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Dev Kumar Shah,1 Suneel Piryani,2 Rano Mal Piryani,3 Mohammad Nazrul Islam,1 Rajesh Kumar Jha,4 Gopendra Prasad Deo51Department of Physiology; 2Department of Community Medicine & Public Health; 3Internal & Pulmonary Medicine and Medical Education; 4Department of Pharmacology; 5Department of Anesthesiology, Chitwan Medical College, Bharatpur, Chitwan, NepalBackground: The educational environment of an institution affects learning and has a significant role in determining students’ academic achievement. The objective of the study was to determine the undergraduate medical students’ perception about educational environment in clinical years of study utilizing Dundee Ready Education Environment Measure (DREEM) questionnaire.Methods: A descriptive cross-sectional questionnaire-based study was conducted among fourth and fifth-year medical students toward the end of their 2016 academic year in Chitwan Medical College, Bharatpur, Nepal. The 50-item DREEM questionnaire was used to collect the data. The items were scored based on a 5-point Likert scale. The data were analyzed using SPSS version 20. Scores obtained were expressed as mean±SD.Results: The mean total DREEM score was 122/200. The mean score for Students’ Perceptions of Learning, Students’ Perceptions of Teachers, Students’ Academic Self-Perceptions, Students’ Perceptions of Atmosphere, and Students’ Social Self-Perceptions were 29.8/48, 25.9/44, 20.3/32, 28.6/48, and 17.27/28, respectively. This shows the environment for learning was satisfactory. There were nine problem areas with a mean score of ≤2. There was no significant difference observed in educational environment subscales scores according to enrollment year, gender, or funding source for education.Conclusion: The overall student’s perception of the educational environment was satisfactory. Nevertheless, the study revealed some problematic areas in the learning environment which require remedial measures to make the environment more conducive for learning to satisfy the students and achieve a far better outcome.Keywords: DREEM, educational environment, medical students, Nepal, perception

Ram Lochan Yadav,1 Rano Mal Piryani,2 Gopendra Prasad Deo,3 Dev Kumar Shah,1 Laxmi Kumari Yadav,4 Md Nazrul Islam1 1Department of Physiology, Chitwan Medical College, Bharatpur, Nepal; 2Department of Internal Medicine and Health Professional Educational Research Center (HPERC), Chitwan Medical College, Bharatpur, Nepal; 3Department of Anaesthesiology and Critical Care, Chitwan Medical College, Bharatpur, Nepal; 4Department of Microbiology, Chitwan Medical College, Bharatpur, Nepal Background: Problem-based learning (PBL) was introduced into Basic Medical Sciences early in the 1980s at Tribhuvan University (TU), Nepal, followed by other universities where didactic lecture method was still followed as the main teaching strategy. Despite gaining its popularity worldwide as integrated teaching learning method, PBL is not given importance in Nepal. This study aimed to assess the attitude and perceptions of undergraduate medical students regarding learning outcomes of PBL and to know their views about role and qualities of effective tutors for its successful implementation.Methods: This descriptive study was based on a self-administered questionnaire. The first part of the questionnaire measured students’ perception and attitude toward benefits of PBL and the second part measured students’ perception about role of PBL tutor. Bachelor of Medicine and Bachelor of Surgery (MBBS) first year (2014/2015 academic year) students at Chitwan Medical College, TU, were asked to express their opinions about the importance of learning outcomes by rating each statement on a five-point Likert scale and the responses were combined into three categorical variables: “agree” (strongly agree plus agree), “neutral”, and “disagree” (strongly disagree plus disagree). Data were analyzed using SPSS version 21.0.Results: Approximately 85.5% participants agreed that PBL is an interesting method of teaching learning. Most of them (86.7%) accepted that PBL is an interactive and a mutual learning method and improves self-directed learning (83.2%). Although 78% had recommended it better than lecture, many (54.2%) pointed it out as a time-consuming method. The participants were also highly rated (80.5%) to the statement - the tutor’s role in enhancing the constructive active learning and maintaining good intra-personal behavior.Conclusion: Student’s attitude toward PBL was positive. They highly appreciated the roles of a tutor as facilitators and motivators for proper activities in PBL session. PBL sessions were considered effective in improving students professional knowledge and refining problem-solving and self-directed learning skills along with enriching teamwork experience. Keywords: PBL, student’s perception, role of tutor, teaching learning method

Ram Lochan Yadav,1 Prakash Kumar Yadav,1 Laxmi Kumari Yadav,2 Kopila Agrawal,3 Santosh Kumar Sah,4 Md Nazrul Islam1 1Department of Physiology, 2Department of Microbiology, Chitwan Medical College, Bharatpur, 3Department of Physiology, BP Koirala Institute of Health Sciences, Dharan, 4Department of Biochemistry, Janaki Medical College, Janakpur, Nepal Background: Obese people have a higher prevalence of cardiovascular disease, which is supposed to be due to autonomic dysfunction and/or metabolic disorder. The alterations in cardiac autonomic functions bring out the changes in the heart rate variability (HRV) indicators, an assessing tool for cardiac autonomic conditions.Objective: To compare the cardiac autonomic activity between obese and normal weight adults and find out the highest association between the indices of HRV and obesity.Methods: The study was conducted in 30 adult obese persons (body mass index [BMI] >30 kg/m2) and 29 healthy normal weight controls (BMI 18–24 kg/m2). Short-term HRV variables were assessed using standard protocol. Data were compared between groups using Mann–Whitney U test. Obesity indices such as waist circumference, hip circumference, waist–hip ratio (WHR), and BMI were measured and calculated, and they were correlated with HRV indices using Spearman’s correlation analysis.Results: In the obese group, there was a significant increase in the mean heart rate, whereas the HRV parasympathetic indicators were less (eg, root mean square of differences of successive RR intervals [28.75 {16.72–38.35} vs 41.55 {30.6–56.75} ms, p=0.018], number of RR intervals that differ by >50 ms, that is, NN50 [15.5 {2–39} vs 83.5 {32.75–116.25}, p=0.010], etc) and the sympathetic indicator low frequency (LF)/high frequency (HF) ratio (1.2 [0.65–2.20] vs 0.79 [0.5–1.02], p=0.045) was more than that of the normal weight group. Spearman’s correlation between HRV and obesity indices showed significant positive correlation of WHR with LF in normalized unit (r=0.478, p

Dev Kumar Shah, Ram Lochan Yadav, Deepak Sharma, Prakash Kumar Yadav, Niraj Khatri Sapkota, Rajesh Kumar Jha, Md Nazrul Islam Department of Physiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal Background: Many factors shape the quality of learning. The intrinsically motivated students adopt a deep approach to learning, while students who fear failure in assessments adopt a surface approach to learning. In the area of health science education in Nepal, there is still a lack of studies on learning approach that can be used to transform the students to become better learners and improve the effectiveness of teaching. Therefore, we aimed to explore the learning approaches among medical, dental, and nursing students of Chitwan Medical College, Nepal using Biggs’s Revised Two-Factor Study Process Questionnaire (R-SPQ-2F) after testing its reliability. Methods: R-SPQ-2F containing 20 items represented two main scales of learning approaches, deep and surface, with four subscales: deep motive, deep strategy, surface motive, and surface strategy. Each subscale had five items and each item was rated on a 5-point Likert scale. The data were analyzed using Student’s t-test and analysis of variance. Reliability of the administered questionnaire was checked using Cronbach’s alpha. Results: The Cronbach’s alpha value (0.6) for 20 items of R-SPQ-2F was found to be acceptable for its use. The participants predominantly had a deep approach to learning regardless of their age and sex (deep: 32.62±6.33 versus surface: 25.14±6.81, P

Rashidul Alam Mahumud,1 Md Golam Hossain,2 Abdur Razzaque Sarkar,1 Md Nurul Islam,2 Md Ripter Hossain,2 Aik Saw,3 Jahangir AM Khan1,4 1Health Economics and Financing Research Group, Center for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; 2Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh; 3Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 4Adjunct Faculty, Health Economics Unit, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden Introduction: Contraceptive discontinuation is a worldwide incident that may be connected with low incentive to avoid pregnancy. Contraceptive discontinuation highly contributes to unplanned pregnancy and unwanted births.Objectives: The objective of this study was to observe the prevalence of discontinuation and switching of contraceptive methods among Bangladeshi married women. In addition, the sociodemographic factors associated with contraceptive discontinuation and switching were assessed.Methods: Secondary cross-sectional data was used in this study. A total of 16,273 married Bangladeshi women of reproductive age (15–49 years) were considered in the present study, from the Bangladesh Demographic and Health Survey, 2011. Logistic regression models were used to determine the relationships between key sociodemographic factors and user status.Results: The prevalence of discontinuation and switching of contraceptive method among women were 38.4% and 15.4%, respectively. The logistic regression model demonstrated that women in early reproductive years (25–29 years and 30–34 years) significantly more often (odds ratio [OR] =0.84 and 0.71, respectively) discontinued use of contraceptives. Significantly higher rates of discontinuation were pronounced among women who used the pill (OR =0.72) and injectable contraception users (OR =0.60), had small family size (OR =0.49), lived in a rural community (OR =1.65), and who were less educated (OR =1.55).Conclusion: Contraceptive discontinuation may reflect an association among less education, currently married, and smaller family size. Awareness of contraceptive methods can decrease the burden of unplanned pregnancies and thus progresses the family planning program. Keywords: prevalence, contraceptive discontinuation, switching, BDHS, odds ratio, logistic regression