Diversity unsupported is diversity derailed

In this view point challenges of a diverse student body and its impact on quality of education and student’ social interactions are discussed. Enhanced institutional responsibility and ownership of all institutional members to provide adequate support for all individuals that make up the student body has been discussed as a major strategy to overcome these challenges

Medical students: A reflective journey over time

Experiences in medical education have changed significantly in the last two decades. This evolution is apparent in the teaching/ learning environment, types of education resources and learners. In this article two students provide a reflective account of their individual journeys in medical education spanning across 20 years. While some things remain unchanged, significant differences emerge that stress upon the educators and institutions to stay mindful of these transitions in order to develop learning environments that nurture the growth of future physicians.Experiences in medical education have changed significantly in the last two decades. This evolution is apparent in the teaching/ learning environment, types of education resources and learners. In this article two students provide a reflective account of their individual journeys in medical education spanning across 20 years. While some things remain unchanged, significant differences emerge that stress upon the educators and institutions to stay mindful of these transitions in order to develop learning environments that nurture the growth of future physicians

Microbiological safety of areca nut-containing, ready-to-eat chewing substances common among Pakistani paediatric population: A pilot study

Objective: To evaluate microbiological contamination of areca nut-containing, ready-to-eat chewing substances easily accessible to vulnerable paediatric population.Methods: A pilot study was conducted at the Aga Khan University Medical College from June to October 2016 on twelve samples of areca nut-containing chewing substances (four supari, paan masala and gutka each) collected from various localities of Karachi. These were evaluated individually for total colony counts, hygiene indicator organisms, pathogenic organisms, and levels of aflatoxin. Microbial contamination was analysed using pour-plate method. Fungal aflatoxin levels were measured by enzyme-linked immunosorbent assay (ELISA)..Results: Wet gutka preparations were contaminated by Escherichia coli and Enterobacteriacaea. High levels of fungal aflatoxin (range: 0.43-1.84 mg/kg), a proven carcinogen, were identified in all the 12(100%) products. No sample contained pathogenic bacteria. However, 1(8.33%) sample did not meet hygiene criteria cut-off.Conclusions: Habitual use of unhygienic chewing substances containing fungal toxins is a public health concern that needs to be addressed through a preventative, behaviour-changing strategy.

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

Students\u27 perception of educational environment at Aga Khan University Medical College, Karachi, Pakistan

Objective: To assess educational environment in Aga Khan University Medical College (AKUMC) by Dundee Ready Educational Environmental Measure (DREEM) scale.Methods: A cross-sectional survey of students at the AKUMC with simple random sampling was carried out from June 2014 till March 2015. Responses in five subscales were used to calculate DREEM scores.Results: The average DREEM score was 125.77±16.8 with a reliability of 91.3%. With regards to subscales, on the 12-item students\u27 perceptions of learning (PoL) subscale, the maximum score was 48; 11 items of students\u27 perceptions of teachers (PoT) had a maximum score of 44; students\u27 academic self-perceptions (ASP) identified by 8 items showed maximum score of 32; students\u27 perceptions of atmosphere (PoA) with 12 items obtained maximum score 48 and students\u27 social self-perceptions (SSP) subscale of 7 items had a maximum score of 28.Conclusion: Students perceived a positive learning environment at AKUMC Karachi

Dream of a conducive learning environment: One DREEM for all medical students!

Objective: To compare students\u27 response assessed by Dundee Ready Educational Environment Measure on the basis of the year of study, gender and pre-medical educational background.Methods: This cross-sectional study was carried out at the Aga Khan University Medical College, Karachi, Pakistan, from June 2014 to March 2015, and comprised medical students. The average scores of Dundee Ready Educational Environment Measure scales and subscales were compared between gender and educational background. Responses were also compared on the basis of year of study.Results: Of the 416 participants, 184 (44%) were males and 232 (56%) were females. There were 100 (24%) students in the first year, 90 (21.6%) in second, 92 (22.1%) in third, 91 (21.9%) in fourth and 43 (10.3%) in the fifth year. The mean Dundee Ready Educational Environment Measure score was 125.7±16.8. The mean score of females and students with higher secondary school background was significantly better as compared to males and students in British General Certificate of Education background, respectively (p \u3c 0.0001, p=0.017). Female medical students were satisfied with the atmosphere of teaching and learning (p \u3c 0.0001; p=0.011). Year-wise comparison showed significantly better Dundee Ready Educational Environment Measure score responses by fourth-year students (p \u3c 0.0001).CONCLUSIONS: Assessment by Dundee Ready Educational Environment Measure endorsed approval of conducive learning environment with reference to atmosphere, teaching, learning, sense of well-being, academic self-perception and achievement by all medical students

Stretching the boundaries of medical education: A case of medical college embracing humanities and social sciences in medical education

Objective: Aga Khan University, a private medical college, had a vision of producing physicians who are not only scientifically competent, but also socially sensitive, the latter by exposure of medical students to a broad-based curriculum. The objective of this study was to identify the genesis of broad-based education and its integration into the undergraduate medical education program as the Humanities and Social Sciences (HASS) course. Methods: A qualitative methodology was used for this study. Sources of data included document review and in-depth key informant interviews. Nvivo software was utilized to extract themes. Results: The study revealed the process of operationalization of the institutional vision to produce competent and culturally sensitive physicians. The delay in the establishment of the Faculty of Arts and Sciences, which was expected to take a lead role in the delivery of a broad-based education, led to the development of an innovative HASS course in the medical curriculum. The study also identified availability of faculty and resistance from students as challenges faced in the implementation and evolution of HASS. Conclusions: The description of the journey and viability of integration of HASS into the medical curriculum offers a model to medical colleges seeking ways to produce socially sensitive physicians

Impact of humanities and social sciences curriculum in an undergraduate medical education programme

Objective: To evaluate the impact of humanities and social sciences curriculum in an undergraduate medical education programme.Methods: The qualitative study was conducted from May 2016 to May 2017 at a private medical college in Karachi where humanities and social sciences subject is an art of the undergraduate curriculum as a 6-week module at the start of Year 1 of the five-year programme. Focus group discussions were held with students from all the five years as well as with faculty related to humanities and social sciences, basic sciences and their clinical counterparts. The views of alumni of the undergraduate programme who are now members of the faculty at the institution were also explored and semi-structured interviews were conducted with institutional academic leaders. MAXQDA software was used to identify the themes for analysis.Results: Of the 50 participants, 27(54%) were students, 21(42%) were faculty members and 2(4%) were academic leaders. From the 11 sub-themes, 5 themes were identified: Expectations, Strengths, Challenges, Way forward, and Institutional role and responsibility. Faculty members perceived humanities and social sciences as encouraging creative and critical thinking, boosting students\u27 confidence and positively impacting their behaviour. Student perception seemed to change as they progressed through the years and they appreciated its impact at different stages.Conclusions: The existing humanities and social sciences curriculum can be further strengthened by integrating contents throughout the five-year programme and continuing it as a longitudinal theme rather than limiting it to a one-time exposure at the start of the programme

Level I nodal positivity as a factor for involvement of the submandibular gland in oral cavity carcinoma: A case series report

Introduction: The routine practice of neck dissection in the surgical management of oral carcinoma has evolved into a more functionally conservative approach. Over time, the rationale for removal of the submandibular gland has been questioned. Routine extirpation of the submandibular gland can aggravate the xerostomia experienced by many patients, significantly affecting their quality of life. Objective: The objective of the present study was to determine the incidence of submandibular gland metastases in oral cavity carcinoma and to identify possible factors that may affect their involvement. Methods: A total of 149 cases of oral carcinoma presenting at a private tertiary care hospital in Karachi, Pakistan, over the course of 1 year were reviewed retrospectively. Results: Histopathological data showed that the submandibular gland was involved in 7 (4.7%) cases. Involvement of level I lymph nodes was found in all of the cases. Direct extension of primary tumor was noted in two cases when the primary tumor was in the floor of the mouth. Conclusion: The results suggest that preservation of the submandibular gland during neck dissection for oral carcinoma can be practiced safely when there is no evidence of direct extension of the primary tumor toward the submandibular gland or when there is no clinical or radiological evidence of neck disease in level I. Presence of pathological lymph nodes in level I requires caution when contemplating preservation of the submandibular gland

Clinical features and outcome of sporadic colorectal carcinoma in young patients: A cross-sectional analysis from a developing country

Background: Early onset colorectal carcinoma (CRC) is rare and has been hypothesized to be a biologically and clinically distinct entity personifying aggressive disease and worse survival.Methods: Data for 131 patients was collected by retrospective chart review. Cox proportional hazard model was used to compute prevalence ratios and 95% confidence intervals.Results: Early onset sporadic CRC accounted for 32% of all CRC treated in the specified time period. The mean age was 33.3 ± 7.9 years and the male to female ratio was 2 : 1. Colon and rectal cancers accounted for 55% and 45% of patients, respectively. 96% of rectal carcinoma patients received appropriate therapy as opposed to 65% of colon cancers. On multivariable analysis, appropriate reception of therapy (PR 4.99; 95% CI, 1.21-20.6) and signet ring morphology (PR 2.40; 95% CI, 1.33-4.32) were significantly associated with rectal cancers as opposed to colon cancer. Kaplan-Meier analysis revealed a trend towards inferior survival for rectal carcinoma 2 years after diagnosis.Conclusion: A high prevalence of early onset CRC was noted in the study. A trend towards inferior survival was seen in patients with rectal cancer. This finding raises the possibility of rectal carcinoma being an aggressive subset of young CRC