The Use of Cumulative Disciplinary Score in an Integrated Curriculum to Prevent Deliberate Omission of Course Content

Background & Objective: Student assessment is one of the most challenging issues of an integrated curriculum. While calculating an overall score is in line with the goals of integrated curriculum, it poses the risk that some students will deliberately leave out the content of some disciplines, based on the fact that they have lower credits in each block exam. In the present study, we describe the experience of Tehran University of Medical Sciences, Iran, where an integrated medical curriculum has been launched since September 2011 as part of curriculum reform initiative. Methods: In the first academic year, students passed 4 blocks: Molecule and Cell; Tissue; Development and Function; Cardiovascular Function; Blood circulation; and Blood-Respiratory Function. Each block included anatomy, histology, physiology, and embryology. The overall block score was reported at the end of each block. In addition, a cumulative disciplinary score was calculated at the end of the academic year through the summation of the weighted subscores of each discipline in each block. Results: At the end of the year, the number of students who had failed in histology, anatomy, embryology, and physiology were 15, 17, 44, and 3, respectively. They were required to take a disciplinary examination before the beginning of the next academic year. Conclusion: A comparison of the number of students who failed disciplines with low credits (e.g. histology) with those who failed disciplines with high credits (e.g. physiology) suggests that the former had systematically been ignored by some students. The calculation of a cumulative disciplinary score may reduce the deliberate omission of course content in integrated blocks. Key Words: Integration, Student assessment, Cumulative disciplinary scor

Alterations in metabolic pathways: a bridge between aging and weaker innate immune response

Aging is a time-dependent progressive physiological process, which results in impaired immune system function. Age-related changes in immune function increase the susceptibility to many diseases such as infections, autoimmune diseases, and cancer. Different metabolic pathways including glycolysis, tricarboxylic acid cycle, amino acid metabolism, pentose phosphate pathway, fatty acid oxidation and fatty acid synthesis regulate the development, differentiation, and response of adaptive and innate immune cells. During aging all these pathways change in the immune cells. In addition to the changes in metabolic pathways, the function and structure of mitochondria also have changed in the immune cells. Thereby, we will review changes in the metabolism of different innate immune cells during the aging process

A Case Based-Shared Teaching Approach in Undergraduate Medical Curriculum: A Way for Integration in Basic and Clinical Sciences

To present a multiple-instructor, active-learning strategy in the undergraduate medical curriculum. This educational research is a descriptive one. Shared teaching sessions, were designed for undergraduate medical students in six organ-system based courses. Sessions that involved in-class discussions of integrated clinical cases were designed implemented and moderated by at least 3 faculties (clinicians and basic scientists). The participants in this study include the basic sciences medical students of The Tehran University of Medical Sciences. Students’ reactions were assessed using an immediate post-session evaluation form on a 5-point Likert scale. Six two-hour sessions for 2 cohorts of students, 2013 and 2014 medical students during their two first years of study were implemented from April 2014 to March 2015. 17 faculty members participated in the program, 21 cases were designed, and participation average was 60 % at 6 sessions. Students were highly appreciative of this strategy. The majority of students in each course strongly agreed that this learning practice positively contributed to their learning (78%) and provided better understanding and application of the material learned in an integrated classroom course (74%). They believed that the sessions affected their view about medicine (73%), and should be continued in future courses (80%). The percentage demonstrates the average of all courses. The program helped the students learn how to apply basic sciences concepts to clinical medicine. Evaluation of the program indicated that students found the sessions beneficial to their learning

Misconceptions and Integration

Introduction: Pervasive beliefs regarding curricular reform and integration have flourished among medical students, faculty members and medical school administrators. These concepts have extensively impacted the reform process, sometimes by resisting the reforms and sometimes by diverting the curriculum from its planned objectives. In the current paper, we have tried to address the challenges of integration in MD program by looking at the existing literature and the experience of the international universities. Methods: We collected the questions frequently asked during the curricular reform process. We, then, evaluated them, and selected 5 main ideas. In order to find their answers, we searched the literature using these keywords: integration, reform, and undergraduate medical curriculum. Results: The findings are discussed in five sections: 1) Reform is not equivalent to integration, 2) Integration can be implemented in both high school and graduate programs, 3) Organ-system based integration is not the only method available for integration, 4) Integration of two phases (basic sciences and physiopathology) can be considered but it is not mandatory, 5) Integration does not fade basic sciences in favor of clinical courses. Conclusions: It seems that medical education literature and prior experience of the leading universities do not support most of the usual concepts about integration. Therefore, it is important to consider informed decision making based on best evidence rather than personal opinions during the curricular reform process

Comparison of Academic Achievement and Educational Environment of Basic Sciences Phase of MD Program in Tehran University of Medical Sciences, before and after Curricular Reform

Introduction: Curriculum reform of MD program in Tehran University of Medical Sciences involves fundamental changes in many aspects of the program. Three years after implementation of the new curriculum, evaluation of program outcomes is necessary. The aim of this study was to compare academic achievement and educational environment of basic sciences phase of the previous curriculum with those of the revised curriculum. Methods: In this retrospective cohort study, the average score of basic sciences courses for all medical students accepted to Tehran University of Medical Sciences in 2011 and previous three years (2008-10) was extracted. The results of the 44th, 46th, 48th and 50th basic sciences comprehensive exams, including university rank and the standard score were analyzed. DREEM questionnaire was used to assess the educational environment which was completed by students admitted in 2010 and 2011 at the end of basic sciences phase. The data were analyzed by means of ANOVA, Chi-Square and t-test. Results: The total number of medical students from 2008 to 2011 was 1032, of whom 589 students (57%) were female. The difference between the basic sciences average score, number of probationary and failed semesters over the years was not statistically significant. Based on the results of comprehensive exams, the university ranked third in 2008 and first in three subsequent years. University’s standard scores in all comprehensive exams were 0.61, 0.96, 0.85 and 0.94 respectively. The DREEM questionnaire scores were 91.5±0.46 and 93.5±0.41 (out of 200) respectively before and after the reform. This difference and differences between scores of questionnaire’s five areas were significant for the two groups. Conclusion: Although slight improvements could be seen in most of the assessed outcomes after the reform, they are not statistically significant. This could be attributed to near-perfect performance of the university in previous years or to the short interval between the intervention and outcome evaluation and therefore, concerns about academic failure following the curriculum reform do not seem to be valid. Regular monitoring of the outcomes is necessary for assessing long-term effectiveness of the curriculum reform

Alterations in metabolic pathways : a bridge between aging and weaker innate immune response

Aging is a time-dependent progressive physiological process, which results in impaired immune system function. Age-related changes in immune function increase the susceptibility to many diseases such as infections, autoimmune diseases, and cancer. Different metabolic pathways including glycolysis, tricarboxylic acid cycle, amino acid metabolism, pentose phosphate pathway, fatty acid oxidation and fatty acid synthesis regulate the development, differentiation, and response of adaptive and innate immune cells. During aging all these pathways change in the immune cells. In addition to the changes in metabolic pathways, the function and structure of mitochondria also have changed in the immune cells. Thereby, we will review changes in the metabolism of different innate immune cells during the aging process.Peer reviewe

Epidemiological characteristics of COVID-19: a systematic review and meta-analysis.

Our understanding of the Coronavirus disease 2019 (COVID-19) continues to evolve and there are many unknowns about its epidemiology. This study aims to synthesise case fatality rate (CFR) among confirmed COVID-19 patients, incubation period and time from onset of COVID-19 symptoms to first medical visit, intensive care unit (ICU) admission, recovery, and death. We searched MEDLINE, Embase, Google Scholar, and bibliographies of relevant articles from 01 December 2019 to 11 March 2020 without any language restrictions. Quantitative studies that recruited people with confirmed COVID-19 diagnosis were included. Two independent reviewers extracted the data. Out of 1675 non-duplicate studies, 43 were included in the meta-analysis. The pooled mean incubation period was 5.68 (99% confidence interval [CI]: 4.78, 6.59) days. The pooled mean number of days from the onset of COVID-19 symptoms to first clinical visit was 4.92 (95% CI: 3.95, 5.90), ICU admission was 9.84 (95% CI: 8.78, 10.90), recovery was 18.55 (95% CI: 13.69, 23.41), and death was 15.93 (95% CI: 13.07, 18.79). Pooled CFR among confirmed COVID-19 patients was 0.02 (95% CI: 0.02, 0.03). We found that the incubation period and lag between the onset of symptoms and first clinical visit for COVID-19 are longer than other respiratory viral infections including Middle East respiratory syndrome and severe acute respiratory syndrome; however, the current policy of 14 days of mandatory quarantine for everyone potentially exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might be too conservative. Longer quarantine periods might be more justified for extreme cases