International Journal of Medical Students

Student Perspectives on E-Learning in a Malaysian Medical College One Year into the COVID-19 Pandemic: A Cross-Sectional Study

Sylvia Wei Wei Kong — 2023-09-14

Background: During the coronavirus disease 2019 (COVID-19) pandemic, most in-person classes in Newcastle University Medicine Malaysia (NUMed) were replaced with e-learning. Our study aims to explore students’ e-learning experiences and its perceived benefits and challenges during the pandemic.

Methods: 285 students recruited via convenience sampling participated in this cross-sectional study. Participants completed a self-administered online questionnaire on sociodemographic factors and experiences with e-learning. Descriptive statistics and Spearman’s correlation tests were used to analyze the data.

Results: Most students used laptops (n=275, 96.5%) for e-learning and owned at least two electronic devices (n=245, 86%). Over half our students (n=148, 51.9%) reported no change to theoretical knowledge, while about three-quarters (n=213, 74.7%) perceived practical skills to have worsened. Students preferred paper-based exams (n=170, 59.6%) and objectively formatted online exams (n=193, 67.7%). Since transitioning to e-learning, the majority of students (n=207, 72.6%) reported difficulties studying online and were unsatisfied with their academic performance (n=166, 58.2%). Students preferred e-learning due to the lower risk of contracting COVID-19 (n=256, 89.8%), the convenience of online classes (n=244, 85.6%) and flexible schedules (n=219, 76.8%). However, the lack of patient contact (n=236, 82.8%), lecturer and peer interaction (n=234, 82.1%), and unreliable internet (n=201, 70.5%) made e-learning challenging. Students’ experiences were generally affected by multiple factors encompassing personal, lecturer, and environmental aspects.

Conclusion: E-learning during the COVID-19 pandemic has negatively impacted students’ practical skills and performance satisfaction. Therefore, the university should look towards addressing e-learning constraints and providing adequate support to improve students’ educational experiences in the ongoing pandemic.

Stereological Estimation and Zonal Distribution of the Hepatotoxic Effects of Doxorubicin on the Female Albino Rat (Rattus Norvegicus)

Khulud Nurani — 2023-09-19

Background: Doxorubicin is an anti-neoplastic agent widely indicated for a variety of cancers. One of its adverse effects is hepatotoxicity which presents with hepatocyte necrosis, sinusoidal dilation, and fibrosis. However, there remains a dearth in the quantification and zonal distribution of this damage.

Methods: Twenty-three adult female Wister albino rats were placed into baseline, control, and experimental group receiving 2.5mg/kg bodyweight Doxorubicin intra-peritoneally thrice weekly for 3-weeks. Rats were sacrificed on days 0, 7, 14 and 21 and livers harvested for processing. Masson’s Trichrome was used in staining 7 µm thick sections. Images were taken and analyzed via STEPanizer, and data entered into SPSS for analysis.

Results: Rats treated with Doxorubicin had increased liver to body weight ratios from 5.00% at baseline to 6.15%, 6.69% and 7.56% on days 7, 14 and 21 (p=0.090). There was a decrease in hepatocyte densities from 51.88/mm2 to 48.61/mm2, 46.65/mm2 and 42.24/mm2 on day 7, 14 and 21 (p=0.779). Collagen fiber deposition increased from 0.12±0.06 cm3 to 0.47±0.55 cm3, 1.64±0.11 cm3 and 1.88±0.24 cm3 on days 7, 14 and 21 (p=0.009). Deposition was greatest periportally and least pericentrally. Volume of sinusoidal spaces increased from 5.46±0.50 cm3 to 5.49±0.15 cm3, 5.53±0.24 cm3 and 5.50±0.17 cm3 on days 7, 14 and 21 respectively (p=0.827). Sinusoids were larger pericentrally than periportally.

Conclusion: Doxorubicin administration is associated with an increase in volume density of fibrotic tissue and sinusoidal spaces but decrease in hepatocytes. The quantitative changes presented may facilitate histopathological grading of Doxorubicin-induced hepatotoxicity.

The Role and Impact of Dyslexia Awareness Workshops in the Medical Curriculum

Mitchell Osei-Junior — 2023-09-18

Background: To increase recognition of the number of students who study medicine with dyslexia and the support available, it is important to cultivate a culture in which peers can support fellow peers with dyslexia academically and pastorally. This study aims to understand medical students’ perceptions of dyslexia and confidence with supporting fellow peers with dyslexia before and after a workshop on dyslexia.

Method: Pre-Post Intervention Evaluation form of 36 1st year medical students before the start of a small group dyslexia awareness session and one month after using a standardized 36 True/False/Don’t know questionnaire to elicit any significant change in knowledge about dyslexia. A standardized 6-item Likert Scale questionnaire was also administered in the same time frame to measure confidence in supporting peers with dyslexia.

Results: Pre-dyslexia awareness workshop, the mean score on the knowledge and beliefs about dyslexia questionnaire was 15.22, post-intervention this improved to 24.03 (p<0.001). Additionally, pre-intervention greater than 70% of participants reported feeling not confident in items in the confidence questionnaire associated with supporting dyslexia peers academically or signposting to reasonable adjustments and further support. This changed post-intervention with greater than 88% agreeing or strongly agreeing with these items.

Conclusion: At a baseline level, medical students have less precise accuracy in knowledge and beliefs about dyslexia and are not confident in supporting dyslexia peers academically. The findings suggest that dyslexia awareness workshops in the medical curriculum have benefits in increasing knowledge about dyslexia and providing students with confidence in supporting their fellow peers with dyslexia.

HLA-DQB1*0301 in Bullous Pemphigoid and Pemphigus Vulgaris: A Meta-Analysis

Dylan Thibaut — 2023-09-18

Background: The linkage of HLA-DQB1*0301 to autoimmune disorders is becoming more common in literature. Despite bullous pemphigoid (BP) and pemphigus vulgaris (PV) both having similar symptoms, such as blistering skin conditions, research has shown different relationships with HLAs.

Methods: In this systematic review, HLA-DQB1*0301 and the odds of developing BP and PV were explored. Google Scholar and Pubmed were consulted, and articles were included if living subjects were used, odds ratio was available or could be ascertained from the study, and if it was not a meta-analysis of other researcher’s works. MetaXL software was used to generate data for analysis and a forest plot was generated for each. Nine studies conducted between 1996 and 2021 met study selection criteria for the BP HLA-DQB1*0301 meta-analysis (1,340 patients and 6,673 controls) and five studies (247 patients and 2,435 controls) for PV.

Results: HLA-DQB1*0301 increased the odds of developing BP (OR= 1.64, 95% CI [1.44, 1.87], I²= 0%) yet decreased odds of PV (OR= 0.60, 95% CI [0.40, 0.89], I²= 34%).

Conclusion: Results suggest HLA-DQB1*0301 may serve opposite roles in BP and PV despite similarity in symptoms, finding higher odds for developing BP versus lower odds for developing PV. Understanding this HLA’s function in each requires further exploration. Limitations of the analysis included minor asymmetry in the PV Doi plot, suggesting publication bias. No funding was used; study protocol was not registered.

Cover, Credits, & Content

Executive Committee of IJMS — 2023-09-18

From Student to Physician: Determining Which Lifestyle Behaviors May Be Risk Factors for Burnout at a South Florida Medical School

Rachel Lin — 2023-09-18

Background: Compared to other professions, physicians have significantly higher rates of burnout and poor lifestyle behaviors, including inadequate sleep, poor diet, limited exercise, and lack of supportive social relationships. Among physicians in training, burnout and increasingly poor lifestyle behaviors can begin as early as the preclinical years of medical school.

Methods: A cross-sectional survey composed of questions from standardized surveys measuring diet (Yaroch’s FVS), exercise (NPAQ-S), sleep (NHANES), stress management (HRQOL), social support (BRFSS), substance use (AUDIT-QF, WHO), and burnout (Mini-Z) was conducted on a South Florida medical school in May 2021. One hundred forty-four students fully completed the survey for a response rate of 16%. Descriptive analysis was performed via SPSS to determine the effects of these lifestyle factors on the likelihood of student burnout.

Results: In this sample of medical students, over half (61%) experienced burnout per the Single Item Burnout Measure. Independently, lack of sleep (p<0.02) and decreased social support (p<0.001) were lifestyle factors positively associated with increased risk of burnout. Furthermore, students who experienced burnout reported more poor mental health days and decreased life satisfaction (p<0.001).

Conclusion: Over half of the medical students experienced burnout. Lack of sleep and lack of social support were significantly associated with increased risk of burnout. In addition, burned-out students showed significantly increased levels of poor mental health and decreased life satisfaction. These findings help us identify specific lifestyle factors that institutions could use to further combat medical student burnout.

Decreasing Medication Delays: Maximizing the Efficiency of Patient Assistance Program Applications Through an Electronic System at a Student-Run Free Clinic

Jasmine A. Liu-Zarzuela — 2023-09-15

Patient outcomes are highly dependent on the accurate and timely receipt of medications. Patient assistance programs (PAPs) provide key medications to uninsured patients at little to no cost. In Texas and our county, nearly 1 in 5 people are uninsured. Approximately 3,500 uninsured patients over the past year have received care from our clinic. PAP applications require various administrative steps to obtain approval for medication assistance, resulting in delays for patients to receive their medications. To combat these delays, we implemented a new electronic system, which has significantly decreased all administrative steps in completing applications.

Global Surgery Research: An Overview and the Role of Medical Students and Surgical Trainees in Advancing Global Surgery Research in LMICs

Yvan Zolo — 2023-09-18

Global surgery research is a critical area of study aimed at enhancing access to safe and effective surgical care for patients in low- and middle-income countries (LMICs). It is essential to explore the significance of global surgery research and highlight the potential contributions of medical students and surgical trainees in addressing the pressing needs of LMIC populations. Global surgery research is pivotal in driving progress and fostering innovation by evaluating surgical disease burden, identifying access barriers, developing sustainable solutions, and strengthening health systems. Additionally, integrating sustainability principles into global surgery research endeavors ensures surgical interventions benefit patients while minimizing the environmental impact of surgical care delivery. Medical students and surgical trainees can engage in global surgery research, including collaborating with experienced researchers, developing research projects with local partners, conducting literature reviews, collecting and analyzing data, and disseminating research findings. Despite challenges faced in conducting research in LMIC, such as limited resources and sociopolitical instability, opportunities exist to nurture the interest of medical students and surgical trainees in global surgery research. By actively participating in global surgery research, medical students and surgical trainees can contribute to improving healthcare outcomes in LMICs while honing invaluable research skills for their future careers.

Early Point of Care Ultrasound Training in Medical Education, Making the Case with a Case Report

James Wilcox — 2023-09-15

Background: Point of Care Ultrasound (PoCUS) emerged in the early 1990’s as a promising clinical and educational tool that allows for quicker diagnosis at the bedside. Our PoCUS program at Indiana University School of Medicine uniquely exposes students to training during their first weeks of medical school, with training continuing through all 4 years. Our paper demonstrates the portability and efficiency of PoCUS devices to benefit student run clinics, where vulnerable patients come to seek free medical care.

Case: We report the case of a 48-year-old man presenting to our student run clinic with shortness of breath and cough. He recently immigrated from Nigeria, had no prior interaction with United States healthcare, and faced a significant language barrier. Physical examination conducted by the medical students revealed mild bibasilar crackles and 1+ pitting edema in the lower extremities. This prompted the students to suspect heart failure, and the first-year medical student used bedside ultrasound to reveal a reduced ejection fraction of approximately 15%, which resulted in expedited and escalated medical care.

Conclusion: This case report demonstrates how incorporating PoCUS early into the undergraduate medical curriculum might improve patient care by expediting the diagnosis, while also enhancing student education. The use of bedside ultrasound rapidly updated the team to the severity and type of heart failure present. Therefore, the care team quickly escalated the appropriate treatment, and impressed the importance of follow up care to the patient.

A Rare Case Report of Neurological Condition: Moersch-Woltman Syndrome with Positive Anti-GAD Antibodies

Aakanksha Pitliya — 2023-09-15

Background: Moersch-Woltman Syndrome (MWS), also known as Stiff person syndrome (SPS), is a rare, progressive condition of the central nervous system. Symptoms can include severe immobility, rigidity, and painful muscle spasms in the trunk and limbs. Muscle spasms can occur in MWS patients because they are more sensitive to noise, rapid movements, and mental disturbance. The condition affects women twice as frequently as it does males. It is a rare disease, affecting only 1-2 people per million. The case report aims to highlight the importance of the diagnostic challenges associated with MWS and the significance of glutamic acid decarboxylase (GAD) antibodies.

The case: A 57-year-old female patient presents with history of migraine headaches, anxiety, and depression. The patient experienced widespread and distressing muscle spasms affecting the shoulders, upper and lower back, and limited range of motion in the neck. Physical examination revealed dense diffuse muscle stiffness throughout the body. Further investigations were ordered, including a comprehensive range of laboratory tests and imaging tests. A positive test for GAD antibodies confirmed the diagnosis of MWS. Treatment included administration of Clonazepam and Baclofen. A follow-up appointment, three weeks later, indicated a noticeable 15-20% reduction in spasticity.

Conclusion: This case highlights the crucial role of anti-GAD antibodies in confirming the diagnosis of SPS. Healthcare professionals should consider testing for these antibodies in patients presenting with the described symptoms. A multidisciplinary approach involving neurologists, physical therapists, psychiatrists, and orthopedic surgeons is essential to provide comprehensive care and optimizing outcomes for individuals with MWS.

Addressing Bias among Medical Care Teams on the Wards: A Perspective from Asian Medical Students in the United States

Jesper Ke — 2023-08-24

This piece provides a personal perspective of the bias that affects Asian-American medical students in the United States in the clinical wards. In the evolving landscape of medical education, discussions about race, professionalism, and structural change have come to the forefront, especially with regards to patient interactions. However, less has been discussed about bias that may be perpetuated within a clinical team: between medical students, residents, and faculty physicians. This piece builds on these personal experiences to highlight some steps that can range from the individual to institutional level to address some of these biases, especially as it pertains to Asian-American Medical Students. Overall, this piece shares perspectives that draw strongly on personal experiences in the hopes of creating change for both colleagues and aspiring physicians across the medical spectrum.

Scientific Conferences for Medical Students: Why do We Need more Spaces for Students to Enhance Research?

Amy Phelan — 2023-09-29

Reducing the Risks of Nuclear War—the Role of Health Professionals

Kamran Abbasi — 2023-08-24

Walking the Walk: A Review of Medical Students’ Perspective of a Surgical Theatre as the New Classroom

Tamara A. Mallia — 2023-06-26

Medical school trains eligible students for a medical degree (MD). As part of the clinical years in the MD program, students attend surgical theatre sessions to learn medical concepts from hands-on experience in the theatre. This review aims to provide a comprehensive overview of the role surgical theatre plays in the learning process and clinical experience of medical students. Google Scholar, PubMed and NCBI databases were searched for articles from 1990 to March 2022 using the search terms ‘Operating Room’ or ‘Operating Theatre’ or ‘Surgical Theatre’ and ‘Learning’, ‘Medical Students’ and ‘Surgeons’. Only articles on medical students’ perceptions on their learning experience in the surgical theatre were included. Thirty-four articles were eligible for inclusion. Unpreparedness, anxiety, lack of clear learning outcomes, fear and intimidation were the most common reported experiences by students. These demotivate medical students from attending theatre, along with poor surgical field visibility, resulting in a negative learning experience. Positive experiences during theatre time were more likely to attract students to choose a future surgical career. Limitations include the inclusion of surgical residents’ perspectives and the exclusion of other surgical team members’ perspectives. Studies included students across different clinical years, and results were primarily based on subjective perceptions. Evidently, the surgical theatre is a great learning opportunity for medical students. However, for this learning environment to be beneficial, students need to be included during surgical discussions and procedures. Additionally, clear learning outcomes need to be present whilst adequately training students prior to their first surgical attendance.

Pseudo-Chilblains in Adult Patients with Confirmed COVID-19: A Systematic Review

Seon Hayles — 2023-08-18

Background: Pseudo-chilblains have been associated with COVID-19. Many reports, however, lack confirmation of COVID-19 infection. While likely associated, all chilblains/chilblain-like lesions during this time should not be assumed to be COVID-19 related. This study examines the characteristics of adults with pseudo-chilblains and confirmed COVID-19.

Methods: A systematic review of PubMed/MEDLINE database was performed using the PRISMA guidelines. Adults (>18 years) with confirmed COVID-19 were included. De-identified registries were excluded to avoid duplication. We extracted study design, age, sex, race, geographic location, relationship of COVID-19 diagnosis to chilblains onset, confirmatory testing, hospitalization status, anatomical location, cold/damp exposure, presence/absence/description of pseudo-chilblains symptoms, presence/absence of biopsies/histopathologic findings, tissue IHC/PCR, presence/absence/details of extracutaneous COVID-19 disease, pre-existing chilblains, treatment and resolution timeline. The search was completed in July 2022.

Results: We identified 13 studies (29 patients). In COVID-19-infected adults, pseudo-chilblains were reported primarily from North America and Europe, occurring in both sexes over a wide age-range, affected well and ill patients, favored the hands and feet and could be symptomatic or asymptomatic. Most patients had extracutaneous symptoms. Resolution time ranged from <1 week to >50 days. There was marked variation in treatment strategies and appearance of pseudo-chilblains relative to entire disease course. Biopsies were infrequently performed but findings similar to classical chilblains were described.

Conclusions: Many patients reported as pseudo-chilblains of COVID-19 lack confirmed infection. Infection confirmation, photographic documentation and histopathology are critical to establish homogeneity in reported pseudo-chilblains during this global pandemic. Further work clarifying the relationship of acral eruptions and COVID-19 is necessary.