Windsor Insight Summer 2016

20 Pages·2016·5.43 MB·English

Windsor Insight
ISSUE #2 SUMMER SEMESTER 2016
WINDSOR CELEBRATES GRADUATION CERMMONY IN
CANADA FOR THE FIRST TIME
EDITOR IN-CHIEF
Dr. Bikramajit Singh Saroya

EDITORIAL BOARD
Dr. Andy Vaithilingam
Dr. Fatai Babatope Oluyadi
Mr. Agu Obasi

LAYOUT EDITOR
Rondon Carr
WHATS INSIDE
 PRESIDENT’S MESSAGE
 WINDSOR WELCOMES NEW
FACULTY
 FAIMER WORKSHOP
 LEARNING OBJECTIVES IN
MEDICAL EDUCATION
 THE ART OF SUTURING: A
BRIEF OVERVIEW
 BECKER USMLE REVIEW
VISITS ST. KITTS
 HOW TO GET 90S IN
MEDICAL SCHOOL
 CHESS AS A LEARNING
TOOL FOR MEDICAL
STUDENTS
 GUESS THE DIAGNOSIS!
“GLIMPSES OF THE GRADUATION CEREMONY”
PRESIDENT'S MESSAGE TO GRADUATING PHYSICIANS
By Brijinder K Gupta

It is the first time we are meeting in
Toronto for an occasion like this and we
are very pleased, to have a vast number of
our students attend. We had the
Graduation Ceremony in the US for the
past 3 years, therefore we thought it fit to
accommodate you the Class of 2016 so
that you could be closer to home and
have the opportunity to celebrate with
your friends and family.

Windsor University opened its doors in
1998 in Turks and Caicos Islands under
the leadership of late Dr. Srinivas
Gaddam and five other colleagues with
just eight (8) students. It was their vision
to provide medical training to individuals
of all strata of society. Having to deal
with several bureaucracies which slowed
the progress of our institution, we decided
to move our institution to St. Kitts in
2000. We started here with twelve (12)
students in Fort lands followed by Bird
Rock. But now we can boast of our
campus set on three acres of land at
Brighton's Estate, Cayon where we train
approximately 600 students. Right at this
moment we are constructing a state of the
art Library, additional classrooms, faculty interact with a vast variety of individuals. arduous hours either in a hospital
offices and a Simulation Laboratory to You are privileged to gain a multi- emergency department or surgical theatre.
aid the Clinical Science Students. national network of friends and will I wish you reflect on this for a while
We are very proud of our 340 alumni eventually realize that some primary care with the hope that you realize that your
who are in various residency programs in doctors/specialists were once your profession requires much patience,
the US and Canada and 170 in other classmates or members of your study endurance, love and respect. No matter
countries. We are particularly proud of group. the situation, always remember the
our 840 Alumni, who are all holding their confidence and trust placed on you by
own in their respective fields, some of It will be your duty to earn the respect of your patients and their families. You
who are in extremely important and your patients and colleagues alike. therefore will need to reassure them that
strategic positions in the medical globe. A p p r o a c h y o u r t a s k s w i t h you will do your best. You are well
We are also proud of our alumni who are professionalism, ensuring at all times the poised to change the present medical
in fellowship in various fields of confidentiality with which you must techniques and improve patient care.
medicine, like Trauma & ER, Neurology, operate. Be cognizant of the fact that your Every day you will face challenges, but
Pa ll ia t ive Care, Neona to logy, training prepared you for the doctor/ be prepared to discern new opportunities
Rheumatology etc. patient relationship which takes into and broaden your horizon. I welcome
account a caring nature that begins with you to the medical profession and
Graduates, you have embarked on a the practice of being a good listener. By congratulate you for achieving this
lifelong learning career which will take now you would appreciate the benefits of milestone, while wishing you well in
you many places and allow you to hard work having endured many long, future endeavors.
WINDSOR WELCOMES NEW FACULTY
Pathology at Dr. Rajendra Prasad
Government Medical College, Himachal
Pradesh, India) and Vice Dean (In 2012,
he joined Azeezia Institute of Medical
Sciences And Research, Kerala, India as
Professor & Head of Pathology
Department and was subsequently
promoted to Vice Dean)

He also held the post of Foreign Expert in
Pathology at the Southern Medical
University, Guangzhou, China in from
2006-7 and also worked at the Bokamoso
Private Hospital, Gaborone, Botswana as
the Chief Pathologist and Director of
Laboratory Services from 2009-11
He came to the Caribbean in 2012 as
Professor of Pathology at the Medical
University of the Americas, Nevis where
he was also involved in the RLRA
research projects and Promotions
Committee. He moved to Windsor
University School of Medicine in 2014
where he was the Course Director of
Pathology and Associate Dean for Faculty
Dr. Jeevan Divakaran Dr. Ila Chauhan
Affairs. He left Windsor briefly in 2015 to

teach Pathology at the Trinity School of
Education
Medicine, St Vincent and has now
Education MBBS - Coimbatore Medical College,
rejoined the Windsor family.
MBBS - Coimbatore Medical College, Coimbatore, Tamil Nadu, India, 1995

Coimbatore, Tamil Nadu, India, 1995 Residency - DNB Radiation Oncology, G
He has also been actively involved in
Residency – Pathology, Pt B D Sharma Kuppusamy Naidu Memorial Hospital,
r es ea r ch (s p ec ia l int er es t in
PGIMS, Rohtak, 2000 Coimbatore, Tamil Nadu, India, 2005
Gastrointest ina l Pathology and
Senior Residency - Jawaharlal Institute of
Dermatopathology) with publications in
Dr Jeevan started his career in Pathology Post Graduate Medical Education and
indexed national as well as international
in 2000 as an Assistant Professor with Research, Puducherry, India, 2007
journals. He is extremely passionate about
teaching and diagnostic responsibilities at
teaching his subject and has also
the PSG Institute of Medical Sciences & Dr Ila served as a short service
undergone training courses in medical
Research, Coimbatore, India. He also commisioned officer in the Army
education and teaching.
held additional posts of Warden of the Medical Corps of India after completing

Gents Hostel, Secretary of the Indian M.B.B.S. , caring for service personnel
He strongly believes that ‘in order to be a
Medical Association - Peelamedu PSG and their families
good teacher, one must be a good learner’.
Branch, Co-ordinator of Student Quiz
His hobbies include playing table tennis
Club and Secretary of the Faculty Club. After completing residency in Radiation
and badminton. He is an avid cricket fan.
Subsequently he worked at various Oncology, she worked in JIPMER, one of

prestigious medical universities in India, the premium teaching hospitals in India
attaining the rank of Professor. He also as senior resident. She was responsible
managed a few administrative positions for out and inpatient care of cancer

including that of Head of Department (In patients. She also conducted basic
2011, he headed the Department of oncology classes for medical students.
Subsequently she joined the Ex- Dr Shepherd started her medical
servicemen Comprehensive Health education at Igbinedion University,
Services of India which cares for veterans Nigeria. She subsequently transferred to
of Indian Armed forces and their families. Windsor in 2012. After recent completion
She came to the Caribbean in 2012, of her MD she joined the Anatomy
joining Medical University of Americas, Department as a Lecturer. She believes
Nevis, as Assistant Professor in Pre- that Anatomy is an important
Clinical Sciences, and was involved in foundational course in Medicine and
teaching the ICM and FCM courses for unlike some other courses, it's very
all basic science semesters. This included relatable, not abstract, and easily grasped
academic lectures and hands-on training - this is why it is one of her favorite
during labs sessions. courses to learn and teach.

She briefly returned to her home country A physician teacher with a genuine
in 2014, working as Resident Medical interest in the complete well being of her
Officer at the Jain Group of institutions in students what she lacks in experience she
Bengaluru. more than makes up for with her
enthusiasm to teach and her thirst for
She is a sincere and dedicated knowledge and advancement. She has an
professional, well-loved and respected by avid interest in the research field of
her patients wherever she worked. She regenerative medicine having written a
believes that clinical skills and empathy Dr. Stella Ebere-Shepherd research paper on "The role of
towards the patient are the building regenerative medicine in the treatment of
blocks of the road to recovery. She joined Education diabetes mellitus and it's late
the Windsor family in May 2016. MD, Windsor University School of complications". She loves to travel and
Medicine, St Kitts, 2015 experience new people and cultures.
Music and writing are her other pastimes.
FAIMER WORKSHOP ON CURRICULUM DEVELOPMENT &
EVALUATION, PRINCIPLES OF ASSESSMENTS AND EDUCATIONAL
RESEARCH
By Soumitra Chakravarty,
Bikramajit Singh Saroya

It was an honor and a privilege to have

esteemed Professors and Medical

Educators from FAIMER visit Windsor

University School of Medicine to conduct

a workshop covering various crucial

aspects of Medical Education like
Dr. John (Jack) R. Boulet, Ph.D. Professor Janet Grant,
Curriculum, Assessments, Educational Vice President, Research
and Data Honorary Professor, University College
Research and Evaluation Principles. We
Resources L o n d o n M e d i c a l S c h o o l
have learnt a lot of great things and
Foundation for Advancement of Professor Emerita of Education
received many ideas for the continuous
International Medical Education and in Medicine, The Open University, UK
development of our beloved University.
Research Special Adviser to the President, World
Guest Speakers: 3624 Mar
ket Street, Philadelphia, PA, Federation for Medical Education

19104 Director: Centre for Medical Education in
Context [CenMEDIC] & FAIMER Prof. Grant discussed various components Directors learnt how to make competency
Centre for Distance Learning of curriculum evaluation. She showed us grade sheets. We also discussed different
several models of evaluation and points regarding scores; starting from
th th
DATES: April 25 to 27 , 2016 explained the factors that determine the definition of a score, characteristics of
effectiveness of evaluation. We learnt that good score, scoring methods and score
C ur r icu lum Des ign a nd
defining the purpose of evaluation is the report. In the end of this session we did a
Integration - Prof. Janet Grant
most important aspect of Curriculum Video Exercise in which we learnt how to
evaluation. Quantitative Data should be make a checklist for OSCE clinical skills
Prof. Grant discussed the steps and gathered using a variety of methods like examinations.
options in Curriculum designing. She evaluation of courses, peer-evaluation,
began with the school’s mission and student evaluation of faculty, USMLE/ Attending members - Assessments
vision and informed us about the NBME scores etc. It is most important to Committee and Course Directors
importance of the Mission Statement for determine the reasons behind the
development of the Educational collected data being good, satisfactory or
Standard setting - Dr. Jack
Objectives of the program. She told us poor as this would guide the school to
Boulet
about the various types of curricula and make changes for improvement. She also
that there is no evidence that one type is told qualitative data derived from student
better than the others but there is interviews, valid questionnaires in context The session included a look into a various
evidence that some curricula are less of this institute were more important than parameters involved in setting passing
effective than others. just quantitative data. Data analysis is scores in different types of assessments
more important than measuring and data e.g. MCQs and OSCEs. We did several
The faculty learnt that curriculum collection. exercises involving multiple choice
designing was always contextual and that Attending members: Curriculum scenarios and OSCE scenarios especially
we have to keep in mind the major health Committee communication skills. Dr. Boulet
issues of North America and Nigeria emphasized that although the processes
since these are the areas where our involved in setting a standard passing
Test development and Scoring:
student population would go for higher score for both MCQs and clinical skills
Dr. Jack Boulet
education and medical practice. are not 100% accurate, the faculty must

be extremely carefully in setting standard
Dr. Boulet presented on general concepts
We were informed by Dr Grant that for scores in order to remove the usual
of testing, methods used in health
purposes of integration, in most institutes, arbitrariness. One important point he
profession, education, scoring and score
basic sciences integrate with clinical raised, was that passing scores should not
reporting. He discussed the concept of
sciences but often, the clinical sciences necessarily be the same for all subjects.
"What to assess? and "How to assess it?".
fail to reinforce the knowledge of basic The difficulty of the test items should be
He informed us about the factors that
sciences. Most institutions are trending an important factor to be examined before
determine the quality of assessments and
towards adopting fully integrated putting a blanket passing score across
shared with us methods to prepare
curricula which is merely to look good on subjects.
blueprints and test specifications to ensure
paper. There is extensive evidence that
that one assess what is taught. Dr. Boulet
these programs face several problems Attending members: - All faculty
discussed in detail the process of
when managed ineffectively. We realized members
determining the test content. Since our
that self-reflection and improvement is
curriculum is a competency based
the best practice in improving curricula.
Educational Research: Dr. Jack
curriculum, we discussed the different

assessment methods like MCQs, written Boulet
Attending members: Curriculum
Committee and computer based clinical simulations,
OSCE and observation of performance Dr. Boulet believed that Windsor

with real patients along with the Pros and University SOM has tremendous
Curriculum Evaluation - Prof.
Cons for each and the best methods to test potential for Educational Research. Since
Janet Grant and assess our 6 Core Competencies. We our University has been around for over
had an exercise where all the Course 15 years we have extensive data for
HIGHLIGHTS FROM FAIMER WORKSHOP
HIGHLIGHTS FROM FAIMER WORKSHOP
conducting Educational Research projects with Dr Boulet and he gave many efficacy of watching a medical video with
projects. In this interactive session we ideas of improving and expanding them. 1.5 times speed etc.
discussed different research ideas The educational ideas discussed included
applicable to our school. Few faculty active learning, emotional disturbance and Attending members - Research
members who are already working on its effect on academic performance, the Committee and other interested Faculty
such projects discussed their ongoing role of counseling/mentoring students, the
LEARNING OBJECTIVES IN MEDICAL EDUCATION
By Sanjib Das Writing Learning Objectives Cognitive domain action verbs were
Identified by a taxonomist, Benjamin
Begin with a statement such as "by the
What are learning objectives? completion/end of this course/lesson/ Bloom .
A learning objective is a clear, concise, presentation/CBT, you will be able to . . .“ 6 levels of Bloom’s taxonomy
objective description of what your Express the objective in terms of what the 1. Knowledge: define, label, list, name,
learners will be able to accomplish at the user will be able to do, not what you are order, recognize, recall, label, memorize,
end of a given instructional unit. A presenting. reproduce, repeat
Learning Objective is also known as a Inscribe objectives that include the 2. Comprehension: classify, describe,
performance objective or competencies. discuss, explain, identify, indicate, locate,
Among all the activities involved in the
instructional design process, developing
objectives is one of the most critical.
Synonym : Instructional objectives,
learning outcomes.

Purpose
Learning objectives enlighten learners
about what they will know, understand or
be able to do at the end of a block of
instruction (lecture, topic, lesson,
workshop etc).
Objectives should be clear, honest,
complete, and correct.
Well-written objectives should serve as
the basis for test items and inform
learners how their performance will be
following components: recognize, report, review, select, translate
assessed.
3. Application: apply, choose,

A-Who are your students? demonstrate, employ, illustrate, interpret,
Composing
i. What class year? operate, practice, schedule, sketch, solve,
Determine the goal of the learning
ii. What are the learner's characteristics? use
activity (the terminal objective).
4. Analysis: analyze, appraise, calculate,
Determine what learners must
B-What will they do? categorize, compare, contrast, diagram,
demonstrate to achieve that goal (the
Behaviour = Action verb+ content differentiate, discriminate, distinguish,
enabling objectives).
An action verb describes a performance. examine, test, question
Write objectives based on the above
Verbs such as "know, understand, 5. Synthesis: arrange, assemble, collect,
skills, task, or knowledge
analyze, evaluate etc" or many others compose, construct, create, design,

typically begin a learning objective. formulate, manage, organize, plan,
prepare, propose, write -list 5 internet resources
6. Evaluation: argue, assess, choose, -provide 10% of research evidence Write a learning objective by using the
defend, estimate, judge, predict, rate, template below
score, select, support, value, evaluate Summary
• By writing learning objectives, the • When will the learning be achieved (by
C-What do they need to perform the instructor is selecting the content, the end of named clerkship/ lecture /
learning objectives? developing the instructional strategy, clinic/ lab)?
Conditions=Requirements for learning assessing the student’s performance and Stem:___________________________
-Text book evaluating the instruction. • Who is the learner?
-Equipments(Stethoscope, microscope • A learning objective is a specific Audience:________________________
etc.) statement of observable student behaviors • What will the learner be able to do?
-Setting(small group, clinical setting) that can be evaluated and contributes to Action verb:______________________
-Computer access reaching the goal. Content:_________________________
• Learning objectives combine action • With what requirements?
D-How well will they need to perform verbs and content to describe the desired Conditions:_______________________
the learning objectives? behavior. • How well?
Degree=the criteria for assessing • An easy way to write a learning Degree:__________________________
performance objective is to use the A+B+C+D formula.
THE ART OF SUTURING: A BRIEF OVERVIEW
By Kusai Alsalhanie " a p p r o x i m a t i o n w i t h o u t For example, a vascular surgeon
strangulation."1 Basically, suturing is should pay close attention so as not to
"The skill and art of suturing dates to gently close the wound's edges until break the suture material when
back thousands of years to the Smith the tissue restores its natural tensile connecting two vessels using a
1
Papyrus era ." It is believed that strength. The purpose of suturing in running technique, otherwise he/she
ancient Egyptians were the first to use the medical world is not limited to will have to start from the beginning.
suturing in wound care. Over the closing a wound. Suturing is also Another issue is running the risk of
years, the technique and materials important in the elimination of dead clamping the vessels if the procedure's
have changed but the basic purpose space, it provides a better aesthetic duration is elongated. However, a
for suturing has not. Suturing is outcome, reduces wound infection, vascular surgeon should be firm with
defined as - "Surgical uniting of two supports the wound and facilitates his sutures to avoid excessive
2
surfaces by means of stitches." healing. It also aids the reduction of bleeding once the clamp has been
Suturing in itself is a simple concept. post-operat ive pain, and most removed.
However, it requires skilled hands, a important ly contro ls bleeding

focused mind and precise attention to (hemostasis). Mastering the art of
Suturing Material Selection and
details. Like any other medical suturing requires basic knowledge
Instrument Handling
procedure, suturing requires sufficient such as understanding a good

knowledge on the suturing materials, technique, handling the instruments
Nowadays, a variety of needles are
basic wound healing process, basic properly and comfortably dealing
used in surgeries. In the classical
anatomy of the body and the proper with different instruments. When
procedures, a non-needled thread is
technique for closure. There are many executing a suture, a surgeon should
fitted with the spring eye or regular
techniques used in closing a wound. be firm, to avoid a loose stitch, but
3
eye needle at the time of use.
The hallmark of proper suturing is should not be too forceful with the
Atraumatic sutures are widely used
captured in the o ld adage sutures to avoid breaking the stitches.
now to reduce tissue trauma.
Atraumatic suture is defined as a good memory. It ties smoothly yet The following principals are guides
6
needle-suture combination where the requires multiple knots to enhance for suture selection:
3
thread is attached to the needle. secur ity. Most common used

monofilaments sutures are: Nylon,  There is no need for sutures once
The surgical needle has three Monocryl, PDS and Pro lene. tissue reaches maximal strength.
essential parts: the tip (a delicate point Multifilament sutures can be either Therefore, non-absorbable or long
that penetrates the tissue), the swage braided or twisted for example; Vicryl term absorbable sutures can be used
(where the thread is attached to the (braided), Silk (braided) and Chromic for tissues that heal slowly e.g.
4
needle), and the portion in-between (twisted). tendons, fascia. Likewise a short

where the needle is grasped by the term absorbable sutures can be used
needle holder. When choosing a suture material, to close tissue that heal rapidly e.g.
whether to use an absorbable or non- colon and bladder.
Needles can be classified into absorbable sutures might be the first
different types based on the needle quest ion that comes to mind.  Foreign bodies in potentially
shape, type, length and other Absorbable sutures are usually contaminated tissues may convert
characteristics. Needle's shape is (normally) used internally when contamination to infection rapidly.
variegated. Some examples include: applying intradermal sutur ing Therefore, avoid multifilament
Fish hook shaped needle, 3/8 circle, technique. It degrades by two different sutures that may convert a
5/8 circle, 1/2 circle, 1/4 circle, mechanisms; proteolytic enzymes as contaminated wound into an infected
straight, semi-curved and spoon in catgut sutures or via hydrolysis as in one.
shaped needle. Needle types can be synthetic polymers like PDS, Vicryl
round bodied, reverse cutting, cutting and Monocryl. It is very important to  For cosmetic outcome, avoid
needle, etc. understand that absorption time or half material that will induce a higher
-life is different from dissolution time. degree of tissue reaction. Therefore,
The suture material is a significant use the smallest size, commensurate
component of learning how to suture. Half-life is the time at which the with the natural tissue strength,
The search for the ideal suture suture material loses 50% of its monofilaments suture and avoid skin
material is still ongoing. Suture tensile strength. Dissolution time is s u t u r e s by u s ing r u nn in g
material can be broadly classified as the time needed for the suture subcuticular sutures. Skin tape or
absorbable or non-absorbable. material to be completely dissolved. adhesive (glue) enhances a cosmetic
Furthermore, it can be classified as result.
natural or synthetic, dyed or undyed, N o n- a bs o r ba b le s u t u r e s a r e
monofilament or multifilament, permanent, primarily used for skin  Foreign bodies in the presence of
coated or uncoated. In general, closure and need to be removed later f l u i d s c o n t a i n i n g h i g h
multifilament sutures are more prone with exceptions such as usage of concentrations of crystalloids may
to infection and induce greater degree Seracor sutures in cardiac and heart act as a nidus for precipitation and
3
of tissue reaction. However, it is valve surgeries. It is the surgeon's stone formation. Therefore, use
characterized by its easy handling, decision to select the suturing rapidly absorbable sutures in urinary
5
low memory and high knot security. material. A number of factors and biliary tract.
On the other hand, monofilament determines this selection such as tissue  Remove sutures as soon as the
suture has less tissue drag and type, healing process and time, the patient's condition is stabilized.
reaction, is less prone to infection, nature of the material, availability of
difficult to handle and low knot the material and the surgeon's The basic instruments used in
security. Monofilament suture experience and preference. cutaneous suture include a needle
1
consists of parallel fibers and possess driver, skin forceps and skin hook.
The needle holder has a ratchet-type