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Article Contents

Answer to part 1, answer to part 2, answer to part 3, answer to part 4, answer to part 5.

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Educational Case: A 57-year-old man with chest pain

Contributed equally.

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Nikhil Aggarwal, Subothini Selvendran, Vassilios Vassiliou, Educational Case: A 57-year-old man with chest pain, Oxford Medical Case Reports , Volume 2016, Issue 4, April 2016, Pages 62–65, https://doi.org/10.1093/omcr/omw008

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This is an educational case report including multiple choice questions and their answers. For the best educational experience we recommend the interactive web version of the exercise which is available via the following link: http://www.oxfordjournals.org/our_journals/omcr/ec01p1.html

A 57 year-old male lorry driver, presented to his local emergency department with a 20-minute episode of diaphoresis and chest pain. The chest pain was central, radiating to the left arm and crushing in nature. The pain settled promptly following 300 mg aspirin orally and 800 mcg glyceryl trinitrate (GTN) spray sublingually administered by paramedics in the community. He smoked 20 cigarettes daily (38 pack years) but was not aware of any other cardiovascular risk factors. On examination he appeared comfortable and was able to complete sentences fully. There were no heart murmurs present on cardiac auscultation. Blood pressure was 180/105 mmHg, heart rate was 83 bpm and regular, oxygen saturation was 97%.

What is the most likely diagnosis?

An ECG was requested and is shown in figure 1.

How would you manage the patient? (The patient has already received 300 mg aspirin).

30 minutes later the patient's chest pain returned with greater intensity whilst waiting in the emergency department. Now, he described the pain as though “an elephant is sitting on his chest”. The nurse has already done an ECG by the time you were called to see him. This is shown in figure 2.

ECG on admission.

ECG 30 minutes after admission.

What would be the optimal management for this patient?

He was taken to the catheterization lab where the left anterior descending coronary artery (LAD) was shown to be completely occluded. Following successful percutaneous intervention and one drug eluding stent implantation in the LAD normal flow is restored (Thrombosis in myocardial infarction, TIMI = 3). 72 hours later, he is ready to be discharged home. The patient is keen to return to work and asks when he could do so.

When would you advise him that he could return to work?

One week later, he receives a letter informing him that he is required to attend cardiac rehabilitation. The patient is confused as to what cardiac rehabilitation entails, although he does remember a nurse discussing this with him briefly before he was discharged. He phones the hospital in order to get some more information.

Which of the following can be addressed during cardiac rehabilitation?

A - Acute coronary syndrome

Although the presentation could be attributable to any of the above differential diagnoses, the most likely etiology given the clinical picture and risk factors is one of cardiac ischemia. Risk factors include gender, smoking status and age making the diagnosis of acute coronary syndrome the most likely one. The broad differential diagnosis in patients presenting with chest pain has been discussed extensively in the medical literature. An old but relevant review can be found freely available 1 as well as more recent reviews. 2 , 3

C - Atorvastatin 80 mg, Clopidogrel 300 mcg, GTN 500 mcg, Ramipril 2.5 mg,

In patients with ACS, medications can be tailored to the individual patient. Some medications have symptomatic benefit but some also have prognostic benefit. Aspirin 4 , Clopidogrel 5 , Atenolol 6 and Atorvastatin 7 have been found to improve prognosis significantly. ACE inhibitors have also been found to improve left ventricular modeling and function after an MI. 8 , 9 Furthermore, GTN 10 and morphine 11 have been found to be of only significant symptomatic benefit.

Oxygen should only to be used when saturations <95% and at the lowest concentration required to keep saturations >95%. 12

There is no evidence that diltiazem, a calcium channel blocker, is of benefit. 13

His ECG in figure 1 does not fulfil ST elevation myocardial infarction (STEMI) criteria and he should therefore be managed as a Non-STEMI. He would benefit prognostically from beta-blockade however his heart rate is only 42 bpm and therefore this is contraindicated. He should receive a loading dose of clopidogrel (300 mg) followed by daily maintenance dose (75 mg). 14 , 15 He might not require GTN if he is pain-free but out of the available answers 3 is the most correct.

D - Proceed to coronary angiography

The ECG shows ST elevation in leads V2-V6 and confirms an anterolateral STEMI, which suggests a completely occluded LAD. This ECG fulfils the criteria to initiate reperfusion therapy which traditionally require one of the three to be present: According to guidance, if the patient can undergo coronary angiography within 120 minutes from the onset of chest pain, then this represents the optimal management. If it is not possible to undergo coronary angiography and potentially percutaneous intervention within 2 hours, then thrombolysis is considered an acceptable alternative. 12 , 16

≥ 1 mm of ST change in at least two contiguous limb leads (II, III, AVF, I, AVL).

≥ 2 mm of ST change in at least two contiguous chest leads (V1-V6).

New left bundle branch block.

GTN and morphine administration can be considered in parallel but they do not have a prognostic benefit.

E - Not before an exercise test

This patient is a lorry driver and therefore has a professional heavy vehicle driving license. The regulation for driving initiation in a lorry driver following a NSTEMI/ STEMI may be different in various countries and therefore the local regulations should be followed.

In the UK, a lorry driver holds a category 2 driving license. He should therefore refrain from driving a lorry for at least 6 weeks and can only return to driving if he completes successfully an exercise evaluation. An exercise evaluation is performed on a bicycle or treadmill. Drivers should be able to complete 3 stages of the standard Bruce protocol 17 or equivalent (e.g. Myocardial perfusion scan) safely, having refrained from taking anti-anginal medication for 48 hours and should remain free from signs of cardiovascular dysfunction during the test, notably: angina pectoris, syncope, hypotension, sustained ventricular tachycardia, and/or electrocardiographic ST segment shift which is considered as being indicative of myocardial ischemia (usually >2 mm horizontal or down-sloping) during exercise or the recovery period. 18

For a standard car driving license (category 1), driving can resume one week after successful intervention providing that no other revascularization is planned within 4 weeks; left ventricular ejection fraction (LVEF) is at least 40% prior to hospital discharge and there is no other disqualifying condition.

Therefore if this patent was in the UK, he could restart driving a normal car one week later assuming an echocardiogram confirmed an EF > 40%. However, he could only continue lorry driving once he has passed the required tests. 18

E - All of the above

Cardiac rehabilitation bridges the gap between hospitals and patients' homes. The cardiac rehabilitation team consists of various healthcare professions and the programme is started during hospital admission or after diagnosis. Its aim is to educate patients about their cardiac condition in order to help them adopt a healthier lifestyle. This includes educating patients' about their diet, exercise, risk factors associated with their condition such as smoking and alcohol intake and finally, about the medication recommended. There is good evidence that adherence to cardiac rehabilitation programmes improves survival and leads to a reduction in future cardiovascular events.​ 19 , 20

Oille JA . Differential diagnosis of pain in the chest . Can Med Assoc J . 1937 ; 37 (3) : 209 – 216 . http://www.ncbi.nlm.nih.gov/pmc/articles/PMC536075/ .

Google Scholar

Lee TH , Goldman L . Evaluation of the patient with acute chest pain . N Engl J Med . 2000 ; 342 (16) : 1187 – 1195 . http://www.nejm.org/doi/full/10.1056/NEJM200004203421607 .

Douglas PS , Ginsburg GS . The evaluation of chest pain in women . N Engl J Med . 1996 ; 334 (20) : 1311 – 1315 . http://www.nejm.org/doi/full/10.1056/NEJM199605163342007 .

Baigent C , Collins R , Appleby P , Parish S , Sleight P , Peto R . ISIS-2: 10 year survival among patients with suspected acute myocardial infarction in randomised comparison of intravenous streptokinase, oral aspirin, both, or neither. the ISIS-2 (second international study of infarct survival) collaborative group . BMJ . 1998 ; 316 (7141) : 1337 – 1343 . http://www.ncbi.nlm.nih.gov/pmc/articles/PMC28530/ .

Yusuf S , Zhao F , Mehta S , Chrolavicius S , Tognoni G , Fox K . Clopidogrel in unstable angina to prevent recurrent events trail investigators . effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation . N Engl J Med . 2001 ; 345 (7) : 494 – 502 . http://www.nejm.org/doi/full/10.1056/NEJMoa010746#t=articleTop .

Yusuf S , Peto R , Lewis J , Collins R , Sleight P . Beta blockade during and after myocardial infarction: An overview of the randomized trials . Prog Cardiovasc Dis . 1985 ; 27 (5) : 335 – 371 . http://www.sciencedirect.com/science/article/pii/S0033062085800037 .

Schwartz GG , Olsson AG , Ezekowitz MD et al.  . Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: The MIRACL study: A randomized controlled trial . JAMA . 2001 ; 285 (13) : 1711 – 1718 . http://jama.jamanetwork.com/article.aspx?articleid=193709 .

Pfeffer MA , Lamas GA , Vaughan DE , Parisi AF , Braunwald E . Effect of captopril on progressive ventricular dilatation after anterior myocardial infarction . N Engl J Med . 1988 ; 319 (2) : 80 – 86 . http://content.onlinejacc.org/article.aspx?articleid=1118054 .

Sharpe N , Smith H , Murphy J , Hannan S . Treatment of patients with symptomless left ventricular dysfunction after myocardial infarction . The Lancet . 1988 ; 331 (8580) : 255 – 259 . http://www.sciencedirect.com/science/article/pii/S0140673688903479 .

Ferreira JC , Mochly-Rosen D . Nitroglycerin use in myocardial infarction patients . Circ J . 2012 ; 76 (1) : 15 – 21 . http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3527093/ .

Herlitz J , Hjalmarson A , Waagstein F . Treatment of pain in acute myocardial infarction . Br Heart J . 1989 ; 61 (1) : 9 – 13 . http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1216614/ .

Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK, et al . ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation . Eur Heart J . 2012 ; 33 (20) : 2569 – 2619 . http://eurheartj.oxfordjournals.org/content/33/20/2569 .

The effect of diltiazem on mortality and reinfarction after myocardial infarction . the multicenter diltiazem postinfarction trial research group . N Engl J Med . 1988 ; 319 (7) : 385 – 392 . http://www.nejm.org/doi/full/10.1056/NEJM198808183190701 .

Jneid H , Anderson JL , Wright RS et al.  . 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/Non–ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update) A report of the american college of cardiology foundation/american heart association task force on practice guidelines . J Am Coll Cardiol . 2012 ; 60 (7) : 645 – 681 . http://circ.ahajournals.org/content/123/18/2022.full .

Hamm CW , Bassand JP , Agewall S et al.  . ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The task force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the european society of cardiology (ESC) . Eur Heart J . 2011 ; 32 (23) : 2999 – 3054 . http://eurheartj.oxfordjournals.org/content/32/23/2999.long .

O'Gara PT , Kushner FG , Ascheim DD et al.  . 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: Executive summary: A report of the american college of cardiology foundation/american heart association task force on practice guidelines . J Am Coll Cardiol . 2013 ; 61 (4) : 485 – 510 . http://content.onlinejacc.org/article.aspx?articleid=1486115 .

BRUCE RA , LOVEJOY FW Jr . Normal respiratory and circulatory pathways of adaptation in exercise . J Clin Invest . 1949 ; 28 (6 Pt 2) : 1423 – 1430 . http://www.ncbi.nlm.nih.gov/pmc/articles/PMC439698/ .

DVLA . Https://Www.gov.uk/current-medical-guidelines-dvla-guidance-for-professionals-cardiovascular-chapter-appendix .

British Heart Foundation . Http://Www.bhf.org.uk/heart-health/living-with-heart-disease/cardiac-rehabilitation.aspx .

Kwan G , Balady GJ . Cardiac rehabilitation 2012: Advancing the field through emerging science . Circulation . 2012 ; 125 (7) : e369–73. http://circ.ahajournals.org/content/125/7/e369.full .

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17 Free Medical School Question Banks (Save Money & Level Up!)

Medical school question banks are integral to evidence-based study . Along with active recall and spaced repetition, regular question practice is the best way to go if you want to score high on your exams without wasting your valuable time.

What’s even better than great question banks is when they’re completely free . So that’s what this guide is going to show you, you’ll learn:

• The best free medical school question banks for general question practice
• Free question banks for specific subjects
• Other recommended resources for solid practice

Ready to get started? Let’s go.

General Medical School Question Banks

The free resources we’ll be covering here are:

• PassMedicine

Made Ridiculously Simple (MedMaster)

Lecturio free question bank, test prep review.

Please note that while a lot of these are designed for the USMLE exam, the questions are still 100% relevant to the basic science subjects of any medical school curriculum. Use them as extra practice for your school exams no matter what country/institution you find yourself!

PassMedicine – Medical Students Years 1-3

Mainly used by UK-based students and junior doctors for exam prep, PassMedicine has an excellent free resource for pre-clinical study.

The 3,865 questions here cover general principles, all organ systems, haemtology and oncology, psychiatry and neurology.

The best thing about this resource?

Most questions are case-based (vignette style). Making them perfect for applying your knowledge (rather than recalling it) !

You’ll have to sign up and list your institution of study, but that’s all you need.

Here’s how a typical question looks…

What’s also cool about this platform is the feedback. You’ll see the percentage of students answering for each question type and a detailed explanation (including links out to useful YouTube content) too.

To find out more about PassMedicine’s features check out our PassMedicine review here .

MedMaster Inc is the company behind the Made Ridiculously Simple series of books (ones I recommend a lot on my study guides across this site).

The main website is home to a ton of free downloadable content (for both Mac and PC) for various med school areas. You’ll have to subscribe with your name and email before downloading.

Here’s what you’ll find in terms of question banks:

• USMLE Step 1 Made Ridiculously Simple Question Bank : 1,100 organized “mix and match style” question for quick review
• NCLEX-RN Made Ridiculously Simple : 1000 questions quiz

The quizzes run in a separate program so you’ll need access to a desktop or laptop to make use of them.

Here’s an example of a question from the respiratory section…

Note : MedMaster recommends using them alongside their books for maximum effectiveness. But it’s still a nice touch anyone can download them for free!

MedBullets is home to 1000+ free USMLE Step 1 style Qbank.

Again, you’ll have to sign up for a free account first.

MedBullets is essentially a community site where people can submit questions and content for later review. You can create custom tests from specific topics or mix and match as you like.

You can set up different learning modes choosing to see explanations at the end of the test or for each question as you work through them. You can also set how many questions you want to do and time per question. Here’s how a quick 4 question oncology-based quiz looks using the platform…

Their 90-day premium trial is insanely generous too (especially compared to some of the other platforms on this list). Signing up for that will enable you to practice with even more questions.

Lecturio’s free question bank is a great resource for COMLEX, USMLE and MBBS materials.

The USMLE Step 1 pre-clinical Qbank has over 2200 free questions to practice with. It even includes a statistics report and the ability to see your peers accuracy when faced with the same questions (similar to PassMedicine).

Like MedBullets you can set up custom tests, order by difficulty and subject and set the number of questions you want to answer in each round (max. per test: 40).

You can also toggle the tutor and timer modes as you see fit.

You’ll have to sign up for a Lecturio account first.

The Premium (paid) upgrade provides in-depth explanations and linked video lectures.

MDlexicon.com is a simple site home to a host of question banks covering all categories of the USMLE and a core “basic sciences” medical school curriculum.

Here’s how the main website looks…

Each of these are internal links within the site to appropriate questions.

You won’t get to take “rounds” or blocks of questions like you can on some of the platforms above (you have to answer each individually), but it’s still a very useful, free resource. Here’s how a typical question looks (most are vignette style)…

4Tests is home to a free 60 question USMLE-style exam that’s provided by Kaplan Test Prep.

You can take the test directly on the site. There’s no need to sign up for an account or provide login details.

ValueMD is a forum that has over 4000+ USMLE style questions to practice from.

Categories are broken down into:

• Behavioral Science
• Biochemistry
• Microbiology
• Pharmacology

You’ll need to register and login to get started, but it’s quick, easy and free.

Test Prep Review has several free module-based questions to practice with based on the USMLE, COMLEX and beyond.

You can find access to 20-question long practice tests in all the core medical science subjects. An answer key is included at the end.

Although it’s not strictly a Qbank, I feel Zanki is well worthy of a mention on this list.

It’s an Anki (digital flashcard) deck that’s 30K+ cards rich in med school content.

The Anking overhaul (the gold standard version of Zanki), has made this into an essential free resource for med students across the globe looking to master the basic medical sciences.

Zipping through it, you can unlock cards relevant to topics/organ systems as you go and test yourself rapidly using cloze-style (fill-in-the-gap) formatted cards.

Take a look at my article; What Is The Best Anki Deck For Step 1? for more information.

Subject-Specific Medical School Question Banks

After these great free general question bank resources, let’s look at subject specific platforms.

Free Question Banks for Anatomy

University of minnesota’s web anatomy.

UM’s WebAnatomy is old and hasn’t been touched in several years but it’s still an excellent free resource for students wanting to practice anatomy and physiology questions.

The main menu links out to the subcategories within the subject as well as covering biochemistry and histology.

Most questions are drop down multiple choice but there are also lots of diagram matching quizzes too.

For more free anatomy and physiology question practice see the article below:

Related : 9 Anatomy & Physiology Study Games For College Students (Free, Quick & Fun)

Free Question Banks for Pathology

Utah med (webpath).

The University of Utah’s WebPath resource is a massively useful resource that’s home to both tutorials and question banks. It’s been around now an incredible 26 years!

It covers the following areas:

• General Pathology
• Systemic Pathology
• Anatomy & Histology

You can find all their free questions and quizzes in the Examination section of the site.

Most are multiple choice, some are timed and the question rounds last anything between 20-60 questions.

Here’s an example of their timed review quizzes for the cell injury topic inside general pathology.

Free Question Banks for Pharmacology

Pharmacology2000.com.

Pharmacology2000.com is a 50 chapter deep resource jam packed with free topic-specific multiple choice tests and question quizzes.

The primary resources used to build the Qbank include:

• Harrison’s Principles of Internal Medicine
• Basic & Clinical Pharmacology from Katzung
• Goodman & Gilman’s The Pharmacological Basis of Therapeutics

No need to login, register or anything else. Just dive straight in and start practicing pharma.

Free Question Banks for Microbiology

SanFoundry is home to 1000+ microbiology MCQ’s free to practice with in browser.

The questions cover over 100 topics including:

• Microorganisms characterisation and identification
• Microscopic examination of microorganisms
• Morphology and fine structure of bacteria
• Reproduction and growth
• Antibiotics and other chemotherapeutic agends

An excellent resource for sharpening your microbio skills!

Medical School Question Banks: Free Trials

As well as all the resources above (that’ll take you a while to go through), I strongly recommend exhausting the free trials at the following sites.

Each has extensive question banks you can make use of for extra practice.

Note : You will have to create a free account with your email or social media accounts first though. So expect email updates!

• Firecracker : 7 day free trial
• Kaplan (3300+ questions): 7 day free trial
• Pastest (48 hour free unlimited access trial): 38,000+ questions covering USMLE, OSCEs, MRCP etc
• QUPI : 30 day free trial (10,000+ questions)

I suggest timing your use of these so you only have one trial going at a time. That way you can get through as many free questions as possible!

What Are The Best Question Banks For The USMLE?

As for non-free Qbanks that are considered the best in the game, this is the trifecta that most U.S. students recommend:

• USMLE-Rx (5 day free trial)
• BoardVitals

Summary: Best Free Medical School Question Banks

Medical school question banks are fundamental to helping you master concepts and score well in both internal school and important board exams.

The list above? Should hopefully keep you busy!

If you enjoyed this post, you might find the following articles useful:

• How To Study Pharmacology In Medical School (Ultimate Guide)
• USMLE STEP 1: Reddit’s Best Tips 
• How To Study For Biochemistry (Ultimate Guide)

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Born and raised in the UK, Will went into medicine late (31) after a career in journalism. He’s into football (soccer), learned Spanish after 5 years in Spain, and has had his work published all over the web. Read more .

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Enhanced learning strategies of undergraduate medical students with a structured case presentation format

Sarabmeet singh lehl.

Department of General Medicine, Government Medical College and Hospital, Chandigarh, India

Monica Gupta

Sanjay d’cruz, background:.

Improvement of the learning in undergraduate bedside teaching needs to be promoted through innovative interventions. Changes in the structured format (SF) for bedside case discussion may help students improve their learning experience and gain insights into collaborative self-directed learning. The aim of the present study was to encourage collaborative and self-directed learning strategies by MBBS undergraduate students through a new case presentation format structured for this purpose.

MATERIALS AND METHODS:

This was an interventional study carried out in the year 2010–2011. A new SF for bedside cases presentation was developed. A comparison with the traditional format was done by holding one session in each format. Uniformity of topic and teaching style was ensured by having the sessions on pulmonary medicine cases with the same teacher. The student perspective of the educational process was analyzed using evaluation pro forma, Likert scale, and narratives.

Ninety final year and prefinal year MBBS students participated in this study. There was significantly higher participation in history taking (50.7%) and clinical examination (60%) in the SF. A higher statistically significant number of clinical possibilities were considered in the SF (85.3% vs. 66.6%). Similarly, significantly higher number of students indulged in self-directed learning and referred to learning resources in the SF. The SF provided students an active role (96.9%), encouraged access to resources (93.9%), and control of learning (75.7%). The additional interactive session was productive (90.9%), discussions were streamlined (66.6%), and the role of a teacher was considered important (75.7%).

CONCLUSION:

The SF generated higher participation in the aspects of history taking, clinical examination, and consideration of differential diagnoses. It led to a perceived improvement in self-directed and collaborative learning among students.

Introduction

Bedside teaching is an essential component of undergraduate medical training. This learning environment is considered better than didactic teaching in the development of essential skills in doctor–patient communication, elicitation of history, clinical examination, and engendering reasoning and professionalism in students. It lies at the heart of medical education and practice as its focus is on the problem of the authentic patient.[ 1 , 2 ]

Failure to utilize the full potential of this methodology represents a missed opportunity due to a variety of factors including lack of teaching and facilitation skills, time constraints, diverse administrative demands on teachers; noncooperation and rapid turnover of patients; overdependence on diagnostic technologies; and a failure on the part of students to accept autonomy over their learning. This leads to opportunistic teaching without active involvement of all the students or a time for reflection and discussion to meet their diverse learning needs.[ 1 , 2 , 3 , 4 ]

The learning process, based on psychological and sociological approaches, is a blend of individualistic and social constructivist philosophy. This includes activation of prior knowledge and acquisition of new knowledge from perceptions arising from interaction in a social environment. In the clinical setting, it occurs through team cohesion, social bonding, and learning by the whole group.[ 4 , 5 , 6 ]

In case-based teaching, preceptors set the stage for experiential learning by anchoring instruction into cases, actively involving students, modeling professionalism, providing direction, feedback, and creating a collaborative learning environment.[ 4 ] Learning in the clinical environment is influenced by many factors some of which are outside the teacher's control. Increasing student admissions in medical institutes places a higher demand for expert teachers to supervise them with the aim of developing a competent health professional workforce which can adapt, transfer, and apply knowledge in an effective and timely manner.[ 7 , 8 ]

Problem-based learning (PBL) model in preclinical teaching has much in common with student learning during clinical attachments, but it has been underutilized in this phase of medical education.[ 9 ] Application of PBL principles in clinical encounters with real patients has a positive influence on student learning.[ 10 ]

The aim of the present study was to encourage collaborative and self-directed learning strategies by MBBS undergraduate students through a new case presentation format structured for this purpose.

Materials and Methods

Study design and setting.

This interventional educational research was conducted in the Department of General Medicine at a Government Medical College in India during the MBBS clinical rotation of 4-week duration in the year 2010–2011.

Study participants and sampling

All successive final and prefinal year MBBS students who came for bedside clinical rotations in small groups eight–ten students participated in the study. A total of ninety students participated in this study.

Data collection tool and technique

A written and informed consent of all the student participants was taken. The student perspective of the educational process was analyzed using evaluation pro forma (EVP), Likert scale, and narratives. The data were evaluated using descriptive statistics and Chi-square test.

Ethical consideration

The study was approved by the Research and Ethics Committees of the Medical College vide No. GMC/TA-I (19D)/53206 Dated September 23, 2010.

Methodology

To ensure uniformity of subject content and teaching style, the cases used in the discussion were from pulmonary medicine and one faculty member conducted the sessions being evaluated. This faculty member had one clinical session per week with each group of students. The traditional case presentation form for clinical case presentation was reviewed by taking inputs from faculty members and students. This was called traditional format (TF) for the purpose of the study. Then, the new structured format (SF) for the intervention was developed by the faculty based on a SF used in an earlier study.[ 10 ] The aim was to introduce elements for collaboration, self-learning, and revisiting the problem. Both formats are shown in Table 1 (the additional activity in the SF is shown in italics). This format also had an additional tutorial of 1 h duration after a 2-day interval.

Outline of the traditional and structured case presentation format

All items are similar but the structured format has additional instructions for students. GPE=General physical examination, TF=Traditional format, SF=Structured format

The first clinical bedside session (Week 1) was conducted using the TF of bedside teaching, i.e. one student prepared the case using the TF which was discussed with the whole group. Before the fourth clinical bedside session (Week 4), the participants were introduced to the SF. They were required to prepare the case using the instructions in the SF [ Table 1 ].

The evaluation was done through two pro formas. The first pro forma was a Self-Assessment Questionnaire (SAQ) [ Table 2 ] consisting of Yes/No and open-ended questions to identify the learning activities undertaken by the individual participants. This was completed by the students immediately before the first case presentation (Week 1) as SAQ-TF and before the fourth session (Week 4) as SAQ-SF. At the end of the clinical rotation in General Medicine, participants were asked to complete an EVP which had ten predesigned statements to be rated on a 5-point Likert scale. In addition, comments from the participating students were also invited [ Table 3 ]. All questionnaires and pro forma were strictly anonymous, and students were required to submit them in a box for evaluation.

Questionnaire to identify prior self-directed and collaboration by students

Format for evaluation of postrotation experience of students with traditional and structured format

Instructions: You have experienced two formats of bedside case presentations. Express your views on these formats in a few sentences

Ninety students of the MBBS prefinal and final professional participated in this study. Completed responses were received from 60% in the TF and 83.3% in the new format (SF), respectively. The response to the SAQ is shown in Table 4 .

Analysis of students’ participation and learning activity

*Chi-square test, P <0.05=Significant. S=Significant NS=Not significant

The participation in case history taking and clinical examination was significantly higher with SF. The student interaction on discussion of differential diagnosis was poor in both groups, however statistically better with the new format. A larger percentage of students considered at least two appropriate diagnostic possibilities in the SF as compared to TF, and this difference was also statistically significant. Majority of the students in both groups accessed at least two or more educational resources, but again there was marked improvement in their ability and keenness in accessing the resources in the SF.

The commonly prescribed textbooks of clinical methods, that is, MacLeod's Clinical Examination and Hutchison's Clinical Methods were accessed by the majority of students, whereas standard textbooks of General Medicine such as Harrison's Principles of Internal Medicine and Davidson's Principles and Practice of Medicine were less frequently consulted for clinical bedside cases.

The EVP was completed by 66 students (73.3%). The responses were clubbed into two main groups, i.e., agreed – strongly agreed and disagreed – strongly disagreed, while the undecided responses were excluded. This is shown in Figure 1 . The majority of students perceived that the two formats were inherently dissimilar, TF was not better and it did not provide more opportunities for self-expression nor did it increase student interest. On the other hand, students perceived that, in SF, they had a more active role, accessed more resources, and had more control on learning. The majority did not consider the additional session in SF to be a waste of time or that the discussions did not occur in a streamlined manner. Importantly, the majority of students indicated that the teacher had an active role to play in any bedside teaching.

Analysis of responses to the end-of-rotation evaluation pro forma by 66 participants (in percentages)

A summary of the free responses of students’ experience of the two processes was that the SF promoted group activity by involving active participation of all students ( n = 44, 66.6%); 16 responses (24.2%) that SF was a better, organized, and step-wise approach. Responses directed toward the content varied from 8 (12.1%) indicating that SF increased understanding and learning and 22 (33.3%) that it increased the diagnostic and analytical capabilities. The learning environment in SF was described in various terms as interesting, effective, better, friendly, comfortable, less fearful, student oriented, encouraged expression and discussion, resolved doubts, promoted thinking process, self-learning, and curiosity. Two responses indicated that the teacher needed to be experienced in effectively using a new format of learning.

In addition to the paucity of information on conducting effective bedside teaching in textbooks of medical education, a literature review observed that the utilization of this modality was declining due to many factors including an increased reliance on technology and simulation.[ 3 ] However, while determining competence for practice, replacement of the long case by objective structured clinical examination (OSCE) with the promise of a more reliable assessment has been challenged by the higher reliability of 0.84–0.88 for the long case versus 0.73 for OSCE.[ 11 ] Therefore, there is a need to retain and improvise the long case in bedside clinical examination for assessment of clinical bedside skills and competence.

Utilization of a structured musculoskeletal examination by trainees across a range of postgraduate specialties indicated that 90% perceived that it led to more confidence in the examination of this system.[ 12 ] A structured PBL tutorial for teaching nervous system increased the comfort, accountability, preparedness, and participation by students in addition to efficient utilization of time. However, some participants considered the SF resulted in an increase of workload, lack of flexibility, restricting the free flow of ideas, and conversion of an effective discussion into a series of presentations.[ 13 ] A similar viewpoint emerged in a model of PBL for clinical attachments where students identified a need for complementary clinical skills teaching, loss of flexibility, and potential conflict with informal bedside teaching and relationship to the objectives of the course.[ 10 ]

In a controlled study to evaluate whether structured teaching of bedside cardiac examination skills would improve the medical residents’ examination technique, two groups of medical residents were evaluated using either a traditional demonstration and practice method or an innovative collaborative discovery method against a control group which received usual ward teaching. Both intervention groups had better technical examination skills compared with controls after the session. However, there was only modest benefit as it did not translate into a significant increase in recognition of key clinical findings.[ 14 ] Another study investigated medical students’ and tutors’ views on competencies and behaviors in small group settings and they concluded that collaborative learning promoted constructiveness of feedback; active listening and contribution and goal orientation.[ 15 ] The value of collaborative learning to ease conceptualization and retention of practical knowledge has also been advocated in a recent review.[ 16 ] Another structured bedside teaching module in pulmonary medicine helped students enhanced their clinical skills, understand complex material, and promoted inquiry and critical thinking.[ 17 ]

In the present study, participation in case history, examination, and consideration of alternative clinical possibilities was significantly higher in the SF; however, the use of additional learning resources, other than standard prescribed textbooks such as e-resources or references was inadequate. Although the students spent more time in discussion in the SF but on a whole, the percentage of individual participation was poor in both the formats. The possible explanation for failure to achieve the intended outcomes is that students did not have prior training in PBL processes in the preclinical years, resulting in their inability to achieve the expected goals as learners by identifying material for self-learning. Probably, the TF did not encourage the development of collaborative learning skills and peer-learning and therefore their participation was limited despite sensitizing them regarding the key features in the new case format before the allotment of the case. Students who enter a medical school where a PBL curriculum is already in place have been observed to adapt and embrace the independence and responsibility generated by this process to transition successfully in clinical clerkships. On the other hand, students from institutions with traditional teaching appear to find this transition to the clerkships difficult as they are not prepared to be more independent or to naturally assume responsibility for their learning.[ 10 ] It is suggested that bedside sessions should be structured well before, during, and after the encounter.[ 18 ] The structured approach may provide a “scaffolding” by directing students toward more effective learning strategies with emphasis on preparation, participation, and accountability.[ 13 ]

In the present study, the role of the teacher in both sessions was that of an expert and students felt that active participation by teachers with experience would help in implementing this methodology. In different forms of PBL, the teacher has often been ascribed a facilitative or a nonexpert role but the importance of a teacher having subject as well as process expertise has been also highlighted in studies.[ 19 , 20 ] Teaching is similar to clinical situations, and an expert supervisor can result in increased efficiency and reduced cognitive load for students. A subject matter expert to facilitate the PBL process was observed to be especially relevant in an environment where prior exposure to active self-learning or PBL strategies have not been ingrained in the students in their earlier educational years.[ 8 , 9 , 10 ] The utilization of educational resources by students in the present study was inadequate, indicating a need for the teacher to direct them toward relevant resources or internet-based searches.

A structured teaching format, ACTIVE, was observed to improve resident engagement and knowledge with minimal resources and offered an innovative alternative to a standard lecture without compromising on other activities or introducing major structural changes in the residency program.[ 21 ]

In the present study, students perceived that the two formats were different and the new format enabled them to express their views in a comfortable environment that encouraged group participation. It must be appreciated that, in educational research, enthusiasm of students for innovative teaching strategies has often produced a biased opinion in favor of any new method used in educational research.[ 10 ] However, it has been observed that students prefer a more positive learning environment with higher levels of involvement, task orientation, innovation, and individualization.[ 22 ]

The MBBS teaching program is tightly scheduled and extra time for participation in new teaching activities encroaching on students and faculty time is an administrative deterrent. An evaluation of ward-based teaching identified clinical teaching to be a valuable but underutilized methodology, with incongruence between student and teacher expectations and indicated a need for protected time for this activity, as well as blended teaching and faculty development.[ 23 ] As review meetings after an interval are not always possible due to other competing teaching schedules, an asynchronous learning mode may be adopted.[ 10 ] Such an approach using an online virtual learning environment, within a PBL strategy was a viable opportunity for student as well as faculty training.[ 24 ] PBL is an established means of effective small group teaching method for medical students.[ 25 ] In addition, training with simulated patients blended with small group teaching at the bedside with real patients may achieve an increase in student competence.[ 26 ]

The present study conducted among a small group of students with a single faculty member and topic in a single institution is a factor that will not set the stage for immediate generalization of the results. There are, however, similarities with other studies on this subject. Developing countries are gearing up to meet the shortage of medical professionals by increasing intake of students into undergraduate medical courses which may not be matched by a proportionate increase in trained medical faculty. Therefore, faculty priorities, which include, among other things, an increasing clinical work load, leadership role in the workplace, administrative commitments, research, and teaching activities without losing sight of personal development and self-care will need to be constantly recalibrated.[ 27 ] This brings in the concept of faculty development which should mirror the rapidly changing educational landscape.

Limitation and recommendation

There were few limitations and had they been foreseen; the study would have provided more vital information on student learning processes. The response rate of 60% in the TF was poor. While case selection was opportunistic, it would have been better to prepare standard cases with predefined learning objectives. In addition, the students did not independently generate learning objectives to enable Self directed learning (SDL). The gap between case presentation and the review session was too short to allow a meaningful SDL experience.

The clinical bedside case presentation is an ideal modality for the development of competent clinicians of the future by combining communication with the patient, analysis of history, skills in clinical examination, synthesis of information, formulation of a differential diagnosis, order relevant investigations, learn professionalism, and ethics by observing faculty. This study moves away from the standard bedside teaching by including a hybrid of bedside case presentation, a SDL period, and a review session with an attempt to give more control of learning to students.

Whatever teaching model is used, whether it is structured or traditional teaching, it needs to take into view the learning methodology adopted by the educational system. The development of a PBL program in the preclinical years can make the transition of students easily into independent, self-motivated learners in later years. The present study was an attempt to use a structured case presentation format to enhance student learning strategies. SF generated higher participation among the students in the aspects of history taking, clinical examination, and consideration of differential diagnoses through self-directed learning and utilization of learning resources. Any innovation in the educational teaching–learning processes will also need to be synchronized with the assessment system and the regulatory authority, on its part, needs to develop matching assessment, and evaluation systems which will serve as the driver of student learning.

Financial support and sponsorship

No financial support from any funding source.

Conflicts of interest

There are no conflicts of interest.

Acknowledgment

We acknowledge the academic support of faculty of FAIMER, CMC, Ludhiana, India.

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Case-based Learning

Our experience in clinical pharmacology teaching.

Hasamnis, Ameya A.; Arya, Aditya; Patil, Sapna S. 1

Department of Pharmacology, School of Medicine, Taylor’s University, Kuala Lumpur, Malaysia

1 Department of Public Health, School of Medicine, Taylor’s University, Kuala Lumpur, Malaysia

Address for correspondence: Dr. Ameya A. Hasamnis, Department of Pharmacology, School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University, Malaysia. E-mail: [email protected]

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Majority of junior doctors struggle to apply the knowledge of pharmacology to prescribing drugs. A paradigm shift in teaching of clinical pharmacology is the need of the hour in medical curriculum. One of the ways to enhance the teaching of clinical pharmacology is to develop and conduct case-based learning for MBBS students instead of didactic lecturing. Case-based learning session can bridge the gap between theory and practice. Case-based learning provides hands-on training in a classroom setting. We tried to develop and conduct case-based learning for year two medical students and evaluated their response via the Dundee Ready Education Environment Measure questionnaire. Majority of our students enjoyed learning clinical pharmacology through case-based learning. Case-based learning also provided students the opportunity to embrace the principles of problem solving, critical thinking, and lifelong learning. It helped students to amalgamate the concept of development of P drug list with rationale prescribing habits. Majority of our students also agreed that they understood the content of the subject taught in the session.

INTRODUCTION

Mastering the art and acquiring the knowledge of prescribing drugs is an essential skill required by all junior doctors. Drugs prescribed to the patients should be appropriate to the case encountered and must have a justification for its use. This justification should be based on principles of both evidence-based approach and recently approved guidelines. Medical students in their early years of career get confused with integrating the knowledge of basic pharmacology and clinical practice. Case-based learning (CBL) as a teaching tool for basic medical sciences has been greatly valued. It has shown to improve students’ understanding of the subject, which has resulted in improved performance in assessments and practice.[ 1 ] CBL in clinical pharmacology can bridge the gap between theory and practice.[ 2 ] Formulating CBL sessions to meet the expected outcomes is the need of the hour in medical curriculum. Clinical pharmacology CBL can amalgamate the concept of development of P drug list with rationale prescribing habits. We developed and conducted case-based clinical pharmacology session for year two medical students and evaluated their learning responses.

MATERIALS AND METHODS

Four case-based clinical scenarios were developed, keeping in mind the level of knowledge and understanding of year two MBBS students. A total of 80 students were included in the study. A committee of medical educators from within the faculty was set up to develop this scenario. Areas of knowledge, skills, and ethical consideration were incorporated in the case. No didactic lecturing session regarding this case and related drugs was conducted for the students. The case was uploaded on the e-portal of the university a week ahead of the session. Students were informed about this via university e-mail system and WhatsApp message sent to class representative. They were provided guidance on the framework of CBL and on how to approach the case. They were provided with a reading list with specific emphasis on drugs used (classification, names of drugs, mechanism of action, adverse effects, drug interactions, and clinical uses based on evidence and approved guidelines).

On the day of the session, students were divided into four groups of eight students each. As each session could accommodate 32 candidates, these sessions were conducted for three times.

Each group was given a CBL along with a questionnaire to discuss. A total of 40min were given for discussion and for preparing presentation. Each group then displayed their presentation followed by active interaction with the lecturers. Constructive feedback was given to all students at the end of the session. Model answers to questions were uploaded on the university e-portal.

At the end of the session, all students were asked to complete the Dundee Ready Education Environment Measure (DREEM) questionnaire. The DREEM is a 50-item questionnaire. It measures the educational environment in health professional education programs.[ 3 ] It is reported to be appropriate for use within health professional programs.[ 3 ] The DREEM gives a global score of 200 for the 50 items it contains.[ 3 ] DREEM questionnaire is made up of five subscales, namely perception of teaching, perception of teachers, academic self-perception, perception of atmosphere, and social self-perception.[ 3 ]

In our study, the average overall DREEM score was 155 with a range of 121–175, which indicated excellence in learning pharmacology through CBL session. Students’ perception of learning subscale score was 41±4.10, which indicated “teaching highly thought of.” Perception of teachers subscale score was 33±3.62, which indicated “moving in the right direction.” Academic self-perception subscale score was 27±3.83, which indicated “confident about the subject taught.” Perception of atmosphere subscale score was 36.03±2.32, which indicated a “more positive atmosphere” and social self-perception subscale score was 25±1.82, which indicated “very good socially.” Overall, the scores indicated that students enjoyed learning clinical pharmacology through CBL sessions and majority of them were satisfied with the understanding of the content of the subject during the session.

CBL session explores the concept of hands-on training in a classroom setting. The effectiveness of CBL is appreciated in various studies till now. We tried using CBL in clinical pharmacology to address the issue of problem solving, critical thinking, and rationale prescribing in medical students. CBL also provides a platform for student-centric learning activities, which enhances problem-solving and critical-thinking abilities in early years of medical career.[ 4 5 ] In our study, the scores of perception of atmosphere and social self-perception, which measure overall social and learning comfort of students, were similar to a study conducted earlier by Kassebaum et al. ,[ 6 ] where they found that CBL made the learning more enjoyable to the students. In this study, scores of academic self-perception and perception for teachers were more positive and were similar to a study conducted by Kamat et al. ,[ 7 ] which assessed the impact of case-based teaching on learning rational prescribing and found it to be better in facilitating the learning process. The impact of CBL was evaluated in various studies till now and mostly all of them concluded that the students enjoyed the sessions and felt that it enhanced their understanding.[ 7 8 9 ] These findings were similar to the observations of our study.

Our study concludes that the use of CBL sessions in clinical pharmacology enhances the quality of learning of the medical students. Higher order skills such as analysis and application can be developed using this pedagogical approach. Such sessions can help a student develop evidence-based strategy on the basis of guidelines for appropriate use of drugs. It is a small step in integrating theory with practice in early years of medical career.

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Case Presentation

Case study: a patient with uncontrolled type 2 diabetes and complex comorbidities whose diabetes care is managed by an advanced practice nurse.

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Geralyn Spollett; Case Study: A Patient With Uncontrolled Type 2 Diabetes and Complex Comorbidities Whose Diabetes Care Is Managed by an Advanced Practice Nurse. Diabetes Spectr 1 January 2003; 16 (1): 32–36. https://doi.org/10.2337/diaspect.16.1.32

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The specialized role of nursing in the care and education of people with diabetes has been in existence for more than 30 years. Diabetes education carried out by nurses has moved beyond the hospital bedside into a variety of health care settings. Among the disciplines involved in diabetes education, nursing has played a pivotal role in the diabetes team management concept. This was well illustrated in the Diabetes Control and Complications Trial (DCCT) by the effectiveness of nurse managers in coordinating and delivering diabetes self-management education. These nurse managers not only performed administrative tasks crucial to the outcomes of the DCCT, but also participated directly in patient care. 1  

The emergence and subsequent growth of advanced practice in nursing during the past 20 years has expanded the direct care component, incorporating aspects of both nursing and medical care while maintaining the teaching and counseling roles. Both the clinical nurse specialist (CNS) and nurse practitioner (NP) models, when applied to chronic disease management, create enhanced patient-provider relationships in which self-care education and counseling is provided within the context of disease state management. Clement 2 commented in a review of diabetes self-management education issues that unless ongoing management is part of an education program, knowledge may increase but most clinical outcomes only minimally improve. Advanced practice nurses by the very nature of their scope of practice effectively combine both education and management into their delivery of care.

Operating beyond the role of educator, advanced practice nurses holistically assess patients’ needs with the understanding of patients’ primary role in the improvement and maintenance of their own health and wellness. In conducting assessments, advanced practice nurses carefully explore patients’ medical history and perform focused physical exams. At the completion of assessments, advanced practice nurses, in conjunction with patients, identify management goals and determine appropriate plans of care. A review of patients’ self-care management skills and application/adaptation to lifestyle is incorporated in initial histories, physical exams, and plans of care.

Many advanced practice nurses (NPs, CNSs, nurse midwives, and nurse anesthetists) may prescribe and adjust medication through prescriptive authority granted to them by their state nursing regulatory body. Currently, all 50 states have some form of prescriptive authority for advanced practice nurses. 3 The ability to prescribe and adjust medication is a valuable asset in caring for individuals with diabetes. It is a crucial component in the care of people with type 1 diabetes, and it becomes increasingly important in the care of patients with type 2 diabetes who have a constellation of comorbidities, all of which must be managed for successful disease outcomes.

Many studies have documented the effectiveness of advanced practice nurses in managing common primary care issues. 4 NP care has been associated with a high level of satisfaction among health services consumers. In diabetes, the role of advanced practice nurses has significantly contributed to improved outcomes in the management of type 2 diabetes, 5 in specialized diabetes foot care programs, 6 in the management of diabetes in pregnancy, 7 and in the care of pediatric type 1 diabetic patients and their parents. 8 , 9 Furthermore, NPs have also been effective providers of diabetes care among disadvantaged urban African-American patients. 10 Primary management of these patients by NPs led to improved metabolic control regardless of whether weight loss was achieved.

The following case study illustrates the clinical role of advanced practice nurses in the management of a patient with type 2 diabetes.

A.B. is a retired 69-year-old man with a 5-year history of type 2 diabetes. Although he was diagnosed in 1997, he had symptoms indicating hyperglycemia for 2 years before diagnosis. He had fasting blood glucose records indicating values of 118–127 mg/dl, which were described to him as indicative of “borderline diabetes.” He also remembered past episodes of nocturia associated with large pasta meals and Italian pastries. At the time of initial diagnosis, he was advised to lose weight (“at least 10 lb.”), but no further action was taken.

Referred by his family physician to the diabetes specialty clinic, A.B. presents with recent weight gain, suboptimal diabetes control, and foot pain. He has been trying to lose weight and increase his exercise for the past 6 months without success. He had been started on glyburide (Diabeta), 2.5 mg every morning, but had stopped taking it because of dizziness, often accompanied by sweating and a feeling of mild agitation, in the late afternoon.

A.B. also takes atorvastatin (Lipitor), 10 mg daily, for hypercholesterolemia (elevated LDL cholesterol, low HDL cholesterol, and elevated triglycerides). He has tolerated this medication and adheres to the daily schedule. During the past 6 months, he has also taken chromium picolinate, gymnema sylvestre, and a “pancreas elixir” in an attempt to improve his diabetes control. He stopped these supplements when he did not see any positive results.

He does not test his blood glucose levels at home and expresses doubt that this procedure would help him improve his diabetes control. “What would knowing the numbers do for me?,” he asks. “The doctor already knows the sugars are high.”

A.B. states that he has “never been sick a day in my life.” He recently sold his business and has become very active in a variety of volunteer organizations. He lives with his wife of 48 years and has two married children. Although both his mother and father had type 2 diabetes, A.B. has limited knowledge regarding diabetes self-care management and states that he does not understand why he has diabetes since he never eats sugar. In the past, his wife has encouraged him to treat his diabetes with herbal remedies and weight-loss supplements, and she frequently scans the Internet for the latest diabetes remedies.

During the past year, A.B. has gained 22 lb. Since retiring, he has been more physically active, playing golf once a week and gardening, but he has been unable to lose more than 2–3 lb. He has never seen a dietitian and has not been instructed in self-monitoring of blood glucose (SMBG).

A.B.’s diet history reveals excessive carbohydrate intake in the form of bread and pasta. His normal dinners consist of 2 cups of cooked pasta with homemade sauce and three to four slices of Italian bread. During the day, he often has “a slice or two” of bread with butter or olive oil. He also eats eight to ten pieces of fresh fruit per day at meals and as snacks. He prefers chicken and fish, but it is usually served with a tomato or cream sauce accompanied by pasta. His wife has offered to make him plain grilled meats, but he finds them “tasteless.” He drinks 8 oz. of red wine with dinner each evening. He stopped smoking more than 10 years ago, he reports, “when the cost of cigarettes topped a buck-fifty.”

The medical documents that A.B. brings to this appointment indicate that his hemoglobin A 1c (A1C) has never been <8%. His blood pressure has been measured at 150/70, 148/92, and 166/88 mmHg on separate occasions during the past year at the local senior center screening clinic. Although he was told that his blood pressure was “up a little,” he was not aware of the need to keep his blood pressure ≤130/80 mmHg for both cardiovascular and renal health. 11  

A.B. has never had a foot exam as part of his primary care exams, nor has he been instructed in preventive foot care. However, his medical records also indicate that he has had no surgeries or hospitalizations, his immunizations are up to date, and, in general, he has been remarkably healthy for many years.

Physical Exam

A physical examination reveals the following:

Weight: 178 lb; height: 5′2″; body mass index (BMI): 32.6 kg/m 2

Fasting capillary glucose: 166 mg/dl

Blood pressure: lying, right arm 154/96 mmHg; sitting, right arm 140/90 mmHg

Pulse: 88 bpm; respirations 20 per minute

Eyes: corrective lenses, pupils equal and reactive to light and accommodation, Fundi-clear, no arteriolovenous nicking, no retinopathy

Thyroid: nonpalpable

Lungs: clear to auscultation

Heart: Rate and rhythm regular, no murmurs or gallops

Vascular assessment: no carotid bruits; femoral, popliteal, and dorsalis pedis pulses 2+ bilaterally

Neurological assessment: diminished vibratory sense to the forefoot, absent ankle reflexes, monofilament (5.07 Semmes-Weinstein) felt only above the ankle

Lab Results

Results of laboratory tests (drawn 5 days before the office visit) are as follows:

Glucose (fasting): 178 mg/dl (normal range: 65–109 mg/dl)

Creatinine: 1.0 mg/dl (normal range: 0.5–1.4 mg/dl)

Blood urea nitrogen: 18 mg/dl (normal range: 7–30 mg/dl)

Sodium: 141 mg/dl (normal range: 135–146 mg/dl)

Potassium: 4.3 mg/dl (normal range: 3.5–5.3 mg/dl)

Lipid panel

    • Total cholesterol: 162 mg/dl (normal: <200 mg/dl)

    • HDL cholesterol: 43 mg/dl (normal: ≥40 mg/dl)

    • LDL cholesterol (calculated): 84 mg/dl (normal: <100 mg/dl)

    • Triglycerides: 177 mg/dl (normal: <150 mg/dl)

    • Cholesterol-to-HDL ratio: 3.8 (normal: <5.0)

AST: 14 IU/l (normal: 0–40 IU/l)

ALT: 19 IU/l (normal: 5–40 IU/l)

Alkaline phosphotase: 56 IU/l (normal: 35–125 IU/l)

A1C: 8.1% (normal: 4–6%)

Urine microalbumin: 45 mg (normal: <30 mg)

Based on A.B.’s medical history, records, physical exam, and lab results, he is assessed as follows:

Uncontrolled type 2 diabetes (A1C >7%)

Obesity (BMI 32.4 kg/m 2 )

Hyperlipidemia (controlled with atorvastatin)

Peripheral neuropathy (distal and symmetrical by exam)

Hypertension (by previous chart data and exam)

Elevated urine microalbumin level

Self-care management/lifestyle deficits

    • Limited exercise

    • High carbohydrate intake

    • No SMBG program

Poor understanding of diabetes

A.B. presented with uncontrolled type 2 diabetes and a complex set of comorbidities, all of which needed treatment. The first task of the NP who provided his care was to select the most pressing health care issues and prioritize his medical care to address them. Although A.B. stated that his need to lose weight was his chief reason for seeking diabetes specialty care, his elevated glucose levels and his hypertension also needed to be addressed at the initial visit.

The patient and his wife agreed that a referral to a dietitian was their first priority. A.B. acknowledged that he had little dietary information to help him achieve weight loss and that his current weight was unhealthy and “embarrassing.” He recognized that his glucose control was affected by large portions of bread and pasta and agreed to start improving dietary control by reducing his portion size by one-third during the week before his dietary consultation. Weight loss would also be an important first step in reducing his blood pressure.

The NP contacted the registered dietitian (RD) by telephone and referred the patient for a medical nutrition therapy assessment with a focus on weight loss and improved diabetes control. A.B.’s appointment was scheduled for the following week. The RD requested that during the intervening week, the patient keep a food journal recording his food intake at meals and snacks. She asked that the patient also try to estimate portion sizes.

Although his physical activity had increased since his retirement, it was fairly sporadic and weather-dependent. After further discussion, he realized that a week or more would often pass without any significant form of exercise and that most of his exercise was seasonal. Whatever weight he had lost during the summer was regained in the winter, when he was again quite sedentary.

A.B.’s wife suggested that the two of them could walk each morning after breakfast. She also felt that a treadmill at home would be the best solution for getting sufficient exercise in inclement weather. After a short discussion about the positive effect exercise can have on glucose control, the patient and his wife agreed to walk 15–20 minutes each day between 9:00 and 10:00 a.m.

A first-line medication for this patient had to be targeted to improving glucose control without contributing to weight gain. Thiazolidinediones (i.e., rosiglitizone [Avandia] or pioglitizone [Actos]) effectively address insulin resistance but have been associated with weight gain. 12 A sulfonylurea or meglitinide (i.e., repaglinide [Prandin]) can reduce postprandial elevations caused by increased carbohydrate intake, but they are also associated with some weight gain. 12 When glyburide was previously prescribed, the patient exhibited signs and symptoms of hypoglycemia (unconfirmed by SMBG). α-Glucosidase inhibitors (i.e., acarbose [Precose]) can help with postprandial hyperglycemia rise by blunting the effect of the entry of carbohydrate-related glucose into the system. However, acarbose requires slow titration, has multiple gastrointestinal (GI) side effects, and reduces A1C by only 0.5–0.9%. 13 Acarbose may be considered as a second-line therapy for A.B. but would not fully address his elevated A1C results. Metformin (Glucophage), which reduces hepatic glucose production and improves insulin resistance, is not associated with hypoglycemia and can lower A1C results by 1%. Although GI side effects can occur, they are usually self-limiting and can be further reduced by slow titration to dose efficacy. 14  

After reviewing these options and discussing the need for improved glycemic control, the NP prescribed metformin, 500 mg twice a day. Possible GI side effects and the need to avoid alcohol were of concern to A.B., but he agreed that medication was necessary and that metformin was his best option. The NP advised him to take the medication with food to reduce GI side effects.

The NP also discussed with the patient a titration schedule that increased the dosage to 1,000 mg twice a day over a 4-week period. She wrote out this plan, including a date and time for telephone contact and medication evaluation, and gave it to the patient.

During the visit, A.B. and his wife learned to use a glucose meter that features a simple two-step procedure. The patient agreed to use the meter twice a day, at breakfast and dinner, while the metformin dose was being titrated. He understood the need for glucose readings to guide the choice of medication and to evaluate the effects of his dietary changes, but he felt that it would not be “a forever thing.”

The NP reviewed glycemic goals with the patient and his wife and assisted them in deciding on initial short-term goals for weight loss, exercise, and medication. Glucose monitoring would serve as a guide and assist the patient in modifying his lifestyle.

A.B. drew the line at starting an antihypertensive medication—the angiotensin-converting enzyme (ACE) inhibitor enalapril (Vasotec), 5 mg daily. He stated that one new medication at a time was enough and that “too many medications would make a sick man out of me.” His perception of the state of his health as being represented by the number of medications prescribed for him gave the advanced practice nurse an important insight into the patient’s health belief system. The patient’s wife also believed that a “natural solution” was better than medication for treating blood pressure.

Although the use of an ACE inhibitor was indicated both by the level of hypertension and by the presence of microalbuminuria, the decision to wait until the next office visit to further evaluate the need for antihypertensive medication afforded the patient and his wife time to consider the importance of adding this pharmacotherapy. They were quite willing to read any materials that addressed the prevention of diabetes complications. However, both the patient and his wife voiced a strong desire to focus their energies on changes in food and physical activity. The NP expressed support for their decision. Because A.B. was obese, weight loss would be beneficial for many of his health issues.

Because he has a sedentary lifestyle, is >35 years old, has hypertension and peripheral neuropathy, and is being treated for hypercholestrolemia, the NP performed an electrocardiogram in the office and referred the patient for an exercise tolerance test. 11 In doing this, the NP acknowledged and respected the mutually set goals, but also provided appropriate pre-exercise screening for the patient’s protection and safety.

In her role as diabetes educator, the NP taught A.B. and his wife the importance of foot care, demonstrating to the patient his inability to feel the light touch of the monofilament. She explained that the loss of protective sensation from peripheral neuropathy means that he will need to be more vigilant in checking his feet for any skin lesions caused by poorly fitting footwear worn during exercise.

At the conclusion of the visit, the NP assured A.B. that she would share the plan of care they had developed with his primary care physician, collaborating with him and discussing the findings of any diagnostic tests and procedures. She would also work in partnership with the RD to reinforce medical nutrition therapies and improve his glucose control. In this way, the NP would facilitate the continuity of care and keep vital pathways of communication open.

Advanced practice nurses are ideally suited to play an integral role in the education and medical management of people with diabetes. 15 The combination of clinical skills and expertise in teaching and counseling enhances the delivery of care in a manner that is both cost-reducing and effective. Inherent in the role of advanced practice nurses is the understanding of shared responsibility for health care outcomes. This partnering of nurse with patient not only improves care but strengthens the patient’s role as self-manager.

Geralyn Spollett, MSN, C-ANP, CDE, is associate director and an adult nurse practitioner at the Yale Diabetes Center, Department of Endocrinology and Metabolism, at Yale University in New Haven, Conn. She is an associate editor of Diabetes Spectrum.

Note of disclosure: Ms. Spollett has received honoraria for speaking engagements from Novo Nordisk Pharmaceuticals, Inc., and Aventis and has been a paid consultant for Aventis. Both companies produce products and devices for the treatment of diabetes.

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Best Online Classes for MBBS Students

Table of Contents

Introduction: Exploring the Best Online Classes for MBBS Students

Embarking on a medical journey requires continuous learning and staying updated with the latest advancements in the field. Online classes have become an invaluable resource for MBBS students, providing flexibility and access to quality education. In this article, we will delve into some of the best online classes tailored for MBBS students.

Comprehensive Video Lectures

MedCram offers in-depth video lectures covering a wide range of medical topics. These concise yet informative sessions are ideal for MBBS students looking to reinforce their understanding of complex subjects. The platform’s visual approach aids in better retention and comprehension.

2. Coursera – Medical Courses

Diverse courses from top universities.

Coursera collaborates with prestigious universities to offer a variety of medical courses. MBBS students can choose from subjects like anatomy, pharmacology, and pathology. The platform provides a flexible learning schedule, making it convenient for students with rigorous academic commitments.

Adaptive Learning Platform

Osmosis employs adaptive learning technology to tailor courses based on individual learning styles. MBBS students benefit from interactive lessons, practice questions, and video explanations. The platform’s personalized approach enhances comprehension and long-term retention.

4. Khan Academy – Medicine

Free and accessible learning.

Khan Academy provides free, world-class education, including an extensive collection of medical courses. MBBS students can access video lessons, practice quizzes, and resources covering various medical disciplines. The platform’s user-friendly interface makes learning easily accessible.

5. Stanford Online – School of Medicine

Specialized medical courses.

Stanford Online offers specialized courses designed by the School of Medicine. These courses cater to the specific needs of MBBS students, covering advanced topics and emerging trends in the medical field. The affiliation with Stanford ensures the highest quality of education.

6. AnatomyZone

3d anatomy resources.

AnatomyZone specializes in 3D anatomy resources, providing MBBS students with a unique visual learning experience. The platform offers interactive anatomy videos, quizzes, and clinical case studies, enhancing understanding and application of anatomical concepts.

7. Prognosis: Your Diagnosis

Clinical case simulations.

Prognosis offers an engaging learning experience through clinical case simulations. MBBS students can apply their knowledge to solve virtual patient cases, honing their diagnostic and decision-making skills. The interactive nature of the platform makes it a valuable tool for practical learning.

8. Quantum Studios – Complete Anatomy

Virtual dissection and anatomy learning.

Quantum Studios’ Complete Anatomy app allows MBBS students to virtually dissect and explore the intricacies of the human body. The app provides detailed 3D models, interactive quizzes, and a platform for collaborative learning, making it an immersive resource for anatomy studies.

9. Medscape Education

Continuous medical education (cme) courses.

Medscape Education offers CME courses covering a wide spectrum of medical disciplines. MBBS students can stay updated on the latest research, guidelines, and clinical practices. The platform’s accreditation ensures the credibility of the educational content.

10. Armando Hasudungan – YouTube Channel

Visual learning through illustrations.

Armando Hasudungan’s YouTube channel offers visually engaging illustrations and explanations of medical concepts. MBBS students can benefit from concise videos covering topics like physiology, pathology, and pharmacology, enhancing their visual memory of crucial information.

Online classes provide MBBS students with flexible and diverse learning opportunities, supplementing traditional classroom education. Choosing the right platform depends on individual preferences, learning styles, and the specific needs of the medical curriculum.

In a dynamic field like medicine, staying informed and continuously expanding knowledge is paramount for future healthcare professionals. These online classes serve as valuable companions in the educational journey of MBBS students, offering convenience and quality education.

• Are online classes a suitable replacement for traditional medical school education? Online classes complement traditional education by providing additional resources and flexibility. However, they are not a complete replacement for hands-on practical experience.
• How can MBBS students balance online classes with their regular coursework? Time management is key. MBBS students should create a schedule that allocates dedicated time for online classes while ensuring they meet their academic requirements.
• Are the courses mentioned in this article accredited? Many of the courses offered by reputable platforms are accredited. It’s advisable for students to verify the accreditation status before enrolling in any course.
• Is there a cost associated with the online classes mentioned? While some platforms offer free courses, others may have associated costs. It’s essential to check the pricing details on each platform before enrollment.
• How can MBBS students make the most out of online learning? Actively engage with the material, participate in discussions, and utilize supplementary resources. Additionally, seek a balance between online learning and practical, hands-on experiences.

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Model Question Papers For MBBS 1st Year [Sample Papers]

In this post, you can refer to model question papers which have been designed as per the new CBME curriculum (according to the latest syllabus and question paper pattern) for 1st year MBBS course.

ANATOMY PAPER 1

Long essays (2 × 10 = 20 marks).

• Describe the knee joint under the following headings: Bones forming Ligaments Movements with muscles causing them and their nerve supply Applied aspects (1+3+3+1+2)
• Describe the stomach under the following headings: Location Parts Relations Blood supply Lymphatic drainage Applied aspects (1+1+3+2+2+1)

Short Essays (10 x 5 = 50 marks)

• Explain the course, relations and distribution of the common peroneal nerve. At which site is the nerve commonly injured and why? Explain the anatomical basis of the clinical features observed as a result of such an injury. (3+1+1)
• Describe the mechanism, location and applied importance of porta-caval anastomosis. (1+2+2)
• Describe the gross anatomy and applied importance of the vermiform appendix. (3.5+1.5)
• Explain the protective mechanisms of the inguinal canal that prevent the occurrence of inguinal hernia.
• Describe the lobes, relations and applied anatomy of the prostate gland. (2+2+1)
• Describe the boundaries, contents and applied aspects of the ischiorectal fossa. (2+2+1)
• Describe the supports of the uterus and their applied importance. (4+1)
• What is Down syndrome? Explain the genetic mechanism underlying it. (2+3)
• Correlate the structure and function of the juxta-glomerular apparatus.
• Explain the mechanism of midgut rotation during development and its consequences.

Short Answers (10 x 3 = 30 marks)

• What is Trendelenburg gait? Explain its anatomical basis. (2+1)
• A man sustained severe trauma to the lower chest wall on the left side in a road traffic accident. He was taken to the emergency department where he was found to have a fracture of the 9th and 10th ribs and a ruptured spleen. Explain the probable mechanism by which splenic rupture might have occurred.
• Name the attachments and contents of the lesser omentum. (1.5+1.5)
• Name the attachments and contents of the broad ligament of the uterus. (1.5+1.5)
• Describe briefly the gross anatomy of the perineal body and its applied importance. (2+1)
• Draw a typical pedigree chart showing sex-linked recessive inheritance.
• Draw a neat, labelled diagram (high-power view) of a haematoxylin and eosin stained section of a pancreatic acini.
• Compare and contrast the histology of the duodenum, jejunum and ileum.
• Enumerate the derivatives of the paramesonephric duct.
• Enumerate the derivatives of the 2nd pharyngeal arch.

ANATOMY PAPER 2

Long essays (2 x 10 = 20 marks).

• Describe the femoral triangle under the following headings: Boundaries Contents Add a note on femoral sheath and its applied aspects. (3+4+3)
• A young male patient came to the emergency with a history of severe abdominal pain in the right iliac fossa. On examination tenderness at McBurney’ s point was noted. What is McBurney’s point? Name the organ involved Describe its positions, peritoneal fold and blood supply Explain the anatomical basis for tenderness at McBurney’s point. (1+1+6+2)
• Describe the origin, course, branches and distribution of Obturator nerve. (1+2+2)
• Describe the boundaries of hepatorenal pouch and give its clinical significance. (3+2)
• Describe the peritoneal folds and visceral relations of spleen. Explain the embryological basis of notched superior border of spleen. (2+2+1)
• Describe the attachments, actions, nerve supply and modifications of external oblique abdominis muscle. (2+1+1+1)
• Describe the prostate under the following – parts and coverings, structures opening in the posterior wall of prostatic urethra, give the clinical significance of venous drainage. (2+2+1)
• Describe the origin, course, branches of the Internal pudendal artery. Add a note on its surgical importance. (1+1+2+1)
• Describe the Articulating surfaces, Ligaments, Applied aspect of Sacroiliac joint. (2+2+1)
• Describe the principles of genetic counselling.
• Compare and contrast the structure and function of rods and cones.
• Describe the development of uterus and explain the embryological basis of septate uterus. (3+2)
• Mention any 3 factors maintaining the medial and lateral longitudinal arches of foot.
• Enumerate the structures passing through sacral hiatus.
• Explain the clinical importance of arterial arcades of jejunum and ileum.
• Name the muscles attached to the perineal body and give its clinical importance. (2+1)
• Draw a neat labelled diagram of interior of anal canal and add a note on clinical significance of pectinate line. (2+1)
• Draw a pedigree chart of X linked inheritance with example.
• Compare and contrast the mucosa of the fundus and pyloric part of the stomach.
• Describe the structure and functional significance of portal acinus.
• Explain the embryological basis of nerve supply of the tongue.
• Explain the embryological basis of Fallot ‘s tetralogy.

PHYSIOLOGY PAPER 1

• Define Cardiac output and mention its normal value. Explain the factors regulating Cardiac output. (2+8)
• Describe the mechanism of concentration of urine. Explain the role of hormones in producing concentrated urine. (7+3)
• Kwashiorkor causes retention of fluid in the arms, lower limbs and face leading to a swollen appearance. Identify the sign and define (2) Analyze the cause for retention of fluid (3)
• A 30 year old males came with a history of severe burning sensation and pain in the abdomen associated with nausea and vomiting since 1 week. History revealed that the pain was relieved after intake of food. Personal history revealed that he was a chronic smoker and alcoholic. What is probable diagnosis (1) Describe the mechanism of HCl secretion (3) Explain the basis for use of proton pump inhibitor in the treatment of above condition (1)
• Define compliance. State its normal value. Name conditions where lung compliance is altered.(1+1+3)
• Explain with a graph the segments of the left ventricle pressure volume loop.
• Explain the transport of oxygen in arterial blood.
• Explain the Intrinsic mechanism of coagulation.
• Explain the physiological basis of oxygen therapy in different hypoxias. What are the side effects of 100% oxygen administration? (3+2)
• Explain the long term mechanism of regulation of blood pressure.
• Describe the movements of the small intestine.
• Explain the mechanism of Humoral immunity. List the types of immunoglobulins with their functions. (2+3)
• Explain how apoptosis is a natural process with the help of one example.
• Explain the role of plasmin in lysis of blood clot.
• How does AV nodal blocks appear on ECG?
• Explain the effect of gravity on the ventilation perfusion ratio.
• Explain why glycosuria is seen at plasma glucose concentration of 180 mg%.
• Account for the elevated levels of serum Amylase in acute pancreatitis.
• Describe the structure of glomerular filtration membrane.
• Enumerate clinical features of hypovolemic shock.
• Describe the different components of blood that are used in blood transfusion.
• What constitutes Dead space? What are its types?

PHYSIOLOGY PAPER 2

• Trace the pain pathway. Classify the types of pain. Explain the gate control theory. (5+3+2)
• A 26 year married lady menstruating regularly missed her menstrual cycle. The Urine Gravindex test was positive. What is the physiological basis of this test (2) What physiological changes would occur in the different systems? (5) Mention the methods by which she can plan her family in future (3)
• A 73 year old man’s wife notices that her husband is not making any sense when he talks and does not seem to understand simple commands. Analyze the site of lesion (2 marks) Design a flowchart for the pathway of spoken speech. (3 marks)
• Describe the mechanism of action of insulin. Explain its regulation. (3+2)
• Describe the connections of Basal ganglia. Explain its functions. (2+3)
• Provide experimental evidence for operant conditioning.
• Explain the transmission of impulse across the neuromuscular junction.
• Explain the mechanisms by which the receptor quantity and sensitivity are regulated.
• Account for all the causes of short stature.
• Describe the role of hypothalamus in the control of food and water intake. (3+2)
• Describe the uterine and ovarian changes during menstrual cycle. (3+2)
• Explain the visual reflexes.
• Enumerate differences between Excitatory and inhibitory postsynaptic potential.
• Describe the role of ACTH in the regulation of glucocorticoids.
• Explain all mechanisms by which generation of a nerve action potential can be blocked.
• Describe features of Wallerian degeneration with the help of a diagram.
• List criteria to diagnose metabolic syndrome.
• Enumerate the functions of pineal gland.
• Explain the different waves of EEG.
• Account for the pain and loss of hearing in a person having common cold during rapid descent in an airplane.
• Explain the tests to detect latent tetany.
• Enumerate the functions of the limbic system.

BIOCHEMISTRY PAPER 1

• A 57 year old man was brought to the emergency with a history of 12 hours shortness of breath, coughing and tightness in the chest region. The symptoms appeared suddenly. His past medical history is significant for diabetes mellitus and hypertension. He is a known smoker and alcoholic. At the time of admission his B.P was 180/100 mm of Hg. The laboratory tests showed CKMB as 45 IU/L (Reference range 5-25 IU/L). Suggest the probable diagnosis? (1) Define isoenzymes. (1) Discuss different isoenzyme forms of any two relevant enzyme along with their characteristics, and clinical significance (8)
• Discuss Vitamin B12 with respect to the following: Dietary sources and RDA. (2) How is it absorbed from the intestine? (2) Biochemical role as coenzyme (2) Deficiency manifestations and their biochemical basis (3) Why do vegans develop Vitamin B12 deficiency? (1)
• What are Phospholipids? Mention the composition and function of any four of lipids. (1+4)
• Mention the reference range of HDL cholesterol (HDL-C). Justify the role of HDL-C as scavenger of cholesterol illustrating the metabolic pathway. (1+4)
• Define oxidative phosphorylation.. Explain the Chemiosmotic theory of oxidative phosphorylation with a suitable diagram. (1+4)
• A 25 year old type 1 Diabetic patient presented with hypertension, dry mucous membrane and poor skin turgor. On examination the patient was tachypneic and his breath had fruity odour. His blood investigations showed RBS – 550mg/dL pH- 7.25 pCO2 – 38 mmHg HCO3 – 16 mEq/L Suggest the acid base disorder (1) Explain the causes, biochemical abnormalities and compensatory mechanisms in this acid base disorder. (2) What is anion gap and how do you relate anion gap in this case. (2)
• A 12 year old girl came with h/o of distension of abdomen and complained of frequent episodes of weakness, sweating and pallor that subsided on eating. O/E significant findings showed hepatomegaly. Blood examination revealed: Fasting Plasma Glucose – 40mg/dL Triglycerides – Increased Lactic acid – Increased Uric acid – Increased Ketone bodies – Increased Suggest the probable diagnosis (0.5) Name the deficient enzyme in this case (0.5) Outline the reactions of the affected pathway in this case (2) Analyze the reason for increased lactic acid and uric acid levels in this case. (2)
• Mention the reference range of serum calcium. Explain the regulation of blood calcium level. (1+4)
• Compare and contrast Marasmus and Kwashiorkor.
• Explain the anapleurotic reactions of TCA cycle. (5)
• Explain the synthesis of ketone bodies. Justify the role of ketone bodies as alternate sources of energy. (3+2)
• Discuss Oral Glucose Tolerance Test (GTT) under the following headings: Indications, contraindications, procedure and interpretation of oral GTT. (1+1+1+2)
• Draw a neat labelled diagram of Mitochondria and Name any two mitochondrial disorders. (2+1)
• Enumerate the six components of ECM.
• Explain the protein sparing action of carbohydrates in the body.
• Mention the Biological Reference Range in the serum for the following analytes: Na K Cl Ca Phosphorus Bicarbonate
• List any 3 functions each of copper and zinc.
• Discuss the relationship between Vitamin E and selenium.
• Digoxin, a cardio tonic drug, inhibits which transport pump in the membranes. Explain the mechanism of this pump.
• Mention the role of lipases involved in the digestion of lipids.
• Define osmolality. Mention the reference range of plasma osmolality.
• Mention the therapeutic significance of competitive inhibition citing three examples.

BIOCHEMISTRY PAPER 2

• A 14 year old male presented with one week history of episodic severe abdominal pain associated with vomiting 3 to 4 times a day and dark reddish urine. In the past, he had 2 episodes of similar abdominal pain along with altered sensorium and generalized epileptic for which he was on treatment. General physical examination and neurological and abdominal examination was unremarkable. Laboratory investigations showed hemoglobin of 11 gm% and urine was strongly positive for porphobilinogen. Peripheral smear showed microcytic hypochromic anemia. Suggest the probable diagnosis? What is the biochemical basis for the above-mentioned laboratory findings. Explain the pathway implicated in this condition (1+3+6)
• Explain any five liver function tests with their clinical interpretation.

Short Essays (10 x 5= 50 marks)

• Classify proteins based on their functions with suitable examples.
• An 81-year-old woman presented with fatigue and was found to have anemia. In fact, she had some pancytopenia. She had low neutrophils, she had low platelets, she had some anemia, and then she was found to have a monoclonal protein. On x-rays, she was found to have bone lesions and advanced bone disease, and she was found to have an elevation in her creatinine with a lower creatinine clearance. Based on the clinical and laboratory evaluation it was diagnosed as paraproteinemia. Explain the biochemical evaluation of this case with their clinical interpretation. List the various immunoglobulins and their functions.
• A 10 day old neonate was brought to hospital with complaints of feeding intolerance, emesis, strong body odour and convulsions. Laboratory tests revealed elevated serum ammonia and citrulline with no acidosis. Based on the presentation and laboratory evaluation doctor advised arginine for treatment following which the baby’s condition improved. Mention the diagnosis with the defective enzyme. Explain the biochemical basis for the treatment given. Write the steps of the pathway implicated. (1+1+3)
• Mention four specialized compounds formed from glycine and their significance. (1+4)
• Explain the Watson crick model of DNA with a neat labelled diagram.
• Enumerate the steps of purine nucleotide degradation.
• Explain the sources of various atoms of purine and pyrimidine rings with illustrations.
• List the various DNA repair mechanisms and explain any two. (1+2+2)
• Define translation. Explain the post translational modifications. (1+4)
• Classify tumor markers with examples and their clinical significance.
• Write the steps of southern blot technique.
• Mention six applications of Recombinant DNA technology in medicine.
• Define transamination reactions with suitable examples and write its significance.
• What is point mutation? Give an example of missense mutation and its consequences.
• Write the mechanism of action of Reverse transcriptase and state its significance.
• Enumerate the Tubular function tests of the kidney and explain the dilution test.
• Describe the Lac operon concept.
• Enumerate the steps of lipid peroxidation
• Mention any three Antioxidant enzymes and write their significance.
• Mention any three biologically important peptides and write their functions.

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The top 13 apps for medical school students

The top apps for medical students to improve studying, nail exam prep, boost productivity, and beat back stress.

Learning all that content in medical school is a bit like trying to drink from a fire hose. There’s a raging torrent of information, and somehow you need to get it all into your head, all while attending labs, submitting assignments, and, you know, still having to tend to your basic needs for food, sleep, and hygiene.

I mean, when last did you do the laundry?

Med school is tough—and it should be. But one of the best ways to get crucial daily studying done is to repurpose all that “in-between” time in your day . Just think about it: if you used the time waiting for the bus (10 minutes), commuting (40 minutes), between lectures (15 minutes), and waiting for your partner to get ready (84 years), you’d find that by the end of the day, you’ve got a good chunk of your work done!

And the best way to capitalize on all that squandered time? These top apps for med students!

(Read our seminal guide on how to study more efficiently !)

The best apps for studying for medical school

If you're looking for a little "secret sauce" to supercharge your efficiency, access to knowledge, and organization, then check out these top apps for med students. Some of them not only contain extensive medical school content for quick reference, but others, like Brainscape, have been engineered to help you study twice as efficiently as any other study tool or technique!

Top med school app # 1: Brainscape

Brainscape is a flashcard-based web and mobile app for serious learners who need to learn, understand, and memorize large amounts of information and fast . It has a vast collection of medical flashcards , created by other top students and educators, for hundreds of popular subject areas in the field of medicine and healthcare.

It also has certified collections of expert-curated and vetted flashcards for the MCAT , USMLE , NCLEX , EMT , Paramedic , and more. Here's an example of the question (left) and answer (right) side of a mobile flashcard from the NREMT-Paramedic class ...

So, what makes Brainscape different from other flashcard apps?

• It has a far more sophisticated spaced repetition algorithm , which automates the intervals at which you revisit new information at the perfect pace for your unique needs.
• It offers detailed learning analytics so that you know exactly how far you've progressed and how far you still have until mastery of a topic is reached.
• Brainscape has flexible content formats , allowing you to make (and learn) flashcards with multi-media and different kinds of text, i.e. much more than just "vocab words".
• It enables you to make your own flashcards on Brainscape's website and sync them to the Brainscape mobile app.

And finally, Brainscape is free for most features , while complete content access can be unlocked for a modest subscription fee that is a fraction of most other medical content repositories.

Learn more about Brainscape now !

Top med school app # 2: Anki

Anki is another popular adaptive flashcard app used by many med students. While its design might not be quite as slick as Brainscape and Quizlet, its software is "open source", meaning it is developed by the public community and not controlled by an evil corporation ( mooo-ha-ha-ha! ). It is also free to use online (at the time of writing), although the mobile app costs $25.

Because Anki does not have official partnerships with publishers or content experts, you can't really know if you can trust the quality, comprehensiveness, and accuracy of the flashcards you find in its marketplace. So, it's best to remember this as you look for others people's flashcards to study.

[For a much deeper dive on this comparison, read our article: Brainscape vs Anki ]

Top med school app # 3: Quizlet

Quizlet is also a very popular flashcard app with pre-created card decks on topics like medical terminology, conditions, and abbreviations. There’s a huge range of user-created flashcards in Quizlet's marketplace, and you can also make your own.

Most of the content in Quizlet is user-generated and in the form of independent "study sets", rather than a complete progressive curriculum (like you might find in Brainscape). Because of this, it could take you a ton of time and research to compile the best and most accurate user-generated study sets for the goal you are shooting for, and there might be a lot of overlap between the different users' content that you combine together.

But, at least it's fun! Quizlet gamifies its learning experience, turning medical content into score-able games . For some, this may be fun but serious learners tend to prefer the hyper-efficient and clean-cut approach Brainscape takes to learning. The bottom line is if you are looking to make your medical vocab studying more fun, Quizlet may be the app for you. If you are looking for a more effective study app that will help you master medical content in less time, go with Brainscape.

[Aaaand for the detailed comparative guide on these two medical apps, check out: Brainscape vs Quizlet .]

Now, let's turn our attention to the best medical apps for healthcare professionals on the job!

The best medical apps for learning and practicing medicine

The apps below have been created both for medical students and qualified physicians. They’re great as references, networks, and information storehouses.

Top medical app # 4: MDCalc Medical Calculator

Being a doctor requires you to be fluent in a spectrum of formulas and equations, which is where MDCalc can make life a whole lot easier. The app contains 500+ medical formulas you’ll need for making good decisions and recommendations for patient care in the clinical environment. From pregnancy wheels, dermatome maps, and dosage calculators to eye charts and growth velocity, MDCalc is the go-to clinical decision tool for 35+ medical specialties.

For study purposes, MDCalc gives a summary of why each formula and calculator is important and how/why it’s used, as well as links to reference articles and studies to help support your understanding and decision making.

App Store | Google Play

Top medical app # 5: Prognosis

Prognosis is a tool for practicing your diagnostic and decision-making skills, using real clinical cases submitted by 200 physicians spanning 33 specialties. Within the app, users can select a case, make their diagnosis, and then check it against the official peer-reviewed diagnosis. The case information provided includes diagnostic reasoning, test results, and key learning points, allowing users the opportunity to learn valuable lessons from each case.

Prognosis is a particularly useful app for getting to grips with different disease groups and their treatment. New cases are released every week, based on real-world clinical experiences.

Top medical app # 6: DailyRounds

There are over 20,000 pharmaceuticals approved by the FDA for prescriptions, which is a whole lot for med students and doctors to get a handle on! DailyRounds offers an extensive drug database, with key information on 10,000+ brands and 2,000+ molecules.

Like Prognosis, this app also contains peer-reviewed clinical cases, which are presented in a way to help you prepare for examinations like the USMLE, AIPGMEE, and NEET PG. A good proportion of these cases are common clinical scenarios, but the app also branches out into rarer conditions and diseases.

All the major specialties are covered: cardiology, nephrology, pathology, anesthesiology, radiology, pediatrics, and surgery.

Top medical app # 7: Human Anatomy Atlas

The Human Anatomy Atlas offers thousands of models to help you understand how the human body works and the names of its myriad muscles, bones, arteries, organs, and more. Used by both medical students and professionals, this medical app includes textbook-level terminology, as well as dissection models, microanatomy, and animations. It’s a great study reference for pre-med and medical students, and a lot lighter to haul around with you than an anatomy textbook!

Top medical app # 8: Epocrates

A key requirement for passing medical school and practicing safe medicine is understanding drug interactions. There are literally thousands of drugs on the market, so this is not easy ... but that’s where Epocrates comes in.

The free version of Epocrates centers on pharmacology and features a powerful drug interaction checker. You can check for harmful interactions between up to 30 brands, generic, OTC, or alternative drugs at a time. There’s also a mystery pill identifier, with pills organized by shape, color, and imprint code. Then there are 600+ dosing calculators, medical equations, and other useful tools.

The professional version of Epocrates includes disease information, infectious disease treatment, laboratory panels, and support for alternative medicines. All in all, this app is a great reference for pharmacology and good prescription practice.

Top medical app # 9: Medscape

This is one of the most popular medical apps on the market. Medscape features a tailored newsfeed, with the latest medical news and expert commentary in various specialties. There’s information on the hot-off-the-press FDA approvals, conference updates, new clinical trial data, and more.

The “consult” section has a huge network of physicians and med students where you can read new case histories and keep up with current medical thought. Medscape also contains 400+ medical calculators, a drug interaction checker, pill identifier, and step-by-step procedural videos.

The best app for productivity and time management

Being in medical school means having an enormous number of things to do, every day, for several years . So it’s hardly surprising that so many students get overwhelmed and exhausted by the workload. The productivity and time management app below will help you manage your task list in a way that makes it feel doable!

Top healthcare management app # 10: Todoist

Todoist has been called “ the best to-do list right now .” It’s used by 25 million people to organize, plan, and collaborate their daily task list. You can use this app to keep your achievements top-of-mind with a widget that shows your current progress toward daily and weekly goals.

You can quickly create reminders for repetitive tasks, and order your list in terms of importance. Todoist is particularly good at breaking large amorphous tasks into small, bite-sized pieces, which is the key to building momentum and winning each day.

Google Play | App Store

The best apps for improving mindset

High achievement is a mental game, as well as a physical one. Unless you learn how to unwind, let go, and relax, you’ll never be able to summon peak performance from yourself at will. The apps below will help you with the flipside of hard work: making sure you’re able to unplug your brain and get restorative rest.

Top med app # 11: Headspace

Get happy. Be less stressed. Sleep soundly. Founded by a former Buddhist monk with a degree in circus arts, Headspace is a vast store of guided meditations and mindfulness exercises , tackling key problem areas like sleep, waking up, working out, focusing, relaxing, and more.

Many world-class athletes, scholars, CEOs, medical students and healthcare professionals use meditation and mindfulness skills to perform at their highest level and enjoy the process.

Top med app # 12: Calm

Calm is a hugely popular app for sleep, meditation, and relaxation. Sleep is essential for clear thought, decisive action, memory retention, and cognition—especially during times of high stress and study—all of which are crucial for medical students and practicing healthcare professionals.

This app contains guided meditations, sleep stories read by various celebrities, breathing programs, stretching exercises, and relaxation soundscapes.

Top med app # 13: Forest

We all know phones are addictive, distracting, and a great way to derail your study time. The Forest app is a similarly addictive (in a good way) method to help you beat phone addiction and overcome distraction, which is especially helpful if you have an important medical exam coming up!

The app rewards you for leaving your phone alone, allowing you to stay focused on more important tasks, like studying. Forest also tracks your focused moments , helping you build good habits, and exercise your willpower, which you can then use to beat procrastination and get the necessary work done for medical school.

Final thoughts on the best medical school apps

There you have it: 13 study, medical, and organization apps that will help you survive and even thrive throughout your years at medical school and as a practicing physician. The world needs good doctors and while the road is long and littered with seemingly insurmountable obstacles, a combination of daily study habits, self-care, determination, and smart study apps like Brainscape will give you the tools you need to rise to the challenge !

If you're still looking for more helpful medical school apps, head to our friend Medarchive Magazine and check out their article " 25 Best Study Apps For Medical Students To Increase Productivity ".

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First Year in Medical College- MBBS students life

• July 7, 2014

After several queries from our readers, mainly the students planning to join and those who have just joined in the Medical School MBBS course about how the first year here in MBBS looks like, we have shared our first hand experience. We will also be talking on details about all the aspects that concerns and are related to a medical student in the 1st year.

Joining a MBBS course is a jolt of fresh enthusiasm and eagerness about what shall come ahead and feeling of security and pride over the profession one has ensued. At the same time the enumerable queries about whether the course is within own capability and the fear of the Hearsay can make days bit of a turmoil. So a good counselling is what you people need at this time.

A NEW BEGINNING…

Lets begin with the entry into a Medical school. Once you are enrolled, you might be in a hurry to know the subjects and many may want to start studying even before joining to stay ahead during the course, but MBBS is something different to start early without a teacher and during the long course ranging 5.5-6 years of study, you’ll have ample of time to study everything if you keep up your aptitude. What you should know is-

MBBS course has Basic Science and Clinical Medicine plus 1 year of compulsory rotatory Internship. First 2 years will be focussing on Basic Science which will encompass subjects

• – Anatomy
• -Physiology
• -Biochemistry
• -Pharmacology
• – Microbiology
• -Community Medicine.

Don’t worry about the subjects right know.. and of course you’ll have practical classes on related subjects.

Clinical Medicine will have subjects like-

• -Medicine with Dermatology, Psychiatry
• -Surgery and Orthopedics
• -Pediatrics and Adolescent medicine
• -Gynecology and Obstetrics

Minor subjects

• -Ophthalmology
• -Forensic Medicine
• -Community Medicine

START OF CLASSES

With the starting of classes, most of you’ll be staying hostel, at many centres hostel is compulsory. Then starts the good days of Hostel, mess, sports, knowing new friends … socializing… and touch of the books..

But what remains still a fear at many parts is the “Ragging”. However it is mostly meant for socialization. Still the myth and sometimes horrific ragging have occurred around medical schools. If a limit is crossed, do not constraint yourself, rather you should try to resolve it with your family member. Let them know whats happening.

LIBRARY..and the SENIORS

is one good friend now for students, and a regular place to meet up, socialize and study. Staying at hostel or close to the College provides you an access to library which is the most important place to be. You’ll surely meet helpful seniors who’ll be ready to guide you through the course and will share their valuable experience about the subjects and teachers as well.

Read How to –

Study Daily in MBBS

Studying during Exams

is one thing that’ll attract you but many may not have opportunity to meet patients in first 2 years, however some centers do start clinical postings from the very year.

Mind that, every Medical college hostel is full of Parties and all those stuff. Night outs, Movies, Sports, Picnics, Dance parties are all cultures, without them life would just Suck.. Don’t expect hostel to be peaceful and ambient for study until the EXAMS arrive..

At first the exams will seem impossible to pass as everything is new, but with time as you are good with medical terms and facts, you’ll be acclimatized with it. Still MBBS exams are difficult and the exam times are moments to remember all life..

First time now you’ll have books as fat as you and which when piled one over other will be taller than you.. Don’t give up… because everyone has gone by the same course, if they can you can… its a routine..

Read- Books for MBBS Basic Science

FRUSTRATIONS..

of the change in life.. too much of study load…loss of social life, loss of the fun-life are due to come, but studying MBBS you have already prepared for the sacrifice, you’ll eventually adjust.

What if I fail?

THE DAILY ROUTINE..

is almost the same.. except during Exams and post exams..

CHOOSE YOUR STUDY PARTNERS…

carefully, as what you’ll become will be determined by the group you are in. If you want fun join similar guys and if you want seriousness.. chose the partners carefully.

EXCITEMENT OF FUTURE ..

is obvious as you are planning on getting a Bachelor of Biomedicine , which is a dream coming true. Don’t let this dream fade away.. keep it as an inspiration to guide you in coming days..

WELCOME… and Best of Luck

If anybody have a different aspect and more to add to, you can always comment below. Lets help the juniors.

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15 comments.

Do medical class consisting of experimenting with healthy body for study, just like dead bodies. Do they use anatomical living model just like in fine art class?

Do medical colleges use living anatomical models or living medical model just as fine art colleges uses life model for anatomical studies.. If so, how can i contact medical colleges.

can you provide the whole syllabus for MBBS first year for TU?

When will we be told to buy stethoscopes and all other medical accessories? Can your write an article on when students are told to buy these stuff and what accessories (from medical to non-medical accessories) are needed?

what are the chapter to be studied in 1st year in tu college of nepai and how to prepare for easy learning?

Hi sir I am currently in class 11th. I want to know which books are best to study for the exams and also to prepare for entrance exams side by side..

I think you are the right person to ask this question because you have already gone through this stage…

Are you from India or Nepal Dipanshu?

Sir give any ideas to pass first year . And how can i overcome my fear about exams And first year in medical

Hello Aswin, Go throught the Student Life section of Medchrome- http://medchrome.com/category/medicalcolleges/student-life , we have written lot of tips and guides for medical students, mainly for 1st and 2nd year students.

how should we study so that we couldnot forget what we have learned???

Sunita, We have written an article regarding this. Study at right time.

Sir I have failed in all 3 subjects of mbbs first year…can you please tell me how to study and what topics to study because only 1 month is left for supp exam..

Nidhi We will be able to help you when you tell us the 3 subjects.

did u pass the exam//

sala pass karne kee liye padna bhi padta hai…..

Comments are closed.

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• Open access
• Published: 08 August 2024

Unveiling the impact of interprofessional education on shaping students’ interprofessional identity and collaboration perception: a mixed-method study

• Qing He 1 ,
• John Ian Wilzon T. Dizon 1 ,
• Fraide A. Ganotice 1 ,
• Binbin Zheng 1 ,
• Pauline Pui Ning Yeung 2 ,
• Xiaoai Shen 1 ,
• Lily Yuen Wah Ho 3 ,
• Arkers Kwan Ching Wong 3 ,
• Franco Wing Tak Cheng 4 ,
• Karen Man Kei Chan 5 ,
• Linda Chan 1 ,
• Sarah So Ching Chan 1 ,
• Amy Yin Man Chow 6 ,
• Jody Kwok Pui Chu 4 ,
• Denise Mae Chua 5 ,
• Edwin Chung-Hin Dung 7 ,
• Wei-Ning Lee 7 ,
• Feona Chung Yin Leung 8 ,
• Qun Wang 9 ,
• Kevin K. Tsia 7 ,
• Dana Vackova 10 ,
• Julienne Jen 11 &
• George L. Tipoe 1  

BMC Medical Education volume  24 , Article number:  855 ( 2024 ) Cite this article

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Interprofessional education (IPE) has the potential to shape students’ collaboration perception and interprofessional identity but remains understudied. This study aims to understand the effects of the IPE program as a contextual trigger to promote collaboration perception change and interprofessional identity formation among healthcare professional students.

Using concurrent triangulation mixed-methods, we examined the relationship between collaboration perception and interprofessional identity change among health profession students ( N  = 263), and explored their perspectives on how their IPE experiences influenced their perception and identity. Participants completed the Interdisciplinary Education Perception Scale and Extended Professional Identity Scale and responded to open-ended questions before and after the IPE intervention. Pearson’s correlation, t-tests, regression (quantitative), and thematic analysis (qualitative) were conducted.

Teams with initially lower collaboration perception (M = 3.59) and lower interprofessional identity (M = 3.59) showed a significant increase in collaboration perception (M = 3.76, t = 2.63; p  = .02) and interprofessional identity (M = 3.97, t = 4.86; p  < .001) after participating in IPE. The positive relationship between collaboration perception and interprofessional identity strengthened after participating in IPE, as evident from the correlation (Time 1: r  = .69; p  < .001; Time 2: r  = .79; p  < .001). Furthermore, collaboration perception in Time 1 significantly predicted the variance in interprofessional identity at Time 2 (β = 0.347, p  < .001). Qualitative findings indicated that 85.2% of students expressed that IPE played a role in promoting their interprofessional identity and collaboration attitudes.

Conclusions

Incorporating the IPE program into the curriculum can effectively enhance students’ collaboration perception and interprofessional identity, ultimately preparing them for collaborative practice in the healthcare system. By engaging students in interprofessional teamwork, communication, and joint decision-making processes, the IPE program provides a valuable context for students to develop a sense of belonging and commitment to interprofessional collaboration.

Peer Review reports

Professional identity is a critical aspect of professional practice, influencing how individuals perceive, present, and conduct themselves within their respective professions [ 1 , 2 , 3 ]. Extensive research in medical education has explored the formation of professional identity through the internalization of behavior, norms, values, and standards within specific professional communities [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. However, there is also a growing interest in interprofessional identity within the medical education field, [ 7 , 9 , 10 , 11 , 12 ] which is defined as “the development of a robust cognitive, psychological, and emotional sense of belonging to an interprofessional community, necessary to achieve shared context-dependent goals” [ 7 ](p6). This emerging interest in interprofessional identity is driven by the recognition of the advantages of interprofessional team-based patient management. Despite this increasing interest, the topic of interprofessional identity remains understudied and requires further investigation.

Interprofessional education (IPE) has become an integral component in many health profession education programs, fostering the development of norms, values, and standards that contribute to professional identity [ 13 ]. Recent research found a positive effect of interprofessional identity on interprofessional collaboration following an IPE course [ 10 ]. The extended professional identity theory (EPIT) [ 14 ], drawing from identity theory and social identity theory [ 15 ], proposes that interprofessional identity functions as a broader social identity associated with belonging to a larger group, triggered by specific contextual factors. Individuals can identify triggers that activate the professional identities of other disciplines, forming a higher-level trigger that activates their interprofessional identity [ 10 ]. The EPIT [ 14 ] proposes three dimensions of interprofessional identity, namely interprofessional belonging, interprofessional commitment, and interprofessional beliefs, and highlights the role of socialization in shaping the collective dimension of an individual’s identity. By shifting the focus from professional to interprofessional identity, the process of interprofessional socialization can promote the formation of interprofessional identity and facilitate collaboration attitudes and behaviors among students [ 14 ]. Given the significance of interprofessional identity in IPE and collaborative practice [ 16 ], some scholars [ 7 , 17 ] advocate for tracking its development over time using a mixed-method approach to bridge the gap between literature and practice.

As identity formation is influenced by individual perceptions [ 18 ], previous studies have investigated collaboration perception and interprofessional identity concurrently [ 7 , 9 ]. However, the conceptual link between these two constructs requires thorough examination in the IPE setting, and the specific role of IPE as an activating contextual trigger for promoting collaboration perception and interprofessional identity remains understudied. Therefore, exploring how an IPE intervention can promote collaboration perception and interprofessional identity among health profession students while exploring the relationship between these constructs, can contribute to the research literature.

In response, the present study aims to investigate the impact of an IPE PRAE intervention (Preparation → Readiness Assurance → Application Exercise → Enrichment Activity) on changes in collaboration perception and interprofessional identity among health profession students. To achieve these aims, a mixed-method approach was utilized. This study was motivated by the need to clarify interprofessional identity formation, the interplay between interprofessional identity and professional identity/competencies, and the contextual factors in the learning and work environment [ 10 ]. Therefore, we hypothesized that there would be a significant improvement in students’ collaboration perception and interprofessional identity after the IPE intervention (H 1 ), and there would be a positive relationship between students’ collaboration perception and interprofessional identity (H 2 ).

This study originated from an IPE project conducted at a university in Hong Kong. The primary goal of the IPE project was to foster collaboration among students pursuing healthcare professions. The specific teaching module focused on the management of emerging infection control cases, and throughout the teaching module, learners were organized into various IPE teams. Each team consisted of approximately 10 individuals representing different disciplines. This IPE PRAE aligns with Mitchell et al.’s [ 19 ] recommendation to develop shared goals, vision, and interdependence within interprofessional teams (Fig.  1 ).

The IPE PRAE Implementation Model. Note IPE: Interprofessional Education; PRAE: Preparation, Readiness assurance, Application exercise, Enrichment activity; RAT MCQs: Readiness Assurance Test Multiple Choice Questions; AE: Application Exercise

Participants and procedures

We adopted a concurrent triangulation mixed-methods approach to confirm, cross-validate, and corroborate findings by integrating both quantitative and qualitative studies at the same time rather than having one inform the collection of the other [ 20 ]. Combining quantitative and qualitative methods allows the findings to be elucidated in comprehensive way [ 21 ].

In September 2022, a cohort of students enrolled in the IPE course was invited to take part in an online survey. The survey links were provided to individual students via mass email at the beginning of the IPE program implementation week (pre-test) and after the program (post-test), which included both quantitative and qualitative survey items. Prior to their voluntary participation in the study, informed consent was obtained from all participants. The study received ethical approval from the Institutional Human Research Ethics Committee (EA210433), ensuring compliance with ethical guidelines.

Among the 357 students who were invited to participate in this study, a total of 263 undergraduate health profession students from two universities in Hong Kong participated (73.7% response rate). The majority of the participants were females (64%) and the mean age was 21.4 years ( SD  = 1.81) with an age range of 18–28 years. Most of the participants were in their Year 5 (39.5%) while others were from Year 4 (21.3%), Year 3 (32.3%), and Year 2 (6.8%), respectively (Table  1 ). Participants were from Chinese Medicine ( n  = 8), Biomedical Engineering ( n  = 18), Law ( n  = 17), Medicine ( n  = 95), Nursing ( n  = 72), Social Work ( n  = 31), and Speech and Hearing Sciences ( n  = 22).

Interdisciplinary collaboration perception

We used the 18-item Interdisciplinary Education Perception Scale (IEPS) [ 22 ] to measure the collaboration perceptions of participants who are exposed to interdisciplinary settin gs. Sample items include, “ Individuals in my profession need to cooperate with other professions ” to which participants can rate their agreement to such statements using the 5-point Likert scale that ranges from “strongly disagree” (1) to “strongly agree” (5). In this study, we used the whole scale to generate a global interdisciplinary perception score (pre-test α = 0.96; post-test α = 0.97). Higher mean scores on the scale indicate a greater perception of interdisciplinary collaboration.

• Interprofessional identity

The 12-item Extended Professional Identity Scale (EPIS) [ 14 ] was used to measure interprofessional identity. The EPIS has three dimensions: interprofessional belonging, e.g., “ I like meeting and getting to know people from other health professions ”, (pre-test α = 0.91; post-test α = 0.94), interprofessional commitment, e.g., “ I would be very happy to spend the rest of my career with an interprofessional team ” (pre-test α = 0.90; post-test α = 0.96), and interprofessional beliefs, e.g., “ Interprofessional team members should jointly agree to communicate plans for patient care ” (pre-test α = 0.93; post-test α = 0.95). Participants responded to the items using a five-point Likert scale ranging from “1 = strongly disagree” to “5 = strongly agree”. Higher mean scores on the overall scale imply greater interprofessional identity and higher mean scores on the individual subscales indicate greater propensity for aligning oneself to any of the three subscales.

Open-ended questions

We used one open-ended question in the pre-test and two questions in the post-test to supplement the quantitative measures we indicated above and evaluated the feasibility and acceptability of the program. In the pre-test, we asked the participants the question, “ What is the most important thing you hope to learn in IPE? ”. In the post-test, we asked the participants the following questions: (1) “ Did the whole learning process meet your expectations? If not , could you describe some reasons? ”, (2) “ What was the most beneficial aspect of IPE? ”

Data analysis

Quantitative analysis. Paired t-tests were used to test for the pre-and post-test mean difference. To test the relationship between pre- and post-test interdisciplinary collaboration perception and interprofessional identity, we used pairwise Pearson’s correlation and linear regression. Given that students were nested within teams, we also explored the students’ team-level collaboration perception and interprofessional identity changes. Following the procedure in previous studies [ 23 ], we calculated each team’s mean global collaboration perception and interprofessional identity in the pre-test and ranked them from highest (1) to lowest (40) where higher-performing team ranking indicates greater interprofessional identity and collaboration perception. Subsequently, we employed an independent t-test to examine the differences between higher-performing teams (Teams ranked 1 to 20) and lower-performing teams (Teams ranked 21 to 40) on interdisciplinary perception and interprofessional identity separately in Time 1 and Time 2. Analyses were performed using the Statistical Package for Social Sciences (SPSS, Version 28) [ 24 ].

Qualitative analysis. Following an interpretive approach, two researchers conducted a thematic analysis by using NVIVO software program version 12 to analyze the qualitative findings, aiming to achieve the credibility, rigor, and trustworthiness of the qualitative findings [ 25 ]. In the initial phase, two researchers independently performed inductive coding on a selection of open-ended responses and identified preliminary themes. This involved closely reading and familiarizing themselves with the data, generating initial codes, and grouping them to form potential themes. The researchers engaged in regular discussions to compare and refine their coding decisions, establishing consensus on the initial code system. In the subsequent phase, the researchers systematically applied the initial code system to the remaining open-ended responses, continuously reviewing and revising the codes and themes as new insights emerged. This iterative process allowed for the identification of additional themes and sub-themes. The researchers collaborated closely to ensure consistency in the identified themes, sub-themes, and codes, discussing any discrepancies and reaching consensus through thorough deliberation. In the final stage of analysis, consensus was reached between the two researchers by refining the themes and codes based on their comprehensive understanding of the data. The refined themes and codes were then applied in the third round of coding for the text responses, ensuring a consistent and comprehensive analysis. Furthermore, the research team upheld reflexivity in their analysis by engaging in discussions regarding the established assumptions. This approach was implemented to mitigate bias and guarantee the study’s credibility and rigor [ 26 ]. To present the qualitative research findings, the study adhered to the Standards for Reporting Qualitative Research, showcasing a dedicated effort to upholding the study’s integrity and trustworthiness.

Changes in student-level collaboration perception and interprofessional identity before and after IPE PRAE

Table  2 ; Figs.  2 and 3 , show the differences between the collaboration perception and interprofessional identity before and after participating in the IPE PRAE. There was a significant increase between the participants’ pre-test ( M  = 4.47, SD  = 0.68) and post-test ( M  = 4.65, SD  = 0.85) mean global collaboration perception scores, p  < .001; d  = 0.21; and pre-test ( M  = 3.78, SD  = 0.61) and post-test ( M  = 3.91, SD  = 0.77) global interprofessional identity scores, p  = .006; d  = 0.17. Overall collaboration perception and interprofessional identity significantly improved after the IPE experience.

Overall EPIS mean score pre- and post-IPE experience. Note Asterisks (**) denote significant differences with p  < .01. IEPS: Interdisciplinary Education Perception Scale, IPE: Interprofessional Education

Overall IEPS mean score pre- and post-IPE experience. Note Asterisks (**) denote significant differences with p  < .01. EPIS: Extended Professional Identity Scale; IPE: Interprofessional Education

Except for the interprofessional beliefs, for which teams’ mean score was already high in T 1 , the mean pretest-posttest differences on interprofessional belonging and commitment were all significant, indicating improvement after IPE participation (Table  2 ; Fig.  4 ). Specifically, interprofessional belonging [Pre-test: 3.72 (0.69) vs. Post-test: 3.86 (0.81), p  = .008; d  = 0.17] and interprofessional commitment mean scores significantly increased after participating in IPE [Pre-test: 3.68 (0.67) vs. Post-test: 3.87 (0.83), p  = < 0.001; d  = 0.22].

Comparison of EPIS subscales pre- and post-IPE experience. Note Subscales with asterisks (**) and (***) denote significant mean differences with p  <  .01 and p  < .001, respectively. EPIS: Extended Professional Identity Scale; IPE: Interprofessional Education

Changes in team-level collaboration perception and interprofessional identity across the IPE program

Our results indicate that higher-performing (i.e., Top 20) teams did not show significant differences in team-level collaboration perception and interprofessional identity between Time 1 and Time 2. However, lower-performing (i.e., Bottom 20) teams demonstrated a significant difference in team-level mean global interdisciplinary collaboration perception, with a higher collaboration perception at Time 2 ( M  = 3.76, SD  = 0.28) compared to Time 1 ( M  = 3.59, SD  = 0.24), p  = .02; t  = 2.63; d  = 0.59 (see Table  3 ; Fig.  5 ). Similarly, lower-performing teams also displayed a significant difference in team-level mean global interprofessional identity, showing an increase at Time 2 ( M =  3.76, SD  = 0.28) compared to Time 1 ( M  = 3.59, SD  = 0.24), p  < .01; t  = 4.86; d  = 1.09 (see Table  4 ; Fig.  6 ).

Comparison of higher-performing (i.e., Top 20) vs. lower-performing (i.e., Bottom 20) teams’ collaboration perception before and after participating in the IPE program. Note IPE: Interprofessional Education

Comparison of higher-performing (i.e., Top 20) vs. lower-performing (i.e., Bottom 20) teams’ interprofessional identity before and after participating in the IPE program. Note IPE: Interprofessional Education

Relationship between collaboration perception and interprofessional identity in pre- and post-IPE

The findings revealed significant and positive correlations between pre-test and post-test global interprofessional identity, its subscales, and interdisciplinary collaboration perception ( p  < .001). The correlation coefficients across all global scales and subscales ranged from r  = .24 to r  = .97, indicating moderate to strong positive relationships (see Table  5 ). The relationship between collaboration perception and interprofessional identity strengthened from the pre-test ( r  = .69; p  < .001) to the post-test ( r  = .79; p  < .001).

Interdisciplinary collaboration perception scores in Time 1 significantly predicted the variance in interprofessional identity scores in Time 2 (β = 0.347 [95% C.I. = 0.265–0.521], p  < .001), controlling for age, gender, and year level of the participants. The regression results indicated that interprofessional perception in Time 1 and the controlled demographic variables explained 14.5% of the variance in interprofessional identity scores in Time 2 ( R 2  = 0.145, F (4,258) = 10.941, p  < .001).

Additionally, team-level correlational analysis revealed a significant positive correlation between the collaboration perception and interprofessional identity of lower-performing teams in Time 1 ( r  = .93, p  < .001). Similarly, higher-performing teams exhibited a significant positive correlation between collaboration perception and interprofessional identity in Time 1 ( r  = .94, p  < .001). However, no significant correlation results were observed in Time 2.

Qualitative results

Student ipe outcome expectations.

There were 263 students who responded to the open-ended questions. Prior to participate the IPE program, students were asked to comment on their expectations for the program. Within the categories, there are three themes with 11 sub-themes (Appendix 1 ). Students’ written reflections indicated that they expected the IPE program could help form their interprofessional identity (56%), promote interprofessional perceptions and competencies (23.8%), and acquire knowledge, skills, and experiences (20.2%). Regarding the code frequency that falls within each theme, students expected the IPE PRAE to promote interprofessional commitment the most (33.1%) and improve their communication skills (20.8%). Around 20.8% of the students believed that the IPE PRAE improved their communication skills. Approximately 42.6% of students stated that it was their first time participating in a program that required them to work with other professions. One student wrote: “The most important thing I hope to learn is how to collaborate… , I hope that I can build connections , develop interpersonal skills , as well as gain knowledge in relation to the health care sector. I look forward to working with my diverse team members!” (Law, Year 3).

Perceived program outcomes

After the program, the majority of students (85.2%) perceived the whole IPE learning process as meeting their expectations. One student stated, “ I think the whole learning process met my expectations to a large extent. I learnt a lot of medical knowledge. I was impressed by my teammate’s professionalism. . ” (Nursing, Year 3). However, it is worth noting that some students raised concerns and provided constructive feedback in response to open-ended questions. Common concerns included teammates being too reserved to communicate effectively and a tendency to focus solely on their own professions, which hindered collaborative efforts. Students offered suggestions for improvement, such as incorporating more hands-on activities, real-life simulations, and strategies for conflict resolution. Additionally, logistical issues were mentioned, and some students proposed the utilization of online meetings as a potential solution.

Beneficial dimensions of the IPE program

The beneficial dimensions of IPE PRAE as perceived by participants were subsumed under five major themes. The majority of students stated that the program facilitated the development of interprofessional identity through the development of interprofessional belonging (49.1%), commitment (26.8%), and belief (2.7%). There were 36.4% of students who stressed that they could learn from and collaborate with students from other health professions. Around 12.7% of students expressed that IPE is a vehicle to meet people from other health professions and make new friends. Students reported being provided a range of opportunities to collaborate in a formal and informal manner. In describing the importance of IPE experience as interprofessional socialisation shaping their interprofessional identity, one student stated that: “I learned to view patient care not only from the medical side of things but also from social and legal perspectives. This experience was highly inspiring and educational; it taught me how to collaborate with my team members…I am now better equipped to work with other interprofessional teams in the future.” (Social work, Year 3).

In terms of interprofessional commitment, students perceived that they could identify themselves as a part of the interprofessional team and that they preferred to work with others. One student stated that “It was the first time that I worked with individuals of other professions , which provided me insight into how it actually works.” (MBBS, Year 5). Moreover, through IPE, students also recognized that their interprofessional beliefs have been reinforced: they can understand how to set common goals, make joint decisions, and strive for consensus when they work together to manage patients. One student reported that “ Different professions have their own focus , and only these varied opinions can help develop a more inclusive care plan. Patients’ benefits are maximized.” (Chinese Medicine, Year 5). Additionally, 16.3% of students reported that the program improved their interprofessional competencies and perceptions. Students highlighted that they could develop communication skills, understand how to construct the care plan, and strengthen their awareness of interprofessional collaboration for patient treatment. Furthermore, 5.1% of students recognized the IPE learning experience as valuable and enjoyable. They acquired real workplace experience, managed time effectively, and learned content knowledge. One student mentioned that “I was able to directly communicate with professionals of different disciplines , which was a very precious learning opportunity.” (Speech and Hearing Sciences, Year 3).

This study presents an empirical investigation that explores the impact of an IPE program on the transformation of health profession students’ collaboration perception and interprofessional identity. The results, both from quantitative and qualitative analyses, provide promising evidence that the IPE program serves as a contextual trigger, effectively fostering students’ interprofessional collaboration perception and interprofessional identity (Fig.  7 ). Following the program, students acknowledged the value of the entire learning process in facilitating cross-disciplinary learning and influencing their interprofessional identity. Notably, teams with initially low collaboration perception and interprofessional identity demonstrated a significant increase after their participation in the IPE program.

How the IPE serves as the contextual trigger for shaping students’ interprofessional identity and collaboration perception. Note IPE: Interprofessional Education

Beyond labels: interprofessional identity formation and collaboration attitudes improvement

Encouragingly, we found that after participating the IPE program, a significant improvement in students’ interprofessional collaboration perception and interprofessional identity from Time 1 to Time 2 can be detected. Particularly, students’ interprofessional commitment and belonging showed positive development. Through active engagement in collaborative teamwork, communication, and joint formulation of health management plans within the IPE program, students experienced enhanced social inclusiveness within their own profession, a strengthened sense of belonging in the interprofessional team, and improved collaboration with other professions. Furthermore, at the team level, the lower-performing teams exhibited a significant improvement in interprofessional collaboration perception and interprofessional identity compared to the higher-performing teams. The qualitative findings provide additional support for the quantitative results. Notably, students from lower-performing teams articulated a more comprehensive and specific appreciation for the benefits of IPE. Their insights included the recognition of the advantages of integrating diverse ideas to formulate patient care management plans, the value of interacting with peers from different professions that they typically do not encounter, and a heightened emphasis on the importance of ‘team collaboration’ and ‘working with others’. Upon recognizing the benefits of interprofessional collaboration, they may have been more receptive to new ideas and approaches, thereby fostering a more cohesive and dynamic learning environment. Moreover, these students demonstrated a deep-rooted commitment to effectively learn, communication, teamwork, and collaboration within interprofessional teams. Their interactions with peers from varied professions likely sparked novel insights and facilitated a richer exchange of knowledge and experiences, leading to enhanced collaboration attitudes and a stronger sense of interprofessional identity. This proactive engagement with the core tenets of interprofessional education could have fuelled their growth and development throughout the program, resulting in more pronounced improvements in their collaboration attitudes and interprofessional identity.

In contrast to earlier findings that indicated non-significant [ 27 ] or declining tendencies in interprofessional identity over time [ 7 ], our findings indicate otherwise. This difference could be attributed to the developmental stage of the students. Junior-year health profession students are typically in the stage of independent operation and may lack awareness and understanding of the importance of team collaboration, which can influence their interprofessional identity [ 7 ]. However, the senior-year students in our sample demonstrated a conscious effort to develop their interprofessional identity through IPE. Also, while previous studies have highlighted that an IPE intervention can influence professional identity formation [ 13 , 28 ], our quantitative and qualitative findings add new insights that IPE can also influence, or more specifically enhance, interprofessional identity and interprofessional collaboration perception. As such, understanding the effect of participating in IPE on health profession students’ training at various stages of learning and their interprofessional identity could shed light on how educators can effectively incorporate an interprofessional curriculum into profession-specific curricula [ 7 ]. Doing so would enable students to develop both professional and interprofessional identities upon graduation.

Furthermore, our findings support previous studies in the field, such as in one study [ 29 ] which demonstrated the positive impact of interprofessional learning on the attitudes and perceptions towards collaboration of health profession students. However, it is worthwhile to note that some studies have reported a decline in students’ attitudes towards interprofessional learning [ 30 ], while others have found no significant changes after the interprofessional learning (e.g., Lockeman et al. [ 31 ]). In our study, the immersive and intensive interprofessional learning experience, involving a diverse group of health professionals collaborating to manage a patient case, fostered a distinct understanding of interprofessional collaboration. This finding strongly supports the notion that IPE serves as a motivational context, prompting students to recognize the significance of collaboration with professionals from other disciplines [ 32 ].

Our qualitative findings corroborate the aforementioned quantitative results where students’ responses formed themes that corresponded to the three dimensions of Reinders [ 14 ], interprofessional identity model. Specifically, the majority of students reported that the IPE learning experience facilitated interprofessional belonging, in which they met, learned and collaborated with people from other health professions. Additionally, students also identified themselves as part of an IPE team and preferred to work with others in an interprofessional team, indicating the enhancement of interprofessional commitment. Through the program, students gradually formed interprofessional reliance, which began to shape their attitudes and perceptions and resulted in an appreciation of interprofessional collaboration.

Building bridge: establish the connection between collaboration perception and interprofessional identity

Social identity theory provides a clue that an individual’s perception of their future roles contributes to the promotion of their identity [ 33 ]. We based this assumption on the idea that “maintenance of identities are guided partly through perceptions of oneself, other people, and situations” [ 18 ](p21). In support of social identity theory assertions, our results suggest that students’ collaboration perception plays a crucial role in the development of their interprofessional identity, and the positive correlation would be strengthened through interprofessional learning. Qualitative findings also supported the quantitative results, manifesting that the majority of students noted that the IPE program provides a learning platform where they can collaborate, communicate with, and acquire new insights and knowledge from different professions. Such learning experiences also strengthen awareness of the importance of interprofessional collaboration for patient treatment. The more they have actual collaborations with other professions, the more interprofessional belonging and commitment they receive from the IPE team. In turn, upon the formation of the interprofessional identity, students are prone to have a positive collaboration perception towards IPE, which helps develop interdisciplinary autonomy and competence as well as actual cooperation.

Breaking barriers: IPE serving as the contextual trigger

Identity development is a complex process influenced by contextual triggers, as beliefs alone may not translate into actions unless integrated into one’s identity. Previous research has highlighted the importance of regular and high-quality interprofessional contact in preventing a decline in interprofessional identity [ 7 ]. The qualitative analysis of students’ responses to the open-ended questions regarding the beneficial dimensions of the IPE program revealed a positive perception of incorporating sequential collaboration-oriented activities as a means to facilitate the development of interprofessional identity and improve collaboration attitudes. In line with the IPE implementation strategies proposed by Diggele et al. [ 34 ], we utilized an online learning forum for pre-class material discussions, fostering team cohesiveness through the collaborative formulation of team names. Small-group meetings allowed students to collectively analyze case scenarios, develop patient management plans, complete group assignments, and engage in team learning reflection. Encouraging within-group and between-group interactions proved effective in enhancing students’ interprofessional identity and interdisciplinary perceptions. To promote such interactions, it is crucial to provide formal and informal opportunities for interprofessional engagement [ 34 ]. Notably, Labrague et al. [ 35 ] emphasized the benefits of simulation in fostering interprofessional communication, recognition of professional responsibilities, teamwork, and professional self-assurance. We therefore designed our IPE program to revolve around simulation-based learning activities. This approach directly focused on clarifying roles and responsibilities within a given setting, dispelling negative stereotypes, and providing students with valuable practice before entering real work placements. Qualitative analysis revealed that students valued this collaborative learning experience and displayed a genuine interest in understanding other professions.

The implications of this study are significant for educators, curriculum designers, and policymakers in the field of health professions education. Incorporating an IPE program into the curriculum can effectively enhance students’ collaboration perception and interprofessional identity, ultimately preparing them for collaborative practice in the healthcare system. By engaging students in interprofessional teamwork, communication, and joint decision-making processes, the IPE program provide a valuable context for students to develop a sense of belonging and commitment to interprofessional collaboration. These programs can help break down professional silos and promote a collaborative culture among future healthcare professionals. Educators should consider integrating IPE experiences throughout the curriculum, starting from the early stages of professional education, to ensure that students have ample opportunities to develop their interdisciplinary perception and interprofessional identity over time.

However, it is important to acknowledge the limitations of this study. Firstly, the study relied on self-report measures, which are subject to social desirability bias. Future research could incorporate objective measures or observational data to complement self-report data. Additionally, the study involved only one cohort of IPE students without a control group, although data were collected at two time points (pre-test and post-test) using a mixed-method design. Future studies could employ a longitudinal study design to explore the long-term effects of IPE on promoting interprofessional identity and collaboration perceptions. Follow-up studies that assess the sustainability of these effects beyond the immediate post-intervention period would be valuable.

This study shows encouraging results that have impacts theoretically, methodologically, and practically. Theoretically , we stimulated a discussion on the conceptual link between collaboration perception and interprofessional identity where our empirical data established their relations at both individual and team levels. Methodologically , we used a concurrent triangulation mixed-method design which allowed our research questions to be studied from different perspectives complementing the strengths of each perspective [ 36 ]. Practically , this study contributes to the understanding of the effects of IPE on the formation of students’ interprofessional identity and collaboration perception through deliberate IPE program design. Both quantitative and qualitative data lend support to our understanding that interprofessional identity is a malleable construct that can be improved. For the IPE community of practice, we hope that our effort to understand how to best design IPE to develop desirable outcomes (e.g., interprofessional identity) will get their needed attention to enable us to elevate further the discussion of IPE as a contextual trigger for facilitating students’ collaboration perception and interprofessional identity formation.

Data availability

The data that support the findings of this study can be requested from the corresponding author upon reasonable request.

Abbreviations

Interprofessional Education

Extended Professional Identity Theory

Preparation, Readiness Assurance, Application Exercise, Enrichment Activity

Bachelor of Medicine, Bachelor of Surgery

Interdisciplinary Education Perception Scale

Extended Professional Identity Scale

Readiness Assurance Test Multiple Choice Questions

Application Exercise

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Acknowledgements

The authors would like to thank the participants of the study, along with the institutional leaders at the University of Hong Kong for their support of this work.

This research was supported by Bau Institute of Medical and Health Sciences Education, Li Ka Shing Faculty of Medicine, The University of Hong Kong.

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Contributions

QH proposed and conceptualized the study, curated and interpreted the data, performed qualitative data analysis, and was a significant contributor to the writing and editing of the manuscript. JIWTD curated the data, performed quantitative data analysis, and was a significant contributor to the writing and editing of the manuscript. FAG co-supervised the project within which the study was conducted, acquired the funding, co-conceptualized the study, and was a significant contributor to the writing and editing of the manuscript.BZ, PPNY, XS, LYWH, AKCW, FWTC, KMKC, & LC contributed in writing the original draft of the manuscript. SSCC, AYMC, JKPC, DMC, ECHD, WNL, FCYL, QW, KKT, DV, & JJ contributed to the review and editing of the manuscript. GLT co-supervised the project and provided administrative supervision and coordination.

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Correspondence to Fraide A. Ganotice or George L. Tipoe .

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He, Q., Dizon, J.I.W.T., Ganotice, F.A. et al. Unveiling the impact of interprofessional education on shaping students’ interprofessional identity and collaboration perception: a mixed-method study. BMC Med Educ 24 , 855 (2024). https://doi.org/10.1186/s12909-024-05833-0

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Received : 29 April 2024

Accepted : 29 July 2024

Published : 08 August 2024

DOI : https://doi.org/10.1186/s12909-024-05833-0

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• Interprofessional education
• Collaboration perception
• Health professions education
• Medical education

BMC Medical Education

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• Faculty and Staff
• Leading a Study Abroad Program

Marketing and Recruiting

Market the Program

In order to meet your enrollment goals, you will need to actively market your study abroad program. The most effective marketing tool is an engaged faculty leader who is passionate about their course and can get students excited about participating in their study abroad program. After you complete and submit your required forms to the Office of Education Abroad, we will create a digital brochure and application link for your program that you can share with interested students.

While the Office of Education Abroad will market all study abroad offerings through our normal marketing platforms via social media, printed posters, and our monthly newsletter, the responsibility for marketing a program belongs to the faculty leader and department or school . The following are some marketing ideas to help you get started:

• Create a flier or pamphlet or both:  Fliers and pamphlets are effective in getting students to notice the course. You will need a big stack of fliers for the annual study abroad fair in September! Make sure you send your flier/pamphlet to the Office of Education Abroad so we put it in our information area.  CWRU-branded templates have been provided by UMC. 
• Talk the course up in your classes:  Promote your course to as many individual students and classes as you can. Ask your fellow faculty members to talk up your course as well. 
• Submit to  the daily :  Write a short article about your program or announce an information session and send it to the Office of Education Abroad to submit to the daily . 
• Attend the study abroad fair:  Study abroad fairs provide you with the opportunity to learn about other programs and promote your own. Students who go to the fairs are interested in going abroad, so this is a good venue to promote your course. 
• Send emails:  While it is never good to send out a lot of promotional emails, sending a few doesn't hurt. Ask your department chair or dean if he or she would be willing to send an email about your course to all of the students in your department or school. 

Marketing Statement

The following statement must be included on all print and virtual materials:

For information about all study abroad programs offered through and approved by Case Western Reserve University, contact the Office of Education Abroad at  [email protected]  or visit the  Office of Education Abroad website .

Review the Application Requirements

All CWRU students intending to study abroad for credit are required to complete an advising meeting. For faculty-led study abroad programs, the faculty leader is responsible for holding an advising meeting with all students who intend to participate in your study abroad program to discuss academic expectations for the course, program logistics, and financial considerations . Faculty are responsible for tracking student advising meetings in the application portal.

Enroll Students

Once your course is approved by the appropriate university channels, you will need to submit your course to be listed in the appropriate term in the Student Information System (SIS). Study abroad courses are sent to the Office of the Registrar in the same way all other courses are submitted. When submitting your course to be listed in SIS, be sure to indicate that students will need your permission before they register for the course. Once the student has completed the study abroad program application and been accepted to your program, you will be able to give them permission to register in SIS. All faculty-led study abroad program participants must be students enrolled in the course for credit . Participants may not enroll through an audit or College Credit Plus program.

Coordinate Program Fees and Finances

Faculty are required to submit to the Office of Education information on program finances and budget, including:

• Program fee amount students will pay and estimated out-of-pocket expenses
• Account number where student program fees will be kept or journaled
• Name and contact information of the individual who will pay invoices and make reimbursements for the program

Most study abroad programs require a $250 or greater non-refundable deposit that is paid to the Office of Education Abroad and journaled back to the department.

• Fall and Spring semester study abroad programs : students pay their study abroad program fee as a course fee in SIS upon registration, and the funds are moved into the account number given on the program information form almost immediately. Reimbursements and invoices for the study abroad program are paid out of that account.
• Summer term study abroad programs:  students pay their study abroad program fee directly to the Office of Education Abroad by March 30. After the program fee due date, the Office of Education Abroad journals these funds and the student deposits back to the department to pay invoices and make reimbursements to fund the study abroad program. Students are also required to pay tuition for courses offered during the summer term .

When a department is paying vendor invoices and faculty/staff reimbursements for a study abroad program, please note that these cannot be paid until the funds are in the department's account. 

The Office of Procurement requires that faculty complete W-8-BENE or W-8BEN tax form, as well as the Supplier Information Form . Faculty need to collect this information from foreign vendors early in the program development process. Both of these forms have extensive instructions on them. If the faculty member or the vendor have any questions, the faculty member should contact the Office of Procurement at [email protected] .

Next Steps: Before Going Abroad

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