Structured oral examination in pharmacology for undergraduate medical students: Factors influencing its implementation

Objectives:

The study aims to understand the process and factors influencing the implementation of structured oral examination (SOE) for undergraduate medical students; in comparison with conventional oral examination (COE) in pharmacology.

Methods:

In a randomized, parallel group study, 123 students of pharmacology were divided into two groups, SOE (n = 63) and COE (n = 60). Students of each group were subdivided into two, and four examiners took viva voce individually. Three sets of questionnaires from autonomic nervous system were prepared, each having 15 items with increasing difficulty levels and were validated by subject experts and pretested. Ten minutes were allotted for each student for each viva. Feedback of students and faculty about the novel method was obtained.

Results:

SOE yielded significantly lower marks as compared to COE. There were significant inter-examiner variations in marks awarded in SOE and COE. Other factors influencing implementation were difficulty in structuring viva, rigid time limits, lack of flexibility in knowledge content, monotony, and fatigue. The students perceived this format not different from COE but felt that it required in-depth preparation of topic. Faculty opined that SOE led to less drift from main topic and provided uniform coverage of topics in given time.

Conclusion:

Conducting SOE is a resource-intensive exercise. Despite structuring, inter-examiner variability was not completely eliminated. The students’ performance was depended on factors related to examiners such as teaching experience, vernacular language used, and lack of training. Orientation and training of examiners in assessment strategies is necessary. Standardization of questionnaire is necessary before the implementation of SOE for summative assessment.KEY WORDS: Objectivity, pharmacology, reliability, structured oral examination, validity, viva voce     

Effect of antihypertensive therapy on cognitive functions of patients with hypertension

Objectives:

Hypertension is known to be associated with cognitive decline. Many studies revealed that control of hypertension with antihypertensive therapy controls the cognitive decline associated with hypertension. While there are reports that suggest that antihypertensive drugs do not provide protection from cognitive decline, the present study is designed to evaluate the cognitive status of patients recently diagnosed as hypertensive and effect of 3 month long antihypertensive therapy on cognitive functions.

Materials and Methods:

A predesigned pretested questionnaire was used to collect the information. The PGI memory scale (PGIMS) was employed to assess memory function of patients. Baseline memory functions were evaluated before starting the treatment with antihypertensive and compared with the cognitive function scores of healthy volunteers. After the 3 months of treatment, cognitive functions were evaluated again by the same scale. The unpaired t-test was used to compare the cognitive functions between case and control and the paired t-test was used to compare pre- and post-treatment score.

Results:

This study revealed that mean scores of six subtests of cognitive functions were less in cases as compared to subjects in comparison group. After 3 months of antihypertensive therapy, scores of five sub-tests were found to be increased. Among these five subtests, four were those which were found declined at the baseline.

Conclusion:

This suggests that antihypertensive therapy given for 3 months improved the score of those cognitive function tests in which hypertensive patients perform poorly during recruitment and there was no deterioration of any test after 3 months of antihypertensive therapy.     

Reporting statistics in clinical trials published in Indian journals: a survey

Objectives

Clinical trials are having very important place in the hierarchy of evidence based medicine. It has been observed that current methods of use and reporting of statistics of clinical trials are responsible for errors in the interpretation of results. So we decided to evaluate clinical trials published in three Indian journals of 2007 and 2008 to analyse statistical issues which may affect the interpretation of results.

Settings and Design

Retrospective observational study

Materials and Methods

We analyzed all the clinical trials (46) published in Indian pediatrics, Indian journal of pharmacology, journal of postgraduate medicine and of 2007–2008.

Results

We found that median number of end points reported in clinical trials was 4 and median number of end points which were used for testing of significance was also 4. (21) 45% of trials reported repeated measurement. 18 (39%) trials had three or more than three treatment groups. median number of test of significance was 15. post hoc subgroup analysis was done in 19% (9) of trials. P value was the sole criteria for interpretation of results in most of the trials, confidence interval was calculated in 11 (23%) trials. Baseline comparison between the study groups was done in 41 (89%) trials. in all cases comparison was done by statistical tests. Exact sample size was calculated in 18 (39%) trials.

Conclusion

There are great chances of having error during the interpretation of results of these trials was because of multiple treatment groups, repeated measurements of endpoints, multiple tests of significance, over reliability on P value and less use of confidence interval. Statistical methods available for reducing chances of errors should be used and result should be interpreted accordingly.