Retention of case-based learning on infectious diseases by third-year medical students

Background: Undergraduate medical students infrequently see a variety of cases of infectious diseases during their batch-wise rotatory clinical postings. Traditional didactic teaching resulted in lack of learner-centred teaching, lack of in-depth knowledge and less retention of learning. The main aim and objective of this complete-enumeration, before-and-after study (without controls) is to employ case-based learning (CBL) as an adjunct to traditional didactic lectures (TDL) for teaching infectious diseases to third-year undergraduate medical students to study the retention of knowledge by comparing the cognitive domain scores in pre- and post-tests.Methods: After obtaining ethical permissions and written informed consent, TDLs were delivered to give a preview on ten topics (selected by lottery system from topics in syllabus) and a pre-test was conducted after TDL. After pre-test, CBL sessions were conducted jointly by two facilitators (using identical CBL modules) in two randomly-assigned sub-groups (n=28) to enable discussion. After CBL, two post-tests (identical to pre-test) were conducted at intervals of one and six months to determine the levels of retention of learning.Results: The differences in the student-wise and question-wise scores in the pre-test and one-month post-test and that between the pre-test and six-month post-test were highly significant. However, the difference between the mean scores in one-month and six-month post-test were not statistically significant.Conclusions: CBL modules using case scenarios were found to enable learning. The marginal differences between the scores in the one-month and six-month post-tests indicate that a single post-test administered six months after the educational intervention (CBL) would be adequate

Cross-sectional comparative study of socio-demographic and health profile of children in a NGO- run open house and street children in a metropolitan city

Background: Street children are underprivileged urban children who suffer poverty, deprivation of education, vulnerability to various types of abuse, lack of supervision by adults, and with varying status of street-based existence and contact with their families. The study compares the socio-demographic and health profiles of children in a NGO-run Open House and street children.Methods: Respondents satisfying intake criteria were interviewed using a pre-tested questionnaire and their height and weight were measured and the data were statistically analysed.Results: 72% were aged between 12-16 years. Their occupations included rag picking, unorganised labour, street vending, cleaning vehicles, hotel work and begging. The reasons for street living were parental abuse, poverty, parental death, or peer pressure. Between the two groups of children, there were significant differences in frequencies of genital lesions (p=0.014; OR=0.465), injuries (p=0.01; OR=0.5), scabies (p=0.01; OR=0.31), and pyoderma (p=0.03; OR =0.38). A majority from both groups chewed tobacco regularly, some were addicted to more than one substance and had started using addictive substances due to peer pressure or to alleviate depression.Conclusions: Multi-pronged interventions ought to focus on improving income levels and housing of impoverished families, curbing parental abuse, and providing educational and health care facilities, establishing more number of drop-in Open Houses, providing avenues for legal income, and educating on the hazards of promiscuity and substance abuse

Compliance with standard norms in collection, segregation and transport of biomedical waste in a tertiary care hospital: a cross-sectional study

Background: This cross-sectional study was conducted to determine the gaps between the stipulated procedures for collection, segregation and transportation of bio-medical waste (BMW) and the actual practices; the levels of BMW-related awareness and training status of hospital employees; the protocols for occupational exposure to hazardous BMW and their implementation; and to recommend corrective measures.Methods: Primary data were collected by interviewing the staff in-charge of all BMW generating units of a tertiary care hospital and by recording information by direct on-site observation on a checklist. The participant’s confidentiality was maintained throughout the study.Results: The interviews and actual observations in 26 BMW generating units (out-patient departments, in-patient wards, laboratories, operation theatres, post-mortem room) revealed availability of trained person in-charge for BMW (3.85%), mixing of infectious and non-infectious waste at point of generation (73.07%), untreated syringes sent for final disposal (60.86%), availability of colour-coded bags (50%) and absence of puncture-proof containers (85.71%). 84.61% of interviewees reported having taken tetanus and hepatitis B immunizations.Conclusions: The necessary interventions include periodic training and re-training of personnel, active supervision of BMW handlers to enforce the use of protective gear and vaccination of all staff against tetanus and hepatitis B. Periodic BMW audit would be essential to determine the trends in the diversity and quantities of waste produced in health care settings and facilitate administrators to devise strategies for improved management of BMW

Effect of case-based learning in reproductive physiology on cognitive domain scores of first-year medical students in Western India

Background: The Medical Council of India has recommended early clinical exposure, problem-oriented approach and case-based learning throughout the graduate medical curriculum. Case-based learning is a teaching-learning model that helps effective use of student and faculty time.Methods: This complete-enumeration, before-and-after type of educational intervention study (without controls) was conducted in a municipal medical college in Western India. After explaining the objectives of the study to first-year medical students, aged 18 years and above, of either sex, written informed consent was obtained from students (n=55) who were willing to participate in the study. The pre-test was conducted after lectures by faculty from the Departments of Physiology and Community Medicine. An identical post-test was administered after case-based learning, which was conducted by the same faculty in two sub-groups. The outcome studied was the difference in cognitive domain scores after attending lectures (by a pre-test) and case-based learning (by a post-test).Results: The overall mean score increased from 5.36 ± 0.97 (95% CI: 5.11 - 5.62) in the pre-test to 6.49 ± 1.14 (95% CI: 6.19 - 6.79) in the post-test. The differences between the pre- and post-test correct responses were statistically significant for two questions.Conclusions: The participating first-year medical students had adequate basic knowledge of reproductive physiology. Gender differences in correct responses were statistically significant for few questions. Use of case scenarios enhanced cognitive domain scores

Cross-sectional study on accidental occupational exposures amongst urban slum-based private medical practitioners

Background:This cross-sectional, complete enumeration study was conducted in an urban slum to determine the frequency of occupational exposure of private medical practitioners to patient body fluids and the remedial measures adopted following such events and also to examine their high-risk practices, personal protective measures, immunisation and training status in relation to occupational exposures.Methods: After Institutional Ethics Committee approval, private medical practitioners practising for ≥ 1 year in the locality who gave written informed consent were interviewed in their own clinics using a pre-tested formatted questionnaire.Results: Of the 108 respondents interviewed, the majority were non-allopathic, male practitioners. The speciality-wise and gender-wise differences in training in occupational exposure were not significant (p=0.135). Prior to disposal, 10.18% cut needles while 26.85% disinfected needles with 1% hypochlorite solution (p=0.0001). 50.93% never bent or recapped needles (p=0.0008). Only 19.44% regularly used gloves while examining patients (p=0.0039). 41.66% were completely unimmunised against Hepatitis B (p=0.004), while only one female non-allopathic practitioner (0.92%) had taken complete immunisation against tetanus (p<0.05). Of the 7.41% respondents who had history of needle stick injuries, only one female non-allopathic practitioner had reported occupational exposure. Those unaware about the need for post-exposure prophylaxis for occupational exposure and that anti-retroviral therapy was part of post-exposure prophylaxis constituted 87.96% and 95.37%, respectively.Conclusions: Reporting of occupational exposure, complete immunisation against hepatitis B and tetanus and use of personal protection was inadequate. Specialised hands-on training ought to be an integral component of continuing medical education for private medical practitioners.

Outcome of combination of methods of educational interventions in physiology for first-year MBBS students

Background: This comparative, before and after study (without controls) was conducted in a municipal medical college to compare the cognitive domain scores obtained by first-year MBBS students after didactic lectures with that obtained after an educational intervention that combined integrated teaching with clinical scenarios.Methods: After obtaining prior permissions, the purpose of the study was explained to first-year MBBS students and written informed consent was obtained. After attending curriculum-based didactic lectures on the alimentary system, the students (n=62, females: n=29, 46.77% and males: n=33, 53.23%) took a pre-test comprising ten questions (total 20 marks). After the pre-test, the participants attended an educational intervention that combined integrated teaching with clinical scenarios on the same topic. Subsequently, the post-test was administered using a questionnaire that was identical to that of the pre-test.Results: The mean overall marks obtained in the pre-test was 14.73±1.87 (95% CI: 14.26-15.19), while that obtained in the post-test was 17.16±1.73 (95% CI: 16.73-17.59), exhibiting highly significant (p <0.00001) difference. The gender difference in scores was significant (p=0.011) for only question no. 1 in the pre-test and there was no significant gender difference in the post-test.Conclusions: A combined method of educational intervention was found to enhance the cognitive domain scores of students. Though a larger study would be needed to generalize the findings, male students seem to need an additional educational intervention to improve their cognitive domain scores. Despite time limitations in the teaching schedule for the first-year MBBS course, integrated teaching with case scenarios can be implemented to impart early clinical exposure

A cross-sectional study of post-vaccination anti-HBs titer and knowledge of hepatitis B infection amongst medical students in a metropolitan city

Background: Medical students are at risk of acquiring hepatitis B virus infection due to occupational contact with patients’ blood or other body fluids. This study was conducted to determine knowledge of hepatitis B virus infection and anti-HBS antibody titer amongst medical students.Methods: This cross-sectional observational study was conducted on medical students who satisfied the intake criteria and gave written informed consent to participate in the study. After Institutional Ethics Committee clearance, written informed consent was obtained and a structured, pre-validated questionnaire (pre-test) was administered to the participants. After an educational session, an identical questionnaire was administered (post-test). For determining anti-HBs titer (vaccinated participants) and HBsAg (non-vaccinated participants), blood was aseptically collected by cubital venepuncture. HBsAg and anti-HBs antibody levels were determined by immuno-chromatographic assay and enzyme-linked immunosorbent assay, respectively.Results: 140 healthy, HBsAg-negative medical students (79 males; 61 females) participated in the present study. There was increased median correct response in the post-test with increased minimum and first quartile. 91 (65%) who were vaccinated against Hepatitis B were enrolled for anti-HBs titer estimation. There was no significant gender difference in mean antibody titer. 19 (20.9%) had inadequate levels of anti-HBS antibodies. 50% seroconversion was seen after single dose of hepatitis B vaccine.Conclusions: It is essential to delve into the logistic aspects of evaluating all medical students for hepatitis B infection, procuring and offering free vaccination and assessing anti-HBS titer of vaccinated individuals

Retention of case-based learning on infectious diseases by third-year medical students

Background: Undergraduate medical students infrequently see a variety of cases of infectious diseases during their batch-wise rotatory clinical postings. Traditional didactic teaching resulted in lack of learner-centred teaching, lack of in-depth knowledge and less retention of learning. The main aim and objective of this complete-enumeration, before-and-after study (without controls) is to employ case-based learning (CBL) as an adjunct to traditional didactic lectures (TDL) for teaching infectious diseases to third-year undergraduate medical students to study the retention of knowledge by comparing the cognitive domain scores in pre- and post-tests.Methods: After obtaining ethical permissions and written informed consent, TDLs were delivered to give a preview on ten topics (selected by lottery system from topics in syllabus) and a pre-test was conducted after TDL. After pre-test, CBL sessions were conducted jointly by two facilitators (using identical CBL modules) in two randomly-assigned sub-groups (n=28) to enable discussion. After CBL, two post-tests (identical to pre-test) were conducted at intervals of one and six months to determine the levels of retention of learning.Results: The differences in the student-wise and question-wise scores in the pre-test and one-month post-test and that between the pre-test and six-month post-test were highly significant. However, the difference between the mean scores in one-month and six-month post-test were not statistically significant.Conclusions: CBL modules using case scenarios were found to enable learning. The marginal differences between the scores in the one-month and six-month post-tests indicate that a single post-test administered six months after the educational intervention (CBL) would be adequate

Compliance with standard norms in collection, segregation and transport of biomedical waste in a tertiary care hospital: a cross-sectional study

Background: This cross-sectional study was conducted to determine the gaps between the stipulated procedures for collection, segregation and transportation of bio-medical waste (BMW) and the actual practices; the levels of BMW-related awareness and training status of hospital employees; the protocols for occupational exposure to hazardous BMW and their implementation; and to recommend corrective measures.Methods: Primary data were collected by interviewing the staff in-charge of all BMW generating units of a tertiary care hospital and by recording information by direct on-site observation on a checklist. The participant’s confidentiality was maintained throughout the study.Results: The interviews and actual observations in 26 BMW generating units (out-patient departments, in-patient wards, laboratories, operation theatres, post-mortem room) revealed availability of trained person in-charge for BMW (3.85%), mixing of infectious and non-infectious waste at point of generation (73.07%), untreated syringes sent for final disposal (60.86%), availability of colour-coded bags (50%) and absence of puncture-proof containers (85.71%). 84.61% of interviewees reported having taken tetanus and hepatitis B immunizations.Conclusions: The necessary interventions include periodic training and re-training of personnel, active supervision of BMW handlers to enforce the use of protective gear and vaccination of all staff against tetanus and hepatitis B. Periodic BMW audit would be essential to determine the trends in the diversity and quantities of waste produced in health care settings and facilitate administrators to devise strategies for improved management of BMW

A cross-sectional study of impaired glucose tolerance amongst undergraduate medical students

Background: Diabetes is an important chronic disease both in terms of prevalence and associated morbidity and early mortality. Mortality rates in diabetics are two- to threefold higher than those without diabetes. Type 2 Diabetes Mellitus is preceded by a period of abnormal glucose homeostasis and hence early diagnosis is important in decreasing this morbidity and mortality. The oral glucose tolerance test (OGTT) is currently the gold standard for the diagnosis of diabetes.Methods: This cross sectional single observer study was conducted amongst all the undergraduate students and interns of a municipal medical college to assess the point prevalence of impaired glucose tolerance and the factors predisposing to the same. After necessary permissions, participants giving written informed consent were interviewed and participants were subjected to an oral glucose tolerance test (OGTT) and their heights, weights were measured.Results: None of the participants had an increased fasting blood glucose but 30 min, 60 min and 90 min post OGTT blood glucose levels were increased in 9 (11.84%) participants and 120 min post OGTT blood glucose was increased in 15 (19.73%) participants. Increase in Body Mass Index (BMI) shows a positive correlation with fasting (r=0.155) and 120 min post OGTT blood glucose (r=0.042). Increase in weekly junk food servings shows a positive correlation with fasting (r=0.014), 90 min (r=0.004) and 120 min post OGTT blood glucose (r=0.009).Conclusions: Impaired glucose tolerance was present in a substantial number of non-diabetic students and had a correlation with BMI, exercise and junk food intake