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We present a case report of a 55-year-old woman who had a femoral vein intravascular papillary endothelial hyperplasia that required excision of the mass and subsequent repair of the right femoral vein using her right anterior accessory saphenous vein. She first presented with findings of a non-occlusive deep vein thrombus. However, after 6 months of persistent and enlarging mass with subsequent intravascular component on a follow-up duplex scan, a decision was made to bring her to the operating room for exploration and excision.

Remnant vascular grafts may result in significant neurological deficits owing to compression of adjacent neural structures. We report this finding in two cases after extracorporeal membrane oxygenation decannulation and removal of an arteriovenous fistula in the upper extremity. In both cases, removal of the graft, patch arteriotomy, and external neurolysis resulted in significant recovery of neurological function. We review the preoperative workup, diagnostic studies, and technical approach to treatment in an effort to increase recognition among vascular and cardiovascular surgeons and to demonstrate a safe and effective management option through a multidisciplinary approach.

Background: As per the recent advancement in medicine, novel learning methodological innovations such as flipped classroom (FC) and problem-based learning (PBL) have earned ample recognition in medical education. The present study was directed with an aim to assess the effectiveness of combined learning method (CLM: FC combined with PBL) over traditional lecture-based classroom (TLC). Objectives: The objectives of this study were as follows: to determine whether CLM improves learning outcome among medical students and to determine whether there is any significant difference in students' perceptions regarding learning method implemented. Materials and Methods: A randomized controlled trial (educational interventional study) was conducted with 100 medical students; they were randomly allocated into two equal groups: experimental group (EG) was taught by CLM, whereas control group (CG) was taught by TLC method. Closed- and open-ended questionnaire was used for the collection of data. Statistical analysis was done by applying independent samples t-test and Chi-square test. Results: A significant difference in the learning outcome was observed between the mean posttest scores of the two groups (CG = 31.5, EG = 46.2). There was a significant difference in the mean scores of perception between the groups (P ≤ 0.05). Chi-square test showed that students' satisfaction is associated with the CLM (P = 0.00001). Conclusion: FC combined with PBL can be considered a better alternative to the lecture-based classroom for educating medical students on maternal and child health care.

Amongst the three major vascular beds (coronary, cerebrovascular, and peripheral), peripheral vascular disease (PVD) has traditionally received the least attention, despite its growing global burden. The aging population has led to the increased prevalence of PVD, thereby increasing visibility to its various diagnostic and treatment modalities. In the past decade, research and development of innovations in the management of PVD has exploded. Modern advances in imaging, molecular technology, medical devices, and surgical techniques have reduced the morbidity and mortality of PVD. However, many challenges still remain due to the debilitating and progressive nature of this disease. In this article, we will introduce some common vascular diseases, the state of art in diagnosis and treatment, the limitations of modern technology, and our vision for this field over the next decade.

Introduction: The COVID-19 pandemic has caused a significant toll on healthcare across the globe. The pandemic caused many other consequences, including economic implications and teaching consequences, notably in higher education throughout the world. COVID-19 and the resulting closure of university campuses have had many impacts on Health Professions Education (HPEd), affecting all aspects, including teaching methods, assessment methods, curricula, student-teacher relationships,student selection processes, and student well-being. It has had significant effects on the setting in which students are required to learn more skills such as psychomotor skills. This manuscript aims to investigate the changes implemented in medical education during the pandemic and describe one medical school’s response to medical education changes during the pandemic.Methods: This study was a combination of a case study done by in-depth investigation of the current context at one medical school during the pandemic and action research done by gatheringinformation to change a condition in a particular place.Results: Many changes were implemented in medical education, including online teaching for basic science courses (first two years of the program) and online assessments (video-based remote proctoring) in the program’s first two years. Such courses as Clinical Skills are using telemedicine/telehealth concepts in training. There were changes such as video-based remoteproctoring of NBME shelf-examinations even in the assessments of clerkships/clinical rotations.Conclusions: Adaptations of medical education during this pandemic is highly dependent on technology. Most of the changes will be practiced until the campuses are open. We need tounderstand that these changes were made over this unprecedented period, i.e. the pandemic as an emergency rather than as a normal change process.

Introduction: The term continuing professional developmentencompasses competencies required to practice the high qualitymedicine, including medical, managerial, ethical, social, andpersonal skills, whereas continuing medical education refers onlyto expanding the knowledge and skills required by physicians. Thecompetencies for basic science faculty identified are managementand administration, teaching, assessments, curriculumdevelopment, and research. This study aimed to evaluate theoutcomes of faculty development initiatives at Avalon UniversitySchool of Medicine and examine the optimal approach to facultydevelopment activities.Methods: This is a survey-based quantitative study. A crosssectionalsurvey was conducted after implementing the facultydevelopment activities. We took thirteen basic science facultymembers as a unit and recruited them for different facultydevelopment activities from 2015. Faculty members were involvedin various faculty development courses, workshops, and trainingsessions. A survey was conducted among faculty membersusing a questionnaire on the Likert scale to identify if there areany increased knowledge or skills on teaching and assessmentmethods, educational scholarship, and scholarly activities afterimplementing faculty development initiatives. The facultyresponses were tabulated and quantified in the Excel sheet andanalyzed by SPSS software. Results: All thirteen faculty members responded to thequestionnaire (100% response rate). There was an increased selfreportedknowledge and skills of faculty members. 70% of thefaculty agreed that they are able to get involved in designing theircourse learning objectives. 100% of the faculty were aware ofdifferent teaching methods, and 93% of them were implementingdifferent types of teaching methods, including small groupdiscussions, flipped classrooms, standardized patient-basedteaching, and problem-based learning. 100% of the faculty wereaware of different assessment methods and implementing them.There were self-reported and observed behavioral changes.Conclusions: Faculty development activities at Avalon UniversitySchool of Medicine have shown to be effective. At larger institutions,the department chair can lead the faculty development activities.

Background: Caribbean graduates contribute significantly to the US healthcare workforce. The accreditation requirements of local governments vary from one Caribbean island to another island. The Educational Commission for Foreign Medical Graduates (ECFMG) requirement that all future applicants be graduates from accredited medical schools drove Caribbean medical schools to seek accreditation. Accreditation has been found to significantly impact the educational processes of Canadian medical schools. Our study aims at investigating Caribbean medical school leaders’ perceptions of the impact of accreditation on their school’s processes. Methods: This qualitative study and data analysis were done using a framework analysis. Academic leaders and faculty members from three different types of Caribbean medical schools (accredited, denied-accreditation schools, never applied for accreditation) were interviewed using semi-structured interviews. Results: A total of 12 participants from six different Caribbean medical schools participated in the interview process. Themes of processes influenced by accreditation at Caribbean medical schools were similar to those found in the Canadian context and align with best practices of Continuous Quality Improvement (CQI). Conclusions: Caribbean medical schools are changing their educational processes as a result of accreditation requirements. Some processes are not maintained in a continuous manner, raising questions about the development of a true CQI culture.

Introduction: There are two popular methods of clinical skillsteaching. One is Peyton’s method, and the other one is RobertGagne’s method. A hybrid model which is a combination ofboth teaching methods is developed and implemented at AvalonUniversity School of Medicine in Clinical Skills. The aim of thestudy was to evaluate the hybrid model of clinical skills teaching.Methods: This is a quasi-experimental study where a controlgroup with a sample size of 26 was compared with two studygroups; one group included 24 participants, and as the other oneconsisting of 16 subjects selected without randomization. Allstudents in the class were included in the study, except for thosewithdrew voluntarily. The quantitative data were gathered in theform of a questionnaire on the Likert scale which was collectedas the end of course evaluations. The quantitative data for theresponses on the Likert scale was analyzed for descriptivestatistics: Mean, Median, and Mode. The quantitative data alsoincluded the students’ performance on assessments of clinicalskills which was analyzed using ANOVA test. The qualitativedata were gathered in the form of open-ended questions in theend of course evaluations. The qualitative data were also collectedfrom the faculty members who were the examiners for the clinicalskills course as the feedback taken from them. Results: There was a significant improvement in the feedback ofstudents (end of course evaluations) after implementing the hybridmodel of clinical skills teaching which was shown by increasedMean, Median, Mode for the most pointers on the Likert scale.Also, there was a notable improvement in the performance ofstudents with a significant p-value (pConclusion: The hybrid model is very effective in teaching clinicalskills. This teaching method can be evaluated by replicating thisstudy at larger institutions with more number of students.

Objective: To determine the attitude toward mental illness among medical students and nonpsychiatric doctors of Mamata Medical College. Materials and Methods: The study was cross-sectional, conducted in Mamata Medical College, Khammam, from September 2016 to March 2017. Our study sample contains 150 medical students doing internship and 100 nonpsychiatric doctors working in Mamata Medical College, Khammam, who are willing to participate in the study. Results: In the present study, we observed negative attitude toward mental illness among both medical students and nonpsychiatric doctors. When compared attitude toward mental illness among medical students and nonpsychiatric doctors, we found that there was no statistically significant difference. Compared to nonpsychiatric doctors, the medical students had stigma that people with severe mental illness are dangerous and it is more discomfortable talking to a person with a mental illness. Compared to medical students, the nonpsychiatric doctors had stigma that being a psychiatrist is not like being a real doctor and it is not important that any doctor supporting a person with mental illness also assesses their physical health. Nonpsychiatric doctors also had stigma that they do not want to work with a colleague if they had a mental illness. Conclusion: This study demonstrates the need for educational programs aimed at medical and nonpsychiatric doctors for providing basic information and thus demystifying mental illness.

Background Medical students are usually subjected to a high workload environment and stress is one of the most important health risks that medical students encounter. The negative impact of stress on the student's mental and general health in basic science has often been under reported. Methods and Materials A cross-sectional questionnaire survey was performed in Avalon University School of Medicine (AUSOM), Curacao, amongst the first to fourth semester basic science students with an objective to explore and understand their perspectives on different health risks. Results More than ⅔ of the students (79.61%, n=82) were feeling stressed out during their basic sciences. The mean stress level among the basic science students was 7.42 ± 2.13 (scale:1-10). Common health issues encountered by the students were: sleep problems, impaired concentration, low mood, mood swings, difficulty in making decisions, emotional distress, anxiety, substance abuse, and abnormal weight gain. Conclusion Although lack of sleep and behavioral problems are the most common health issues encountered by the pre-clinical medical students. There is an urgent need to implement health promotion strategies in medical curriculum for mental and physical well-being of the students.

Introduction: The standardized Patient Program (SPP) is a standard educational training method which provides the preclinical students a better clinical foundation by linking the realm of clinical medicine to basic sciences. It incorporates a modern simulation technique and enhances the ability of the students wherein they can practice, apply and learn the basics of patient encounter. The main objective of this study was to analyze the implementation and efficiency of the SPP in Avalon University School of Medicine (AUSOM). Methods: A quasi-experimental “before-and-after” study design was conducted among the 3rd Semester (MD3) medical students at AUSOM. 24 students voluntarily participated in the study. The effectiveness of the program was evaluated after comparing the summative examination scores before and after implementation of the SPP (graded in 100 points system). Mean scores were calculated and a comparison of the change in scores was made, using a paired t-test in Stata (©Stata corp). Results: The mean final summative clinical skills examination scores of the students before and after the introduction of the SPP were 78.46±6.62 (SEM: 1.35, range: 89-70) and 86.54±6.41 (SEM: 1.31, range: 98-65), respectively. There was a statistically significant increment (t=5.5058, p=0.0001) in the scores of the students after the introduction of the SPP. Conclusion: Introduction and implementation of SPP at AUSOM at preclinical years increased the overall students’ performance in clinical skills. It is necessary that medical schools implement SPP early in preclinical years to strengthen learning and inoculate necessary clinical skills in medical students.

Background: Persons with psychiatric co- morbidity have markedly high risk of suicide attempts. Aim To study the socio-demographic variables, role of life events and prevalence of psychiatric diagnosis in suicide attempters. The present study has been undertaken with an intention to have deeper insight in to the mental health of suicide attempters. Methods A semi structured interview consisting of socio-demographic details, a proforma to document suicide attempt data, Presumptive Stressful Life Event scale (PSLE) to know the desirable or undesirable life events. Mini International Neuropsychiatric Interview plus (MINI Plus) was used to assess the psychiatric abnormality. Data was statistically analyzed using Statistical Package for the Social Sciences - Version 10 (SPSS -10). Results: Suicide attempters experience peaking of stressful events in the early months before the attempt. Most common diagnoses were depression, personality disorders, followed by alcohol dependence and anxiety disorders. Conclusion: Suicide attempters are more among the groups of young age, female gender, rural background, married, belonging to nuclear family and low socio economic class. Majority of the suicide attempters are suffering with psychiatric illness.