Basic Medical Sciences Research Articles

Relationship between depression and lifestyle factors in Chinese adults using multi-level generalized estimation equation model.

Relationship between depression and lifestyle factors in Chinese adults using multi-level generalized estimation equation model.

The Maslach Burnout Inventory-Student Version's Factorial Structure and Cross-Cultural Validity in a Nigerian University.

The Maslach Burnout Inventory (MBI) is the most widely accepted tool for assessing burnout among students worldwide. However, no studies have yet tested the validity of the student version of the MBI in Nigeria. The study aimed to assess the factorial structure and cross-cultural validity of the Maslach Burnout Inventory-Student Version MBI-GS (S) in a Nigerian university. An online cross-sectional study was conducted among 536 undergraduate students from three departments in the Faculty of Basic Medical Science at a Nigerian university. Data were collected using MBI-GS (S) and a confirmatory factor analysis was performed to explore its factor structure. The results revealed that the three-factor, 15-item structure of the MBI-GS (S) demonstrated a valid factorial structure among Nigerian undergraduate students, evidenced by the extraction of three components with eigen values exceeding 1, accounting for 73.7% of the variance, in line with the three-factor structure of the original MBI. The internal consistency of the questionnaire was high, with a Cronbach's alpha value of 0.901. The Cronbach's alpha for emotional exhaustion, cynicism, and academic efficacy were 0.901, 0.841, and 0.941, respectively. A weak negative correlation was observed between emotional exhaustion and cynicism, and a moderate negative correlation was found between emotional exhaustion and academic efficacy, and cynicism and academic efficacy. These findings suggest that the MBI-GS (S) is a reliable tool for assessing burnout levels among Nigerian university students. They provide strong evidence for the factorial validity and reliability of the MBI-GS (S), supporting its cross-cultural validation for assessing burnout.

Nasal mucosa is much more susceptible than oral mucosa to infection of SARS‐CoV‐2 Omicron subvariants: Wearing nasal masks where facial masks cannot be used

we analyzed airway tissue tropism of SARS-CoV-2 and found that the nasal mucosa is much more susceptible than oral mucosa to infection of SARS-CoV-2 Omicron variant and subvariants, suggesting the importance of protecting nasal epithelium from Omicron variant infection. We have designed a bifunctional mask that can be used as a facial mask under regular conditions and a nasal mask in some settings (e.g., eating and drinking) where facial mask cannot be used This article is protected by copyright. All rights reserved.

Endometriosis Increases the Risk of Stroke: A Mendelian Randomization Study.

HomeStrokeVol. 54, No. 2Endometriosis Increases the Risk of Stroke: A Mendelian Randomization Study No AccessResearch ArticleRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialNo AccessResearch ArticleRequest AccessFull TextEndometriosis Increases the Risk of Stroke: A Mendelian Randomization Study Ming Zheng and Shaoping Zheng Ming ZhengMing Zheng Correspondence to: Ming Zheng, MD, PhD, Institute of Military Cognition and Brain Sciences, Academy of Military Medical Sciences, 27 Taiping Rd, Beijing 100850, China. Email E-mail Address: [email protected] or E-mail Address: [email protected] https://orcid.org/0000-0002-3651-7701 Institute of Military Cognition and Brain Sciences, Academy of Military Medical Sciences, Beijing, China (M.Z.). Beijing Institute of Basic Medical Sciences, China (M.Z.). *M. Zheng and S. Zheng contributed equally. Search for more papers by this author and Shaoping ZhengShaoping Zheng https://orcid.org/0000-0002-3544-0431 Departments of Obstetrics and Gynecology, Fuzhou General Hospital, Fujian, China (S.Z.). *M. Zheng and S. Zheng contributed equally. Search for more papers by this author Originally published23 Jan 2023https://doi.org/10.1161/STROKEAHA.122.041163Stroke. 2023;54:e30–e33AbstractDownload figureDownload PowerPointFootnotes*M. Zheng and S. Zheng contributed equally.For Sources of Funding and Disclosures, see page e32.Supplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.122.041163.Correspondence to: Ming Zheng, MD, PhD, Institute of Military Cognition and Brain Sciences, Academy of Military Medical Sciences, 27 Taiping Rd, Beijing 100850, China. Email [email protected]edu.cn or [email protected]com

Perception of medical students to “NEW NORMAL” and its Reflection on their studies during COVID 19.

Objective: To find the effectiveness of online teaching and its reflection on their academics during COVID19 pandemic in basic medical science. Study Design: Cross Sectional Descriptive study. Setting: University Medical and Dental College, Faisalabad. Period: March 2019 to November 2021. Material & Methods: A total of 531 undergraduate MBBS & BDS (1st & 2nd year) students were included. A questionnaire was designed and shared online in Google classroom to get students’ feedback. The data obtained was analyzed on SPSS 25 by using ANOVA and Chi-Square Tests. Results: 62.76% students declared that learning in physical classrooms is more understandable than e-learning, while 58% students were satisfied with this transformation of online teaching and secured better grades in e- assessments, while 69% students agreed with the fact that on campus assessment is more productive. According to our results 68.24% students preferred physical teaching and assessment methodology and 67.11% students agreed that team work with peers is more productive in on campus classes than e-classes. Conclusion: We investigated various aspects of e-learning experience of medical students and found a mixed opinion. By improving our infrastructure and using modern techniques we can make online medical education system more effective and productive for our students in future.

Meet the First Authors.

Meet the First Authors.

Blending Old and New Teaching Methods and Tools in Medical Education

OBJECTIVES To identify a preference for current teaching methods and use new teaching aids through feedback by medical students and teachers of first and second-year MBBS. METHODOLOGY This cross-sectional study was conducted on 91 MBBS students and teachers of Nowshera Medical College (NMC), Nowshera. Both male and female students and teachers of NMC of class first and second-year MBBS participated in the study. A feedback proforma-based questionnaire was filled out by all the participants online using Google forms. Participants were given the option to select more than one option in the case of the mode of teaching and tool of teaching. The data was collected, analyzed and presented in tabular and graphical forms using SPSS version 23. RESULTS Out of the 91 participants who responded to our research, 45 (49.5%) were males, and 46(50.5%) were female. The majority, 74 (81.3%), were MBBS students, while 17(18.7%) were MBBS teachers. Most of the participants selected more than one option. Most 48(52.7%) of the participants preferred lectures as the mode of delivery while 35(38.4%) opted for SGD, for demonstrations 14(15.3%), PBL 33(36.2%), assignments 13(14.2%0 and notes opted by 4(4.39%). 60.4% (55) were selected to use whiteboards and markers. Only 15.3% (14) were in favour of Powerpoint use, dissection 25(27.4%), models 29(31.86%), and figures 11(12%). CONCLUSION Lectures remain the most preferred teaching method in basic medical sciences among teachers and students, along with other teaching methods. Multiple teaching tools must be used during the class instead of solely depending on Powerpoint presentations.

Virtual Learning and Undergraduate Students’ Academic Achievement in Mathematics During Covid-19 Lockdown in Ibadan, Oyo State

This paper investigated Virtual Learning and Undergraduate Students’ Academic Achievement in Mathematics during Covid-19 Lockdown in Ibadan, Oyo State. The study adopted One-group pretest-posttest Quasi-Experimental design. The population for this study was two hundred and eighty (280) First-year students in the faculty of Basic Medical and Applied Science, Lead City University, Ibadan, Nigeria. Sample for the study comprised Fifty (50) students who participated in the virtual learning in Applied Mathematics coded MTH 112 during COVID-19 Lockdown. The instrument for the study was Forty (40) objective questions optioned A to D on Applied Mathematics Achievement Test (AMAT). The instrument was validated and tested for reliability with reliability coefficients of 0.71. Student t-test statistics was used to test the Hypotheses generated at 0.05 level of significance. Hypothesis one revealed a significant difference in the achievement of students in Applied Mathematics when exposed to virtual learning, t-calculated (21.328) was greater than t-table (1.985). Hence hypothesis one was rejected. Hypothesis two also revealed a significant difference in the achievement of male and female students in Applied Mathematics in favour of male students, t-calculated (20.050) was higher than t-table (2.011). This infers that the male students achieved better than female students in AMAT when exposed to virtual learning. Hence, hypothesis two was also rejected. The study concluded that, Virtual learning encourages students’ achievement in Applied Mathematics and recommended virtual learning to be adopted especially where physical classroom is constrained.

Association of Thyroid Dysfunction with Unexplained Infertility in Women of Karachi Pakistan

Background: Thyroid autoimmunity and thyroid dysfunction is predominant in women of procreative age and has been linked with hostile fertility. Objective: To evaluate the association of thyroid dysfunction with unexplained infertility (UI). Material and Methods: A case-control study was performed by the department of Physiology Basic Medical Sciences Institute in collaboration with Jinnah Postgraduate Medical Centre, Karachi from May 2018 to June 2019. A sample size of 88 subjects; Group A (44 healthy fertile controls) and Group B (44 UI women) was calculated. Study variables included height, weight, body mass index, serum Triiodothyronine (T3), Thyroxine (T4), Thyroid-stimulating Hormone (TSH), Thyroid Binding Globulin (TBG), and Anti-thyroid peroxidase antibody (Anti -TPO). Results: UI females had high TSH concentration without any disturbance in T3 and T4 in comparison with controls, 40% of women with UI had TSH levels higher than 2.5 mIU/L as compared to 4% in controls. The mean TSH was 2.47±1.97mIU/L in UI females as compared to 1.10±2.14 mIU/L in controls. Both logistic regression models adjusted for age and body mass index showed that fertile controls were significantly less likely to be found with higher TSH (aOR=0.71, 95% CI: 0.52-0.98, p=0.040) and TBG (aOR=088, 95% CI: 0.81-0.95, p=0.002) as compared to females with UI. Conclusion: Minimal deviation of TSH (increased), raised anti-thyroid antibodies with slightly low T3 and T4 levels was observed in UI females. Mild variations in TSH within the normal range may contribute to some cases of UI therefore a direct need for thyroid profile assessment in all infertile females is recommended.

9thEmirati-German Congress in Medicine and Dental Medicine 21–22 November 2022 University of Sharjah, United Arab Emirates

The 9th Emirati-German Conference was hosted by the University of Sharjah, United Arab Emirates during 21–22 November 2022. A host of eminent scholars, researchers, physicians, and health-care professionals presented their innovative work across a wide range of medical disciplines including basic medical sciences, clinical sciences, and dental medicine. The format of the conference was a hybrid design with face-to-face sessions in the medical campus of the University of Sharjah. This event provided an excellent opportunity to all health-care professionals in the related medical, dental and allied health fields to upgrade their current knowledge and to network with the world-renowned scientists from the University of Sharjah, Academic Reinbek Hospital Hamburg, University of Lubeck Germany, and several other speakers from UAE. OBJECTIVES The main theme of this conference was cancer. The key objectives of this conference were: To identify best practices in different cancer types including colorectal, hepatobiliary, breast, central nervous systems, and othersTo provide a forum for a broad debate about cancer etiology, prevention, and early detection of common cancers for a better clinical outcomeTo understand diagnostic modalities, treatment strategies, surveillance, palliative care, and research on common cancersTo demonstrate key approaches to identify, prioritize, and address major cancers with a substantial burden on health-care systemsTo establish or re-establish and strengthen networks between those working in all stages of the cancer continuum in the MENA region and the European perspectives.

An Estimation of Haemoglobin Variants Among Patients Attending A Tertiary Hospital In South West Nigeria

Background: Globally, hemoglobinopathies, which are genetic diseases of hemoglobin production, are a major cause of morbidity and mortality. African communities make up a sizable portion of the population that is susceptible to a variety of erythrocyte genetic and homological illnesses. Aim: The aim of this study is to investigate the prevalence and spectrum of hemoglobin variants among patients attending a tertiary hospital in South West Nigeria. Materials and Methods: The study research was conducted at the University of Medical Sciences Teaching Hospital, Ondo State Southwest Nigeria. Respondents were recruited from the hospital department clinics and tested at Department of Haematology, Faculty of basic medical science. Blood will be drawn via venipuncture into tubes that had been treated with the anticoagulant ethylene diamine tetracetic acid (EDTA) Results: The study show the frequency and gender distribution of different forms of haemoglobin (Hb) among the subjects; Hb AA 264; HbAS 60; HbAC 6; HbSC 8 and HbSS 12. Of the 350 subjects studied, 106 were males, while 244 were females. Among the male subjects, 85 were HbAA, 12 were HbAS; 2 were HbAC; 3 were HbSC and 4 were HbSS. Among the female subjects, 179 were HbAA, 48 were HbAS; 4 were HbAC; 5 were HbSC and 8 were HbSS. The study shows the frequency of the fetal hemoglobin among the Hb SS patients in the study based on age range. 50% of the participants with fetal hemoglobin were between 10-15 years, 25% were between 16-20 years, 8.3% were between 21-25 years, 8.4% were between 31-35 years and 8.3 % were between 36-40 years Conclusion: The study showed increased prevalence of various hemoglobin variants. Awareness should be created at religious centers, schools on the importance of genotype testing. As a preventative precaution. We advise the implementation of mutation identification and carrier screening.

Basic medical sciences should be mainly taught by clinicians for a tight integration of basic and clinical sciences in medical education.

Today, medical education faces many problems. However, the most serious problem is the inability to integrate basic and clinical sciences. For this reason, students alienate from basic sciences, and clinicians are leaving sciences to basic scientists every day. Basic medical sciences learned in the preclinical term are remembered less by students and cannot be sufficiently associated with clinical reality. This is because basic scientific knowledge learned without a clinical framework is low-value data that the student does not know how to use. Therefore, all reform initiatives in the medical education curriculum stick to the obstacle of basic sciences. Now is the time to take bold steps. The first step should be to remove the preclinical term from medical education. Medical education should only consist of clinical education terms. This will gain the student and clinician a lot more time for clinical training. The second step should be to take basic sciences education from basic scientists and place it under the responsibility of clinicians. Clinicians can decide much better how much of basic science knowledge is clinically relevant. As a component of clinical education, it is best for students to internalize the basic sciences during classes, at the bedside, and in other clinical practices under the clinician's authority. Thus, students may be graduated as academic clinicians who have internalized the basic sciences and integrated the basic sciences with clinical reality.

Use of Anatomage Virtual Dissection table for Teaching Anatomy in Medical College

Background: Conventional teaching methodology for subject of Anatomy by use of cadaver is becoming obsolete because of unavailability of cadaver to the medical institutes. Anatomy is an important subject in basic medical sciences, thus need to be taught in depth in early year of medical curriculum. As availability of cadavers for teaching Anatomy has become extremely difficult. Aim: To evaluate students’ opinion on the use of the Anatomage 3 D virtual dissection table as an additional teaching tool to cadaver dissection in studying anatomy and understanding the relations of structures. Methods: A descriptive retrospective study was held at the department of Anatomy Azra Naheed Medical College. An electronic questionnaire was given to 2nd year MBBS students in which 6 questions regarding opinion of students who were taught through cadaveric specimen & 3D Anatomage table, regarding use of 3D Anatomage for active learning of anatomy topics. Results: Present study showed that the most of the students preferred using 3D Anatomage for learning anatomy as it enhances active learning. 80.4% responded positively in developing deeper understanding of the topic with use of Anatomage table as compared to conventional teaching. 89.5% responded positively to visualize better the anatomical features of different parts of body with the help of anatomage table. 81.7% responded positively regarding use of Anatomage table in active learning and in developing interest in subject of Anatomy. Conclusion: Students consider the use of the anatomage table, an effective teaching tool for gross anatomy, for visualizing anatomical relation of different parts of the body, for deeper understanding and active learning of Anatomical features, and in developing interest in the subject of Anatomy. Students can incorporate digital anatomy into the learning and teaching of basic medical science. The use of 3DAnatomage table gives the impression to have an important role in Medical education Keywords: Anatomage Virtual dissection table, Traditional dissection, Learning anatomy, 3D interactive anatomage table.

Clinical students’ reflections on the preclinical anatomy learning experience

ObjectivesAnatomy is a fundamental pillar of medical knowledge that bridges basic medical science knowledge and clinical practice. However, integrated modern medical curricula have reduced the anatomy teaching content, and cadaveric dissection is no longer conducted. Medical graduates who lack anatomy knowledge are anticipated to be inadequately equipped for safe clinical practice. This study was aimed at exploring clinical year students' experiences regarding their anatomy learning during the preclinical phase in Malaysian medical schools. The findings reflect how the students’ preclinical anatomy training prepared them for their clinical years of study. MethodsA qualitative phenomenology study using the focus group discussion method was conducted on 30 final-year students from four public universities. Four focus group discussion sessions were conducted, and students’ responses were transcribed and converted to electronic formats. The transcripts were analyzed thematically with ATLAS.ti software. ResultsThe first-cycle coding of the text analysis generated 157 open codes based on the phrases used by the participants. The subsequent coding cycle produced 16 axial codes—groups of open codes with similar features. During the final coding cycle, the content and interrelations between the axial codes were categorized into six codes: (1) preclinical anatomy learning experience, (2) anatomy content and teaching, (3) anatomy-related competency, (4) the importance of anatomy knowledge in clinical practice, (5) the importance of early exposure to applied clinical anatomy, and (6) suggestions for future anatomy education. ConclusionsThe six identified themes reflected students’ perceptions of their anatomy learning experience, the challenges that they faced during their preclinical years, and their opinions regarding the anatomy knowledge and skills that are functionally relevant during the clinical years. Their responses also echoed the need to improve anatomy teaching and learning, thereby emphasizing the importance of early clinical integration and application.

Unexpected Photocatalytic Degeneration of NAD + for Inducing Apoptosis of Hypoxia Cancer Cells

Unexpected Photocatalytic Degeneration of NAD ⁺ for Inducing Apoptosis of Hypoxia Cancer Cells

Cardiac β-Adrenoceptor Signaling: The New Insight on An Old Target in the Therapy of Cardiovascular Disease

Review Cardiac β-Adrenoceptor Signaling: The New Insight on An Old Target in the Therapy of Cardiovascular Disease Ying Song 1, Anthony Yiu-Ho Woo 2,*, Yan Zhang 3,4,*, and Ruiping Xiao 5,6,7,8 1 Center of Basic Medical Research, Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, 100191, China. 2 School of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, 110016, China. 3 Institute of Cardiovascular Sciences and Key Laboratory of Molecular Cardiovascular Sciences, School of Basic Medical Sciences, Ministry of Education, Peking University Health Science Center, Beijing, 100191, China. 4 Beijing Key Laboratory of Cardiovascular Receptors Research, Peking University, Beijing, 100191, China. 5 State Key Laboratory of Membrane Biology, Institute of Molecular Medicine, College of Future Technology, Peking University, Beijing, 100871, China. 6 Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China. 7 Beijing City Key Laboratory of Cardiometabolic Molecular Medicine, Peking University, Beijing, 100871, China. 8 PKU-Nanjing Joint Institute of Translational Medicine, Nanjing, 210000, China. * Correspondence: yiuhowoo@syphu.edu.cn (Anthony Yiu-Ho Woo), Tel.: +86-24-23986375; zhangyan9876@pku.edu.cn (Yan Zhang), Tel.: +86-10-82805945. Received: 19 October 2022 Accepted: 28 October 2022 Published: 21 December 2022 Abstract: A variety of G protein-coupled receptors (GPCRs) are involved in the regulation of cardiovascular function. The β-adrenoceptors (β-ARs), with three subtypes, are the dominant receptor species in the heart, in which the β1-AR and the β2-AR are considered functional. Stimulation of the β-ARs produces myocardial inotropy via activation of the Gs-cAMP-PKA signaling cascade. Prolonged stimulation of the β1-AR is cardiac harmful because the stimulated β1-AR couples only to Gs proteins and it mediates a cardiotoxic signal. On the other hand, the β2-AR couples dually to both Gs and Gi proteins and the β2-AR-Gi pathway is antiapoptotic. The activated Gi signal also counteracts the β-AR-Gs-promoted positive inotropic effect. Other key players in cardiac β-AR signaling include Ca2+/calmodulin-dependent protein kinases (CaMKs), GPCR kinases (GRKs), β-arrestins and phosphodiesterases. During heart failure, excessive sympathetic stimulation results in the activation of the cardiotoxic β1-AR-CaMKIIδ pathway and the upregulation of GRK2 and Gi in the heart. GRK2 promotes the desensitization of β-ARs and enhances a β2-AR-mediated Gi signaling. These signal transduction processes accompanying the downregulation of the β1-AR are involved in cardiac dysfunction, maladaptive cardiac remodeling, and the progression of chronic heart failure. β-Blockers are widely used in the treatment of cardiovascular disease. They have established their position as one of the “four pillars of heart failure” thirty years ago. In the present review, we provide an overview of the recent progress in the basic research of GPCRs focusing on cardiac β-AR signal transduction.

Moderate Fever Serves as an Adjuvant to Therapy for Pre- and Post-Surgery Sepsis.

Surgical InfectionsVol. 24, No. 1 CommentariesModerate Fever Serves as an Adjuvant to Therapy for Pre- and Post-Surgery SepsisRazvan C. StanRazvan C. StanAddress correspondence to: Dr. Razvan C. Stan, Department of Basic Medical Science, Chonnam National University, Hwasun 58128, Republic of Korea E-mail Address: strazvan@jnu.ac.krDepartment of Basic Medical Science, Chonnam National University, Republic of Korea.Previous Address: Cantacuzino-Military-Medical Research and Development National Institute, Bucharest, Romania.Search for more papers by this authorPublished Online:27 Jan 2023https://doi.org/10.1089/sur.2022.300AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Moderate Fever Serves as an Adjuvant to Therapy for Pre- and Post-Surgery Sepsis." Surgical Infections, 24(1), pp. 4–5FiguresReferencesRelatedDetails Volume 24Issue 1Feb 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Razvan C. Stan.Moderate Fever Serves as an Adjuvant to Therapy for Pre- and Post-Surgery Sepsis.Surgical Infections.Feb 2023.4-5.http://doi.org/10.1089/sur.2022.300Published in Volume: 24 Issue 1: January 27, 2023Online Ahead of Print:December 16, 2022PDF download

The rising menace of antifungal resistance in dermatophytes among the patients of tinea capitis.

To determine the epidemiological profile of dermatophytes among patients of tinea capitis and their susceptibility pattern to fluconazole and terbinafine. The cross-sectional study was conducted at the Department of Microbiology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi, from August to December 2019, and comprised samples of hair and skin from the scalp of tinea capitis patients regardless of age and gender. Demographic details were collected and the samples were processed for direct microscopy and mycological culture. Antifungal susceptibility testing for fluconazole and terbinafine was performed using broth microdilution method. Data was analysed using SPSS 21. Of the 207 patients, 115(55.5%) were males, and 114(55.1%) were children. Alopecia was the most common presenting complaint 141(68.1%), while grey patch tinea was the most characteristic clinical form 53(25.6%). Dermatophytes were yielded in 61(29.5%) cases, non-dermatophytes were isolated in 45(21.7%) specimens, and 101(48.8%) were culture-negative. Among the dermatophytes, trichophyton violaceum was the most common pathogen 21(34.4%), followed by trichophyton mentagrophytes 18(29.5%). Resistance to fluconazole and terbinafine among dermatophytes was recorded in 12(19.7%) and 7(11.5%) isolates, respectively. The frequency of dermatophytes among tinea capitis patients was higher compared to non-dermatophyte species. Antifungal resistance was predominantly seen in trichophyton violaceum and trichophyton mentagrophytes.

Evaluating the effectiveness of Ph.D. courses in basic medical sciences to create knowledge management capabilities from the graduate students’ view of Tehran University of Medical Sciences

Introduction: Knowledge management as a new subject has created a new approach to facilitating education and research in the higher education system. University graduates need to enter the world with the tools to play a role before they go to work, which is considered imperative in knowledge management. The purpose of this study was to survey the effectiveness of the PhD. curriculum to create knowledge management capabilities from the point of view of graduate students in Tehran University of Medical Sciences.
 Methods: This study incorporated a descriptive cross-sectional approach. The research sample included Ph.D. graduates from various fields of basic medical sciences at Tehran University (107 participants). Data collection was via a researcher-made questionnaire constructed based on the components of Bukowitz and Williams’s model, and its validity and reliability were confirmed. The SPSS version 22 statistical software was used for data analysis.
 Results: The findings of this research showed that the average score of knowledge management in courses from the graduate students’ view is higher than the theoretical average. In addition, the highest average is related to knowledge contribution (3.2), and the lowest is related to knowledge assessment (2.69).
 Conclusion: The effectiveness of PhD. courses in creating knowledge management capabilities from the graduate students’ view was higher than the theoretical average. However, it did not have a favorable outcome in some components; therefore, extensive planning and attention is necessary, particularly in terms of knowledge assessment and elimination.

Target-Oriented Clinical Skill Enhancement (TOCSE) Builds Up Confi dence of Fourth-Year Medical Students During First-Time Patient Encounter: An Effective Bridging Tool After Online Didactic Undergraduate Classes During the COVID-19 Pandemic

Background and Objective: Teaching clinical skills to undergraduate medical students has brought significant challenges during the COVID-19 pandemic. Patient discussion utilized hypothetical cases from history taking to diagnosis and management. Further, everything was delivered online. Target-Oriented Clinical Skill Enhancement (TOCSE) is a teaching and learning tool that integrates the basic medical sciences, such as anatomy, physiology, pathology, microbiology, and pharmacology, at the clinical level. TOCSE has been proven to improve the clinical performance of fourth-year medical students. However, clinical confidence remains an issue, especially for medical students on pure online mode of learning during the pandemic. Therefore, this study was undertaken to determine if TOCSE also facilitates the development of confidence in the clinical performance of 4th-year medical students during the first-time patient encounter after online undergraduate classes. Methods: Eight-item Clinical Performance Confidence Scale survey was performed at three (3) time points of fourth-year medical student’s rotation in the Department of Medicine: (1) prior to the deployment to the outpatient department (Pre-OPD), (2) after the first-time patient encounter without TOCSE workshop (Post-OPD no TOCSE), and (3) after the patient encounter with TOCSE workshop (Post-OPD with TOCSE). Mean and standard deviations were used to summarize the confidence level of the 4th-year medical students, based on the 10-point differential scale being 0 as not confident at all and 10 as very confident. Wilcoxon Signed Rank assessed improvements of confidence level from Pre-OPD to Post-OPD. Effect sizes were also calculated to compare the improvement in the items. All statistical tests were performed in SPSS version 26.0. P-values less than 0.05 indicate a significant increase in the confidence level of 4th-year medical students. Results: There is a significant increase in the clinical confidence of 4th-year medical students from Pre-OPD to Post-OPD no TOCSE (mean ± SD: 6.32 ± 1.02 to 7.06 ± 0.95, p<0.001). Comparing the eight items between Pre-OPD and Post-OPD with no TOCSE, performing a complete physical examination has the most remarkable improvement. Further, there is a significant increase in the clinical confidence of 4th-year medical students from Post-OPD no TOCSE to Post-OPD with TOCSE (mean ± SD: 7.06 ± 0.95 to 7.51 ± 0.89, p<0.001). The performance of a complete history-taking has the most considerable improvement (7.29 + 1.03 to 7.89 + 1.01, p<0.001). Correspondingly, the most significant increase in the clinical confidence of 4th-year medical students was seen among the Post-OPD with TOCSE compared to their Pre- OPD confidence scores (mean ± SD: 6.32 ± 1.02 to 7.51 ± 0.89, p<0.001). Among the eight items between Pre-OPD and Post-OPD with TOCSE confidence scores, the item on performing a complete physical examination has the most remarkable improvement (5.67 ± 1.37 to 7.20 ± 1.22, p<0.001), closely followed by performing a complete history-taking (6.53 ± 1.19 to 7.89 ± 1.01, p<0.001). The most significant improvements in clinical confidence were seen in all the items in the Post-OPD with TOCSE than in the Post-OPD with no TOCSE versus Pre-OPD confidence scores. In addition, with TOCSE, the number of medical students who scored 7.50 and above was amplified more than 3 times (17.4% to 58.7%, p<0.001, Pre-OPD vs. Post-OPD with TOCSE, respectively). Conclusion: Target-Oriented Clinical Skill Enhancement (TOCSE) effectively builds up confidence during first-time patient encounters among fourth-year medical students taught online with hypothetical cases during their undergraduate classes. Key words: Target-Oriented Clinical Skill Enhancement, clinical confidence, clinical skill, fourth-year medical students, medical undergraduate challenge, online teaching in COVID-19 pandemic