A B S T R A C TBackground: Assessment and evaluation in the curriculum of medical education plays an important role to enhance the learning ability of medical students and should provide the level of actual performance as well as the capacity to improve overall performance. Aims and Objectives: In the present study, the performance of medical students in Physiology was assessed by conventional type short essay questions (SEQ) and multiple choice questions (MCQ). Materials and Methods: This prospective (observational) study was conducted in the subject of Physiology, A total of 380 samples were taken from students enrolled for the 1st year medical curriculum in year 2013 to 2015. The subjects were divided in two groups: subjects of this group-I was assessed with two theory papers consist of short essay question (SEQ), practical exam without OSPE. The subjects of group-II were assessed their theory part only by MCQs and maximum part of practical exam by objective structured practical examination (OSPE). Results: The theory performance was significantly higher (p<0.05) in group-II students assessed by totally MCQ based two system tests and one terminal exams as compared to conventional type (SEQ). While the marks obtained in practical was assesses by six lab leaving tests, one terminal practical exam (OSPE) was also significantly high (p<0.005) as compared to group-I. Our data showed that the performance of two problem solving tests (one long clinical case) and grant viva (oral) was significantly less in group-II (Table 1). Conclusion: The objectivity of questions prefers over short essay questions by students as they scores well in theory as well as in practical exams, while they poorly performed in clinical exam (the assessment of higher cognitive functions). The objectivity may eliminate the subjective difference in conventional type of evaluation.
Introduction: Posterior circulation territory stroke account for approximately one-fifth of all ischemic strokes. Basilar artery occlusion (BAO) remains a challenging diagnostic entity. BAO is associated with a high mortality rate and cases with spontaneous favorable outcomes are less frequently reported. We aim to assess the mortality and morbidity in BAO patients who presented beyond window period for thrombolytic therapy or interventional procedures. Methods: This study was a prospective observational study conducted at a tertiary care hospital. Thirty two patients admitted to Government Medical College Kota, who presented with a clinical diagnosis of acute basilar artery occlusion supported by imaging evidence (computerized tomography, magnetic resonance imaging or angiography). Demographic details including age, sex, risk factors were recorded for all the patients along with presenting symptoms and clinical signs with radiological correlation. Functional outcome was compared between two groups, namely mechanically ventilated and nonventilated patients. Functional outcome was assessed using modified Ranking scale (mRS) on admission and at the end of 1 month follow up. Results: Total 32 patients were enrolled during the study, which included 17 males and 15 females. Mean age of the enrolled patients was 54.14 years (range 33-67 years). Most common prodromal symptoms were vertigo and headache. Fourteen patients (43.7%) were comatose at the onset of symptoms, 4(12.5%) patients became comatose within 48 hrs of onset and one patient was in locked in state. Cranial nerve abnormalities and Cerebellar signs were observed in 12 and 8 patients respectively. Visual symptoms were observed in 4 patients in the form of either homonymous hemianopia or cortical blindness. Forty six percent patients in the mechanically ventilated group and 64% in the non-ventilated group were hypertensive. Out of all the patients, approximately 34% were diabetic and 38.75% had dyslipidemia. Out of 32 enrolled patients, 15 patients received mechanical ventilator support and 17 patients did not require it. Seven patients in the ventilation supported group while only 3 patients in the nonventilated group showed functional outcome improvement at the end of 1 month follow up. Three patients in without ventilator group deteriorated within seven days and two patients on ventilator supported group were deteriorated after 30 days and died. Five patients had no change in their mRS score at the end of 1month follow up. Conclusion: Prognosis of basilar artery occlusion patients, presenting beyond window period for thrombolysis or intervention, is poor with high mortality and morbidity. Study highlights the need for high index of suspicion for diagnosing basilar artery occlusion and the utility of mechanical ventilation in indicated cases, which may help for better functional outcome.
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