Current medical education and clinical practice has led to a need for advanced faculty development for medical teachers to effectively play the role of educators, researchers and administrators. There is large variability in the teaching programmes across countries, which range from a one-time activity to regularly scheduled workshops and seminars, to a highly advanced course spanning a few months to a year. Several healthcare institutes around the world offer faculty training programmes in health professions education, where the curriculum varies in design as they are developed and implemented by their own institutional body or education unit. Following a discussion of arena blended connected (ABC) learning design during a faculty training programme (Postgraduate Diploma in Health Professions Education) and the subsequent move towards an online approach to education due to the pandemic in 2019, the advisory faculty and students started to envision designing the already existing Postgraduate Diploma in Health Professions Education curriculum along the ABC model favouring blended and outcome-based education. Criteria were set for each topic with clearly defined learning levels to be implemented and the frequency of implementation. We describe the design and development of a curriculum for faculty development of health professions education using the ABC model.
There is considerable controversy on the role of physical activity in irritable bowel disease (IBD) since published reports are conflicting. It is well known that there is known relapse with specific treatment in IBD. This, in addition to onset of extraintestinal symptoms creates a need to think of alternate approaches. In this context, the current article describes the need of a multi-institutional study with standard protocol of physical activity for documenting its effect on both the primary disease and the extra alimentary manifestations. This paper also points out the possibility of using adjuvant complementary medicine such as yoga, whose effects have been documented in other diseases like irritable bowel syndrome. A third approach could be to focus on the intestinal dysbiosis in IBD and concentrate on research on restoring the microbial flora to normal, to see whether the extra-intestinal symptoms are alleviated.
Functional dyspepsia (FD) is a common upper gastrointestinal disorder, characterized by bothersome epigastric pain or burning, fullness after meals or early satiety. The precise pathophysiology remains incompletely understood but may include the role of disordered gut-brain communication leading to disturbances in gastro-duodenal physiological functioning. Even if there are several pharmacological treatment options, it is a chronic and relapsing disorder with persistent symptoms that makes its management difficult. Yoga is a fast-spreading complementary and alternative medicine (CAM) specialty, that has gained attention in the medical field for its ability to address the physical, emotional, mental and social aspects of health and disease. Various other CAM therapies are being used for FD with varying efficacy. However, apart from one research study that used yoga therapy on abdominal pain related functional gastrointestinal disorders in children which included a few FD cases as well (11.6%), no other study using yoga therapy has been done in FD as per our best knowledge. Therefore, in the present review, we have summarized the current scientific understanding of the probable effects of yoga on the pathophysiological mechanisms involved in FD (gastric motility, fundic accommodation, hypersensitivity, duodenal inflammation, psychological distress and gut-brain dysfunction). The literature suggests yoga can have a beneficial role in the management of FD. However, rigorous research and clinical trials are required to confirm the same.
Background At Sri Balaji Vidyapeeth, a competency-based learning and training (CoBaLT©) model for postgraduate (PG) curriculum, within the regulatory norms, was implemented in 2016 after adequate faculty development programmes. This focused on well-defined outcomes. Methods A review of the outcomes was undertaken in 2018 as part of internal quality assurance receiving feedback from all stakeholders, viz. students, alumni and faculty. Recent publications were also reviewed. A major problem identified was lack of clarity in definition of levels leading to subjectivity in assessment while grading. It was also noted that the process needed to be aligned with the programme outcomes. Further refinements were, therefore, made to align and objectivize formative assessment using entrustable professional activities (EPA) with the aid of descriptive rubrics of sub-competencies and milestones. Addition of detailed rubrics for objectivity takes assessment a step beyond the Dreyfus model, aligning overall to the programme outcomes. Results Achievement of appropriate grades in EPAs by individual candidates ensures entrustability in professional activities by the time of completion of the PG programme. The modification was found more transparent and objective with reference to grading by the teachers and more conducive to reflections by the residents on their performance and how to improve it. Conclusions The use of descriptive rubrics along with EPAs brings transparency and plays a key role as an objective assessment tool, which can lend direction to individual resident learning and entrustability. This is an important component of outcome-based education.
Retroperitoneal liposarcoma is a malignant mesenchymal tumour. The incidence is rare and early diagnosis is difficult as they present with non specific symptoms. A 55-year-old male patient, presented to General Surgery Department with complaints of abdominal swelling since two months and discomfort for three to four months. Abdominal examination revealed a mass, soft to firm in consistency with restricted mobility, was palpated in right quadrants. A clinical diagnosis of soft tissue tumour was made. Abdominopelvic computed tomography (CT) scan was performed showing a well-defined circumscribed, low-attenuated mass of retroperitoneal origin crossing midline and significantly displacing the intestinal loops, right grade 2 hydronephrosis and was compressing on inferior vena cava posteriorly. The patient underwent a resection surgery of the lesion and the histopathological examination showed a well-differentiated liposarcoma and Castleman’s disease. These tumours are generally resistant to radiotherapy and/or chemotherapy. Thus the major prognostic factor related to survival is resection with tumour-free margins that includes the tumour as well as adjacent structures showing infiltration.
The undergraduate and postgraduate admission of dental seats in India has been facing a decline in the recent past.The future of the dental profession is at stake in the country due to multifaceted issues.Without solving the actual underlying problem, there is no point in blaming the National Eligibility cum Entrance Test (NEET) or bringing down the scores to fill the seats.It's high time the policymakers, senior professionals, government, and the regulatory body take an action to improve the scenario and save the profession from the crisis.
Introduction: Midline laparotomy wound is closed in layers co-opting the various layers separately from historical times; however various methods of closure had come into vogue in the recent years. One such is the single layer mass closure technique, in which all the layers of the abdominal wall are closed in single layer, except for the skin and subcutaneous tissue. Yet another method described is the retention closure technique incorporating all layers including skin and subcutaneous tissue are closed in a single layer. Aim: To compare the postoperative wound complications in layered closure with retention closure technique in midline laparotomy. Materials and Methods: This was a longitudinal cohort study done on 57 consecutive patients who underwent midline laparotomy on an elective or emergency basis over a 12 months period from January 2014 to January 2015 in the Department of General Surgery at Mahatma Gandhi Medical College and Research Institute, Puducherry, India. They were divided in to two groups depending on the closure type, layered closure (Group A) and retention closure (Group B) depending on the operating surgeon: retention closure was done in a single surgical unit and layered closure was done in rest of the respective units. Patients were followed-up meticulously and immediate postoperative complications were recorded up to four weeks. Statistical analysis was carried out using SPSS version 19.0 (IBM SPSS, US) software with regression modules installed. Chi-square test and t-test were used to analyse the data. Results: In Group A there was 30 patients while in Group B there were 27 patients. In layered closure technique out 30 patients 12 (40%) patients developed wound infection, 1 (3.3%) patient developed partial dehiscence, and 2 (6.6%) patients developed complete dehiscence. In retention closure technique out of 27 patients only 5 (18.5%) patients developed wound infection, 3 (11%) patients developed partial dehiscence and none of them had complete dehiscence in this group. There was significant association between wound complications and patients with uraemia and hypoalbuminemia. Out of 12 uremic patients 8 (66%) developed wound infection (p-value=0.002), 2 (16.7%) patients developed partial dehiscence and 2 (16.7%) patients developed complete dehiscence (p-value=0.06). In patients who had hypoalbuminemia, out of seven patients, 5 (71.4%) patients had wound infection and 2 (28.6%) patients did not have wound infection (p-value=0.01). Four (57.1%) patients had partial dehiscence and 2 (28.6%) had complete dehiscence only 1 (14.3%) patient did not have any dehiscence (p-value=0.001). Conclusion: Retention closure has some advantages over layered closure in preventing wound infections and burst abdomen. Various risk factors are associated with postoperative wound complications, among which hypoalbuminemia and uraemia have a strong association.
The human mankind faced a miserable life due to the ignorance and wrath of the coronavirus.The imposition of lockdowns and restrictions led to job loss and global recessions.A ray of hope after the first wave was due to the vaccine's arrival, but yet there was hesitancy due to suspicions and rumors.The virus had come back with full vigor during the second wave with countless pyres burned.The country faced a severe crisis in terms of a shortage of vaccines, drugs, beds, and oxygen.Still, it is not known when this would end-all will be well only when the human mankind works as one.
The revolutionary concept of enhanced recovery after surgery (ERAS), recognized and proven in colonic surgery, soon caught on as an attractive proposition that translated into better and faster patient recovery after various types of surgery. As an evolving concept, it is being widely accepted, with various surgical specialties suitably adapting the guidelines for use in the perioperative setting. Identification and mitigation of risk factors in special groups of patients such as patients presenting for emergency surgery, those in the extremes of age and weight, and those with various comorbidities require additional care and investigations. The use of ERAS in emergency setting has been remarkably difficult to implement, owing to a short preoperative period, altered physiology, and unexpected postoperative outcomes. There is reluctance in the application of ERAS in emergency due to difficulty in implementing all its components, especially the preoperative components. The rapid advancements in technology and increased availability of point of care diagnostics, such as ultrasound and intraoperative electroencephalogram, and the increasing number of anesthesiologists getting trained in their usage are important factors that are positively influencing perioperative patient care in the last decade. This has led to significant developments in noninvasive and rapid methods of monitoring hemodynamics and postoperative care. This review aims to highlight the influence of newer perioperative practices that are already included or are likely to have positive impact when included in an ERAS program and provide comprehensive review on the application of ERAS in emergency setting and in various surgical specialties.
Training the IMG to be a clinician: The pedagogic challenge to curriculum formulators - JETHS- Print ISSN No: - 2454-4396 Online ISSN No:- 2393-8005 Article DOI No:- 10.18231/j.jeths.2019.022, Journal of Education Technology in Health Sciences-J Educ Technol Health Sci
Postgraduate medical education in India is beset with many problems including lack of a uniform national syllabus, nonexistence of an accepted list of competencies across disciplines, lack of uniformity in teaching/learning methods between different institutions, a poor evaluation system which focuses on a day's performance rather than the whole course and lack of attention to attitude and professionalism both in the training and evaluation processes. Since there is no national-level quality control of the outgoing postgraduates, there is no uniformity either in knowledge or skill level among them. Regulatory control over the whole process inhibits institutions from making any changes. Furthermore, the summative examination process is entirely under regulatory guidelines, with little or no option to universities and institutions to change the same. In this scenario, Sri Balaji Vidyapeeth, Puducherry, introduced and implemented a competency-based training programme for medical postgraduates, which is now in the 4th year. This model is suitable for the Indian milieu as it can be implemented within the regulatory guidelines. The model has been described with details of the processes involved in preparation, implementation, monitoring and overcoming possible hurdles and pitfalls in the Indian context.
CONTEXT: The general dentist must not only have a broad biomedical and clinical education but also be able to demonstrate professional and ethical behavior as well as effective communication and interpersonal skills. In addition he or she must have the ability to evaluate and utilize emerging technologies, continuing professional development opportunities, and problem-solving and critical thinking skills to effectively address current and future issues in health care. But the extent to which the core competencies are taught and the students' level of proficiency in these competencies in Indian scenario is to be explored at large. AIMS: The present study aims at assessing the self-perceived level of competencies and their importance for future practice and the extent to which the competencies are taught in the curriculum among interns of dental college in Pondicherry, India. SETTINGS AND DESIGN: The cross-sectional observational study was conducted among dental interns of Indira Gandhi Institute of Dental Sciences, Pondicherry. SUBJECTS AND METHODS: A total of 72 interns participated in the study. A short version of the Freiburg Questionnaire to Assess Competencies in Medicine" was used in this study. Questionnaire has three sections with same set of questions, which the student had to rate: (i) To what extent do you have the following competencies at your disposal? (ii) To what extent will your future job require the following competencies? and (iii) To what extent is competencies taught to you? After the results were obtained a focused group discussion with the responders was done. Focused group discussion consisted of open questions to the groups in all the four domains and the responses of the students were scribed. RESULTS: In all four domains, self-perceived level of competency was not satisfactory. However, all students stated that the competencies were highly relevant for their future practice. Despite this, most of the competencies are not taught to necessary extent in the curriculum. The results of the present survey revealed that the participating students perceived deficiencies in all domains of competencies. CONCLUSIONS: These results indicate that the core competencies are still barely integrated into dental curricula and that further research in this field is needed.
Corrosive ingestion remains a common problem in developing countries, such as India due to the lack of strict laws that regulate the sale of caustics. While appropriate treatment of the acute phase can mitigate tissue damage improper management of the acute corrosive injury is widely prevalent due to the limited experience of the individual physicians in managing this condition. The aim of this review is to summarize the epidemiology and pathophysiology of corrosive ingestion, principles in the management of acute phase injury, long-term effects of caustic ingestion, and prevention of corrosive ingestion.
Assessment of medical faculty in India for career advancement and recognition still remains one-dimensional, focusing only on research output in the form of published papers of specified type in specified journals.No importance is given for other activities of faculty including teaching research, outreach, patient care, administration, and innovation.A scheme is suggested in the context of Indian medical schools giving weightages for all activities of faculty based on their disciplinary affiliation.This scheme is suggested as a model and not meant to be normative or prescriptive
The list of required competencies for the Indian Medical Graduate (IMG) along with suggested teaching / learning methods and topics for integration have been notified by Medical Council of India. Also, the desired level of proficiency for various competencies has been defined with emphasis on the need to certify some of them. The corresponding Graduate Medical Education Regulations with details of curricular time assignment for various disciplines, scheduling and details of the evaluation process are still to be released and is expected shortly. With implementation fixed for the academic year 2019-20, it is necessary for all faculty to be apprised of the details of the changes being sought to be brought about. This paper will focus on details of the new curriculum, its merits compared to the previous version and some areas of concern which may require attention and rectification later on. One possible strategy for preparing and implementing the curriculum by August, 2019 will be suggested.