Training tutors for implementing problem-based learning at a private medical college of Nepal

Introductions: Problem based learning (PBL)  is an innovative approach of teaching learning methodology in which, instead of traditional lectures, students are divided in small groups and provided with a problem which they try to solve. It has been used in different medical schools, around the world, for over 50 years. In Nepal, the use of PBL methodology is gradually increasing. Methods: Three experts on PBL content and process provided interactive lectures, hands-on exercises and plenary discussion sessions. Effectiveness of the workshop was assessed by validated retro pre questionnaire at the end of the workshop. Paired t-tests were used to test the differences between before and after scores on knowledge, application and opinion on PBL. Effect size was also calculated to determine the size of the difference between before and after the workshop. Results: The PBL training was effective as it increased knowledge, application and opinion on PBL of most of the participants. The workshop benefitted the most to the experienced male basic sciences faculty. However, clinical sciences faculty were skeptical of its application and their opinion of PBL did not change much whereas nursing faculty had some reservation on their opinion about PBL only. Conclusions:  As PBL is implemented during the basic sciences years only, the concerned faculty benefitted the most from the workshop. Further such trainings are advocated to increase the pool of trained tutors for effective implementation of the PBL. Keywords: faculty training, Kathmandu University, Lumbini Medical College, Nepal, PBL problem-based learning, Â

Evaluation of core faculty development workshop: Experience from Patan Academy of Health Sciences, Nepal

Introductions: Faculty development is important to promote the core education principles/philosophies and instil the innovations planned and/or carried out in any educational program. Thus, Patan Academy of Health Sciences (PAHS) has carried out regular faculty development programs for its faculty in order to effectively implement an innovative curriculum, teaching/learning methods and student assessment.  Methods: Effectiveness of the workshop was assessed by validated retro-pre questionnaire at the end of the workshop. Paired t-test was used to test the differences between before and after scores on knowledge and application on various aspects of the program. Effect size was also calculated to determine the size of the difference between before and after the workshop. Results: The core faculty development program was effective as it significantly increased the overall knowledge and application scores among most of the participants. The workshop benefitted the most to the experienced male faculty as the effect size for these groups were very high (Cohen’s d>1.3). Conclusions:  As PBL is implemented during the basic sciences years only, the concerned faculty benefitted the most from the workshop. Further such trainings are advocated to increase the pool of trained tutors for effective implementation of the PBL. Key words: faculty development, innovation, medicine, PAHS Â

My Heart, My Art: A novel Nepali medical student art project and the link to learning

Background: Humanities programs in South Asian medical schools are slowly growing in popularity. Art-making opportunities within those programs, however, are limited despite their potential benefits including solidification and integration of learning. Aim: to examine art created by medical students for the breadth and depth of conceptual understanding that formed the foundation for its creation. Settings and design: Medical school in Nepal; qualitative study. Material and methods: First year medical students at the Patan Academy of Health Sciences in Nepal, in 2011, 2012, 2014 and 2016, were asked to volunteer and submit artistic interpretations of  “cardiac science” during five weeks of learning about the cardiovascular system using any media. Submissions were digitally recorded. This art repository was used as the data set for the present study. Data analysis: curatorial analysis of a repository of art pieces using Rose’s criteria for critical visual analysis. Results: Four main categories were generated: Anatomy Literal Representation, Artistic Representation, Tactile Renderings, and Linked to Health/Nepal. Conclusions: From literal to artistic/fanciful representation, student’s art revealed a strong conceptual understanding of the cardiac science topic. A subset of tactile art highlighted the student’s manual dexterity and propensity for kinesthetic learning. The links made by their art to socially relevant health issues, illustrated the student’s ability to connect science to the needs of their patient population, and the important role for education in disease prevention. This is the first study that has explored art-making in the context of Nepali medical education and its potential role as an adjunct to science learning

Preparing faculty for problem-based learning curriculum at Patan Academy of Health Sciences, Nepal

Introduction: Patan Academy of Health Sciences (PAHS) in Nepal has adopted problem-based learning (PBL) as principal pedagogy to foster attributes predefined for its medical graduates. This study evaluates reaction of participants in PBL tutor-training program focused on PBL process and its assessment. Methods: An orientation program was organized separately for 24 faculty members and 45 higher secondary science majoring students prior to conduction of real-time PBL tutorial sessions. Faculty’s reaction as PBL tutors was collected before and after the orientation program using a 13-item self-administered questionnaire. Internal consistency reliability of the questionnaire items and outcome of the training program were assessed using Cronbach’s alpha, coefficient of variation, Shapiro-Wilk test, paired t-test and adjusted effect size for dependent samples. Results: The pre-test internal consistency reliability was high (0.89) whereas it was acceptable (0.69) for post-test. The average score increased from 26.50 to 34.55 and standard deviation decreased from 5.39 to 2.70 between pre- and post-test. Difference between post- and pre-tests total scores followed normal distribution and suitable parametric test (paired t-test) revealed the difference was highly significant (p< 0.0001). The adjusted effect size was high (1.65) for small dependent samples. Conclusions: The faculty training for PBL and assessment was helpful  in implementing PBL pedagogy at PAHS.  Keywords: Nepal, PAHS, Problem based learning, Process assessment, Tutor training program Â

Validating a problem-based learning process assessment tool in a Nepalese medical school

Introductions: The newly established Patan Academy of Health Sciences (PAHS) has incorporated the measurement of non-cognitive skills and behaviors into the summative assessment in the setting of problem based learning (PBL). This study was conducted to validate a PBL process assessment tool for PAHS.Methods: A list of 72 items of student behaviors observable in PBL tutorials was compiled from literature review. They were categorized under ten broad dimensions consistent with predefined PAHS Graduate Attributes. A series of PBL project committee meetings and expert inputs refined the list of 72 items to 47 and categorized them under eight dimensions. These 47 items, each with a 4-point rating scale, formed the Tutor Assessment of Student Tool (TAS-Tool). Twenty-four trained faculty members used the TAS-Tool to evaluate the performance of 41 senior high school students in PBL tutorials. Results: The internal-consistency of the TAS-Tool was very high rona’s .. eoal of to inonsistent ites furter increased it to 0.975. Principal components analysis with varimax rotation applied to the remaining 45 items gave seven components and explained 69.47% of the variation between the components. These seven components (% variation) were: Immersed in the Tutorial Process (20.16%); Professional (12.71%); Communicator and Team Leader (11.25%); Critical Thinker (8.77%); Reflector (6.22%); Creative (5.95%), and Sensitive (4.41%).Conclusions: TAS-Tool was found to be reliable and valid instrument deemed applicable in formative PBL process assessment at PAHS starting with the pioneer cohort of medical students. Further validation of TASTool through longitudinal study with PAHS students is required for summative purpose.Keywords: factor analysis, problem based learning, summative assessment, tool validation, Nepa

Device occlusion of pseudoaneurysm of ascending aorta

Pseudoaneurysm of ascending aorta is an infrequent but well-recognized and potentially fatal complication after cardiac surgeries. The complication can develop early, delayed or late, and the presentation is also varied. We are presenting here two cases of pseudoaneurysm of ascending aorta following cardiac surgery that were successfully managed by the transcatheter method. The first one occurred following coronary artery bypass surgery and the second one occurred following double-valve replacement surgery. The aortic openings of these aneurysms were occluded with 12 mm and 10 mm atrial septal occluders, respectively, with a good outcome. An immediate postprocedure angiogram showed no residual flow into the sac. Six months of follow-up of both cases also showed excellent results

Localized Rho GTPase Activation Regulates RNA Dynamics and Compartmentalization in Tumor Cell Protrusions*S⃞

mRNA trafficking and local protein translation are associated with protrusive cellular domains, such as neuronal growth cones, and deregulated control of protein translation is associated with tumor malignancy. We show here that activated RhoA, but not Rac1, is enriched in pseudopodia of MSV-MDCK-INV tumor cells and that Rho, Rho kinase (ROCK), and myosin II regulate the microtubule-independent targeting of RNA to these tumor cell domains. ROCK inhibition does not affect pseudopodial actin turnover but significantly reduces the dynamics of pseudopodial RNA turnover. Gene array analysis shows that 7.3% of the total genes analyzed exhibited a greater than 1.6-fold difference between the pseudopod and cell body fractions. Of these, only 13.2% (261 genes) are enriched in pseudopodia, suggesting that only a limited number of total cellular mRNAs are enriched in tumor cell protrusions. Comparison of the tumor pseudopod mRNA cohort and a cohort of mRNAs enriched in neuronal processes identified tumor pseudopod-specific signaling networks that were defined by expression of M-Ras and the Shp2 protein phosphatase. Pseudopod expression of M-Ras and Shp2 mRNA were diminished by ROCK inhibition linking pseudopodial Rho/ROCK activation to the localized expression of specific mRNAs. Pseudopodial enrichment for mRNAs involved in protein translation and signaling suggests that local mRNA translation regulates pseudopodial expression of less stable signaling molecules as well as the cellular machinery to translate these mRNAs. Pseudopodial Rho/ROCK activation may impact on tumor cell migration and metastasis by stimulating the pseudopodial translocation of mRNAs and thereby regulating the expression of local signaling cascades

Cytoskeletal Crosstalk in Cell Migration

International audienceCell migration is a highly dynamic process driven by the cytoskeleton, which mainly comprises the actin microfilaments, microtubules and intermediate filaments. During migration, cells polarize and form protrusions at the front where new adhesions are formed. These nascent adhesions mature into focal adhesions that transmit the traction forces required for movement. All of these steps are coupled to major cytoskeletal rearrangements and are controlled by a wide array of signaling cascades. The constant crosstalk between actin, microtubules, and intermediate filaments ensures their coordinated dynamics to facilitate cell migration. Here, we first describe how master regulators, such as RhoGTPases, can simultaneously control the three cytoskeletal structures. We then summarize the recent crosstalk mechanisms by which cytoskeletal networks can locally regulate one another in order to function in a coordinated and efficient manner during migration