Demotivating factors among third year medical students in a public medical college in Pakistan

Objective: To identify demotivating factors among third year medical students and its possible solutions

Study Design: Mixed methods approach including questionnaire and focus group interview sessions

Place and Duration of Study: Services Institute of Medical Sciences, Lahore, Pakistan, affiliated with the University of Health Sciences, Lahore, from January to July 2016

Methodology: Nieuwhof and associates validated questionnaire strength of motivation in medical students was used for third year medical students. Focus group interviews were conducted to assess possible solutions

Results: A total of 108 students completed the questionnaire but only 65 students gave informed consent for interviews. More than 90% of students agreed that subjects were relevant. Time constraints, ward closures and poor communication about time and place for clinical tutorial were among the issues pointed out by students. Frequent change of teachers and poor motivation on part of tutors were considered reasons for poor attendance by students. Cochrane's alpha score was 0.708. Poorly defined syllabus and topics for clinical teaching, absence of mandatory attendance for clinical teaching, and lack of proper introduction to clinical rotation were concerns for students

Conclusion: Students of third year get demotivated because of sudden change in subjects from basic to clinical and lack of commitment from teachers in a public medial college. These factors can be improved by mandatory attendance, introduction of pre-clinical orientation sessions before start of clinical rotations, and appointment of dedicated clinical tutors who kindle the fire for clinical learning in hearts of medical students

Conservative breast surgery in our setup

Background: Breast conservative surgery [BCS] has been time tested in terms of outcome for early stage carcinoma breast. The disease free period and 5 year survival is almost similar to that of modified radical mastectomy. The benefits remains in terms of breast preservation and avoiding the psychological trauma of mastectomy in females especially the younger age group. This study focuses on 50 patients undergoing breast conservative surgery. Hence discussing the outcome in terms of local recurrence and need for adjuvant therapy

Materials and Method: A total of 50 female patients were operated on between July 2002 and August 2010. Following surgery patients underwent adjuvant therapy with chest wall radiation and hormonal therapy depending upon receptor status. Patients were followed up on 1,6, 12 months and later on yearly basis

Results: Mean age of the patients was 45.04 yrs and mean diameter of the tumor was 3.21cm [SD=+/- 0.923]. Preoperative biopsy was +ve in 92% and ve in 8% patients. Mammograms of all the patients showed malignant changes. Five patients required neoadjuvant chemotherapy for downsizing the tumor from stage 3 to stage 2. Receptor status was +ve in 14 and ve in 36 patients. Local recurrence was present in 10 %[5] patients at follow up. Mean follow up was 48.5 months

Conclusion: BCS is an excellent tool for early stage breast carcinoma when combined with axillary clearance and whole breast irradiation. The benefits are same in terms of outcome and survival as those of formal mastectomies, with less disfigurement. There is however need for patient education as well as strict adherence to multidisciplinary approach in treatment of this overwhelming problem

Comparison of tapp and open mesh hernioplasty

Background: The objective is to determine the outcome of TAPP and Open Methods [Lichtenstein] for inguinal Hernia repair in terms of post operative pain, hospital stay, wound infection and recurrence. TAPP technique is newer modality in the treatment of laparoscopic hernia repair. With advantages over open methods of repair and various potential complications along with greater learning curve it has point of interest for various studies. This study focuses on 100 patients undergoing hernia repair by either method, and elaborating the outcome in terms of pain, operative time, wound infection and recurrence

Materials and Method: Atotal of 100 patients were operated on between July 2005 and August 2010. They were divided into group A for TAPP mesh hernioplasty and group B for Lichtenstein tension free mesh hernioplasy, 50 patients in each group. All the patients were followed up at 1,6, 12 and 24 months for outcome measures

Results: Atotal of 100 male patients with mean age 50.4 underwent hernia repair. There were 58 indirect, 31 direct and 11% mixed types of inguinal hernias. The mean operating time for TAPP was 104.7 higher than in the open technique Mean=35.7 minutes. Post operative pain in majority of TAPP group was mild in 40 [80%] patients and for open technique was moderate in 27 [54%]. The infection rate for the Open technique was 10%. Of the TAPP group 4 patients [8%] had early recurrence, and 1 [2%] patient in the open technique presented with recurrence after 12 months follow up

Conclusion: TAPP technique for inguinal hernia repair is better than Open repair with regards to less pain and early mobilization of patients. The rate of infection is also less. The disadvantages include longer learning curve but it tends to vary in various centers. So the emphasis remains on the need for developing a learning environment for such techniques in order to provide better patient care