Incorporating ABC in physiology education: Active learning, blended learning and curricular changes

Physiology is of central importance in medicine. Teaching the complex physiological frameworks to the current generation of students with the implementation of competency-based medical education (CBME) has become a challenging task. Development of digital technology in educational field during Covid-19 pandemic has made medical educators modify their teaching learning strategies from traditional to blended mode. We offer tips to embrace the three major challenges namely, generational diversity with active learning strategies, technological growth with blended learning, and strategies to implement curricular changes in physiology education. Adult learning principles involve active learning as a crux component. Various simple active teaching strategies that can be adapted for large and small group teaching are highlighted. Blended learning is characterized by self-paced learning, and face-to-face training sessions with online collaborative learning. Simple ways to incorporate the blended mode of teaching strategies with the use of virtual platforms and learning management system (LMS) are described. Further, we discuss the nuances that help to adapt the various curriculum changes brought about by the implementation of CBME. Teaching physiology is an ever-challenging task. With an appropriate mindset, medical educators can turn these challenges into opportunities and make teaching learning a better experience.

Polygenic score for Alzheimer’s disease identifies differential atrophy in hippocampal subfield volumes

Hippocampal subfield atrophy is a prime structural change in the brain, associated with cognitive aging and neurodegenerative diseases such as Alzheimer’s disease. Recent developments in genome-wide association studies (GWAS) have identified genetic loci that characterize the risk of hippocampal volume loss based on the processes of normal and abnormal aging. Polygenic risk scores are the genetic proxies mimicking the genetic role of the pre-existing vulnerabilities of the underlying mechanisms influencing these changes. Discriminating the genetic predispositions of hippocampal subfield atrophy between cognitive aging and neurodegenerative diseases will be helpful in understanding the disease etiology. In this study, we evaluated the polygenic risk of Alzheimer’s disease (AD PGRS) for hippocampal subfield atrophy in 1,086 individuals (319 cognitively normal (CN), 591 mild cognitively impaired (MCI), and 176 Alzheimer’s disease dementia (ADD)). Our results showed a stronger association of AD PGRS effect on the left hemisphere than on the right hemisphere for all the hippocampal subfield volumes in a mixed clinical population (CN+MCI+ADD). The subfields CA1, CA4, hippocampal tail, subiculum, presubiculum, molecular layer, GC-ML-DG, and HATA showed stronger AD PGRS associations with the MCI+ADD group than with the CN group. The subfields CA3, parasubiculum, and fimbria showed moderately higher AD PGRS associations with the MCI+ADD group than with the CN group. Our findings suggest that the eight subfield regions, which were strongly associated with AD PGRS are likely involved in the early stage ADD and a specific focus on the left hemisphere could enhance the early prediction of ADD.

Evaluation of one-month foundation course for the first year undergraduate students at a Medical College in Puducherry, India

INTRODUCTION

Medical Council of India has revised the undergraduate medical curriculum by introducing "Competency-based Medical Education" which emphasizes the foundation course of one-month duration. This period is said to be essential for students to get acclimatized to the new college environment. The present study evaluated the first one-month foundation course from students and faculty members' point of view.

METHODS

The present study was program evaluation. The study participants were all 150 first year medical students joining the college and preclinical department faculty in the academic year, 2019-20. The foundation program was pre-planned and implemented as per the Medical Council of India guidelines. The program was evaluated using a pre-designed questionnaire where the items were aligned with the research question and inputs were obtained from all faculty members. Kirkpatrick framework level 1 was used for evaluation. Feedback was received from the faculty members by force field analysis and from student's using a five-point Likert scale. A summative approach to the qualitative content analysis was done to identify certain themes from the text data and infer meaning for the force field analysis obtained from the faculty. Considering the high rating for most of the sessions, we arbitrarily considered values above 75% to reflect good consensus and below 75% to reflect poor consensus. Consensus measure expressed in percentage was obtained for each item. The quantitative data were analyzed using open Epi info version 7.0.

RESULTS

The consensus scores ranged from 73.7 to 83.3 percent. The sessions on learning styles, student support system, self-directed learning, communication skills, medical ethics, soft skills, and orientation to health systems in India reflected good consensus, indicating that these sessions were well received by the students. Other sessions like stress management, interpersonal skills, presentation skills, email writing and ethics for mobile usage reflected poor consensus, implying the need for further improvement. As per the faculty perception, good coordination, teamwork, and proper planning at interdepartmental and intradepartmental levels were the key features for the successful implementation of the course.

CONCLUSION

Overall, the sessions in the foundation course were well received by the students. As felt by both students and faculty, more interactive sessions need to be incorporated. The major strength of the course was the skill module, visit to special school, and field visit to the community and primary health center. The findings will help us to improve our next year foundation program to meet the purpose of the Foundation course.

Evaluation of habituation to visual evoked potentials using pattern reversal among migraine individuals - a cross-sectional study

Background Migraine is a multifaceted chronic disease with common ocular symptoms. Habituation is the decremental response on repeated stimulations. The literature review indicates controversial results regarding habituation in migraine individuals. The present study aimed to compare the habituation response using visual evoked potential (VEP) measures among migraine and control subjects. Methods This was a cross-sectional study performed among migraine individuals attending the Department of Medicine and Neurology, of the age group of 18-30 years at Sri Manakula Vinayagar Medical College and Hospital, Puducherry. Habituation was evaluated in the two groups, control (n = 40) and migraine (n = 40), using pattern reversal VEP. The recording was done for 15-min duration and divided into four blocks of 3.8 min each. The results were compared employing Student t-test, and p < 0.05 was considered to be statistically significant. Results Our study indicates that latency N75, N145, and P100 amplitude showed significant differences between the two groups. In the right eye, on comparing the first and fourth block P100 amplitude in the migraine group, a significant increase (p < 0.001) was observed in the fourth block. Similarly, in the left eye, the control group showed a significant decrease in the fourth block (p = 0.002), whereas the migraine group showed a significant increase (p < 0.001). Conclusions The present study concludes that migraine individuals report deficient habituation, evaluated using pattern reversal VEP.

Sympathovagal imbalance and neurophysiologic cognitive assessment using evoked potentials in polycystic ovary syndrome in young adolescents - a cross-sectional study

Background Altered lifestyle and urbanization have potentially increased the prevalence of polycystic ovary syndrome (PCOS) among the women in India. The aim of the present study was to evaluate the autonomic function and subclinical cognition impairment using evoked potentials in PCOS-affected young adolescents. Methods This was a cross-sectional study, approved by Indian Medical of Council Research as a short-term student project. The study was performed with adolescent girls (age group, 10-18 years) diagnosed as having PCOS, attending the Department of Obstetrics and Gynecology at Sri Manakula Vinayagar Medical College and Hospital, Puducherry. Autonomic function was evaluated using heart rate variability and cognition employing auditory evoked potentials (P300 latency and amplitude) among the control group (n=30) and the PCOS group (n=30). Results Our study reports indicated that autonomic functions were significantly affected among the PCOS group compared to the control group (p=0.03), with sympathetic dominance and decreased vagal tone. P300 latency was prolonged and amplitude was decreased among the PCOS group, but the results were not statistically significant when compared to the control group. Body mass index showed significant correlation with sympathovagal imbalance. Conclusion The study indicates that autonomic functions are significantly altered in the PCOS group. Subclinical cognition impairment is seen among the PCOS group but is not pronounced enough to be proven statistically. This study informs adolescent girls to make early lifestyle changes as soon as possible before any significant clinical impairment occurs.