical education. Faculties trained in medical education are the main driving force for change. The present study explores the perception of faculties about the current practices and problems in medical/dental/nursing undergraduate assessment, barriers to adoption of best practices, and solutions for addressing them. METHODOLOGY: A qualitative study was designed and data collected through an asynchronous online discussion forum. A group of 31 health professionals (FAIMER fellows selected on the basis of active participation in department of medical education of respective colleges) participated in the forum. An open-ended topic guide with prompts was designed. The forum was initiated by release of discussion topics (threads) at the start of the month and remained in forum throughout the month. Researchers moderated and recorded day-to-day events. All online forum data were coded line by line and analyzed using conventional content analysis. RESULTS: Four categories generated were: (1) Low utility of current skill assessment system due to low validity and reliability; (2) Barrier in adopting newer assessment tool due to the absence of felt need of faculties and students, mistaken beliefs, and limited resources; (3) Poor implementation of newer assessment tools such as formatives and objective structured clinical examination with no blueprinting; and (4) Solutions proposed were regular formative assessment, criterion-based examination, quality-assured faculty development programs, and administrative support. CONCLUSIONS: Barriers in adopting newer assessment tools are related to the faculty's perception and resource constraint. This can be addressed by quality-assured faculty development programs and effective implementation of competency-based education.

An assessment of the validity of the nutritional indices among under-fives in the catchment area of rural health and training center of a teaching institute in Bareilly.

CONTEXT: Nutritional status is a sensitive indicator of community health and nutrition. There is a growing realization that adequate nutrition is a necessary first step in the improvement of quality of life. Malnutrition and infection are connected by a vicious cycle. It is one of the greatest international health problems and the biggest challenges being faced today. Thus, to know the magnitude of undernutrition among preschool children and to find out the sensitive tool for detection of undernutrition, this study was conducted among children under - 5 years of age. AIMS: To assess the validity of the nutritional indices for screening malnutrition. SETTINGS AND DESIGNS: The study was a community-based, cross-sectional survey carried out in the catchment area of Rural Health Training Center, Rohilkhand Medical College, Bareilly. SUBJECTS AND METHODS: Various anthropometric criteria like, Kanawati, McLaren, Rao, Dugdale and weight for age according to the Indian Academy of Pediatrics (IAP) (modified Gomez) classification were used to define nutritional status. STATISTICAL ANALYSIS USED: Data were entered and analyzed in SPSS and receiver operating characteristic (ROC) curves (sensitivity vs. 1 - specificity) were calculated for all the above mentioned indices. RESULTS: Age dependent criteria such as IAP (48.2% malnourished) and McLaren (48.3% malnourished) were followed by the age independent criteria such as Kanawati (74.3% malnourished), Dugdale (45.5% malnourished), and Rao (33.1% malnourished) to classify the mild to moderate malnutrition. ROC showed Dugdale as the best index for the judgement of malnutrition showing maximum area under the curve. CONCLUSIONS: Malnutrition being a public health problem leads to morbidity which is a vicious cycle and needs proper attention to curb its detrimental effect on the children.

An epidemiological study on the predictors of health status of food handlers in food establishments of teaching hospitals of North India.

INTRODUCTION: The US Centers for Disease Control and Prevention (USDHHS-CDC 1996) revealed that the outbreaks of food borne diseases include inadequate cooking, heating, or re-heating of foods consumption of food from unsafe sources, cooling food inappropriately and allowing too much of a time lapse. As we all know that the food handlers have been working in various types of community kitchen and their health status can affect the status of food hygiene which can lead to contamination of foods attributing to acute gastroenteritis and food poisoning in various subgroups of the population e.g., medical/dental/nursing students. The background characteristics of these food handlers may have important role to affect health status of these handlers. METHODS: The indexed study was carried out among the food handlers working in the food establishments the 5 teaching hospitals of Bareilly city in U.P. India during one year i.e., from August 2013 to July 2014. The survey method using schedule was conducted to get information about the background characteristics and food handlers and each food handler was examined clinically for assessing health status. Chi-Square test was used as test of significance and regression analysis was also done to nullifying the effect of confounders. RESULTS: The health status of the mess workers was found to be significantly associated with use of gloves, hand washing after toilet and hand washing before cooking and serving food. CONCLUSION: The rationale of this study was that though many studies have been carried out to show the health status of the food handlers and their background characteristics, no study has highlighted the association of these background characteristics and personal hygiene practices with the health status of food handlers.

Evaluation of mineral status in hypothyroidism in a tertiary care centre

Background: Hypothyroidism is known to be the commonest form of endocrine disorders and has been linked with disturbances in various minerals metabolism. Calcium, phosphorus and magnesium and trace element zinc are required for many enzymes in various metabolic pathways which are directly or indirectly regulated by thyroid hormones. Aim and objectives of the study was to estimate serum zinc, calcium, magnesium and phosphorus in hypothyroid patients, with the objectives to evaluate any relationship with TSH and to compare them with euthyroid controls.Methods: The analytical cross-sectional study included 50 hypothyroid subjects with TSH levels >4.5 mcg IU/mL and 50 euthyroid subjects of 20-50 years in RMCH, Bareilly. TSH was estimated by ECLIA, serum calcium and phosphorus were estimated by autoanalyzer and serum zinc & magnesium by the kit method using semi autoanalyzer. All the biochemical parameters were expressed as median with Interquartile Range (IQR). Mann-Whitney test was applied to compare the parameters of cases and control. Spearman’s rank correlation coefficient 2-tailed was used to correlate the parameters among the cases.Results: A significantly decreased level of serum calcium and increased level of serum magnesium and phosphorus were observed in hypothyroid cases. A significant negative correlation between TSH and serum calcium while a significant positive correlation of serum magnesium and phosphorus with TSH was observed.Conclusions: The indexed study indicates the significant effect of overt or subclinical hypothyroidism over the mineral status of the body which may have inconsistent effect over the various metabolism and enzymes and thereby clinical manifestations.

Cross-sectional Study to Acknowledge the Independent Association of the Socio-demographic Determinants of Alcohol Use in an Urban Slum of North India.

BACKGROUND: To seek pleasure is man's innate nature. In his search for gratification, man has discovered a world of substances that intoxicated him. Those who fell within its trap, their life changed, their families aggrieved and they shrank from company. The addiction remained alone in the end. To many death was a relief. METHODS: A community based cross- sectional study was conducted in the Catchment area of UHTC (Urban Health and training Centre) where all males aged ≥15 years residing in the study area were included. Data was collected by home visit using WHO questionnaire ( AUDIT: Alcohol use disorder identification test) Modified Kuppuswamy scale was used to assess the socio-economic status of the families. Data was analyzed by appropriate test using SPSS 20.0 version. Logistic regression was applied to the positively associated results. RESULTS: According to the AUDIT score, Hazardous, Dependent and harmful drinkers were 7.7%, 9.2% and 2.4% respectively. Age, marital status, education of the head of the family, occupation of the respondent, caste, family history of alcohol use had statistically significant association (P < 0.05, 95% confidence interval). Logistic regression was applied and marital status, family history of alcohol use and caste retained their statistical significance (P < 0.05, 95% confidence interval). CONCLUSIONS: It can be concluded that being young, being low educated, being married and having a family history of alcohol use are more at risk to it. This indicates the dire necessity to consider the above factors in order to combat with this evil of alcohol use.

Knowledge regarding menstruation among school-going adolescents of urban Bareilly

Background: Adolescence in girls has been recognized as a special period. Adolescents are a large and growing segment of the world’s population. Adolescence in girls is a turbulent period of development, which includes stressful events like menarche. Some of the special problems of adolescents are nutritional problems, menstrual disorders, leucorrhoea, and psychological problems. Though menstruation is a natural process, it is linked with several misconceptions and practices in India due to different rituals in the communities, which sometimes result in adverse health outcomes. The objective of the study was to assess the knowledge about menstrual hygiene among urban adolescent girls in Bareilly.Methods: The study was conducted in the urban area of Bareilly taking a sample size of 450 girls with multistage sampling technique.Results: About 40% of participants had complete knowledge regarding menstruation, 64.9% of participants regarded menstruation as a curse of God, and 35.6% of the participants perceived urethra as the main source organ for blood during menstruation.Conclusions: This research addressed the issues in managing their menstruation and maintaining a good standard of menstrual hygiene in adolescent girls.

Comparative Study of: Non-Invasive Conservative Treatments with Local Steroid Injection in the Management of Planter Fasciitis.

BACKGROUND: Planter Fasciitis is an annoying and painful condition that limits function. There is pain and tenderness in the sole of the foot, mostly under the heel, with standing or walking and is considered a self limiting condition. Symptoms resolve in 80% to 90% of cases within ten months. However, this long interval is frustrating for both patients and clinicians. AIM: This study was undertaken to compare the two different modalities of non operative treatment: Non- invasive conservative methods: NSAID's, Soft Insoles, Stretching, Ultrasound therapy and Contrast baths versus local Steroid injection therapy. MATERIALS AND METHODS: Patients by random sampling were divided in two groups. Group A as: Conservative group and Group B as Local Steroid Injections group, 100 patients in each. Patients were assessed as per Visual Analogue Scale (VAS) at the start of treatment and then after 4 wk and 8 wk duration on follow up. STATISTICAL ANALYSIS USED: SPSS for Windows (version 10.0) by the Chi-Square test. RESULTS: The difference in the distribution of subjects belonging to either of the treatment modalities regarding the treatment outcome at four and eight week was found to be statistically insignificant. CONCLUSION: As both treatment modalities are at par on comparison of their treatment outcome it is better to go for conservative approach because this can save the patients from the complications of steroid therapy.

Impact of Communication Skills Training Programme on Interns in a Medical College of India

Introduction: Communicative skills in medical education are inadequately met. Research has shown that poor communication can contribute to improper diagnosis and lack of understanding of patient's problems, investigations, and treatment options. Poor communication can lead to poor compliance to treatment and dissatisfaction among patients Objective: Assessment of the improvement in the communication skills after the training programme workshop Method: The interns posted in the department of community medicine were pre-tested using Kalamazoo Essential Elements Communication Checklist (Adapted) [KEECCA] who then underwent focused training by the trained faculty members. Two weeks following completion of training, all participants were subjected to a post-test and comparison between the pre-test and post-test scores was done using Wilcoxon Signed-Rank Test. The test was two sided and a p value less than 0.05 was considered as statistically significant. In order to know the effect of sensitization programme, feedback of the students and the faculty members as the assessors was taken after the completion of the posting Results: On the application of wilcoxon signed rank test, it was found that the difference between the pre and post test scores of assessment on kalamazoo scale after the training of interns on communication skills was found to be statistically significant as the t-value was 4.072 with the pvalue less than 0.001 that is also highly statistically significant Conclusions: The incorporation of communication skills in the medical curriculum will not only improve the doctor patient relationship but also help in arriving at the proper diagnosis through improved skills

Hazardous, harmful and dependent alcohol users according to audit in an urban slum, Meerut.

Background: Alcohol consumption is the world’s third largest risk factor for disease and disability; in middle-income countries, it is the greatest risk. Approximately 4.5% of the global burden of disease and injury is attributable to alcohol. Alcohol is a causal factor in 60 types of diseases and injuries and a component cause in 200 others. Alcohol is attributed to nearly 3.2% of all deaths and results in a loss of 4% of total DALYs (58 million). Aims & Objective: To assess the pattern of alcohol use among the males aged >15 years in the urban slum, Multan Nagar in Meerut. Material and Methods: A cross-sectional study was conducted in the catchment area of UHTC (Urban Health and training Centre) among 324 males aged > 15 years. Data was collected by home visit using WHO questionnaire (AUDIT: Alcohol use disorder identification test) along with other questions related to the type, initiation and reason behind alcohol use. Chi square test followed by logistic regression was applied to know the association of alcohol use with the socio-demographic determinants. Results: According to the AUDIT score, Hazardous, Dependent and harmful drinkers were 7.7%, 9.2% and 2.4% respectively. Most common age of onset was 20-30 years (46.9%) among the drinkers with most common reason being peer pressure (13.6%). Logistic regression was applied and marital status, family history of alcohol use and caste retained their statistical significance (p-value< 0.05, 95% confidence interval). Conclusion: It can be concluded that early age of onset and peer pressure are the alarming challenges for the eradication of this social evil.