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   Table of Contents - Current issue
Coverpage
January-March 2021
Volume 7 | Issue 1
Page Nos. 1-72

Online since Thursday, March 25, 2021

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EDITORIAL  

What's new in academic medicine? Focus on evolving models of competence in Graduate Medical Education p. 1
Nicholas Taylor, Nicole Defenbaugh, Alaa-Eldin A Mira, Erin Bendas
DOI:10.4103/IJAM.IJAM_30_21  
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REVIEW ARTICLE Top

Finding the calm amid chaos – Mental health of dentists during COVID-19 pandemic p. 5
Gunjan Kumar, Shilpa Rai, Avinash Janeswar, Vinay Suresan, Kunal Jha, Arpita Singh
DOI:10.4103/IJAM.IJAM_114_20  
COVID-19 has challenged health professionals all around the world. Dental practitioners are facing a challenge they were unprepared for. Two years ago, no dentist could have envisioned a situation where every step of every encounter requires personal protective equipment, frequent decontamination of the clinical environment, limiting the daily number of patients, and decreased financial security amid the constant fear of contracting the virus has affected the psychology of the dentists. Psychological distress may negatively affect the decision-making ability of the dentists which in turn might influence patient outcomes and well-being. Solutions need to be devised to attain stability and keep dentistry going. This article provides an overview of proposed mitigation measures. The following core competencies are addressed in this article: Patient care, Interpersonal and communication skills, Medical Knowledge, Systems-based practice.
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ORIGINAL ARTICLES Top

Unmasking the impact of m-learning on medical undergraduates p. 10
Preksha Sharma, Neha Sharma, Neeru Sharma, Dhruva Sharma
DOI:10.4103/IJAM.IJAM_99_20  
Introduction: Newer m-learning devices have become an integral part of medical education. Documentation of impact of these m-learning devices on medical education is still conflicting. The objective of the study was to determine the impact of m-learning on medical undergraduates. Materials and Methods: After obtaining Institutional Ethics Committee approval, this descriptive type of cross-sectional study was carried out among first to fifth semester MBBS undergraduates at a tertiary care teaching hospital. A 31 item prevalidated questionnaire was distributed among respondents and responses were evaluated. Results: Two hundred and sixty-six completely filled responses were obtained. Male preponderance was seen. Most of the students spent 2–4 h on mobile phones. 54.51% students had knowledge regarding m-learning. 79.8 students had medical apps on their electronic portable devices. There has been an improvement in the communication skills among respondents due to m-learning. Some disadvantages were also documented in our study which includes distraction from studies and use of other applications. Conclusion: The awareness about change in the pattern of learning among medical students from “bench-side” to “web-site” is the need of the hour. Internet connectivity is the major area of concern to be looked upon for better m-learning. The following core competencies are addressed in this article: Medical knowledge, Practice-based learning, and Communication skills.
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Pandemic and psychological outcomes among health-care practitioners: A cross-sectional study based on current evidence in Indian context amidst COVID-19 p. 15
Sunny Garg, Alka Chauhan, Devesh Sharma, Sanjeet Singh, Kirti Bansal
DOI:10.4103/IJAM.IJAM_138_20  
Introduction: The dramatic spread of SARS-Cov-2 and the following fatalities put the health-care practitioners under high pressure and increased workload. Coping mechanisms adapted by health-care practitioners represent a challenge to their psychological resilience. This type of pandemic produces fearful behavior and increases the risk of adverse psychological responses. The aim was to study the prevalence of psychological outcomes and exploring the associated factors among health-care practitioners amidst COVID-19. Materials and Methods: This is a cross-sectional, online survey of 588 health-care practitioners who were fighting against the COVID-19. The survey was applied in August, 2020, using a questionnaire that measures depression, anxiety, and stress. Survey included two sections, sociodemographic characteristics and Depression Anxiety Stress Scale-21 (DASS-21) scale. SPSS 22.0 software package was used for statistical analysis. Binary logistic regression analysis was used to assess the factors associated with psychological problems. Pearson's correlation was also used to assess the correlation among the psychological outcomes themselves. Results: Out of 588 health-care practitioners, 49.65% had depressive symptoms, 41.15% had anxiety symptoms, and 30.95% were distressed. Around 25%–35% of health-care practitioners had moderate-to-severe symptoms. Mean age was 28.78 years, and mean score of DASS-21 was 31.29 (standard deviation SD = 27.07). Binary logistic regression analysis revealed that working as specialists and as frontline workers was significantly associated with different psychological outcomes (anxiety and stress). A statistically significant correlation was found between stress, anxiety, and depression. Conclusions: This study revealed that a large number of health-care practitioners were affected severely by psychological morbidities, which required a mental health professional consultation. These negative outcomes were invisible, inconvenient, and frightening in reality. Therefore, recognition of other risk factors and planning of interventions would be beneficial in reducing the damage to psychological well-being of these practitioners. The following core competencies are addressed in this article: Clinical knowledge, Practice-based learning and improvement, System-based practice.
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Emergency mental health calls to first responders following a natural disaster: Examining the effects from Hurricane Harvey p. 22
John Saunders, Deepa Dongarwar, Jason Salemi, Joan Schulte, David Persse, Asna Matin, Sophia Banu, Asim Shah
DOI:10.4103/IJAM.IJAM_71_20  
Introduction: Hurricane Harvey which made landfall on August 25, 2017 was a devastating storm that dumped unprecedented amount of rainfall on the area including Houston, Texas, United States of America. There are limited data about emergency service mental health utilization following disaster events. The goal for this project was to examine mental health calls to emergency medical services (EMS) and to the Houston Police Department following Hurricane Harvey. An analysis looking at this utilization following a natural disaster represents an understudied area and can potentially provide information about city services and community psychiatric services in the acute period following the event. Materials and Methods: Total number of calls to the police department and mental health calls to the police department described as crisis intervention calls (Crisis Intervention Team) were obtained from August 1, 2016 to October 31, 2016 and January 1, 2017 to December 31, 2017. Emergency detention orders (EDO) per date were obtained from January 1, 2017 to December 31, 2017. Data for mental health calls based on the primary impression of mental health complaint were obtained from the Houston Fire Department for EMS from January 1, 2016 to December 31, 2017. Results: There was a statistically significant increase in the number of mental health calls to the police following Hurricane Harvey. When comparing the prestorm, active storm, and poststorm period, there was not a statistically significant difference in the number of EDOs or the number of EMS mental health calls. Conclusions: The increase in police mental health calls suggests that there may have been an increase in the acuity of the mental health calls to EMS around in evaluating calls surrounding the period of Hurricane Harvey. The following core competencies are addressed in this article: Medical Knowledge and Patient Care.
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Self-assessment of preclinical denture setup using a validated, structured, self-designed questionnaire by undergraduate students: A repeated cross-sectional survey p. 30
Pavankumar Ravi Koralakunte, Sunitha Naveen Shamnur, Nandeeshwar Doddabasavaiah Basavapura, Usha G Venkatesh
DOI:10.4103/IJAM.IJAM_55_19  
Introduction: Our aim was to determine if students who perform well on an initial preclinical examination are more accurate on self-assessments with successive examination. Materials and Methods: This was an observational, descriptive, cross-sectional survey. Ninety-one 2nd year dental students completed two consecutive preclinical examinations on ideal teeth arrangement and two self-assessments. Self-assessment was done using a validated, structured, self-designed questionnaire named “prosthetic denture setup–self assessment questionnaire.” The examinations involved artificial teeth arrangement in Class I jaw relation on maxillary and mandibular ideal edentulous casts mounted on a mean value articulator simulating the clinical procedure of a complete denture patient. Students' and their instructor's assessments were evaluated separately, and statistical results were obtained using t-test and Pearson's product moment correlation coefficient test. Regression analysis was done to predict the student self-assessment and validated self-assessment scores on examination outcomes for both indexed and nonindexed values. Results: The results indicated a significant increase in the examination and student self-assessment mean scores. Regression analysis indicated changes in student self-assessment scores, explained 11.9% of the variation in examination scores. Conclusion: Improvement in student self-assessment also showed improvement in successive examination assessments among dental students completing a preclinical denture setup procedure. The following core competencies are addressed in this article: Medical knowledge, Practice-based learning and improvement, Systems-based practice.
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Effectiveness of school-based dental health education on knowledge and practices related to emergency management of dental trauma and tooth avulsion: An educational intervention study p. 39
Y Srilatha, Byalakere Rudraiah Chandra Shekar, NC Krupa
DOI:10.4103/IJAM.IJAM_56_19  
Introduction: Trauma to teeth and jaws are considered major public health problems. The school environment is the most susceptible place for children, to encounter trauma to teeth. Materials and Methods: This interventional study was conducted to evaluate the effectiveness of school-based dental health education (DHE) on knowledge and practices related to emergency management of dental trauma and tooth avulsion among students and teachers of three government and three private schools each selected from two mandals (Mandal is a sub-district which comprises of a cluster of villages and village is the lowest level of administrative sub-division in rural areas of India) of Guntur district. Baseline information was collected from participants using a validated structured questionnaire. DHE on “Dental Trauma and Emergency Management of Tooth Avulsion” was offered using audiovisual aids (Flip charts, Slideshow) by a qualified Public Health Dentist. Subsequently, trained science teachers in each school were requested to undertake health education sessions at monthly interval for the next 3 months. Postintervention data were collected 1 week after initial DHE by public health dentist and 1 week after last reinforcement session by the teacher. Mean knowledge and practice scores were compared using independent sample t-test and Repeated Measures Analysis of Variance. Results: A total of 1180 children (570 males and 602 females, age range: 12–16 years) and 54 teachers (24 males and 30 females, age range: 20–56 years) were included. Mean scores for knowledge and practices increased among students and teachers following intervention with no difference between flipchart and slideshow method. Conclusion: Teachers (preferably science teachers) could be effectively used for DHE provided that they receive proper training and continued education on dental trauma. The following core competencies are addressed in this article: Medical knowledge, Practice-based learning and improvement, Systems-based practice.
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CASE REPORT Top

Hypophosphatasia: A missed diagnosis p. 62
Tess Chamakkala, Thomas Gallagher
DOI:10.4103/IJAM.IJAM_72_20  
Hypophosphatasia is a disorder of bone metabolism due to defective tissue nonspecific alkaline phosphatase (ALP). It is most severe in early life but can present at any age, leading to a likely underdiagnosis of its adult, and commonly less severe, forms. This is the case of a 42-year-old female who presented to endocrinology asking about her low ALP levels in the setting of prior bilateral metatarsal fractures and was diagnosed with hypophosphatasia. This case report aims to highlight the importance of making this diagnosis in order to avoid commonly prescribed therapies that can be harmful. Antiresorptive therapies as well as supplementation with calcium or Vitamin D can potentially worsen the disease. There are no Food and Drug Administration-approved treatments for adult hypophosphatasia, but asfotase alfa and teriparatide are two promising therapies currently being studied. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge.
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LETTERS TO EDITOR Top

De-emphasizing time-based training in the delivery of competency-based medical education for undergraduates in India: Justification, challenges, and potential solutions p. 66
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/IJAM.IJAM_71_19  
In the conventional medical curriculum in India, the duration of medical graduation is 4.5 years, excluding internship. The limitation of time-based advancement can be understood in two ways, either a student is sent to next professional year without attainment of the desired course outcomes or that students spend unnecessary time in a specific professional even after gaining the required outcomes. Acknowledging these limitations and also after realizing the multiple benefits attributed to Competency Based Medical Education (CBME), the same has been implemented in the Indian set-up for undergraduate courses from 2019 batch onwards. In general, CBME advocates against time-based training, especially because not every student can learn at an identical pace. However, adoption of the same strategy (time-variable) in imparting medical education has its own challenges. In India, even though, in principle, we have adopted all principles of CBME, except the time-variability of the course. However, now the same question arises, if all students learn at varying pace, how can we ensure that within a specified time duration, all the students will attain the desired outcomes? Even though, the task at hand is difficult, it can be accomplished, if we all work together in a planned and coordinated manner. In the mission to produce a competent medical graduate within a defined time interval, there is an immense need for better planning, support from administration, active participation of faculty members, involvement of the students, and better collaboration between departments.
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Pre-medical students: Lost in the COVID-19 chaos? p. 68
Isabela Crueza, Theresa T Stawicki
DOI:10.4103/IJAM.IJAM_33_21  
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Nutrition, COVID-19, and vaccines p. 71
Holly Gillis, Thomas John Papadimos
DOI:10.4103/IJAM.IJAM_13_21  
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