An innovation in flipped class room: A teaching model to facilitate synchronous and asynchronous learning during a pandemic

Objective: To conduct an on line Flipped Class Room (FCR) to facilitate synchronous (in class activity) and asynchronous learning [Virtual Learning Environment (VLE)] and acquire feedback of the learning experience from medical students at Aga Khan University.Methods: This interventional study was conducted with year II students undergoing Endocrine Reproduction Module at the Aga Khan University during April 13 to May 22, 2020. Pre reading material and pretest was shared with the students via Virtual Learning Environment (VLE) one week before the class. Microsoft Teams was used to conduct online session by two facilitators, where student discussion on case studies was encouraged. A WhatsApp group was created with the facilitators to respond to any student queries. The session was recorded and later uploaded on VLE. Posttest and a student satisfaction survey was conducted at the end of the session.Results: The average score for the pretest and posttest was 19.67 ± 1.37 and 24.60 ± 1.34 respectively (p value \u3c0.05). The learner curve showed an increase in the knowledge learned by 4.93 points (p value \u3c0.05). Fifty-five percent students felt that placement of session was appropriate and were satisfied with the instructions and expected outcomes, received constructive feedback for improvement and generated positive attitude towards learning.Conclusions: The innovative model of FCR through facilitation of synchronous and asynchronous learning empowered student\u27s engagement and interactive learning. Students perceived this as a great learning experience which they enjoyed with positive reinforcement from feedback given by the facilitators. They suggested continuation of this model for further learning sessions in other modules of undergraduate medical education at Aga Khan University

A take on social wellbeing attributes by first year medical students

Objective: To compare awareness about concept of social wellness in male and female first year medical students. Methods: It was a cross sectional, questionnaire based study conducted from February till December 2010. Responses on aspects of social wellness were rated never, sometimes, mostly and always from lowest to highest (1-4); evaluated as frequency, proportion and percentages by PASW (Predictive analysis software) version 18. Chisquare test was applied for comparison of social wellness in both genders; results to be declared significant with pvalue \u3c0.05. Results: Overall score for social well being of females (20.24±4.50) was higher than male medical students (18.66±4.76; p\u3c0.0001). Majority of the female respondents believed that they exhibit fairness and justice in public dealing (p\u3c0.004), had a good network of close friends and family (p\u3c0 001), were prompt at helping batch fellows (p \u3c0.004), participated in group discussions (p \u3c0.004), followed dynamics of communication (p\u3c0.05) and were better at solving problems (p\u3c0.01) as compared to the male respondents. Conclusion: The scores highlighted a better interaction of females with the social environment

Body mass index or body fat! which is a better obesity scale for Pakistani population?

Ojective: To compare two methods of classifying obesity based on body mass index and body fat percentage.Methods: The cross-sectional study was conducted from November 2012 to August 2013 at Jinnah Postgraduate Medical Centre, Karachi. Male and female volunteers between the ages 15-65 years were selected using simple random sampling. They were classified into different groups for body mass index and body fat percentage measured through bioelectrical impedance scale. The subjects were sub-grouped into underweight, normal weight, overweight and obese. SPSS 11 was used for statistical analysis.Results: The mean age of the 828 healthy volunteers was 25.67±10.10 years. A total of 552 (66.6%) subjects had a higher body fatpercentage and were misclassified by body mass index. Only 276 (33.3%) subjects had body fat percentage values corresponding to the body mass index classification. The difference in terms of categorising obesity was highly significant (p\u3c0.001). Both body mass index and body fat percentage showed positive correlation with age (r=0.144; p=0.001) (r=0.261; p=0.001) and weight (r=0.578; p=0.001) (r=0.444; p=0.001) respectively. Moreover body fat percentage showed a significant positive association with gender (r=0.109; p=0.027) whereas BMI did not.Conclusions: Body fat percentage should be incorporated for a better understanding as well as categorising of obesity

Increased body mass index may lead to hyperferritinemia irrespective of body iron stores

Objective: Obesity causes subclinical inflammation which results in the secretion of various bioactive peptides that are key players in metabolic regulation of iron homeostasis. We sought to establish correlation of one such peptide (ferritin) with marker of subclinical inflammation (CRP) in various BMI.Methods: Total 150 subjects between the ages of 20-60 years were included in the cross-sectional study conducted at Basic Medical Sciences Institute, Jinnah Post Graduate Medical Centre, Karachi, Pakistan. Body Mass Index (BMI) was calculated by weight (kg) /height (m(2)). The given values were used as reference for Group A: normal weight (18.0-22.9 kg/m2), Group B: overweight (23.0-24.9 kg/m2), Group C: obese ( \u3e 25.0 kg/m2) according to South Asian criteria. Serum Iron, Total Iron Binding Capacity, serum Transferrin Saturation, serum Ferritin and C-reactive protein were measured by commercially available kits. ANNOVA with Tukey\u27s minimum significant difference and Spearman Rho correlation were used considering p \u3c 0.05 significant.Results: The results identified an increased serum Ferritin and CRP in obese versus lean subjects (p \u3c 0.001). BMI showed significantly positive correlation with serum CRP (r = 0.815; p-value \u3c 0.01) and Ferritin (r = 0.584; p-value \u3c 0.01). However, serum Iron levels and Transferrin saturation decreased in obese versus normal weight individuals (p \u3c 0.001).Conclusion: This integrated new data reveals that individuals with high BMI had high levels of Serum Ferritin despite low levels of iron with high levels of C- reactive protein. This might be caused due to inflammatory conditions prevailing in the presence of increased adipose tissue

Flipped classroom instructional approach in undergraduate medical education

Objective: In this study we implemented the “flipped classroom” model to enhance active learning in medical students taking neurosciences module at Aga Khan University, Karachi. Methods: Ninety eight undergraduate medical students participated in this study. The study was conducted from January till March 2017. Study material was provided to students in form of video lecture and reading material for the non-face to face sitting, while face to face time was spent on activities such as case solving, group discussions, and quizzes to consolidate learning under the supervision of faculty. To ensure deeper learning, we used pre- and post-class quizzes, work sheets and blog posts for each session. Student feedback was recorded via a likert scale survey. Results: Eighty four percent students gave positive responses towards utility of flipped classroom in terms of being highly interactive, thought provoking and activity lead learning. Seventy five percent of the class completed the pre-session preparation. Students reported that their queries and misconceptions were cleared in a much better way in the face-to-face session as compared to the traditional setting (4.09 ±1.04). Conclusion: Flipped classroom(FCR) teaching and learning pedagogy is an effective way of enhancing student engagement and active learning. Thus, this pedagogy can be used as an effective tool in medical schools

Evaluation of kidney injury molecule-1 as a disease progression biomarker in diabetic nephropathy

Background & Objective: Kidney Injury Molecule-1 (KIM-1) is a peptide whose release into circulation is specific to tubular injury. This study aimed to estimate levels of kidney injury molecule-1 in diabetic patients with and without kidney disease. And evaluate the role of KIM-1 as an early screening marker of progressive kidney injury.Methods: This follow-up study included n=85 subjects from the diabetic clinic of Jinnah Post Graduate Medical Center (JPMC) in collaboration with Aga Khan University from November 2016 till September 2017. They were divided as: i) Group A1 (n=30) participants with diabetes for \u3c5 years without microalbuminuria ii) Group A2 (n= 30) subjects with diabetes for 6-10 years with microalbuminuria; iii) Group B (n=25) subjects as healthy control group. All study participants were followed for 6 months and their blood glucose, urea, creatinine, electrolytes, albuminuria and serum KIM-1 were assayed.Results: High KIM-1 at baseline was present in group A2 patients as compared to controls and group A1 (p\u3c0.001). Higher levels were seen after six months in group A1 along with the presence of micro albuminuria (p\u3c0.001) suggesting kidney damage. Moderate positive association were seen for KIM1 with creatinine levels (r=0.530; p\u3c0.001), and HbA1c (r=0.576; p\u3c0.001) in all patients. While a strong positive association was seen for blood urea nitrogen as a marker for kidney function both at baseline (r= 0.728; p=0.000) and follow up (r=0.747; p=0.001). Multiple logistic regression controlling for age showed that KIM1 was independently associated with BUN (r=0.727; p\u3c0.001), creatinine (r=0.510; p\u3c0.001) and HbA1c (r=0.401; p=0.008) in all groups.Conclusion: Rising KIM-1 levels with progressive kidney damage with or without derangement of kidney function is reported in this study. This finding may pave a way towards identifying KIM1 as a prognostic marker for kidney injury

Teaching shock pathophysiology by flipped classroom: Views and perspectives

Flipped classroom (FCR) is an active learning pedagogical method in which the students prepare prior to class using different modalities, for example, reading materials and videos, and afterward spend the time in class discussing the content and reinforcing the concepts. We chose to replace one problem-based case on Shock with flipped-style teaching in the respiration circulation module of a private medical university. Our objective was to use the clinical presentation of Shock to open a window to interrelate basic science concepts of cardiovascular physiology and pathology. It aimed to merge the case-based discussion with small-group discussions in the form of FCR activity. The qualitative study gives an overview of comments of facilitators, observers, and leadership of the Department and University obtained during focus group discussions and in-depth interviews. Thematic analysis of responses emphasized the importance of FCR as an effective teaching learning modality, which can be made more effective by careful selection of topic and provision of facilities to support technology-enhanced learning. The discussions with facilitators, observers, and leadership revealed its usefulness through student\u27s engagement and increased participation to build learning of the key concepts. Student satisfaction in these activities can be enhanced by construction of knowledge acquired in non-face-to-face component with substantial pre-reading materials, videos, peer discussions, quizzes, and prompt feedback

Enhancing cognitive engagement of pre-clinical undergraduate medical students via video cases and interactive quizzes in problem-based learning

Background: Problem-based learning (PBL) is one of the main pedagogical approaches utilized in the undergraduate medical education (UGME) program at a private medical college in Karachi, Pakistan. Video-enhanced cases and formative assessments were introduced at the end of PBL sessions to evaluate their effectiveness in enhancing student engagement.Methods: A mixed methods study was conducted with Year 2 medical students (n=102; divided into 11 groups) and faculty (n=11) facilitating the PBL process. Of the 10 PBL cases, five were converted to video-enhanced cases and five were kept as paper-based, “traditional” cases. “Micro” videos were used to introduce clinical scenarios, augmented by a set of guided questions related to the scenario. In addition, a formative quiz was conducted to assess concepts at the end of video-enhanced PBL sessions. At the end of a module, students and facilitators completed an online survey regarding this modified learning experience, and this was followed by a focus group discussion with the PBL facilitators.Results: More than two-thirds (71%) of the students and all facilitators preferred video-enhanced over paper-based cases. Seventy-nine percent of the students agreed that this method increased peer-peer and peer-facilitator engagement, while 66% (n=68) of the students and 81% (n=9) of the faculty agreed that the end of PBL formative assessment activity would support the Universal Design for Learning framework.Conclusion: Video-enhanced PBL used during the introduction of the case and formative assessment activities at the end of the PBL sessions improved student engagement and contributed positively to the discussions and their understanding