Lessons learnt: pilot of mid rotation feedback.

The Aga Khan University went through an external review of its undergraduate medical education in December 2006 based on the accreditation guidelines by the Liaison Committee for Medical Education (LCME). The external review panel comprised of international and local experts which developed a comprehensive report on its findings with regards to LCME standards of accreditation. In the final report of the external review one of the areas highlighted as not meeting the standards of LCME was documentation of formal mid-rotation feedback of the students by the faculty in AKU clerkships through years 3 to 5. A four hour faculty development workshop was organized by the Department of Medicine in collaboration with the Department for Educational Development to emphasize the role of feedback in improving student\u27s performance, improve faculty\u27s skill in giving effective feedback, and to come up with recommendations for documenting the formative feedback process. A mid-rotation feedback form was designed to facilitate the documentation process. Faculty members who participated in the workshop took a lead in piloting this form and reported the areas that could be further improved upon to facilitate the process of timely and effective feedback

Simulated patient\u27s feedback to improve communication skills of clerkship students

Background: The changing trends of the society and revisions to medical education have changed the way medical students are trained to adroitly care for patients hence, patient centered care has become need of today\u27s society and communication skills are imperative in developing patient physician relationship. Increasingly, simulations are being used to aid medical students to incorporate theoretical knowledge into practice. There are innumerable studies regarding communication skills in terms of reliability, validity and feasibility but no such study has been documented using simulated patient\u27s feedback in improving communication skills in Pakistan. The aim of this study is to explore whether simulated patients\u27 feedback improves the communication skills of undergraduate medical students.Methods: During a randomized control trail a group of eighty students in the final year clerkship at Al-Nafees Medical College have participated in pre-post Objective Structured Clinical Exam (OSCE) on communication skills. The students were selected through convenience sampling technique. Four Objective Structured Clinical Exam (OSCE) stations based on different scenarios of communication skills were developed. Each station of fifteen minutes duration was assessed by both simulated patients and faculty using a validated tool LCSAS (Liverpool Communication Skills Assessment Scale). The difference between the pre and post-tests of two groups was explored by applying independent t-test. Cronbach\u27s alpha was used to check the reliability of scores and effect size was calculated.Results: Results of this study have showed that there is significant improvement in communication skills after receiving feedback from simulated patients (p value ≤0.05) was observed. An overall Cronbach α = 0.83 on LCSAS reveal a high internal consistency and there was adequate demonstration of effect size(r = 0.8).Conclusion: The results on the scores of the students on the Liverpool Communication Skills Assessment Scale confirm that simulated patient\u27s feedback is essential to enhance the communication skills of the medical students. This study offers significant evidence towards successful conduction of a formal communication skills development initiative at Al-Nafees Medical College using simulated patient feedback during teaching and assessments

Needs assessment for faculty development in health professions education at a medical university in Karachi, Pakistan

Faculty Development (FD) embraces all educational activities used by teachers to improve their knowledge and skills for enhancing their academic competencies. This study aimed to identify the areas in Health Professions Education (HPE) in which formal faculty development is required. A needs assessment survey was conducted from among the faculty members at the Aga Khan University (AKU), Karachi, Pakistan, and the French Medical Institute for Mother and Children, Afghanistan. Data was analysed using SPSS 20.0 and reported frequencies and percentages according to various academic tracks. Competency-based curricula (51%), providing effective feedback (51%), developing Objective Structured Clinical Exam (51%), and clinical supervision (48%) were identified as significant areas for faculty development. Faculty in clinician teacher and clinician educator track require advanced training, i.e., Masters and PhD in HPE. The needs assessment facilitated prioritising the areas for FD. This will contribute to enhancing academic practices and inculcating the culture of lifelong learnin

Challenges of providing timely feedback to Residents: Faculty perspectives

Objective To explore faculty\u27s perceptions of challenges in providing verbal feedback to the Residents and suggest ways to overcome the barriers. Methods As part of a larger study on feedback assessment, five focus group discussions were conducted at the Department of Medicine, Aga Khan University Hospital, Karachi, during faculty development workshops held from January to June 2010. Qualitative grounded theory was used to explore faculty perceptions of challenges in providing verbal feedback to the Residents. Results Of the 54 faculty members, 49(91%) participated. Four themes that emerged were \u27time constraint\u27 indicating high patient load; \u27faculty related issues\u27 indicating faculty\u27s apprehension about its own evaluation by Residents; \u27educational issues\u27 indicating that the importance of feedback was not emphasised; and \u27system and logistic issues\u27 indicating that the assessment form used for assessing Residents was ambiguous. Conclusion Work load of the faculty and the expectations with respect to patient care responsibilities may have an impact on the quality, timing, content and delivery of the feedback provided to the Residents

Ratings of performance in multisource feedback: Comparing performance theories of residents and nurses

Background: Multisource feedback (MSF) is increasingly being used to assess trainee performance, with different assessor groups fulfilling a crucial role in utility of assessment data. However, in health professions education, research on assessor behaviors in MSF is limited. When assessing trainee performance in work settings, assessors use multidimensional conceptualizations of what constitutes effective performance, also called personal performance theories, to distinguish between various behaviors and sub competencies., This may not only explain assessor variability in Multi Source Feedback, but also result in differing acceptance (and use) of assessment data for developmental purposes. The purpose of this study was to explore performance theories of various assessor groups (residents and nurses) when assessing performance of residents.Methods: A constructivist, inductive qualitative research approach and semi-structured interviews following MSF were used to explore performance theories of 14 nurses and 15 residents in the department of internal medicine at Aga Khan University (AKU). Inductive thematic content analysis of interview transcripts was used to identify and compare key dimensions in residents\u27 and nurses\u27 performance theories used in evaluation of resident performance.Results: Seven major themes, reflecting key dimensions of assessors\u27 performance theories, emerged from the qualitative data, namely; communication skills, patient care, accessibility, teamwork skills, responsibility, medical knowledge and professional attitude. There were considerable overlaps, but also meaningful differences in the performance theories of residents and the nurses, especially with respect to accessibility, teamwork and medical knowledge.Conclusion: Residents\u27 and nurses\u27 performance theories for assessing resident performance overlap to some extent, yet also show meaningful differences with respect to the performance dimensions they pay attention to or consider most important. In MSF, different assessor groups may therefore hold different performance theories, depending on their role. Our results further our understanding of assessor source effects in MSF. Implications of our findings are related to implementation of MSF, design of rating scales as well as interpretation and use of MSF data for selection and performance improvement

Free l-glutamate-induced modulation in oxidative and neurochemical profile contributes to enhancement in locomotor and memory performance in male rats

Glutamate (Glu), the key excitatory neurotransmitter in the central nervous system, is considered essential for brain functioning and has a vital role in learning and memory formation. Earlier it was considered as a harmful agent but later found to be useful for many body functions. However, studies regarding the effects of free L-Glu administration on CNS function are limited. Therefore, current experiment is aimed to monitor the neurobiological effects of free L-Glu in male rats. L-Glu was orally administered to rats for 5-weeks and changes in behavioral performance were monitored. Thereafter, brain and hippocampus were collected for oxidative and neurochemical analysis. Results showed that chronic supplementation of free L-Glu enhanced locomotor performance and cognitive function of animals which may be attributed to the improved antioxidant status and cholinergic, monoaminergic and glutamatergic neurotransmission in brain and hippocampus. Current results showed that chronic supplementation of L-Glu affects the animal behaviour and brain functioning via improving the neurochemical and redox system of brain. Free L-Glu could be a useful therapeutic agent to combat neurological disturbances however this requires further targeted studies

Administration of 5-HT-1B agonist ameliorates pseudodementia induced by depression in rats

Major depressive disorder (MDD) is the leading cause of memory impairment in general population. The serotonin hypothesis provides a target model for the treatment of depression and depression-associated memory loss. 5-HT-1B receptor is suggested as a potential candidate in the pathophysiology of depressive illness. Dysfunction of 5-HT-1B receptors has been observed previously in depressive patients. Zolmitriptan, 5-HT-1B agonist is clinically recommended for the treatment of migraine. However, in present study this drug was tested as a potential treatment for depression and associated memory loss by altering the serotonergic function at receptor level. Rats (n=24) were equally divided into unstressed and stressed groups. Depression was induced by 19 days of restraint stress for 4 h which was followed by forced swim test and pattern separation test to assess depressive symptoms and memory impairment, respectively. The initial sign of depression-associated memory loss involves impaired pattern separation which is regarded as pseudodementia. In this study stressed ratsshowed depression- and pseudodementia-like symptoms. After the induction of depression, rats were treated with zolmitriptan at a dose of 0.3 mg/kg which resulted in a significant attenuation of depression and depression-associated memory impairment. Results are discussed with reference to the modulation of function of 5-HT-1B receptor following the administration of exogenous agonist

Prevalence of Transfusion Transmitted Infection in Replacement and Voluntary Blood Donor

The aim of this study is to present the status of transfusion –transmitted infections among the apparently healthy donors so as to increase the awareness of complications of blood transfusion and make the clinicians more vigilant with regard to judicious use of blood. Screening of blood is mandatory for providing safe blood. The magnitude of transfusion transmitted infections (TTI) varies from country to country depending on TTI’s load in that particular population. Transfusion transmitted infections create significant burden on health care system. Donor selection is of paramount importance because infected individuals serve as an asymptomatic reservoir and a potential source of transmission. This retrospective study was carried out in healthy blood donors in the age group of 18-60 years; study was done on blood units collected from replacement and voluntary donors. The serum samples were screened for Hepatitis B Surface Antigen (HBsAg); antibodies against HIV I and II, Hepatitis C Virus (HCV) by Chemiluminescent microparticle immuno assay (CMIA) method. Screening for Syphilis was carried out by RPR Rapid plasma reagent. Seropositivity of transfusion transmitted disease in replacement donors was 1.93% in hepatitis B surface antigen, 2.41% in hepatitis C virus, 0.09% in HIV and 1.15% in syphilis. Voluntary donors had low infectivity rate as compare to replacement donor

Naringenin protects AlCl3/D-galactose induced neurotoxicity in rat model of AD via attenuation of acetylcholinesterase levels and inhibition of oxidative stress

Currently prescribed medications for the treatment of Alzheimer\u27s disease (AD) that are based on acetylcholinesterase inhibition only offer symptomatic relief but do not provide protection against neurodegeneration. There appear to be an intense need for the development of therapeutic strategies that not only improve brain functions but also prevent neurodegeneration. The oxidative stress is one of the main causative factors of AD. Various antioxidants are being investigated to prevent neurodegeneration in AD. The objective of this study was to investigate the neuroprotective effects of naringenin (NAR) against AlCl3+D-gal induced AD-like symptoms in an animal model. Rats were orally pre-treated with NAR (50 mg/kg) for two weeks and then exposed to AlCl3+D-gal (150 mg/kg + 300 mg/kg) intraperitoneally for one week to develop AD-like symptoms. The standard drug, donepezil (DPZ) was used as a stimulator of cholinergic activity. Our results showed that NAR pre-treatment significantly protected AD-like behavioral disturbances in rats. In DPZ group, rats showed improved cognitive and cholinergic functions but the neuropsychiatric functions were not completely improved and showed marked histopathological alterations. However, NAR not only prevented AlCl3+D-gal induced AD-like symptoms but also significantly prevented neuropsychiatric dysfunctions in rats. Results of present study suggest that NAR may play a role in enhancing neuroprotective and cognition functions and it can potentially be considered as a neuroprotective compound for therapeutic management of AD in the future

Development of AD like symptoms following co-administration of AlCl3 and D-gal in rats: A neurochemical, biochemical and behavioural study

Alzheimer\u27s disease (AD) is an age-related neurodegenerative disorder associated with neurochemical and neurobehavioural alterations. Aluminium (Al) is considered as a contributing factor in the etiology of several neurodegenerative disorders like AD. D-galactose (D-gal) is a physiological nutrient but over supply induces some neurochemical and biochemical changes that exacerbate natural aging process. In this study, we aimed to develop AD animal model by co-administration of Al and D-gal in rats. Male albino Wistar rats were intraperitoneally injected with AlCl3 and D-gal at a dose of 150mg/kg and 300mg/kg respectively for one week. After one week rats were subjected to behavioural analysis. After behavioural analysis rats were decapitated to remove their brain. Biochemical and neurochemical analysis were conducted in whole brain. AlCl3+D-gal significantly induced depressive and anxious behaviour in rats. Rats cognitive abilities were also significantly impaired following AlCl3 and D-gal co-administration. AlCl3+D-gal significantly altered antioxidant enzyme activities and biogenic amine levels in whole brain. A marked increase in brain lipid peroxidation and acetylcholinesterase activity was found in test rats. These findings suggest that co-administration of AlCl3 and D-gal for one week could induce AD like symptoms and may be used to develop AD animal model