Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
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Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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On Aug 2018




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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
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An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2008 | Month : April | Volume : 2 | Issue : 2 | Page : 726 - 730

Postgraduate Students As Facilitators In Problem-Stimulated Learning Sessions

SHANKAR PR*, SUBISH P

Department of Pharmacology , Manipal College of Medical Sciences , Pokhara, Nepal.

Correspondence Address :
Dr. Ravi Shankar, Department of Clinical Pharmacology & Therapeutics, KIST Medical College. P. O. Box 14142, Imado, Lalitpur, Nepal. Tel.:00977-1-6916201; Fax: 00977-1-5201496, E-mail: ravi.dr.shankar@gmail.com

Abstract

Problem-based or problem-stimulated pharmacotherapy teaching in undergraduate medical curricula has been identified as a key intervention towards promoting the more rational use of medicines. The department of Pharmacology at the Manipal College of Medical Sciences (MCOMS), Pokhara, Nepal, emphasizes the more rational use of medicines. The department also admits students to the MSc (Medical Pharmacology) programme. The post graduates (PGs) act as facilitators during the undergraduate problem-stimulated learning (PSL) sessions. Recently, microteaching PSL sessions were conducted and the PGs were assessed by the student groups and faculty members.

A total of five sessions were conducted and assessed, each session being of two and half hours duration. The PG facilitators were assessed by the student groups and faculty members by using a scoring form. The PGs were scored from 1 to 5 on various parameters, and faculty members gave a written assessment of the strengths and weaknesses of the facilitators. The PGs also filled in a self-assessment form after each session.

The median total score was 34.5, and the interquartile range was 5. The maximum possible score was 40. The student group gave a higher score to the PG facilitators compared to the faculty members, and the scores were highest for the third session. Initially, the facilitators acted more like teachers in a traditional setting. Occasional problems with discipline were noted. Making the sessions more interactive, facilitating self-directed learning, and toning down the traditional role of a teacher, were problems.
The overall opinion was positive. We plan to continue and strengthen the sessions for future generations of PGs.

Keywords

Facilitators, Pharmacology, Problem-stimulated learning, Self-directed learning

Introduction
Traditional teaching in Pharmacology has been characterized by passive transfer of knowledge about drugs, and memorization of details about drug classes and individual compounds(1). The teaching takes place in the form of lectures, and poorly equips students with the skills necessary to rationalize drug therapy in practice(2).

Recently a number of educational programmes have been developed to improve the teaching and learning of Pharmacology and Therapeutics(3),(4). The Manipal College of Medical Sciences (MCOMS), Pokhara, Nepal admits 150 students to the undergraduate medical course (MBBS) in two batches of 75 students each, in February and and August. Pharmacology is taught in an integrated, organ system-based manner, with the other basic science subjects during the first four semesters of the course. The college mainly admits students from Nepal, India and Sri Lanka.
The department of Pharmacology uses a mixture of didactic lectures and problem-stimulated learning (PSL) sessions for teaching the subject(5). The department concentrates on teaching students to use essential medicines rationally. For the Pharmacology practical session, each semester is divided into two batches of 37 or 38 students, and each batch is further subdivided into five groups of 7 or 8 students each.

In March 2004, the department started a postgraduate (MSc) course in Medical Pharmacology under the Kathmandu University. The postgraduate student is expected to become a competent partner in promoting rational drug therapy among health professionals, and is groomed to become a good teacher(6).

The department teaches MBBS students to use essential medicines rationally. In Pharmacology, the undergraduate students should be able to solve simple problems in therapeutics, prescribe appropriate drugs for a disease condition, and deliver drug-related and disease-related information in a meaningful way to the patient(7). Recently, class activities have included critical analysis of promotional material and drug advertisements against the World Health Organization’s Ethical Criteria for Medicinal Drug Promotion(8). Sessions have also been started on assessing rationality of prescriptions(9).

The postgraduate MSc Pharmacology students are actively involved as facilitators in the PSL sessions. To strengthen this training, the PGs were assessed during their facilitation of the sessions by two faculty members (PRS and PS). The student facilitators were graded on various parameters by the faculty. The facilitators were also evaluated by the students, and the PG facilitators filled in a self-evaluation form detailing their experience of the sessions.
The present study was carried out to obtain the median total score of the facilitators by the student groups and faculty assessors, compare the median total scores among different subgroups of respondents and different sessions, obtain comments for improving the sessions, and to obtain feedback of the facilitators regarding the sessions

Material and Methods

A total of five microteaching sessions were conducted and assessed. The first , second and fifth session were conducted for the fourth semester, while the third and fourth sessions were for the third semester. Each semester of students is divided into two batches for the PSL sessions. The first and second sessions covered the same topics for different batches of fourth semester students, while the third and fourth sessions did the same for the third semester. The fifth session was conducted for the fifth semester. The sessions were of two and half hours duration, and were conducted for the third and fourth semester students. The topics were ‘Alcohol, general anesthesia and drug abuse’, ‘Diarrhea’ and ‘Diuretics’. The sessions concentrated on solving clinical problems, selecting personal or P-drugs for a common disease condition, verifying the suitability of the selected P-drug for a particular patient, and writing the prescription.

The PGs allotted the problems to the different groups, acted as facilitators during the sessions, helped with the student presentations, facilitated the discussion, and added points which were not brought out during the discussion. The form used to assess the PSL sessions by the student groups and the faculty members is shown in Appendix A. The PG facilitators were graded from 1 to 5 according to the following scale: 1- very poor, 2- poor, 3- satisfactory, 4- good and 5- excellent. Organization of the session, selection of problems, facilitating group work and the process of group dynamics, ensuring student participation and interest, facilitating student presentation, adding to the presentation, and ensuring self-directed learning, were the various assessment criteria. The groups were free to give other comments on the sheet. The faculty members gave a written description of the session, and the strengths and weaknesses of the PGs as a facilitator. The assessment was shown to the PGs, and the faculty members gave suggestions for improvement.

The self-assessment form to be filled in by the PGs after each session is shown in Appendix B. The lessons learned from the sessions, overall impression about student group work and about the sessions, were noted. The most difficult part of the session and the most positive aspect of the experience were noted. The facilitator was asked to rate the entire experience on an ascending scale of 1 to 5.

The total score was calculated for each student group and for each faculty member for the various sessions. The median total score was calculated. The scores were compared between faculty members and the undergraduate student groups, and between the first, second and third sessions. The scores of the two PG facilitators were also compared. Mann-Whitney U test was used for dichotomous variables and Kruskal-Wallis test for the others. A p value less than 0.05 was considered to be statistically significant.

The comments made by the student groups and the faculty members were noted, and the more common ones were considered. The self-evaluation forms filled in by the PG facilitators were analyzed.

Results

A total of five sessions were conducted by the PG facilitators. Each PG facilitator facilitated a particular PSL session. The fifth session was facilitated by both the PG facilitators. The median total score was 34.5 (maximum possible score was 40). The interquartile range was 5. The median total scores between faculty and student assessors, according to the first, second or third sessions and according to the PG facilitators, is shown in (Table/Fig 1).

On analyzing the comments of the student and faculty assessors, certain common themes emerged. In certain sessions, the problems selected, did not cover certain aspects of the topic, which were regarded as important. There were problems with the group dynamics. Not all members of the groups participated in the deliberations and group activities. In the initial session, the facilitators were slightly hesitant to mix with the students. The student presenters were not randomly selected, and a few group members were inactive. The facilitators initially acted more like a teacher in a traditional setting, and as a source of information. This was remedied to a large extent in later sessions.

The blackboard and other visual aids were not used optimally by the presenters The facilitator did not steer the discussion towards certain concepts, which the faculty felt were important. Occasional problems with discipline were noted.

Certain themes emerged on analysis of the self-evaluation forms filled in by the facilitators. By the third session, the facilitators were confident of conducting a PSL session, and of making it interesting and interactive. The problems noted were, increasing the interactive nature of the sessions, facilitating self-directed learning by the students, and toning down the traditional role of a teacher. Problems with group dynamics were also commented upon. Involving all students in the deliberations was a problem. Certain students found it difficult to switch from a traditional didactic format to problem-stimulated learning.

Discussion

Problem-based pharmacotherapy training in undergraduate curricula has been recommended as a core intervention to promote the more rational use of medicines(10). PGs as future teachers, have an important role in teaching RUM to medical students. Studies have been carried out to assess the teaching skills of residents and house staff.

A study in the United States (US) had demonstrated the value of a needs assessment in developing a course, to improve the teaching skills of residents(11). Another study had shown that residents and students viewed academic preparation for teaching responsibilities positively, and showed agreement on the characteristics of good teaching(12). An adaptable resident teaching development program (RTDP) has been implemented at the Mount Sinai School of Medicine in the United States(13).

Training residents and other post graduates is important for creating the next generation of teachers. At present, we do not have MD postgraduates (who have joined MD after completing their undergraduate medical degree) in the department, and have only MSc post graduates. PSL sessions play an important role in teaching and learning of pharmacology in our institution, and we have been training the PGs to facilitate the sessions.

In the department, microteaching sessions have been conducted for both lectures and PSL sessions. The microteaching sessions as already detailed, were conducted to strengthen the PG training, evaluate the strengths and weaknesses of the PG facilitators, and provide suggestions for improvement. The opinion of the student groups and the faculty members regarding the facilitation of the PSL sessions by the PGs was positive. The student groups had a more positive opinion compared to the faculty.

It is heartening to note that scores of the PGs improved from the first to the third session, and the highest scores were obtained in the third session. There was no significant difference in scores between the two facilitators.

The small student groups consisted of 7 or 8 students, and had students of different nationalities and both genders. However, not all members of the group participated equally in the group dynamics. This was noted previously also(9). We are in the process of trying out various strategies to improve student participation. We carry out formative assessment during the sessions, and also randomly select the presenters from the groups. The facilitators also try to improve the group dynamics, and to get all the students to participate and contribute.

PBL/PSL is activity based, and the student receives feedback and support from other students and the instructors(14). Learning is based on solving a real problem, and on a foundation of collaboration and integration within a small group context(19). In our institution, PBL does not cut across subjects, and is confined to the department of pharmacology in the basic sciences. A major part of the instruction takes place through lectures. PBL is a concept with which teachers are less acquainted. There is a misconception about PBL that it can only be used in the setting of a full blown problem-based curriculum, with students working in small groups supported by costly logistic and technical facilities(16). ‘Teacher’s Guide to good prescribing’ gives practical hints for problem-based learning. The book recommends only interventions which influence the group process, and not interventions on the content of the discussion.

We do not give the students real cases from the hospital, and only give ‘simulated’ patient problems. The students get support from the faculty members, PGs and other students during the PSL session. The students carry books into the practical hall, and can access internet sources of infor

Acknowledgement

The authors acknowledge the support and help of Professor Archana Saha, head of the department of Pharmacology, during the sessions. We acknowledge the willingness of our post graduates, Mr. Sudesh Gyawali and Ms. Durga Bista to participate in the sessions, and let us evaluate their performance. The role of the third and fourth semester undergraduate students is acknowledged. We also acknowledge the help of our departmental colleagues, Dr. Lalit Mohan and Dr. M. C. Joshi.

References

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Michel MC, Bischoff A, Heringdorf MZ, Neumann D, Jakobs KH. Problem- vs. lecture-based pharmacology teaching in a German medical school. Naunyn Schmiedeberg’s Arch Pharmacol 2002; 366 :64-8.
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Walley T, Bligh J, Orme M, Brecenridge A. Clinical pharmacology and therapeutics in undergraduate medical education in the UK. Br J Clin Pharmacol 1994; 37 :129-35.
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Flockhart DA, Yasuda US, Pezzullo JC, Knollmann BC. Teaching rational prescribing: a new clinical pharmacology curriculum for medical schools. Naunyn Schmiedebergs Arch Pharmacol 2002; 366 :33-43.
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Scobie SD, L;awson M, Cavell G, Taylor K, Jackson SH, Roberts TE. Meeting the challenge of prescribing and administering medicines safely: structured teaching and assessment for final year medical students. Med Educ 2003; 37 :434-7.
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Shankar PR, Dubey AK, Palaian S, Mishra P, Saha A, Deshpande VY. Favorable student attitudes towards pharmacology in a medical school in Western Nepal. Journal of International Academy of Medical Science Educators 2005; 15: 31-8.
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Kathmandu University. Curriculum for postgraduate degree program in Pharmacology (MSc Medical). Dhulikhel: 2003.
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Shankar PR, Mishra P, Shenoy N, Partha P. Importance of transferable skills in pharmacology. Pharmacy Education 2003; 3: 97-101.
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Giri BR, Shankar PR. Learning how drug companies promote medicines in Nepal. PLoS Med 2005; 2: e256.
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Shankar PR, Dubey AK, Upadhyay DK, Subish P, Alwar MC. Educational sessions on assessing rationality of prescriptions: Student feedback. Pharmacy Education 2006; 6:191-5.
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World Health Organization. WHO Policy Perspectives on Medicines. Promoting rational use of medicines: core components. Geneva: September 2002.
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Dunnington GL, DaRosa D. A prospective randomized trial of a residents-as-teachers training program. Acad Med 1998; 73: 696-700.
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Henry BW, Haworth JG, Hering P. Perceptions of medical school graduates and students regarding their academic preparation to teach. Postgrad Med J 2006; 82: 607-12.
Tables and Figures
[Table / Fig - 1]

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