Wisal Omer Mohamed Nabag

ABSTRACT Clinical reasoning skills are considered as essential domain needed to be acquired to become a good physician The Diagnostic Thinking Inventory (DTI) is a tool used for measuring critical thinking skills namely flexibility in thinking and evidence for Structure in memory. To measure the clinical reasoning skills among medical students in Alzaiem Alazhari University.. It is cross-section study which was conducted at the Faculty of Medicine, Alzaiem Alazhari University (AAU) Khartoum,to measure clinical reasoning skills using the diagnostic thinking inventory(DTI) of 5th(92),9th(63) semester & the newly graduate (62) a total of 181students . The study population (74%) were under graduate (in 5th&9th.Semester), while the remainder were newly graduate (26%),all were scored high levels .Tests of correlation, for the 3 subgroups, for DTI scores the flexibility of thinking & Structure of Knowledge and the standard of Bordage, Grant & Marsden in 1990 (81.6& 87.4) for the students in 5th. Semester were 0.004 &0.000 for the 9th Semester students were, 0.001 & 0.000while for the newly graduate students were 0.424&,0.003 which were significant at P>0.05 using one sample t test &Nonparametric test ( Wilcoxon Signed Rank Test) was used when the data distribution was not normal. The correlation, for the 3 subgroups using one-way ANOVA was not significant (0.893& 0.680). DTI is an appropriate instrument for a comparative survey of self-assessed clinical reasoning among students at different semesters. The curriculum of AAU faculty of medicine is integrating basic and clinical sciences in solving community, family and individual health problems according to known methods of problem solving. In addition started teaching clinical reasoning skills earlier so, DTI scores were found to be high in all subgroups 5th, 9th & the newly graduate. There is Conclusive evidence that critical thinking skills and abilities can be taught, so medical curriculum should be integrated & based in problem based learning so as to graduate student with Critical thinking & good clinical reasoning skills. Keywords: Clinical reasoning skills,, Medical students, DTI, Curriculum

Background: Polycystic ovary syndrome (PCOS) is a common complex; heterogeneous endocrine disorder characterized by irregular menses, hyperandrogenism, and infertility. Aims: To study the outcome of laparoscopic ovarian drilling in clinical presentations in form of cycle pattern, acne & Hirsiutism in addition to their conception among infertile Sudanese patients with PCOS.Methods: A hospital based cohort study which was conducted in two hospitals in Khartoum state, Sudan; Omdurman Maternity Hospital & Saad Abu Elela hospital from January to December 2018.Targeted 145 infertile patients diagnosed as PCOS based on Rotter-Dam criteria 2003 definition and who did not conceive after diet, lifestyle and clomiphene; underwent laparoscopic ovarian drilling (LOD).data was collected using semi-structured questionnaires before the drilling ,then the patient was followed in 3 month time concerning the Clinical Presentations, and Conception Results: 65(44.8%) out of 145 infertile patients age was between 21-30 yrs, 67(46.2%) were obese with BMI >30; 90 (62.1%) of participants had irregular cycle., Hirsiutism was seen in 55 (37.9%) and acne was observed in 89 (61.4%). After laparoscopic drilling, 55.2% of patients had normal cycle pattern, amenorrhea & menorrhagia dropped to 3.5% & 11.7% respectively. About 46.2% had normal weight .Acne was seen in 32(22.2%) & Hirsiutism present in 42(19.3%) and 43 (29.6%) get pregnancy, BMI, acne & Hirsiutism before and after LOD were correlated using Chi square P value was 0.001, 0.002, and 0.007 respectively which was significant at (P ≥0.05). Conclusion: The path physiology of PCOS improves, after LOD concerning clinical presentations, & conception. Management of PCOS is essential to address patient concerns, prevent metabolic, & endocrine complications.