Introducing Clinical Pathology Course to Fourth Year Medical Students as a Bridge between Pre-clinical and Clinical Medical Sciences

There isn't any vertical integration of pre-clinical and clinical sciences subjects in the existing Kathmandu University MBBS curriculum. Many of the graduates are not able to correlate the clinico-pathological aspects of various diseases as a result the rational use of investigations for diagnosing various diseases is compromised. There are few published examples of implementation of pathology instruction courses during the clinical years of medical training but it is not universally practiced. This lack of exposure to pathology may lead to poor understanding of laboratory testing and the role of pathologists in patient care. To set and implement an exemplary vertical integration of pre-clinical science with clinical science. A 12 credit hours clinical pathology education course comprising clinical hematology, cytopathology and histopathology was developed. Students belonging from the ongoing fourth year MBBS course of Birat Medical College were enrolled in the course. All of the interactive lecture sessions were delivered via an e-learning interface, using the Zoom platform as the main teaching methods. Evaluation of students' achievement of learning objectives was conducted through distributing pre and post-test online multiple-choice questionnaires. Chi-square tests were used to compare the variables between pre-test and post-test questionnaire responses. Results suggested that the designed clinical pathology course is valuable. The pretest and post-test questionnaire responses revealed the positive impact regarding the importance of introducing clinical pathology courses within the clinical year of MBBS undergraduate curriculum. Response rate to the online session was 100%. The point of agreement between the pre-test and post-test questionnaire responses were highly achieved after intervention of the clinical pathology course. A statistically significant result (p < 0.05) between all of the pre-test and post-test questionnaire responses was noted. There was a strong positive recommendation for incorporating clinical laboratory medicine courses within the MBBS clinical science curriculum. The improvement observed among fourth-year MBBS students on learning the importance of clinical pathology courses was encouraging. This experience thus contributed to set and implement an exemplary vertical integration of pre-clinical science with clinical science.

Cytomorphological study of palpable breast lumps

Background: Breast lump is a very common clinical presentation for which fine needle aspiration cytology is often sought for. Because of it’s significant diagnositic value, FNAC has become a routine tool in the evaluation of the nature of the lesion. The objective of this study was to determine the cytomorphological patterns of breast lump in eastern part of Nepal among individuals attending Nobel Medical College. Materials and Methods: This was a retrospective descriptive study done in department of pathology from December 2012 to June 2015. All individuals presenting with breast lumps was included in this study. FNAC was done as per standard procedure and categorized as per United Kingdom National Health Survey Breast Screening Programme (UK-NHS-BSP) categories and further also categorized in to neoplastic and non-neolastic categories. Results: We studied 771 cases of breast lumps. Occurrence of breast lump was more common in female (97.4%). Neoplastic lesions accounted for 84.1% of cases out of which benign comprised of 94.6% and malignant comprised of 5.6%. Common benign lesions observed were that of fibroadenona (264) and fibrocystic changes (204). Ductal carcinoma was the most common malignant lesions. All malignant lesions were observed in older age and female sex population.Conclusion: Most of the cases of breast lumps are benign in nature and very few accounted for malignant cases. There is predominance of benign lesions in young age and increased malignancy in older age and female population. 

Study on developmental-behavioural pediatrics training experiences of pediatricians and pediatric trainees working in Nepal

BACKGROUND

There are growing concerns about developmental, behavioural, social and emotional wellbeing of children throughout the world. A huge gap exists between the instructions provided on medical disciplines and on areas of Developmental-Behavioural Pediatrics (DBP) during pediatric training in our region.

OBJECTIVE

This study aims to evaluate the Developmental-Behavioural pediatrics (DBP) training experiences of pediatricians and pediatric trainees during their post graduate training in pediatrics.

METHODS

Questionnaires were sent to the pediatricians / trainees and data was analyzed using SPSS software.

RESULT

More than 56 % of respondents were satisfied in 10 out of 11 medical disciplines whereas more than 56% were unsatisfied in 10 out of 11 developmental behavioural pediatrics disciplines. This study has demonstrated that between 50-60 % of pediatricians did not see the cases of ADHD, learning difficulty and family dysfunction for a period of three months prior to the survey which are relatively common conditions. Even in post graduate training nearly 66 % of pediatricians were unsatisfied with their instructions in DB pediatrics.

CONCLUSION

Pediatricians working in Nepal have difficulties in addressing the issues of developmental pediatrics, raising a question about the need to review the curriculum of post graduate training in Pediatrics.