Plant-based Diet for HbA1c Reduction in Type 2 Diabetes Mellitus: an Evidence-based Case Report

Background: diabetes has become a major public health concern with an estimated 180 million cases worldwide. Nutritional changes are one of the key aspects in the management of type 2 diabetes mellitus. Previous studies have suggested an association between vegetarian diets and improvements in glycemic control in type 2 diabetes mellitus, however the relationship is not well established. The aim of this report is to perform a critical appraisal to analyze whether plant-based diet reduces the HbA1c level compared to conventional diet. Methods: a comprehensive computer-based literature search was performed on June 20, 2016 using PubMed, Ovid, EBSCO, and the Cochrane Library. All abstracts and titles from the initial search results were screened, reviewed, and appraised using critical appraisal worksheets by Center of Evidence-Based Medicine, University of Oxford. Results: one systematic review and two RCTs met the inclusion criteria and were considered eligible for this case report. In patients with type 2 diabetes mellitus, HbA1c significantly yielded greater reduction in the plant-based group compared to conventional diet group after 22 weeks of follow up. Similarly, there was a statistically greater reduction in HbA1c level in the plant-based group after 72 weeks. Furthermore, consumption of plant-based diet was associated with a significant reduction in HbA1c. Conclusion: in patients with type 2 diabetes mellitus, HbA1c reduction was greater in patients with plant-based diet compared to patients with conventional diet. Further research should be conducted with larger sample size and longer follow-up perio

Eksplorasi Pembelajaran dengan Keterlibatan Langsung Pasien pada Pendidikan Profesi Dokter Gigi

Background: Clinical stage learning in dentistry provides broad opportunities for students to give services directly to patients (chairside teaching). This certainly requires a great deal of attention to patient safety, so there is a need for supervision and giving feedback in learning. This study aimed to explore learning with the direct involvement of patients in clinical dental stage in dentistry. Methods: This was a qualitative study with a case study design, conducted from January to April 2019. Data collection was carried out through in-depth interviews and focus group discussions (FGD) with clinical supervisors and clincal students at the Dentistry, Universitas Yarsi. Data triangulation was carried out by observation of the implementation of chairside teaching. The data obtained were analyzed qualitatively. Results: In-depth interviews with 5 policy makers and FGDs with 2 groups of clinical supervisors (n = 8 and n = 6), and 2 groups of clincal students (n = 8 each) produced 3 themes. These three themes are the role of clinical teachers, the learning environment with patients, and the role of students. Conclusion: Supervision had been carried out in chairside teaching but it was not optimal yet. Therefore, it is necessary to adjust the level of supervision which is supported by providing constructive feedback to ensure patient safety and help students achieve the expected competencies

Fixed-dose combination antituberculosis therapy as a risk factor for tuberculosis recurrence: an evidence-based case report

Background: a patient with a history of tuberculosis (TB) has a risk up to 27% to develop recurrence within 2 years after being cured. Indonesia itself has more than 7,500 recurrent cases annually, regardless of reinfection or relapse. This is an important problem, as recurrent TB is associated with lower cure rates with the anti-TB therapy and higher risk of developing drug resistance. Some risk factors for this recurrence are smoking, poor treatment adherence, low economic status, and weak immune status. This study is aimed to identify whether the use of fixed-dose combination (FDC) anti-tuberculosis therapy increases the risk for tuberculosis recurrence compared with using separate drug formulation. Methods: the search was conducted on MEDLINE, ProQuest, EBSCO, ScienceDirect, and Cochrane according to clinical question. The studies were selected based on inclusion and exclusion criteria and led to five useful articles. The selected studies were critically appraised for their validity, importance, and applicability. Results: five cohort studies were found with comparable validity. Only 1 study has accurate relative risk (RR) with 3.97 (1.14 – 13.80) and number needed to harm of 18. Other four studies fulfilled the applicability criteria for our case. Conclusion: the use of FDC anti-tuberculosis therapy increases the risk for tuberculosis recurrence compared with using separate drug formulation

Exploring medical students’ professional identity formation through written reflections during the COVID-19 pandemic

Background: Disruptions due to the COVID-19 pandemic have forced medical schools around the world to adapt. Major changes in curriculum delivery during the pandemic have impacted medical students’ professional development. We assess undergraduate medical students’ adaptations and Professional Identity Formation (PIF) by exploring their written reflections. Methods: This phenomenology study analyzes undergraduate medical students’ written reflections. We perform a thematic analysis to identify emerging themes. Results: We purposively selected 80 written reflections, considering the students’ year of study, gender, GPA, and education stage (preclinical or clinical). Three themes emerged: students’ adaptation processes and coping strategies in facing the pandemic; their adaptation processes for learning; and their perceived roles as medical students during the pandemic. Conclusions: Adaptive coping mechanisms were implemented by the medical students in this study. The socialization processes that promote professional identity formation may change due to the tremendous disruption wrought by the pandemic; this has prompted our investigation of students’ roles and various ways of interacting with role models. We highlight the importance of the medical school supporting students’ adaptations and professional identity formation during this pandemic

Improvement in medical students’ knowledge on chronic pain assessment through integrative learning approaches: a randomized controlled trial

IntroductionThis study aimed to compare the knowledge and skills of medical students in chronic pain assessment after being trained using the PQRST (P, provoke and palliate; Q, quality; R, region and radiation; S, severity; T, time) and ACT-UP (A, activity; C, coping; T, think; U, upset; P, people) mnemonics with those using only the PQRST mnemonic.MethodsA double-blind, randomized controlled trial was conducted at the Faculty of Medicine, Universitas Indonesia, including forty students who participated in a simulation-based chronic pain assessment workshop. Pre- and post-test scores were used to assess participants’ knowledge. Two independent raters assessed the students’ skills.ResultsNo significant differences in knowledge or skills were observed between the groups; however, a significant improvement in the post-test scores (85.71 [71.43–95.24]) compared to the pre-test scores (61.90 [25.87–90.48]) was observed. The students reported high satisfaction with the workshop.ConclusionsTraining with the PQRST and ACT-UP mnemonics is not better than training with the PQRST mnemonic alone in improving students’ knowledge and skills in chronic pain assessment. Nevertheless, this pain education workshop was beneficial for student learning. Learning of patient-oriented chronic pain assessment should be provided in a repetitive and integrative fashion using different approaches, such as lectures, demonstrations, simulations, and interactions with patients experiencing chronic pain. To conclude, mnemonics are helpful but not a primary learning tool

Deeper look into feedback practice in an Indonesian context: exploration of factors in undergraduate clinical settings

Purpose The practice of feedback is influenced by the characteristics of students, teachers, and the clinical environment. Most studies on feedback have been conducted in Western settings with different sociocultural backgrounds to Indonesia. This study explores feedback in Indonesian clinical clerkship using a sociocultural lens and aims to provide an exemplar of adaptive practice relevant to non-Western settings. Methods This qualitative study was conducted using an interpretive phenomenology approach. Data were collected through focus groups with students and teachers and interviews with program coordinators. Data were transcribed verbatim and grouped according to data sources, coded, and analyzed thematically. Results Themes identified from the focus group discussions and interviews were categorized as student, teacher, and environmental factors. Student factors include dependence on feedback, tendencies to use a group approach, difficulties recognizing social rules, a perceived lack of resilience, and tendencies to doubt praise. Factors related to teachers include a high level of expertise, being extremely busy, having a strong commitment, and being unsure of students’ acceptance of feedback. Clinical environment factors influence interactions between teachers and learners and include high power distance and collectivistic values. A safe environment is needed to ensure effective feedback interactions. Conclusion High power distance, collectivism, and generational characteristics of students likely impact feedback practice in clinical settings. Designing a safe environment is essential for effective feedback practice

Twelve tips for developing a global community of scholars in health professions education

Scholarship in Health Professions Education is not just original research, it also includes study of educational processes, and application of new knowledge to practice. The pathways to successful scholarship are not always clear to novice educators. In this article, we describe strategies to establish a Community of Scholars (CoS), where more experienced and senior members guide junior members in scholarship to advance the field. Drawing on Lave and Wenger’s concepts of Communities of Practice (CoP), we describe twelve practical tips, which include generation of a shared vision, formation of a global community of scholars, engagement in scholarly initiatives, and development of a professional identity, categorised under three major steps: establish, grow, and sustain the community. The tips embrace inclusivity for diverse cultural contexts which further provide opportunities for Health Professions Educators, interested in forming communities of practice, to work on scholarly outputs and add value to the professional arena

Understanding of clinical reasoning and how it is taught and learned in undergraduate medical programs (Australia & Indonesia)

© 2012 Dr. Ardi FindyartiniBackground: The acquisition of clinical reasoning (CR) skills is one of the main goals of medical education, however, medical curricula do not necessarily elaborate the teaching and learning process for the acquisition of this skill explicitly. Method: This study explored CR teaching and learning in two undergraduate medical education settings at the University of Melbourne (UoM, Australia) and the University of Indonesia (UI, Indonesia) using quantitative and qualitative methods within a comparative case study framework. There were three sources of data used in this study: medical students enrolled in their final semester of pre-clinical training (semester 6) and their final semester of clinical training (semester 12), academic teachers, and curriculum documents. The students’ thinking styles and perceptions of CR teaching and learning were obtained by the administration of two quantitative instruments (Diagnostic Thinking Inventory (DTI) and a new Questionnaire on CR (QCR)) and qualitative focus group discussion. The academics’ views and curriculum documents were explored by conducting qualitative inquiries through semi-structured individual interviews and document analysis. Results: Students from UoM and UI who volunteered for the survey were 168 semester 6 and 12 UoM students and 209 semester 6 and 12 UI students. In addition to this, 4 student FGDs (2 for semester 6, and 2 for semester 12) were conducted at the UoM and 6 FGDs (3 for semester 6, and 3 for semester 12) were completed at the UI. Finally 13 UoM and 11 UI academics were interviewed. The data was collected in 2008 – 2009 in both settings. Following detailed quantitative and qualitative analysis, there were seven major findings from this study: a. The curriculum audit of medical education at UoM and UI demonstrated three issues in relation to CR skills development: that training expectations were often implicit rather than explicit. UoM introduced CR training in the preclinical years through PBL, while UI placed stronger reliance on the clinical training years. b. Semester 12 students in both settings had more flexibility of reasoning style and better structure of knowledge in memory, better awareness of the value of CR learning, and better self-reflection in relation to CR than their semester 6 counterparts. c. All informants in both institutions strongly agreed that the clinical years of training were the best preparation for developing CR skills. d. UoM students and academics more strongly endorsed the value of PBL in developing CR skills at both semester 6 and semester 12 levels than UI students and academics. f. Clear cultural differences in relation to attitudes to learning CR were evident in the two institutions, in particular in relation to the power distance between the academics as content experts and the students and preferences to uncertainty avoidance in teaching and learning CR. These were more evident in the UI context than they were in UoM context. g. There was little relationship between flexibility of reasoning style and structure of knowledge in memory, awareness of value of CR learning and self-reflection in relation to CR, and students’ pre-clinical and clinical grades in both institutions suggesting that they were independent aspects of medical learning in both courses. Conclusion: Despite CR being recognized as an essential skill for medical graduates, UoM and UI did not explicitly express the CR objectives or a specific teaching and learning process to acquire these skills. Despite this observation, students improved their diagnostic thinking style and perceptions during the course suggesting that CR was actually taught and learned during medical training at the UoM and UI. The role of PBL as well as clinical skills tutorials in preclinical years for CR development can be enhanced in both institutions, especially in UI. In the clinical years, both institutions seemed to face a similar challenge to provide a more explicit and systematic way of learning and practicing CR. Finally, the cultural aspects should be considered while improving the curriculum in regards to CR skill development