Basic Science Medical Student Attitudes toward the Patient-Doctor Relationship

This article was migrated. The article was marked as recommended. Introduction: Patients seem increasingly to be in favor of taking a more active role in the patient-doctor relationship. Increasing education and the rising prevalence of chronic and lifestyle diseases require patients to take more responsibility for their health. The present study was conducted among basic science students at a private medical school in Aruba, Dutch Caribbean using the well validated patient-practitioner orientation scale (PPOS) to obtain information on student attitudes toward the patient-doctor-relationship and study whether the attitudes were associated with demographic characteristics.Methods: The study was conducted during November 2016. PPOS measures student attitudes towards the sharing and caring dimensions of the patient-doctor relationship by noting the respondents' degree of agreement with various statements using a Likert-type scale.The gender, age, nationality and semester of study of the respondents were noted. Three binary dependent variables were created using mean caring, mean sharing and mean total scores where mean score of 4 and greater was coded as 1 and otherwise was coded as 0. Subsequently, univariate and multivariate logistic regression models were fitted to analyze the relationship of the dependent variables with gender, age, nationality and semester of study of the respondents.Results: One hundred and seven of the total of 116 students (92.2%) participated in the study.The mean ± SD sharing score was 3.996 ± 0.623 while the mean caring score was 4.253 ± 0.0602. The mean ± SD total score was 4.126 ± 0.501.The mean sharing and mean total scores were significantly higher among female respondents. Female respondents were found to be more likely to be caring, sharing and having a more patient-centered attitude when communicating with patients than males on carrying out the logistic regression analysis.Conclusions: The scores were comparable to those reported previously in the literature. Compared to some other studies no significant differences in scores were noted according to demographic characteristics of respondents other than gender. Studies among students during the clinical years of study are required. Similar studies could be carried out in other offshore Caribbean medical schools.

Knowledge, perception and practice of self-medication among premedical and basic science undergraduate medical students

Aims and Objective: Responsible self-medication is recognized as an important component of self-care. Medical students are in a unique position as they cannot yet legally prescribe medicines but their knowledge about and exposure to medicines increase as they progress through their course. Xavier University School of Medicine in Aruba admits students mainly from the United States, Canada and other countries to the undergraduate medical course. The present study was carried out to study the knowledge, perceptions and practice of self-medication among premedical and undergraduate medical students.Materials and Methods: The study was conducted during June and July 2016 using a questionnaire which had been used previously.  Knowledge and perceptions were studied by noting the respondents’ degree of agreement with asset of 40 statements. The use of selected classes of medicines for self-medication during the preceding one-year period was studied. The knowledge, perception and total scores were calculated and compared among different subgroups of respondents. Age, gender, nationality and semester of study of the respondents were noted.Results: Eighty-five of the 125 students enrolled (69.1%) participated. The mean knowledge, perception and total scores were 73.45, 62.75 and 136.2 (maximum possible scores were 105, 95 and 200 respectively). There was no significant difference in scores among subgroups of respondents. Analgesics, skin ointments, antipyretics and anti-allergics were commonly used for self-medication. Over half the respondents had used some form of self-medication during the preceding year.      Conclusion: The present study provides preliminary information regarding self-medication practices among both premedical and basic science medical students. Further studies on factors influencing and information sources used during self-medication can be conducted. Asian Journal of Medical Sciences Vol.7(5) 2016 63-68

Standardized patient program: Student feedback

Objective: Standardized patients (SPs) are widely used in medical and other health professions education. At xxxx SPs have been used for teaching-learning and assessment of basic science medical students since January 2013. The opinion of SPs about their involvement in teaching-learning and assessment of students has been recently studied. The present study had the objective of studying student perception about various aspects of the program.Materials and Methods: The study was conducted towards end of March and beginning of April 2016. Student perception regarding the program was studied by noting their degree of agreement with a set of 25 statements. Free text comments were also obtained. Gender, nationality and semester of study of the respondents was noted. The total score was compared among different subgroups of respondents.Results: Ninety-eight of the 107 students (91.6%) participated. The mean ± SD total score was 92.33 ± 13.68 (maximum possible score being 125). The scores were significantly higher among first semester students compared to other semesters. Students agreed that interacting with SPs will prepare them for interacting with patients, for their licensing exams and improve their clinical skills. Students learn how to interact with persons from a different cultural background. Suggestions for further improvement were also obtained.    Conclusions: The response rate was high and students’ perception of the SP program was positive. Our experiences would be of special interest to educators in other medical schools with small and/or new SP programs. Similar feedback could be obtained from other xxx schools with SP programs.Asian Journal of Medical Sciences Vol.7(5) 2016 102-107

An Assessment of Diabetic Retinopathy and Diabetes Management System in Nepal

BACKGROUND

Visual damage due to diabetic retinopathy is a major concern which can be reduced through appropriate coordination and cooperation between the diabetes management services and diabetic retinopathy services. The study assessed the existence, availability and accessibility of health care services for diabetes mellitus and diabetic retinopathy in Nepal.

METHODS

The study was carried out from 1 April to 24 June 2015. The tool for assessment of diabetic retinopathy and diabetes management systems developed by the World Health Organization was used for the assessment of major stakeholders like endocrinologists, ophthalmologists, ophthalmic assistants, nurses involved in diabetes care, patients and human resources from Ministry of Health and Population and international non-governmental organizations dealing with eye care services in Nepal.

RESULTS

Thirty-seven key stakeholders were selected for the study. Six out of fifteen ophthalmologists were unaware about the prioritization of diabetes as national health concern. The main function of diabetes association included patient education and awareness 18(48.6%), clinician education and awareness 16(43.2%). Thirteen professionals (35.1%) said that the patients were not found to be aware about diabetic patients' organizations. The information to community is provided occasionally and only through national-level media. All forms of diabetes care were funded out-of-pocket by the patients themselves.

CONCLUSIONS

Coordination should be strengthened for an effective and holistic management of diabetes mellitus making diabetes care and diabetic retinopathy services more accessible. Diabetes mellitus and its complications are becoming a public health threat in Nepal.

Knowledge and Practice on Injection Safety among Primary Health Care Workers in Kaski District, Western Nepal

BACKGROUND

Unsafe injection practice can transmit various blood borne infections. The aim of this study was to assess the knowledge and practice of injection safety among injection providers, to obtain information about disposal of injectable devices, and to compare the knowledge and practices of urban and rural injection providers.

METHODS

The study was conducted with injection providers working at primary health care facilities within Kaski district, Nepal. Ninety-six health care workers from 69 primary health care facilities were studied and 132 injection events observed. A semi-structured checklist was used for observing injection practice and a questionnaire for the survey. Respondents were interviewed to complete the questionnaire and obtain possible explanations for certain observed behaviors.

RESULTS

All injection providers knew of at least one pathogen transmitted through use/re-use of unsterile syringes. Proportion of injection providers naming hepatitis/jaundice as one of the diseases transmitted by unsafe injection practice was significantly higher in urban (75.6%) than in rural (39.2%) area. However, compared to urban respondents (13.3%), a significantly higher proportion of rural respondents (37.3%) named Hepatitis B specifically as one of the diseases transmitted. Median (inter-quartile range) number of therapeutic injection and injectable vaccine administered per day by the injection providers were 2 (1) and 1 (1), respectively. Two handed recapping by injection providers was significantly higher in urban area (33.3%) than in rural areas (21.6%). Most providers were not aware of the post exposure prophylaxis guideline.

CONCLUSION

The knowledge of the injection providers about safe injection practice was acceptable. The use of safe injection practice by providers in urban and rural health care facilities was almost similar. The deficiencies noted in the practice must be addressed.

Knowledge, Attitude and Practice of Self-Medication Among Basic Science Undergraduate Medical Students in a Medical School in Western Nepal

INTRODUCTION

Studies have shown self-medication to be common among medical students. These studies are however, few in Nepal. The present study assessed knowledge, attitude, and practice of self-medication among second and fourth semesters' undergraduate medical students and studied differences in knowledge and attitude (if any) among different subgroups of the respondents.

MATERIALS AND METHODS

A cross-sectional survey was conducted using a questionnaire among basic science medical students of Manipal College of Medical Sciences, Nepal. Semester of study, gender, age, nationality, and the profession of their parents were noted. Students' knowledge and attitude about self-medication was studied by noting their degree of agreement with a set of 40 statements using a Likert-type scale. The average scores and frequency of occurrence of particular behaviors among different categories of respondents were compared using appropriate statistical tests.

RESULTS

Two hundred and seventy-six of the 295 (93.6%) students participated. The mean (SD) knowledge, attitude, and total scores were 74.54 (6.92), 67.18 (5.68), and 141.73 (10.76) with maximum possible scores 100, 100 and 200, respectively. There was no significant difference in scores according to respondents' gender, age, and the profession of their parents. However, the mean knowledge, attitude and total scores were significantly different among students of different nationalities. Mean scores of fourth semester students were significantly higher compared to second semester students. There were differences in knowledge and total scores among students of different nationalities. Eighty two percent of respondents had self-medicated during the one year period preceding the study; 149 respondents (54%) shared that previous experience with the medicine was one of the information sources for self-medication. Prevalence of self-medication among respondents according to semester of study, gender, age, and profession of the parents was not significantly different. The use of self-medication was more common among Sri Lankan respondents compared to Nepalese. Painkillers (73.2%), antipyretics (68.8%), and antimicrobials (56.2%) were most commonly used for self-medication.

CONCLUSION

Students' knowledge and attitude about self-medication is good. The prevalence of self-medication among medical students was high.

Attitude of Basic Science Medical Students Toward Interprofessional Collaboration

Purpose: Interprofessional collaboration (IPC) and interprofessional education (IPE) are increasingly emphasized in the education of health professions. Xavier University School of Medicine, a Caribbean medical school admits students from the United States, Canada, and other countries to the undergraduate medical course. The present study was carried out to obtain information about the attitude toward IPC among basic science medical students and note differences, if any, among different subgroups.

Methods: The study was conducted among first to fifth semester students during July 2015 using the previously validated Jefferson Scale of Attitudes Toward Interprofessional Collaboration (JeffSATIC). Gender, age, semester, and nationality were noted. Participants’ agreement with a set of 20 statements was studied. Mean total scores, working relationship, and accountability scores were calculated and compared among different subgroups of respondents (p<0.05).

Results: Sixty-seven of the 71 students (94.4%) participated. Cronbach’s alpha value of the questionnaire was 0.827, indicating good internal consistency. The mean total score was 104.48 (maximum score 140) while the working relationship and accountability scores were 63.51 (maximum score 84) and 40.97 (maximum score 56), respectively. Total scores were significantly higher among third-semester students and students of Canadian nationality. Working relationship and accountability scores were higher among first and third-semester students.

Conclusion: The total working relationship and accountability scores were lower compared to those obtained in a previous study. Opportunities for IPE and IPC during the basic science years should be strengthened. Longitudinal studies in the institution may be helpful. Similar studies in other Caribbean medical schools are required.

Intraoperative and Immediate Postoperative Outcomes of Cataract Surgery using Phacoemulsification in Eyes with and without Pseudoexfoliation Syndrome

BACKGROUND

To compare the intraoperative and immediate postoperative behavior and complications in eyes with pseudoexfoliation (PEX) syndrome with eyes having senile cataract without PEX during cataract surgery using phacoemulsification (PKE).

MATERIALS AND METHODS

In this prospective study, 68 eyes of 68 patients were divided into two groups: Group 1 (test) comprised 34 eyes with immature senile cataract with PEX and Group 2 (control) included 34 eyes with immature senile cataract without PEX and any coexisting ocular pathology. Phacoemulsification (modern cataract surgery) was performed on both groups through stop and chop technique and comparative analysis of the incidence of intraoperative and immediate postoperative complications was made.

RESULTS

There was no significant difference in rates of intraoperative complications between PEX (2.9%) and Control (0%) group. The mean pupil diameter was significantly smaller in Group 1 (p<0.001). No eye in either group had phacodonesis. 58.8% of eyes in Group 1 and 29.4% in Group 2 had a harder cataract (nuclear sclerosis) ≥ grade 3 (p=0.017). PKE was performed in all eyes with cataract in both groups. Intraoperative complication (zonular dialysis (dehiscence) was encountered in only 2.9% (1 case) of eyes with PEX. PC (posterior capsule) tear (rent) with vitreous loss was seen in 2.9% eyes of Group 1 and none in Group 2. Postoperatively, IOP (intraocular pressure) and aqueous flare response were comparable between the groups. Significantly higher inflammatory cell response was observed in Group 1 (p=0.014). BCVA (best corrected visual acuity) using Snellen chart with pinhole on postoperative day1 was significantly better in the control group compared to the group with PEX (p=0.027).

CONCLUSION

Phacoemulsification can be safely performed by experienced hands in cataractous eyes with PEX. The incidence of intraoperative and immediate post-operative complications in eyes with PEX was not significantly different compared to eyes without PEX in our study. Further studies among a larger population are required.

Student feedback on problem-based learning processes

BACKGROUND

Problem-based learning (PBL) sessions consist of a brainstorming phase, search phase, individual study, and reporting phase. At the Xavier University School of Medicine, Aruba, PBL is a new learning modality first introduced in May 2013.

AIMS

PBL processes have not been studied previously at the Xavier University School of Medicine, hence the present study was carried out to obtain information about the PBL processes and note differences, if any, among different groups of students.

METHOD

The study was conducted among first- to fourth-semester undergraduate medical students during July 2014 using a previously validated PBL processes instrument developed by van den Hurk et al. Information about gender, semester, weekly hours of study, and learning resources used was obtained. Respondents' agreement with a set of 23 statements was noted using a Likert-type scale, which was scored as 1=totally disagree with the statement, 2=disagree, 3=neutral, 4=agree, and 5=totally agree with the statement. Mean scores were compared among different groups of respondents.

RESULTS

Fifty-one of the 58 students (87.9 per cent) participated. The weekly average study time was 29.9 hours. Lecture handouts and textbooks were commonly used information sources. The mean scores (scale 1 to 5) for learning-issue-driven searching, and extensiveness of searching were 3.49 and 3.45, respectively. The score for explanation-oriented preparation was 3.94, while those for breadth and depth of discussion were 3.75 and 3.62, respectively. Most scores were higher among second-semester students, but the difference was not significant.

CONCLUSION

The self-reported scores were comparable to those reported in previous studies done using the same PBL processes instrument in other medical schools. At Xavier University School of Medicine interactive lectures are the major teaching method and topics covered during PBL are also likely to be covered during lectures, which could influence the scores. The findings of our study providing information about how students function during PBL brainstorming and presentation sessions and how they use different learning resources would be of interest to other medical schools worldwide following a hybrid curriculum. Further studies are required.

An educational intervention's effect on healthcare professionals' attitudes towards pharmacovigilance

BACKGROUND

Pharmacovigilance concerns the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. Consumer pharmacovigilance is the involvement of consumers in adverse drug reaction (ADR) reporting. Assessing healthcare professionals' (HCPs) knowledge of and attitude towards pharmacovigilance and consumer pharmacovigilance is integral to strengthening adverse drug reaction reporting systems.

AIMS

To study knowledge of and attitude towards pharmacovigilance and consumer pharmacovigilance among HCPs from KIST Medical College, Lalitpur, Nepal, and to plan an appropriate educational intervention to address deficiencies noted.

METHOD

The study was conducted from February 2013 to December 2013 at KIST Medical College using a self-administered, pretested, structured questionnaire. The maximum possible scores for knowledge, attitude, and total were 100, 95, and 195, respectively. Baseline knowledge and attitude were studied. Two months after the questionnaire, an intervention that used a combination of methods about pharmacovigilance and consumer pharmacovigilance was undertaken. Knowledge and attitudes were studied immediately after the intervention. Scores before and after the intervention were compared using Wilcoxon signed-rank test.

RESULTS

A total of 105 HCPs participated. The median (interquartile range) knowledge, attitude, and total scores before the intervention were 56 (7), 72 (9), and 127 (16), respectively. After the intervention the scores increased significantly to 72 (8), 75 (11.5), and 146 (16.5) (p<0.001), respectively.

CONCLUSION

The intervention was effective in improving HCPs' knowledge of and attitude towards pharmacovigilance and consumer pharmacovigilance. More studies on this topic among HCPs at other institutions and in the community are required.

Student feedback about the integrated curriculum in a Caribbean medical school

PURPOSE

Xavier University School of Medicine adopted an integrated, organ system-based curriculum in January 2013. The present study was aimed at determining students' perceptions of the integrated curriculum and related assessment methods.

METHODS

The study was conducted on first- to fourth-semester undergraduate medical students during March 2014. The students were informed of the study and subsequently invited to participate. Focus group discussions were conducted. The curriculum's level of integration, different courses offered, teaching-learning methods employed, and the advantages and concerns relating to the curriculum were noted. The respondents also provided feedback about the assessment methods used. Deductive content analysis was used to analyze the data.

RESULTS

Twenty-two of the 68 students (32.2%) participated in the study. The respondents expressed generally positive opinions. They felt that the curriculum prepared them well for licensing examinations and future practice. Problem-based learning sessions encouraged active learning and group work among students, thus, improving their understanding of the course material. The respondents felt that certain subjects were allocated a larger proportion of time during the sessions, as well as more questions during the integrated assessment. They also expressed an appreciation for medical humanities, and felt that sessions on the appraisal of literature needed modification. Their opinions about assessment of behavior, attitudes, and professionalism varied.

CONCLUSION

Student opinion was positive, overall. Our findings would be of interest to other medical schools that have recently adopted an integrated curriculum or are in the process of doing so.

Need for involving consumers in Nepal's pharmacovigilance system

In Nepal, reporting of adverse drug reactions (ADRs) occurs on a voluntary basis by doctors, pharmacists, nurses, health assistants, and other healthcare professionals. The country's pharmacovigilance program is still in its infancy; it has limited coverage and underreporting is common. This major limitation could be reduced with consumer involvement. This report examines the necessity and benefits of consumer involvement in Nepal's existing pharmacovigilance program, reflecting on existing examples of consumer pharmacovigilance in different countries to highlight the necessity for such a framework in Nepal.

Students' perception of the learning environment at Xavier University School of Medicine, Aruba: a follow-up study

Xavier University School of Medicine admits students mainly from the United States and Canada to the undergraduate medical program. A previous study conducted in June 2013 used the Dundee Ready Educational Environment Measure to measure the educational environment and impact of different teaching and learning methods in the program. The present study aims to obtain information about students' perceptions of changes in the educational environment, which underwent modifications in teaching and learning, in January 2014. Information was collected about the participants' semester of study, gender, nationality, and age. Students' perceptions of the educational environment were documented by noting their degree of agreement with a set of 50 statements grouped into five categories. Average scores were compared among different groups. The mean total and category scores were compared to those of the 2013 study. Sixty of the sixty-nine students (86.9%) who enrolled in the undergraduate medical program participated in the survey. The majority were male, aged 20-25 years, and of American nationality. The mean±SD total score was 151.32±18.3. The mean scores for students' perception in the survey categories were perception of teaching/learning (38.45), perception of teachers (33.90), academic self-perceptions (22.95), perception of atmosphere (36.32), and social self-perception (19.70). There were no significant differences in these scores among the different groups. All scores except those for academic self-perception were significantly higher in the present study compared to the previous one (P<0.05). The above results will be of particular interest to schools that plan to transition to an integrated curriculum.

Medical Humanities in Nepal: Present scenerio

Medical Humanities is a relatively new concept even in developed countries, and is at the infancy stage in low income countries like Nepal. Medical humanities modules in Nepal are being conducted in a few medical schools. Humanities have an essential role in medical education, the gap between the humanities and medicine has to be bridged and there should be continuous and vigorous debate about the theory and practice of medical humanities

Small group effectiveness in a Caribbean medical school's problem-based learning sessions

PURPOSE

The Tutorial Group Effectiveness Instrument was developed to provide objective information on the effectiveness of small groups. Student perception of small group effectiveness during the problem base learning (PBL) process has not been previously studied in Xavier University School of Medicine (Aruba, Kingdom of the Netherlands); hence, the present study was carried out.

METHODS

The study was conducted among second and third semester undergraduate medical students during the last week of September 2013, at Xavier University School of Medicine of the Netherlands. Students were informed about the objectives of the study and invited to participate after obtaining written, informed consent. Demographic information like gender, age, nationality, and whether the respondent had been exposed to PBL before joining the institution was noted. Student perception about small group effectiveness was studied by noting their degree of agreement with a set of 19 statements using a Likert-type scale.

RESULTS

Thirty-four of the 37 (91.9%) second and third semester medical students participated in the study. The mean cognitive score was 3.76 while the mean motivational and de-motivational scores were 3.65 and 2.51, respectively. The median cognitive category score was 27 (maximum score 35) while the motivation score was 26 (maximum score 35) and the de-motivational score was 12 (maximum score25). There was no significant difference in scores according to respondents' demographic characteristics.

CONCLUSION

Student perception about small group effectiveness was positive. Since most medical schools worldwide already have or are introducing PBL as a learning modality, the Tutorial Group Effectiveness Instrument can provide valuable information about small group functioning during PBL sessions.

Pharmacovigilance Knowledge among Patients at a Teaching Hospital in Lalitpur District, Nepal

BACKGROUND

Consumer's knowledge and perception towards adverse drug reactions (ADR) can play an important role in ensuring a healthy lifestyle and proper use of medicines.

AIMS

This study aimed to assess the knowledge and perception towards pharma covigilance in general and consumer pharmacovigilance in particular among out patients in a teaching hospital of Nepal.

SETTINGS AND DESIGN

A descriptive cross-sectional study using qualitative and quantitative methods was carried out from 1(st) May to 3 June 2013.

METHODS

Every fifth patient visiting the outpatient pharmacy was interviewed using a semi-structured questionnaire. Gender, age, educational qualification, profession and ethnicity were noted. Twenty-three patients were interviewed.

RESULTS

There were 10 males and 13 females. The age of the respondents ranged from 11 to 50 years with a mean age of 27.8 (SD = 5.61) years. Seven (30.43%) respondents were students studying in different levels. Thirteen (56.52%) participants were from the Newar community. Majority of the patients (86.95%) knew ADRs may be caused by the medicines they consume and 18 (78.26%) were of the opinion that ADRs should be reported to doctors and other health care professionals including pharmacists.

CONCLUSION

Knowledge and perception were low in certain areas. There is a need for educational interventions for improving the awareness of patients and general public for ensuring medicine safety and promoting rational use of medicines.