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   Table of Contents - Current issue
Coverpage
October-December 2018
Volume 5 | Issue 4
Page Nos. 251-320

Online since Wednesday, November 14, 2018

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EDITORIAL  

Research in medical education: Changing trends p. 251
Dinesh Kumar Badyal
DOI:10.4103/cjhr.cjhr_73_18  
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REVIEW ARTICLES Top

Internal assessment for medical graduates in India: Concept and application p. 253
Dinesh Kumar Badyal, Tejinder Singh
DOI:10.4103/cjhr.cjhr_74_18  
Assessment in an undergraduate medical course in India comprises of university assessment and internal assessment (IA). IA is a continuous form of assessment based on day-to-day activities and performance during the course. A specified IA is a criterion to appear in university examinations. The concepts in IA need clarification so that there is uniformity as per the Medical Council of India guidelines for IA. The logistic of scheduling various tests in undergraduate courses and the calculation of IA based on marks and subjective assessment needs to be done properly as it is being subjected to scrutiny by students as well as by law. Clarification of concepts, its revisions, and an Excel module can be useful in designing IA in a department, maintaining proper records, and making it easier to calculate it. Our designed module takes care of calculations automatically after marks are entered. The appropriate use of IA for providing feedback and remedial measure can be a great link in using assessment for learning.
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Medical violence (Yi Nao Phenomenon): Its past, present, and future Highly accessed article p. 259
Sudip Bhattacharya, Kanica Kaushal, Amarjeet Singh
DOI:10.4103/cjhr.cjhr_43_18  
Violence against doctors is on the rise worldwide. Doctors are no more considered demigods or authorities in their field; on the one hand, where there is a valid reason for it because of the dilution in the field; however, on the other hand, the distrust is getting generalized to the whole community of physicians. Violence against them in any form is reprehensible. However, acts of violence in a hospital are the most extreme and should be dealt with an iron hand.
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Capacity building in HIV/AIDS care in antiretroviral therapy center through open and distance learning p. 264
Biplab Jamatia, Tapan Kumar Jena
DOI:10.4103/cjhr.cjhr_93_18  
The number of people living with HIV (PLHIV) in India is 26.26 lakhs (18.00–27.85 lakhs) as per annual report 2016–2017 of the National AIDS Control Organization (NACO). Till September 2016, 361 care and support centers were functional, and a total of 10,70,928 PLHIV received care and support services. There are 528 functional antiretroviral therapy (ART) centers and 1108 linked ART centers across the country including 88 ART plus centers till September 2016. About 2000 trained doctors would be needed to man these facilities. It is planned that MBBS doctors with Postgraduate (PG) Diploma in HIV Medicine (PGDHIVM) shall be considered for the post of senior medical officer at ART centers. The PGDHIVM would help to standardize HIV Medicine training and also help to bridge the gap in trained workforce for ART centers. With the above background, Indira Gandhi National Open University developed a 1-year program on HIV Medicine for MBBS doctors, which is being offered through open and distance learning in collaboration with NACO with the objectives that the learner would be able to imbibe comprehensive knowledge on basic of HIV as related to details of management of HIV/AIDS in tertiary care setup, manage all complications as well as opportunistic infections due to HIV/AIDS at time of need, and recognize and handle emergencies related to HIV/AIDS and its complication and take bedside decision for management whenever is required. This program comprises 36 credits (1 credit = 30 study hours), which is divided into four theory and two practical courses. All learners have been provided a total of 20 blocks having 76 units along with three practical logbooks as learning materials for this program. There are 28 days of hands-on skill training in medical colleges identified as the center of excellence by NACO and another 30-day training in an ART center. The program was launched in 2012, and 122 candidates have successfully completed it so far.
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ORIGINAL ARTICLES Top

A study of the perception of medical teachers regarding education in ophthalmology in Western India p. 270
Purvi Raj Bhagat, Kinjal Y Trivedi
DOI:10.4103/cjhr.cjhr_55_18  
Background: Frequent unpleasant incidences, conflicts, and litigations between patients and doctors point to the fact that medical graduates perhaps primarily lack professionalism and competence. Instances of unethical practice are on the rise. Respect for the profession has dwindled, with the field of ophthalmology being no exception. This study aims to identify the current problems of medical education in ophthalmology in Western India along with the possible solutions for improvement. Materials and Methods: Cross-sectional data were collected through an online validated questionnaire from ophthalmology teachers of medical colleges of Western India. The questionnaire included 62 questions with information on their demography, faculty development program details, teaching schedule details, satisfaction regarding the undergraduate (UG) and postgraduate (PG) ophthalmology training, and suggestions regarding improvisation. It was analyzed to identify caveats and find possible solutions. Results: Forty-two responses were obtained. Thirty-one (73.8%) teachers suggested a change in the current teaching methodologies, 30 (71.4%) suggested changes in assessment strategies, 12 (28.6%) suggested curricular reforms, and 6 (14.3%) suggested change in the duration of the courses, both in UG and PG ophthalmology education. Need for interactive, integrated, and problem-based teaching and more skill-based assessments was expressed. Conclusions: Improvement in the current scenario needs an integrated approach of the government, accreditation system, institutional heads, faculties, and medical students to build a strong foundation for a better future.
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Rationale use of microbiological diagnostic techniques: A module for undergraduate medical students p. 276
Aroma Oberoi
DOI:10.4103/cjhr.cjhr_61_18  
Introduction: As we all know that 2nd-year professional students are just the beginner to learn the clinical skills. By teaching rational use of various laboratory techniques, one can shortlist the investigations to be ordered, thereby making it cost effective for the patients. This also encourages rapid and precise investigations, decreasing hospital stay and cost and lesser number of nosocomial infections. Aims and Objectives: The aims of this study were as follows: (1) to develop a module for an interactive disease-based teaching session to impart practical knowledge to undergraduate medical students of the microbiological diagnostic techniques, (2) to evaluate the outcome of this intervention on students for better perception and understanding of clinical microbiology, and (3) to encourage implementation of this knowledge imparted to students later on for rapid and precise investigations, diagnosis, and cost-effective hospital stay in a clinical scenario. Materials and Methods: The study was conducted in the Microbiology Department of Christian Medical College and Hospital, Ludhiana. Forty-five 2nd-year professional students participated in the study. Topics were taught in the theory classes as usual followed by preproject assessment by multiple-choice questions (MCQs). The same topics were taught in the practical classes with special emphasis to diagnostic tests (which test when required). Students were again evaluated by the same set of MCQs as given for preproject assessment. Marks obtained by both teaching methods were analyzed statistically. Results: By postproject analysis MCQ test, it was seen that 22.2% of students scored marks in the range 80%–90% (preproject marks 4.44%). Majority of the students (66.6%) scored between 70% and 80% postproject while the students performing in this range preproject were 6.66% only. The postproject performance in the range 60%–70% and 60%/below 60% was seen among 6.66% and 4.44%, respectively. Paired t-test was used for comparison and was statistically significant (P < 0.05). Conclusion: Results of the current study appear to support continued use of the interactive disease-based session. While prospective research is needed to best assess the utility of the session, the current study does provide support for session benefits. This project is still going on in the department and students are taught clinical microbiology at the end of the syllabus.
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The implementation of team-based learning in MBBS pharmacology teaching: A student's perception p. 281
Harminder Singh, Amit Jain, Ritu Bala, Kuhu Verma, Somrita Modak
DOI:10.4103/cjhr.cjhr_66_18  
Background: The objective of this study was to assess the student's perceptions/observation of team-based learning (TBL) in a 2nd year MBBS Pharmacology teaching using the TBL Student Assessment Instrument (TBL-SAI). Methodology: The TBL strategy was administered to 100, 2nd year MBBS Pharmacology students with the help of TBL-SAI surveys. The survey includes 33 items, each rated from one (strongly disagree) to five (strongly agree) and measures three subscales: students' perception/observation of accountability, liking for lecture or TBL, and student satisfaction. Results: Total TBL-SAI score for each component fell above the neutral point score. About 77.9% of the students have felt accountable to participate in the learning. Majority (89.5%) showed a preference for TBL comparable to lecture instruction. In addition, 85.6% of the students were satisfied with the course. Conclusion: The TBL design has been effectively implemented in learning of analgesics and antiulcer drugs in pharmacology with the key objectives of encouraging and perceiving student accountability, satisfaction, TBL versus lecture and student engagement. TBL enhances the student teacher interact and is helpful to students who learn in group activities and is a feasible active-learning academic strategy for large student-faculty ratio. This could be effortlessly tailored for other topics, courses, and programs.
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Analysis of reflective writing of 3rd year medical students during the pediatric clerkship p. 286
Padmini Venkataramani, Tharam Sadanandan
DOI:10.4103/cjhr.cjhr_82_18  
Background: Reflection creates an understanding of the self and the situation so that the future actions can be informed. It helps in self-regulated and life-long learning. Guided reflection with the help of a mentor may help medical students entering their early clerkships, challenge their assumptions, and consider new perspectives. Methodology: This is a descriptive report of analysis of reflective writing in the logbooks of the year 3 medical students in pediatrics. Students were requested to identify any significant event in the wards or classroom each week and write a brief reflective report. Mentors had weekly meetings with them and discussed the reports. The reports were classified into four themes (related to children and caregivers, learning, motivation, and miscellaneous) after content analysis. Results: Sixty-six logbooks were analyzed. Twenty-five students did not write reports on one or more weeks. There were 29 reports on children, 18 on caregivers, 20 on how students derived inspiration from children and caregivers, 20 on empathy, 24 on upsetting events, 8 on bad experiences of caregivers, 62 on learning, 9 on motivation, and 3 on miscellaneous matters. Challenges: Regular and weekly mentee meetings and discussions are required for meaningful reflective reports. Language posed difficulties in expression. Conclusions: Reflection helped students to be more aware of what is going on in the wards and address troubling issues by discussion with their mentors. It helped mentors gain an insight into students' perspectives and concerns. Regular mentee meetings helped to establish rapport with mentors and submission of proper reflective reports.
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Combining traditional embryology lectures with technology and perception of students toward it p. 290
Priti Chaudhary, Kamal Arora, Shashi Kant Dhir
DOI:10.4103/cjhr.cjhr_79_18  
Background: Technology-enhanced learning is reliable, established, and effective teaching tool for better understanding of the subject. This study addresses an important issue in medical education, namely, the enhancement of the widely criticized lecture style of teaching by engaging students more actively during class through the use of videos or animations. This study describes the development, implementation, and evaluation of a traditional anatomy lecture series combined with technology. Aim and Objectives: The aim of the study is (a) to combine three-dimensional (3D) videos and animations with traditional embryology lectures and (b) to evaluate the 1st-year MBBS students' perception about this method of learning of embryology. Methodology: This qualitative study was conducted in the Department of Anatomy at Guru Gobind Singh Medical College, Faridkot, during the theory classes of embryology over a period of approximately 3 months among 100 1st-year MBBS students. The students were shown 3D videos and animations of embryology during traditional didactic lecture to explain all the aspects of the development of different systems of the body in 25 classes, of 1-h duration each. Feedback was taken using a structured questionnaire to know the perception of students toward this exercise of using technology during lecture of embryology. Results: A total of 100 MBBS first professional students took part in the study and submitted questionnaire. The students were satisfied with this method of technology-enhanced learning and described better understanding of the concepts with improved learning. More than 90% of the students found that combining 3D videos and animations with traditional lecture helped in solving the confusion and misconceptions regarding topic and did make the topic more interesting. They further added that they wanted to have such type of technology (videos)-enhanced lectures in all other topics of anatomy and in other subjects as well. Conclusions: Technology used in the form of 3D videos and animations changed their attitude toward learning and their learning was improved. It provided satisfaction to students in terms of better learning and understanding of the subject.
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Impact of a one-minute preceptor on learning of pulmonary medicine postgraduates: Perceptions and review of literature p. 297
Deepak Aggarwal, Varinder Saini, Manisha Bhardwaj
DOI:10.4103/cjhr.cjhr_80_18  
Context: Clinical reasoning and patient management skills are integral part of postgraduate (PG) medical education. Often, traditional teaching practices and paucity of time hinder this aspect of a resident's development. One-minute preceptor (OMP) is a learner-centered model that might improve PG learning. Aims: The study was conducted to introduce OMP as an educational tool for pulmonary medicine PG students and to evaluate the perceptions of residents and faculty on its utility. Subjects and Methods: Thirteen pulmonary medicine PG residents and six faculty members participated in this study. After initial sensitization about the teaching tool, thirty OMP sessions were conducted in the outpatient department with each resident undergoing a minimum of two sessions. Resident and faculty perceptions on this process were evaluated through validated questionnaires that were graded on a Likert scale. Results: All 13 residents perceived that OMP can improve their clinical reasoning skills as well as increase their motivation for further study (average Likert score for both: 4.69 + 0.48). However, 53.8% (n = 7) of residents perceived that the time devoted to OMP session was inadequate. Faculty also perceived that OMP was an effective teaching method and advocated its routine use in PG teaching. Conclusion: Both residents and faculty perceived OMP as an effective teaching tool in outpatient teaching of PG residents.
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CASE STUDY Top

Impact of problem-based learning in dentistry curriculum in Nepal: A self-reflection p. 302
Jyotsna Rimal, Ashish Shrestha, Dinesh Kumar Badyal
DOI:10.4103/cjhr.cjhr_122_18  
My project on problem-based learning (PBL) is not new to medical schools but not many dental schools have adopted this approach in their curriculum in South Asian region. This approach not only develops content knowledge and skills but also sharpens the soft skills such as critical thinking, interpersonal, teamwork, presentation, speaking, and communication skills, which are equally needed to become a successful doctor. As a part of fellowship of the Foundation for Advancement on Medical Education and Research, Regional Institute, Christian Medical College, Ludhiana, this approach was tried in 2013 and ultimately incorporated in the curriculum in 2014. This case study describes the journey, challenges, and way forward from initiation of PBL approach in a government dental college of Nepal to its inclusion in national curriculum.
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LETTERS TO EDITOR Top

Syllabic medicine (Cinquain) p. 305
Upreet Dhaliwal
DOI:10.4103/cjhr.cjhr_77_18  
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The “SMART” rationale for an integrated curriculum p. 307
Swapnil Paralikar
DOI:10.4103/cjhr.cjhr_69_18  
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Competitive or competent? – Impact of national eligibility cum entrance test on present-day medical education p. 308
V Dinesh Kumar, P Srinidhi
DOI:10.4103/cjhr.cjhr_76_18  
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What's in a name? p. 310
Kiran Goswami
DOI:10.4103/cjhr.cjhr_70_18  
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COMMENTARIES Top

Commentary on Syllabic medicine (Cinquain) p. 315
Juhi Kalra
DOI:10.4103/cjhr.cjhr_107_18  
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Do we need to align NEET with desired outcomes? p. 317
Juhi Kalra
DOI:10.4103/cjhr.cjhr_112_18  
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Learning through reflections p. 319
Monika Sharma
DOI:10.4103/cjhr.cjhr_109_18  
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