Context: Low back pain (LBP) is the most common orthopedic problem worldwide and is known to affect both younger and older adults. The stressful and time consuming curriculum of medical students predisposes them to this problem. Few statistics are available on prevalence rates of LBP among medical students in India. This study assesses the prevalence and risk factors of LBP in students of a medical college in Delhi. Methods: A cross-sectional study was carried out in a medical college in Delhi. The study subjects (n = 160; 100% participation) were selected via stratified random sampling from all undergraduate medical students (aged 17-25 years). A validated questionnaire was used to collect the data. Results: The overall prevalence of LBP among the students over the past one year was 47.5% (n = 76) with a prevalence of 32.5% at the time of data collection. Prevalence among males and females was 45.3% and 50%, respectively. Significant associations were found between LBP in the past year and coffee drinking (Regular = 57%, Occasional = 38.9%, Never = 65.2%, χ² = 7.24, P= 0.02), body posture (Normal = 32.6%, Abnormal = 75%, χ² = 18.97, P < 0.001), place of study (Study table = 33.8%, Bed = 58.6, Both = 61.5% χ² = 10.51, P = 0.01), family history of LBP (Present = 75%, Absent = 38.3%, χ² = 16.17, P < 0.001) and carrying backpacks (Regular = 50%, Occasional = 33%, Never = 0%, χ² = 16.17, P < 0.001). The mean scores of depression (2.7 vs. 1.6), anxiety (3.5 vs 1.9), and monotonous work (3.9 vs. 1.8) were found to be significantly higher in group with LBP than in the non-LBP group. However, no association with LBP was seen for weight lifting, watching television/working on computers, driving, wearing heels, or body mass index. Discussion: The high prevalence of LBP among medical students and its association with poor study habits, lifestyle habits, and psychological factors highlight a need for life skills training, education, counseling, and restructuring of the medical curriculum.

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Context: The Medical Education Partnership Initiative (MEPI) is a $US 130 million program funded by the United States government supporting 13 African medical schools to increase the quantity, quality, and retention of physicians in underserved areas. This paper examines how community-based education (CBE) is evolving at MEPI schools to achieve these goals. Methods: We utilized data from the first two years of site visits and surveys to characterize CBE efforts across the MEPI network and provide detailed descriptions of three models of CBE among the MEPI programs. Results: There is widespread investment in CBE, with considerable diversity in the goals and characteristics of training activities among MEPI schools. Three examples described here show how schools are strengthening and evaluating different models of CBE to achieve MEPI goals. In Nigeria, students are being sent for clinical rotations to community hospitals to offload the tertiary hospital. In Uganda, the consistency and quality of teaching in CBE is being strengthened by adopting a competency-based curriculum and developing criteria for community sites. At Stellenbosch University in South Africa, students are now offered an elective year-long comprehensive rural immersion experience. Despite the diversity in CBE models, all schools are investing in e-learning and faculty development. Extensive evaluations are planned to examine the impact of CBE strategies on the health workforce and health services. Discussion: The MEPI program is stimulating an evolution in CBE among African medical schools to improve the quality, quantity, and retention of physicians. Identifying the strategies within CBE that are reproducible, scalable and optimize outcomes will be instructive for health professions training programs across the continent.

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Context: The development of teamwork skills is a critical aspect of modern medical education. This paper reports on a project that aimed to identify student perceptions of teamwork-focused learning activities and generate student recommendations for the development of effective educational strategies. Methods: The project utilized a unique method, which drew on the skills of student research assistants (RAs) to explore the views of their peers. Using structured interview guides, the RAs interviewed their colleagues to clarify their perceptions of the effectiveness of current methods of teamwork teaching and to explore ideas for more effective methods. The RAs shared their deidentified findings with each other, identified preliminary themes, and developed a number of recommendations which were finalized through consultation with faculty. Results: The key themes that emerged focused on the need to clarify the relevance of teamwork skills to clinical practice, reward individual contributions to group process, facilitate feedback and reflection on teamwork skills, and systematically utilize clinical experiences to support experiential learning of teamwork. Based on these findings, a number of recommendations for stage appropriate teamwork learning and assessment activities were developed. Key among these were recommendations to set up a peer-mentoring system for students, suggestions for more authentic teamwork assessment methods, and strategies to utilize the clinical learning environment in developing teamwork skills. Discussion: The student-led research process enabled identification of issues that may not have been otherwise revealed by students, facilitated a better understanding of teamwork teaching and developed ownership of the curriculum among students. The project enabled the development of recommendations for designing learning, teaching, and assessment methods that were likely to be more effective from a student perspective.

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Context: Previously, in a low-income country with limited resources like Pakistan, biomedical research was conducted mostly by individuals working in private organizations. Recently, there has been an upsurge in the number of medical students conducting research in both private and public medical colleges of Karachi, Pakistan. We investigated student perceptions of the reasons behind the increase in biomedical research among medical students of private and public medical colleges in Karachi, Pakistan. Methods: This cross-sectional study was conducted at four medical universities of Karachi, using structured data collection tool. Participants included medical students who stated that they were interested in medical research. We assessed how many had been involved in research or stated that they intended to be, and tallied students' stated reasons why they were involved in research. Chi-square analyses were used to assess if year of training, institution, and other factors were associated with the likelihood of past or current actual research involvement. Results: Out of the 398 students with research interest who participated in the study, 349 (88%) stated that they intended to do research projects in their undergraduate years. At the time of the study, only 202 (51%) reported that they had actually conducted research. The reasons given for engaging in research for a minority included personal interest (n = 136; 34%), while majority stated that their motivation was to improve their curriculum vitae (75%) and/or to be more competitive for a residency in the United States (43%). The reasons students gave for involvement in research were related to whether their schools were public versus private and to their year of study. Discussion: According to students' reports, improving one's curriculum vitae to get a strong residency in the USA appeared to be a principal reason for the increase in biomedical research in Karachi. The challenges of research, such as lack of good mentors and increased work-load were reported to affect few students' ability to engage in research.

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Context: We assessed the general knowledge of health literacy and the impact of limited health literacy on patients and to society in United States (US) audiologists and speech-language pathologists in Arkansas. Methods: A 10-item survey was completed by 198 professionals and students in communication sciences and disorders in Arkansas. The 10-items were divided into one demographic question, six patient-related health literacy questions, and three systems-related health literacy questions. Results: Most professionals and students were aware that limited health literacy can be an obstacle for patients, but they were only somewhat or not aware of existing data on the average US adult reading grade level, the readability of clinic forms, or the estimated economic healthcare cost as a result of low health literacy. Discussion: Increasing the awareness of health literacy and the impact of limited health literacy among all healthcare providers would be a worthwhile endeavor. More work is needed to study health literacy in various patient populations and to develop effective approaches to combat low health literacy in the field of communication sciences and disorders, as well as other healthcare disciplines, across the globe. This study suggests that health literacy awareness training may be needed, not only in Arkansas, but also throughout the US and other countries. The outcome should bridge the health literacy and communication gap between providers and their patients.

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Context: According to goal orientation theory, achievement goals are defined as the terminal point towards which one's efforts are directed. The four academic achievement goal orientations commonly recognised are mastery, performance approach, performance avoidance and work avoidance. The objective of this study was to understand the goal orientation of second year undergraduate medical students and how this correlates with their academic performance. Methods: The study population consisted of 244 second year Bachelor of Medicine and Bachelor of Surgery (MBBS) students of Melaka Manipal Medical College, Manipal campus, Manipal University, India. Students were categorised as high performers and low performers based on their first year university examination marks. Their goal orientations were assessed through a validated questionnaire developed by Was et al. These components were analysed by independent sample t-test and correlated to their first year university examination marks. Results: Confirmatory component factor analysis extracted four factors, which accounted for 40.8% of the total variance in goal orientation. The performance approach goal orientation alone explained 16.7% of the variance followed by mastery (10.8%), performance avoidance (7.7%) and work avoidance (5.7%). The Cronbach's alpha for 19 items, which contributed to internal consistency of the tool, was observed to be 0.635. A strong positive correlation was shown between performance approach, performance avoidance and work avoidance orientations. Of the four goal orientations, only the mean scores in work avoidance orientation differed for low performers and high performers (5.0 vs. 4.3; P = 0.0003). Discussion: Work avoidance type of goal orientation among the low performer group may account for their lower performance compared with high performer group. This indicates that academic achievement goal orientation may play a role in the performance of undergraduate medical students.

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A case report is a description of a clinical case that has unique features. It may include a previously unreported clinical condition or observation of a disease, a unique use of imaging or diagnostic tool to reveal a disease, a new therapeutic intervention of a known disease, a previously unreported complication of a disease, or a new adverse event from a medication. A case report should be crisp, focused, and include few figures and references. A case report generally has a short unstructured or no abstract, a brief or no introduction, a description of the case, a discussion and a brief conclusion. Case reports are valuable sources of new and unusual information that may stimulate further research and applicability to clinical practice. Writing case reports properly is important if they are to be accepted by journals and credible and useful to readers.

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Context: There is a need to understand the factors that influence African women medical doctors to pursue international health research training because they remain under-represented in research fields but increasingly represented in medicine. Methods: We conducted a program study with Kenyan women (N = 12) who participated in a US funded AIDS International Training and Research Program implemented by the University of Washington. Interviews were conducted to understand their clinical research career motivations and training pathways into global health research. The transcripts were analyzed for themes using predefined code areas. Results: The findings outline entry into research, professional and career balance motivations, and two stages of a career path into research. Discussion: Kenyan women medical clinical researchers shared similar motivations as US women but differed as well. Kenyan medical doctors pursued health research within a context of limited resources, but the ability to balance work and family while contributing to public health through research and leadership was highly valued. International training programs can effectively engage women in research training by developing women's health research areas, supportive family policies, and aligning program design with local training to develop career pathways for women.

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The varying health needs in Syria because of the trend of increasing communicable and noncommunicable diseases necessitate new curricula for all health professions schools in which community health needs, socio-cultural aspects of health and disease can be emphasized. There is a need to produce more primary level healthcare professionals who are trained to apply the principles, policies and strategies of the World Health Organization and achieve better health for all. A new perspective in the Faculty of Dentistry in Damascus University has been suggested and is presented here. Graduates generally are not well prepared to provide primary level healthcare in the community. Community-oriented medical education (COME) can produce health-oriented professionals who are equipped with broad skills and able to work for health promotion, disease prevention, and cure. Health orientation is one of the most radical features of COME, wherein the curriculum is appropriate to learners' future practice in the community. Community orientation enables students to become more people focused so that they can work towards people's self-empowerment, change people's attitudes and behaviors, and improve their self-awareness and esteem. This viewpoint addresses the importance of redesigning the dental curriculum and the need to implement COME in Damascus University. It is proposed as an example of changes needed in all health professions schools in Syria. The call to redesign the curricula to serve the health needs of the Syrian population will be difficult to achieve but is vital. Improving our understanding of the concept of COME and having all sectors of government and society commit to it will make the transition possible and will make the COME a reality.

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The abstract for an article submitted to a clinical or academic journal often gets little attention in the manuscript preparation process. The abstract serves multiple purposes in scholarly work dissemination, including the one piece of information reviewers have to invite presenters to professional conferences. Therefore, the abstract can be the most important and should be the most powerful 150-250 words written by authors of scholarly work. This brief for healthcare practitioners, junior faculty, and students provides general comments, details, nuances and tips and explains the various uses of the abstract for publications and presentations in the healthcare field.

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Context: Globalisation has led to significant changes in health care, yet medical education remains domestically focused. The majority of the world's children live in developing countries, and education related to global child health is important for paediatric residents. Methods: Chief residents and program directors from the 16 Canadian paediatric training programs were surveyed using a questionnaire regarding global child health training program content, electives, attitudes and perceptions towards global child health. Results: No programs had a formalised global health curriculum. All program directors and chief residents reported that programs offer global child health sessions, but 50% of the programs did not address six out of twelve of the content areas including topics such as refugee health and international adoption. All program directors agreed global child health understanding is important for paediatric trainees; 83% agreed more emphasis should be placed on this during post-graduate training. Discussion: A formalised global child health curriculum is lacking for Canadian paediatric residents: Program directors are willing to integrate global child health training modules into their post-graduate training programs.

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Formal training in research is lacking most of the medical training programs of the world. Research can be of great help in producing more physician scientists. Students' journals can encourage research amongst medical students. But student journals face a lot of problems. The editors are students who are busy with their curricula. Moreover, there is no compensation. Additionally, since, not many student journals are visible, students doing research try and submit to prestigious journals and when face rejection, get de-motivated. There is no single solution to all the problems faced by a student journal. However, it needs to be appreciated that they are a necessity, hence, they should be encouraged actively. Collaboration between the multiple stakeholders involved (funding agencies, institutions, experts on biomedical ethics, student researchers and their faculty mentors) is the need of the hour to further expand and empower the existing student journals and set up new ones.

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