Indian Medical Graduate Research Articles

Teaching the Indian Medical Graduates “Empathetic Communication Skills” Toward Cancer Patients and Their Family Donors

Teaching the Indian Medical Graduates “Empathetic Communication Skills” Toward Cancer Patients and Their Family Donors

Perception of 2nd year MBBS students about online zoom classes during COVID-19 pandemic: A questionnaire-based study

Progress is impossible without change, and those who cannot change their minds cannot change anything” by George Bernard Shaw. Using Zoom technology to deliver lecture, connect students and enable anytime, anyplace learning is increasing in COVID-19 pandemic, however keeping students engaged in online learning is difficult in medical education. The study aimed to determine the student's perception regarding online classes in Forensic medicine. We used zoom video lectures which can be accessed by students from anywhere. The study was conducted at Mayo Institute of Medical Sciences, Barabanki. It is a cross-sectional questionnairebased study. Analysis was done on percentage wise distribution of various parameters used. The study was conducted among 152 study participants, out of which 82(53.95%) were male and 70(46.06%) were female. Majority of the study participants 95(62.5%) felt online classes help them in understanding the topic adequately. 120(78.9%) respondants perceived that only teacher talks during online classes.140(92.1%) respondents feel major limitation of online class is in regard to practicals. Overall opinion of majority of participants is positive and in favour of online classes to avoid exposure to COVID -19 pandemic. However, practical/clinical exposure will have to be ensured in the training of Indian medical graduates. Normally student's perception regarding online zoom classes in forensic medicine was determined to be positive. Practical class learning is indispensible in medical education, which will have to be incorporated as situation permit.

Blueprint for summative theory assessment in pharmacology - A tool to increase the validity as per the new competency based medical education

Background: Constructing blueprint for assessment is an important approach evolving today and being emphasized to assess the medical students. It is necessary that the items in the question paper should match the course and a proportional weightage should be given to each competency of the curriculum with respect to its domain and clinical relevance. Aim and Objectives: The aim of the study was to prepare test blueprints for 2nd year medical undergraduate syllabus of Pharmacology papers – Paper I and Paper II. Materials and Methods: This study was carried out in the Pharmacology Department of Geetanjali Medical College, Udaipur. All the competencies based on the knowledge domain of the 2nd-year medical undergraduate curriculum for the Indian medical graduate were divided into two parts for theory paper I and paper II of pharmacology. Each competency or its subdivision was given pharmacological and clinical importance from score 1 to 3 and weightage was calculated for each competency. After devising both the blueprints, they were sent by email for validation by the peers and experts in the field of pharmacology. Results: Two final blueprints were prepared each for Papers I and II for summative theory assessment in pharmacology. General pharmacology carried the maximum weightage in Paper I which was found to be 30 marks out of 100 followed by 16 marks for central nervous system. In Paper II weightage of antimicrobial drugs was highest, that is, 35 marks followed by hormonal and related drugs which was 21 marks out of 100. Conclusion: Blueprints should be executed as an essential part of preparing the theory papers for all subjects. The blueprints should be periodically reviewed by the experts in the field and redesigned as per the changes in the curriculum.

A study on effective use of technology in training first MBBS students for foundation course during pandemic era

Background: Medical education in India is being revolutionized with the introduction of “Competency-based undergraduate curriculum” for an Indian Medical Graduate. It demands great commitment, flexibility to adopt to changes, and lifelong learning. For this, 1 month foundation course was introduced across the country. Unfortunately, the pandemic had cast its shadow on a conduct of this very pertinent foundation course at a classical offline mode and made a shift to online learning inevitable. Aim and Objectives: The aim of the study was to study how the use of technology can result in effective delivery of course content through feedback analysis and online objective assessment. Materials and Methods: Feedback from the students was obtained employing a predesigned questionnaire mailed to them using Google forms and online objective assessment was also conducted after the end of the course. Results: The majority of the students felt that the topics selected were absolutely essential for the medical profession and scored fairly well in the assessment. Conclusion: The results of the present indicate that there was not much difference in students perception about the foundation course whether covered through online or offline mode suggesting a blended learning format to be a useful teaching learning method during the post-pandemic phase.

Has National Medical Commission Short-Changed the Subject of Community Medicine in Its Latest Minimum Requirements for Indian Medical Graduates? A Systems Review.

System analysis is examination of various elements of a system with a view to ascertain whether the proposed solution to a problem will fit the system and in turn effect an overall improvement in the system. The National Medical Commission (NMC) which was constituted by the act of the Parliament, has brought out minimum requirements for annual MBBS admissions regulations, 2020, which replace minimum requirements published by erstwhile Medical Council of India. The NMC also published new competency-based medical education syllabus for MBBS students with an aim to focus on practical skills. This study brings out the scope of the community medicine (CM) in the present context and as envisaged by the NMC. It also analyzes the infrastructure and workforce required in the department of CM and gives recommendations to improve the system.

Health Management Training of UGs- A Missed Opportunity!

The objectives of UGs medical education have been clearly defined. At the end of undergraduate program, the Indian Medical graduate should be able to recognize “ Health for All” as a national goal, learn every aspect of national policies on health, achieve competency in holistic medicine, develop scientific temper and observe medical ethics. In consonance with the national goals, each medical institution should evolve institutional goals to define the kind of trained manpower they intend to produce. The indian medical graduates coming out of medical colleges be familiar with the basic factors which are essential for the implementation of national health programs, acquire basic management skills in the area of human resources, material and resource management related to health care delivery system, general and hospital management, principal inventory skills and counselling.

Indian Medical Graduate (IMG) as a communicator

Indian Medical Graduate (IMG) as a communicator - JETHS- Print ISSN No: - 2454-4396 Online ISSN No:- 2393-8005 Article DOI No:- 10.18231/j.jeths.2020.018, Journal of Education Technology in Health Sciences-J Educ Technol Health Sci

Developing Humanistic Competencies Within the Competency-Based Curriculum

We herein, describe the rationale, content, methodology and evaluation of a health humanities module in the new competency-based curriculum, and share our experience of the same. Providing training in health humanities to the healthcare trainees will definitely go a long way in having a professional and responsive Indian medical graduate, who is able to provide empathetic and holistic healthcare to all sections of the society.

Feedback on foundation course curriculum from the new Indian medical graduates

Introduction: Foundation course is one of the new curricula Medical council of India implemented for the present academic course at the beginning of the MBBS program It is a month duration where all the students should undergo this foundation course. In this course, students were sensitized to a new professional environment which is going to help them in their career as a medical profession. The purpose of the course is to orient the students in all aspects of the medical college environment, equipping them with certain basic skills required for patient care, enhancing their communication, language and computer and learning skills. Sports and extracurricular activities are also given importance in the foundation course. The present study was an attempt to take responses in the form of feedback by the students with regards to the foundation course. Methods: It was a cross-sectional study. Institutional ethical clearance was taken before the start of the study. After taking consent from the students, the data was collected using self-administered, semi-structured questionnaires. The feedback form with the foundation course was e-mailed to all the newly joined first year students of Bijapur Lingayat District Educational (Deemed to be University) Shri.B.M.Patil Medical College hospital & Research Centre. Karanataka, India. Results: The majority of students said implementation of the foundation course for Indian medical graduate was good, but the duration of the course was lengthy. Conclusion: The study makes it evident that the foundation course introduced at the commencement of the MBBS programme is important for medical undergraduates to acquire basic skills in the medical profession.

Flipped jigsaw activity as a small group peer-assisted teaching learning tool in Biochemistry Department among Indian Medical Graduate: An experimental study.

Medical council of India has made remarkable modifications in the curriculum of medical students after a long period of more than 20 years with regulations on Graduate Medical Education 1997. Innovative and interactive teaching methods have taken center place in the implementation of the new curriculum nationwide. Small group teaching and problem-assisted learning have brought a paradigm shift in biochemistry teaching, which was earlier teacher cantered and was taught by only didactic lectures due to which biochemistry was considered a boring and dry subject. The present interventional study was conducted in the Department of Biochemistry, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi. All the students of MBBS first professional Batch 2018-2019 were enrolled in the present study. After sensitizing the faculty and students regarding jigsaw method of learning, it was undertaken in two different batches on 4 different days, with faculty and senior residents acting as facilitators. The groups were named according to rainbow colors. The topics were taught by power point presentation before the conduction of jigsaw activity that was discussed in form of seven clinical cases. Post jigsaw, a prevalidated feedback questionnaire was filled by the students. The faculty and senior residents gave a constructive feedback via focused group discussion. In our study 100% students opined that teaching and being taught by peers was beneficial in enhancing the in depth knowledge of the topic. Ninety-two percent students opined jigsaw learning helpful in promoting self-directed learning in the student, whereas 88.5% students felt that this teaching learning tool to be made a the regular part of the curriculum. Jigsaw groups create many opportunities for creative interchange of ideas and lively and meaningful participations. But due to limitation of time and logistics, it can be used in conjunction with routine methods of learning.

DO WE NEED ETHICS? – II MBBS STUDENTS PERCEPTIONS IN LEARNING MEDICAL ETHICS.

Back ground: An Indian Medical Graduate is expected to have knowledge & acquire competencies during his formal medical course, but an understanding of professional values and ethical conduct is essential for fostering the development of a good doctor.The two major aspects of teaching medical ethics include explicit teaching of cognitive base and stage appropriate opportunities for experiential learning and reflection throughout the curriculum.
 Material and Methods: It is a classroom based intervention study involving 150 second MBBS students. Self administered, semi-structured questionnaire was devised for this study. The questionnaire consisted of two parts- students perception towards learning medical ethics and their perception on statements of ethical issues which was graded on a 5 point Likert scale. An interactive lecture was done followed by which students were divided into 6 groups and case based discussions were done. Finally reflective narration was done.Statistical analysis was done by EPI Info Software. Results were expressed in mean, standard deviation and paired ‘t’ test was done.
 Results: The mean pre-test & post-test score of the students towards learning medical ethics in current curriculum were 2.86 and 3.98 respectively. The mean pre-test and post-test score of students regarding statements on ethical issues were 2.82 & 3.92 respectively.
 Conclusion: Medical ethics is one of the neglected topics in healthcare. To strengthen ethical reasoning and judgment in decision making, we need to expose students to various ethical scenarios based on which debates, seminars, interactive workshops can be conducted utilizing the work experience of multidisciplinary medical expertise.
 Keywords: Medical ethics, Medical practice, Students

Prevalence and Correlates of Burnout among Undergraduate Medical Students - A Cross-sectional Survey.

Background:Burnout among medical students is important for its prevalence, consequences, and modifiable risk factors. Although there are studies on the topic across the globe, Indian studies are few in number. A prevalence estimate of burnout and its determinants among Indian medical graduates will keep us informed about the emotional and motivational factors hindering their professional growth.Methods:From a total of 500 students spanning 5 professional years, data could be collected from 375 students. The study used a questionnaire primarily consisting of “personal burnout” domain of the Copenhagen Burnout Inventory (CBI), which is a validated instrument to assess the burnout at a cutoff score of 50. The questionnaire also included a set of potential personal correlates of burnout. In addition to summary statistics, both univariate and multivariate analyses were used for discerning the relationship of these correlates with burnout.Results:The prevalence of burnout among medical students in the college under study was 48.5% (95% confidence interval 43.4–53.7). The proportions of moderate, higher, and severe burnout were 44.8%, 3.2%, and 0.5% respectively. Univariate and multivariate analyses revealed that female gender and perceived stress were associated with burnout. Choosing medicine by one's own choice and maintaining hobbies and interests were associated with less chance for burnout.Conclusion:Burnout is a prevalent phenomenon among medical students. There are modifiable risk factors for burnout and addressing them will help in training a medical student with high motivation and professionalism.

Introduction of Early Clinical Exposure(ECE) in 1st year M.B.B.S Students in the Department of Physiology

Background: Medical council of India regulations on Graduate Medical education 2012 states that “Indian Medical Graduate should possess requisite knowledge, skills, attitudes, values and responsiveness, so that he or she may function appropriately and effectively as a physician of the community while being globally relevant”1.
 Early Clinical exposure (ECE) is a teaching learning methodology, which orients medical students towards actual clinical scenarios and helps them correlate their theoretical knowledge with real life situations in the first year of medical college.
 Methodology: The project was done in the department of physiology at PIMS Medical College, Jalandhar. The ECE program was used as a supplement to the traditional lectures in Nervous System Physiology. One hundred and fifty (150) first year MBBS students participated in early clinical exposure program conducted in the year 2017–18. A Feedback questionnaire (including both open and closed ended questions), after getting validated by the faculty were filled by the students. Students were also encouraged to give their written open comments anonymously.
 Post session feedback from the students was taken by Questionnaire graded on Likert’s scale.
 Results: All the students commented that ECE helped them in their understanding of Nervous system Physiology. Most (63%) appreciated the synchronization of classroom knowledge with clinical exposures, and thought that integrated teaching helped in better understanding of practical applications of physiology (65%)

Are our Indian medical graduates equipped and informed to handle end of life dilemmas?

Introduction: Euthanasia stands as the much debated, controversial and legally questionable end of life dilemma encountered by health care professionals globally. In India, currently active euthanasia has been debated for granting legal sanction. Yet, the health care professionals especially the medical graduates were not exposed to these ethical end of life dilemmas in their formative years. This scenario calls for an analysis into their understanding of this issue, how they want to handle such dilemmas and whether they had adequate exposure and training to handle such end of life dilemmas in their curriculum. Methodology: A questionnaire with three segments of 9, 5and 6 questions each was administered to 100 medical graduates who were enrolled voluntarily for this study. The collected data were analysed by descriptive statistics. Results: Only 53% showed awareness about euthanasia. Among them only 17% among were aware of physician assisted death. The third year graduates had finite idea about this concept among all years studied. The study found that the medical graduates wanted legalisation of euthanasia. Only 37% opined that if legalised they might administer if needed on their patients. Personal belief was cited as the primary reason for hesitancy to administer euthanasia. Less than 50% only were aware of right of the patient to decide to have euthanasia. Majority reported that the duration allotted for formal teaching of these were minimal and restricted to only second professional year. Conclusion: End of life ethical dilemmas do exist and this study pointed the clear gap in understanding, implementation of medical graduates about these concepts. The study stresses the need for exposing the medical graduates to these bioethical concepts in their curriculum in a more active way. Keywords: Euthanasia, Physician assisted death.

Preferred online teaching and assessment methods among Indian medical graduates in coronavirus disease era

Background: The coronavirus disease (COVID)-19 pandemic triggers a change in the medical teaching and learning program from the classical didactic classroom lecture to the modern online method for preventing the spread of the coronavirus and preserving social distancing. Aim and Objective: The aim of the study was to investigate the preferences and applications of different online teaching and assessment methods for Indian medical graduates (IMG). Materials and Methods: A total of 310 MBBS 1st year (Phase-1) students were included in this questionnaire-based cross-sectional analysis after the preparation of the question with the aid of Google forms. Some questions were supported by yes or no answers. Other questions were such as multiple-choice question (MCQs), in which students can choose more than one option. Google forms have been given to IMG of medical colleges. Consent should be drawn from all MBBS students interested in the research. Results: PPT with voice recording is the most preferred (54.8%) online teaching method and MCQ based assessment by Google form is the most preferred (81%) online assessment method among IMG. About 76.1% of students feel comfortable with 30–60 min of online lectures and are mostly (58%) satisfied with their home environment for online teaching and learning. With all the pros and cons, 84.5% of students still say that traditional face-to-face teaching is more effective compared to the new online method. Conclusion: Our study concludes that online teaching is in need of a COVID-19 pandemic era, but cannot replace the efficacy of conventional face-to-face classroom teaching with a modern online method due to more engagement and feedback between teachers and students.

The power of subjectivity in competency-based assessment.

With the introduction of competency-based undergraduate curriculum in India, a paradigm shift in the assessment methods and tools will be the need of the hour. Competencies are complex combinations of various attributes, many of which being not assessable by objective methods. Assessment of affective and communication domains has always been neglected for want of objective methods. Areas like professionalism, ethics, altruism, and communication—so vital for being an Indian Medical Graduate, can be assessed longitudinally applying subjective means only. Though subjectivity has often been questioned as being biased, it has been proven time and again that a subjective assessment in expert hands gives comparable results as that of any objective assessment. By insisting on objectivity, we may compromise the validity of the assessment and deprive the students of enriched subjective feedback and judgement also. This review highlights the importance of subjective assessment in competency-based assessment and ways and means of improving the rigor of subjective assessment, with particular emphasis on the development and use of rubrics.

Disability-inclusive compassionate care: Disability competencies for an Indian Medical Graduate.

The new curriculum of the Medical Council of India (MCI) lacks disability-related competencies. This further involves the risk of perpetuating the medicalization of diverse human experiences and many medical students may graduate with little to no exposure to the principles of disability-inclusive compassionate care. Taking into consideration the UN Convention, the Rights of Persons with Disabilities, Act 2016, and by involving the three key stakeholders – disability rights activists, doctors with disabilities, and health profession educators – in the focus group discussions, 52 disability competencies were framed under the five roles of an Indian Medical Graduate (IMG) as prescribed by the MCI. Based on feedback from other stakeholders all over India, the competencies were further refined into 27 disability competencies (clinician: 9; leader: 4; communicator: 5; lifelong learner: 5; and professional: 4) which the stakeholders felt should be demonstrated by health professionals while they care for patients with disabilities. The competencies are based on the human rights approach to disability and are also aligned with the competencies defined by accreditation boards in the US and in Canada. The paper describes the approach used in the framing of these competencies, and how parts of these were ultimately included in the new competency-based medical education curriculum in India.

Predictors of high achievers in Indian medical undergraduates: Association with emotional intelligence and perceived stress.

BACKGROUND:Today's Bachelor in Medicine, Bachelor in Surgery (MBBS) students will become Indian Medical Graduates in future. Emotional intelligence (EI) is an essential component in the making of an Indian Medical Graduate. There is increasing stress during medical training. The study was conducted to compare the association of EI score and perceived stress scale (PSS) among average and excellent undergraduate medical students. The secondary objective was to find the predictors of excellent academic performance.MATERIALS AND METHODS:This descriptive cross-sectional study was conducted after institutional ethics committee approval. All 522 consented students studying in 2nd, 4th, 7th, and 9th semesters filled up established pre-validated questionnaires ; Schutteself report EI test and Cohen's perceived stress scale. Sociodemographic details of the respondents were collected. Average attendance and marks of previous semester examinations of all included students were collected from academic cell of the institution. All students were grouped into three groups: average, good, and excellent performers from the marks collected. Comparison of EI scores and PSS scores was done between students in excellent and average groups using unpaired t-test.RESULTS:Of the 94.9% of respondents, 78.2% of the students were included in the study. The mean EI and PSS scores were 123 ± 14.5 and 22.8 ± 13.9, respectively. There was no statistically significant difference in EI scores between average and excellent performers ([123.8 ± 18.7] vs. [127.7 ± 16]; P – 0.089). Perceived stress was lower in excellent performers ([20.9 ± 11.1] vs. [24.8 ± 15.0]; P – 0.01). EI was associated with better performance in clinical year students. EI was negatively correlated to perceived stress.CONCLUSION:Our study provides predictors of excellent academic performances among Indian medical undergraduates. This study suggests introduction of extracurricular activities in ongoing undergraduate curricular syllabus. It imparts awareness among students about the importance of attending classes. This study bestows higher EI and lower perceived stress to better academic performance.

COVID-19 pandemic highlights the need to reconsider psychiatry training of Indian medical graduate

In the middle of COVID-19 crisis in India and the psychological impact on millions of peoples, is it time to reconsider psychiatry training for Indian medical graduate under the new competency-based curriculum? India has one of the highest numbers of medical colleges in the world and also has over a million doctors, including MBBS graduates working at the primary health-care centers who are important pillars for health-care delivery. In a major drawback that also plagued the earlier curriculum, the new competency-based curriculum has not incorporated a single mandatory skill in psychiatry which a medical trainee has to demonstrate to become doctor. Mental health and the COVID-19 pandemic are interlinked in a complex manner. Hence, millions are likely to have mental health consequences. With no skill required in psychiatry as a must for a medical trainee to become an MBBS doctor, the mental health services during or aftermath of a disaster are severely compromised and need urgent reconsideration under the new curriculum.

Implementation of rational drug therapy teaching learning module via project work in second year undergraduate medical students

Introduction: Teaching rational drug therapy (RDT) to future Indian medical graduates is important and forms a core area of pharmacology. Objectives: To develop and implement RDT teaching module and to evaluate its effectiveness in second year undergraduate students. To evaluate its impact on the knowledge and reasoning skills of students via their ability to perform prescription audit of real-life prescriptions. To obtain feedback from students and faculty regarding the RDT module. Methods: A pre-test on core concepts of RDT was taken. RDT concepts were taught in the form of interactive lectures followed by project work involving two components; OPD component and ward component. Totally, 40 students collected four prescriptions each from OPDs from major specialities for prescription audit by preset criteria. One indoor patient per student was selected from wards. This patient was followed from admission till discharge. The students prepared a write up on rationality of treatment taking help of faculty. This was called the project. Evaluation of this project was done on preset criteria involving presentation, content and viva voce from a total of 100 marks. This was followed by post-test. Results: There was a 352% gain in students’ knowledge and reasoning skills based on pre- and post-test scores. P-value was < 0.001 on the basis of paired T test. More than 95% students felt there was gain in knowledge and it was useful. Conclusion: Involving students in learning RDT concepts via project work had an impact on their knowledge and reasoning skills.