Integration of geriatrics into a spiral undergraduate medical curriculum in Pakistan: evaluation and feedback of third-year medical students.

Background: In the last decades there has been a sharp rise in the elderly population throughout the world. The unique needs of the elderly require a multidisciplinary and comprehensive medical approach. None of the 50 medical schools in Pakistan teach geriatrics in their undergraduate or postgraduate training. This paper discusses the development and implementation of the first geriatric curriculum in a medical school of Pakistan and its effect on knowledge and attitudes of third-year medical students. Methods: The curriculum was designed through collaboration and approval of various academic departments at the Aga Khan University in Karachi Pakistan. After a review of existing geriatric curricula at other institutions, a problem-based, inter-disciplinary spiral curriculum was designed. Strategy of student and course evaluation was planned and incorporated in the curricular program. No extra resources or funds were used. A component of the new curriculum was assessed by evaluating pre- and post- course knowledge, and seeking feedback from participating third-year students. Results: A significant improvement in mean scores for summed overall knowledge in geriatrics (pre-test mean 4.7 vs. post-test mean 6.4, p value of of \u3c0.001; out of a maximum possible of 9 was noted. Breakdown of knowledge mean scores into component areas of knowledge showed a significant increase in understanding in aging demographics (pretest 0.7 vs. post-test 1.7, p value of \u3c0.001), geriatric history taking (pretest 0.64 vs. post-test 0.88, p 0.001) and geriatric assessments (pre- test 1.4 vs. post- test 1.7,p value 0.01). A strong majority (87%) of the students felt that the overall course objectives were achieved. All students were satisfied with the quality of teaching, 90% rating it good or higher. Conclusion: An important advance in medical education was achieved via integration of a low cost, spiral geriatrics curriculum in a medical university of Pakistan. We found that introduction of the geriatric curriculum improved the knowledge of third-year medical students. This was our school\u27s initial step towards building professional capacity in response to a rising elderly population

Association of sociodemographic factors with depression in women of reproductive age.

Introduction: Women suffer disproportionately from depression, which has a high prevalence in developing countries. Sociodemographic factors are associated with depression, some of which may be modifiable and lead to better outcomes for depression among women. Objectives: To determine sociodemographic factors associated with depression among women of reproductive age in Karachi. Methods: A case control study was conducted on 376 women in 2 hospitals in Karachi. Patients were diagnosed by psychiatrists and family physicians by Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria and SRQ20. Results: The odds for women with depression being married for \u3e5 years, being abused by in-laws, spending ≤3 hours per day with their spouses, and being just satisfied or not satisfied with their married life was more than that for controls. Conclusion: The authors\u27 findings highlight the important modifiable risk factors for depression, which if addressed will help decrease the burden of depression among women

Standard setting methods for pass/fail decisions on high-stakes objective structured clinical examinations: A validity study

Authentic standard setting methods will demonstrate high convergent validity evidence of their outcomes, that is, cutoff scores and pass/fail decisions, with most other methods when compared with each other.Background: The objective structured clinical examination (OSCE) was established for valid, reliable, and objective assessment of clinical skills in health professions education. Various standard setting methods have been proposed to identify objective, reliable, and valid cutoff scores on OSCEs. These methods may identify different cutoff scores for the same examinations. Identification of valid and reliable cutoff scores for OSCEs remains an important issue and a challenge.APPROACH: Thirty OSCE stations administered at least twice in the years 2010-2012 to 393 medical students in Years 2 and 3 at Aga Khan University are included. Psychometric properties of the scores are determined. Cutoff scores and pass/fail decisions of Wijnen, Cohen, Mean-1.5SD, Mean-1SD, Angoff, borderline group and borderline regression (BL-R) methods are compared with each other and with three variants of cluster analysis using repeated measures analysis of variance and Cohen\u27s kappa.Results: The mean psychometric indices on the 30 OSCE stations are reliability coefficient = 0.76 (SD = 0.12); standard error of measurement = 5.66 (SD = 1.38); coefficient of determination = 0.47 (SD = 0.19), and intergrade discrimination = 7.19 (SD = 1.89). BL-R and Wijnen methods show the highest convergent validity evidence among other methods on the defined criteria. Angoff and Mean-1.5SD demonstrated least convergent validity evidence. The three cluster variants showed substantial convergent validity with borderline methods.CONCLUSIONS: Although there was a high level of convergent validity of Wijnen method, it lacks the theoretical strength to be used for competency-based assessments. The BL-R method is found to show the highest convergent validity evidences for OSCEs with other standard setting methods used in the present study. We also found that cluster analysis using mean method can be used for quality assurance of borderline methods. These findings should be further confirmed by studies in other settings

Problem-based learning: Where are we now? Guide supplement 36.2 - Viewpoint

The educational principles of self-directed, collaborative, and life-long learning can be effectively inculcated into the curriculum where PBL is adopted as a major learning strategy instead of PBL as a whole-curriculum-concept. In developing countries, where the entry level of the majority of students is at the high-school leaving level, a guided discovery model may well be the answer. A curriculum that introduces students to carefully constructed problems sequenced according to a matrix design ranging from simple to complex conditions and according to a logical progression of anatomical and/or physiological and/or pathological and/or pharmacological concepts makes learning easier. Centralized curricular governance, conceptualization and management have a very strong impact on the kind of curriculum, or more specifically which variant of PBL, an institution is able to implement. However, decentralized empowerment of a large number of faculty members is crucial for faculty ownership. A curricular change, especially to PBL from a traditional curriculum, demands adequate preparation time of at least 2--3 years. The time between proposing the change to introducing the change should focus not only on faculty development and training, development of the curriculum and its policies, but also on resource development and preparation of the student body

Educational models and strategies in health education. Introduction.

Introduction:Effective facilitation of PBL tutorials requires tutors to develop observation skills, cognitive strategies and motor skills. The initial tutor training workshops at Aga Khan University were geared towards providing an understanding of the theory of the PBL process but not hands-on experience in facilitation. Objectives: To use structured, small group experiential learning (SSGEL) to enhance skills in PBL tutorial facilitation, with opportunities to practice and provide individual feedback. Methods: The workshop was structured using Gagne\u27s principles of instruction as a framework, making the learning more experiential and systematic. Cue cards were used with trigger statements related to disruptive behaviors and inappropriate feedback statements from students that commonly occur during PBL sessions, to give tutors an opportunity to handle these simulated situations. Outcomes: Analysis of the post workshop evaluation forms provided generally positive feedback from participants on the structure and content of the revised workshop. Participants highlighted the session on PBL experience as highly interactive and rated it as a good learning experience, with an average rating of 4.54 out of 5. Conclusion: The structured small group experiential learning exercise provided faculty with an opportunity to practice facilitation skills focusing on developing a standard approach in dealing with common, difficult situations in maintaining group dynamics during a PBL session. The structure of the program was designed to enable participants to better understand the rationale and philosophy of PBL and the curricular change in our school, and to prepare them to serve more effectively as PBL tutors

Validation of the SETOC instrument — Student evaluation of teaching in outpatient clinics

Purpose: There is a paucity of evaluation forms specifically developed and validated for outpatient settings. The purpose of this study was to develop and validate an instrument specifically for evaluating outpatient teaching, to provide reliable and valid ratings for individual and group feedback to faculty, and to identify outstanding teachers in that setting. Method: By literature reviews and pilot studies at the Faculties of Health Sciences, McMaster University (Canada) and Aga Khan University (AKU-Pakistan), a 15-item instrument, Student Evaluation of Teaching in Outpatient Clinics (SETOC), was created with five subscales: “Establishing Learning-Milieu, Clinical-Teaching, General-Teaching, Clinical-Competence, and Global-Rating.” Seven-point Likert-type rating scales were used. Students also nominated three “best” outpatient teachers. Participants: 87 faculty members (79%) rated by all 224 third to fifth-year students (clerks) at outpatient departments of the AKU hospital over a one-year period. Analyses: Repeated measures generalizability studies, correlations, concurrent validity of SETOC scores with best teacher nominations. Results: Inter-rater G-coefficient and internal consistency of SETOC student ratings were 0.92 and 0.98. Average inter-item and inter-subscale correlations were 0.79 and 0.86. Comparing SETOC scores against “Best Teacher” nominations, sensitivity, specificity, positive and negative predictive values were greater than 0.84.Student ratings ranged from unsatisfactory (fourteen instructors) to outstanding (four instructors). Mean-scores for Learning-Milieu, Clinical-Teaching and General-Teaching were lower than those for Clinical-Competence and Global-Rating (p=0.000 for all). Conclusions: The SETOC elicited reliable and valid student ratings that can provide specific feedback to individual faculty with weak or outstanding teaching skills, and identify overall group shortcomings for faculty development

Assessment of medical professionalism: Development and psychometric analysis of professionalism assessment Tool (PAT) in Pakistani context using Delphi techniques

Objective: This study aims to develop and assess the content validity along with the reliability of a Professionalism Assessment Tool (PAT) with an intention to measure professionalism among undergraduate medical students. Methods: This psychometric analytical study validation study was carried out at Rawalpindi Medical University from 1st February to 1st June, 2021 after establishing feasibility and obtaining ethical approval. The non-probability convince sampling was employed to collect data. Using Nunnally\u27s, the ratio of e subjects per item was selected, as our preliminary tool has 48 items so 384 sample size was estimated for scale validation. The preliminary 48-item tool with five subscales(cSS) developed through mutual consensus by the Delphi technique namely Communication skill(cSS1),-7 item, Accountability(cSS2)-8 item, Altruism(cSS3)-13 item, Self-Directed Learning (cSS4)-10 item and Ethics(cSS5),-10 item was labelled as Professionalism Assessment Tool (PAT). The tool was administered to 4th year MBBS students, the data obtained was analyzed by calculating Cronbach\u27s alpha to estimate the reliability. The SPSS version 26 was used for data analysis. Results: The 48-item PAT had an overall reliability (Cronbach\u27s alpha) of 0.783. The Reliability of the new Subscales were communication skills (0.405), self-directed learning (0.527), Accountability (0.378), Altruism (0.486) and Ethics (0.715). Conclusion: The final tool developed for assessment of professionalism had 48 items on a seven point Likert like scale, across five Subscales. Results showed that it was determined as a useful tool in assessing professionalism in undergraduate medical students to generate reliable results for valid decision-makin

Basics of faculty-to-faculty mentoring: A process to identify support and challenges.

Faculty mentoring is relatively new in health sciences literature. Faculty mentors are considered to have multiple roles including being a supervisor, teacher, or a coach. Little or no attention to formal mentoring of faculty allows faculty to seek informal mentoring, creating a risk of unexpected outcome. There is dearth of literature with respect to formal mentoring programs from the subcontinent. Although, informal faculty mentoring has been in place but there is no standard faculty mentorship model to be followed at Aga Khan University Medical College (AKU-MC). An observational study was conducted in September 2021 at AKU MC with convenient sampling to share the perceptions of the AKU-MC faculty mentors in a faculty mentorship workshop so that further advanced level faculty development workshops could be planned in this area. Twenty-two faculty mentors participated to share their perspectives on the responsibilities of faculty mentor, faculty mentee and the institution to see faculty grow and to have a sustainable mentorship programme. Challenges faced by the faculty mentors during the process of mentorship were also discussed. Majority of the participants emphasized on the role of the faculty mentor to be supportive, guiding, reflective and formative (respond to the emotional needs, encourage, effective communication, know own limitations, observe, provide feedback). Faculty mentor role modeling, ability to maintain confidentiality, creating and maintaining mentor-mentee relationship, availability of framework of formal mentoring in an academic institution and opportunities within the academic setting to learn mentorship were the main challenges of being a faculty mentor. The process provided valuable training and education to the faculty for the development and strengthening of formal mentoring program. Faculty recommended that institutions should provide the opportunity for development of junior faculty mentors by organizing capacity building activities

Chart-stimulated Recall as a Learning Tool for Improving Radiology Residents\u27 Reports

RATIONALE AND Objectives: Workplace-based assessments gauge the highest tier of clinical competence. Chart-stimulated recall (CSR) is a workplace-based assessment method that complements chart audit with an interview based on the residents\u27 notes. It allows evaluation of the residents\u27 knowledge and heuristics while providing opportunities for feedback and self-reflection. We evaluated the utility of CSR for improving the radiology residents\u27 reporting skills.MATERIALS AND Methods: Residents in each year of training were randomly assigned to an intervention group (n=12) or a control group (n=13). Five pre-intervention and five post-intervention reports of each resident were independently evaluated by three blinded reviewers using a modified Bristol Radiology Report Assessment Tool. The study intervention comprised a CSR interview tailored to each individual resident\u27s learning needs based on the pre-intervention assessment. The CSR process focused on the clinical relevance of the radiology reports. Student\u27s t test (P\u3c.05) was used to compare pre- and post-intervention scores of each group.Results: A total of 125 pre-intervention and 125 post-intervention reports were evaluated (total 750 assessments). The Cronbach\u27s alpha for the study tool was 0.865. A significant improvement was seen in the cumulative 19-item score (66% versus 73%, P\u3c.001) and the global rating score (59% versus 72%, P\u3c.001) of the intervention group after the CSR. The reports of the control group did not demonstrate any significant improvement.CONCLUSION: CSR is a feasible workplace-based assessment method for improving reporting skills of the radiology residents