IntroductionOur current medical curriculum devotes a large percentage of time to knowledge acquisition by means of didactic lectures. Psychomotor skill acquisition takes a back seat. Certain lifesaving skills like basic life support skill training have not even made an appearance in the current curriculum. Equal time distribution to cognitive and psychomotor skills should be allotted for MBBS trainees, which is a very practical subject. Simulation can prove to be a valuable tool in imparting skill training. The present study aims to evaluate the efficacy of different teaching modalities in imparting lifesaving skills among first-year MBBS students.Materials and methodsThis cross-sectional study was conducted among 33 first-year students who consented to participate. Approval was obtained from the institutional ethics committee. The students were divided into three groups, each undergoing either didactic lecture or animation-based videos or simulation studies. Pretest, posttest, and skills tests were administered to them. One-way analysis of variance (ANOVA) and paired t test were the statistical tests employed using SPSS version 21.ResultsThe pretest and posttest scores were comparable in the three groups while the improvement in the posttest scores in all the three groups was significant. The skills test was significantly better in the group undergoing simulation training compared to the other groups.ConclusionDidactic, animation, and simulation are all good methods in imparting cognitive knowledge, but simulation is the method of choice in imparting psychomotor skills.Clinical significanceAn overhauling of the medical curriculum to include more skills training to the budding doctors using simulation-based techniques is recommended.How to cite this articleSuseel A, Panchu P, Abraham SV, Varghese S, George T, Joy L. An Analysis of the Efficacy of Different Teaching Modalities in Imparting Adult Cardiopulmonary Resuscitation Skills among First-year Medical Students: A Pilot Study. IJCCM 2019;23(11): 509–512.

Background: Didactic mode of teaching retains a strong hold in the Indian medical education scenario. Is this because there is no alternative teaching method or is it the preferred choice of the learners? When outcomes of teaching are considered, better teaching tools are available. But when the question of choice of the learners is raised, there are no satisfactory answers. This study aims to expose medical students to different modalities of training and to obtain their verdict on what they consider is the best method of teaching to aid in their learning process.Methods: A cross sectional study was conducted on all I year medical students after obtaining institutional clearance. 33 students consented to participate in the study. They were divided into 3 groups and given instructions in cardiopulmonary resuscitation (CPR)- single rescuer method in the didactic, video format and manikin based. A pre-test was taken and a post-test too. A skills test was taken at the end of teaching. Finally, all the students were asked to give a feedback. The results tabulated and analyzed.Results: Students with simulation (manikin) based teaching had more confidence in performance of CPR, performed better in the skills test and post-test when compared to the other groups. Almost unanimously, the students preferred simulation based teaching over the other two tools that they were exposed to.Conclusion: A revolution in medical teaching in the Indian syllabus is the need of the hour. While newer tools are being implemented, the requirements and choices of the recipients of teaching should also be considered.

Background: Time to ROSC has been shown to be an important and independent predictor of mortality and adverse neurological outcome. In resource limited situations judicious deployment of resources is crucial. Prognostication of arrest victims may aid in better resource allocation. This study aimed to assess the time to Return of Spontaneous Circulation (ROSC) in cardiac arrest victims and its relationship with opening rhythms.Methods: Consecutive victims of cardiopulmonary arrest who presented to a single center were included in this study if they met the inclusion and exclusion criteria. Time at which opening rhythm was analyzed and time at which ROSC was achieved was noted. This was done for all cases and mean time to ROSC was calculated for each opening rhythm. All those patients who achieved ROSC were followed up till hospital discharge or death.  Primary outcome measured was achievement of ROSC and the secondary outcome was the survival to hospital discharge.Results: A sample size of 100 was calculated to yield a significance criterion of 0.05 and a power of 0.80 based on prior studies. Out of 100 patients studied. 58% had shockable rhythms and 42% had non-shockable rhythms.  Mean time to ROSC for shockable rhythm was 5.55±3.51 minutes, and for non-shockable rhythm is 17.29±4.18 minutes.  There was a statistically significant difference between opening rhythms in terms of survival to hospital discharge (p=0.0329).Conclusions: Cardiac arrests with shockable rhythms attained ROSC faster when compared to nonshockable rhythms. Shockable rhythms have a better survival to hospital discharge when compared to shockable rhythms. Opening rhythms may aid the clinician in better utility of resources in a resource constrained setting.

Background: Twenty-minute whole blood clotting test (20WBCT) and Modified Lee and White (MLW) method are the most routinely employed bedside tests for detecting coagulopathic snake envenomation. Our study compared the diagnostic utility of MLW and 20WBCT for snakebite victims at a tertiary care hospital in Central Kerala, South India. Methods: This single-center study recruited 267 patients admitted with snake bites. 20WBCT and MLW were performed simultaneously at admission along with the measurement of Prothrombin Time (PT). The diagnostic utility of 20WBCT and MLW was determined by comparing the sensitivity (Sn), specificity (Sp), positive and negative predictive values, likelihood ratios, and accuracy at admission with an INR value > 1.4. Results: Out of 267 patients, 20 (7.5%) patients had VICC. Amongst those who had venom-induced consumption coagulopathy (VICC), MLW was prolonged for 17 patients, (Sn 85% 95% confidence interval [CI]: 61.1-96.0) whereas 20WBCT was abnormal for 11 patients (Sn 55%, 95% CI: 32.04-76.17). MLW and 20WBCT were falsely positive for the same patient (Sp 99.6%, 95% CI: 97.4-99.9%). Conclusion: MLW is more sensitive than 20WBCT to detect coagulopathy at the bedside amongst snakebite victims. However, further studies are necessary for standardizing bedside coagulation tests in snakebite cases.

Background: To study the effect of blood alcohol levels on GCS in Traumatic brain injury patients (TBI) and relate the findings to brain injury severity based on the admission CT scan. Methods: This cross-sectional study with a comparison group is conducted in Emergency Department (ED) of Pushpagiri Institute of Medical Sciences and Research Centre, Central Travancore, Kerala, India from April 2016 to September 2017 including all patients of 18 - 70 years of age presenting with head injury. 200 participants, 100 each of alcohol intoxicated and non- intoxicated were selected by consecutive sampling. GCS, Blood alcohol concentration-BAC (derived from the reading of alcohol breath analyzer) and admission CT Rotterdam Score are collected and analyzed at the end of study. Results: When CT Rotterdam Score is 1-3, GCS was found to decrease with increase in BAC (Chi-square test p value=0.011; Spearman’s Rank Correlation coefficient rs=-0.326). Independent t –test showed that at BAC 1-100 mg/dl, mean GCS decrease by 1.6 while only same decrease is found when the BAC levels ranges from 100-400 mg/dl. When the CT Rotterdam score is 4-6, no significant correlation was found between GCS and BAC (p value=0.092; rs=0.214). In the presence of alcohol, GCS had sensitivity 87.5% and specificity 70% in comparison to alcohol absent TBI patients (sensitivity 98.5%, specificity 69.7%). When features of hypoxia and shock are present, GCS have good agreement with actual CT findings of TBI. (Kappa coefficient: K 0.659, sensitivity 76%, specificity 100% in alcoholics and K 0.756, sensitivity 100%, specificity 80.6% in nonalcoholic). Conclusions: Even in the setting of alcohol intoxicated TBI patient, Glasgow coma score is a useful tool for quick decision making in emergency department.