Medical errors; causes, consequences, emotional response and resulting behavioral change

Objective: To determine the causes of medical errors, the emotional and behavioral response of pediatric medicine residents to their medical errors and to determine their behavior change affecting their future training

Methods: One hundred thirty postgraduate residents were included in the study. Residents were asked to complete questionnaire about their errors and responses to their errors in three domains: emotional response, learning behavior and disclosure of the error. The names of the participants were kept confidential. Data was analyzed using SPSS version 20

Results: A total of 130 residents were included. Majority 128[98.5%] of these described some form of error. Serious errors that occurred were 24[19%], 63[48%] minor, 24[19%] near misses, 2[2%] never encountered an error and 17[12%] did not mention type of error but mentioned causes and consequences. Only 73[57%] residents disclosed medical errors to their senior physician but disclosure to patient's family was negligible 15[11%]. Fatigue due to long duty hours 85[65%], inadequate experience 66[52%], inadequate supervision 58[48%] and complex case 58[45%] were common causes of medical errors. Negative emotions were common and were significantly associated with lack of knowledge [p=0.001], missing warning signs [p=<0.001], not seeking advice [p=0.003] and procedural complications [p=0.001]. Medical errors had significant impact on resident's behavior; 119[93%] residents became more careful, increased advice seeking from seniors 109[86%] and 109[86%] started paying more attention to details. Intrinsic causes of errors were significantly associated with increased information seeking behavior and vigilance [p=0.003] and [p=0.01] respectively

Conclusion: Medical errors committed by residents have inadequate disclosure to senior physicians and result in negative emotions but there was positive change in their behavior, which resulted in improvement in their future training and patient care

Morphological Spectrum of Diseases in Patients Presenting with Enlarged Cervical lymph Nodes, Diagnosed on FNAC

Purpose of the study was to know the relative frequencies of different morphological disease patterns in patients of cervical lymphadenopathy by FNAC. A descriptive cross sectional study. Surgery and Pathology department of Pakistan Railway teaching Hospital Rawalpindi from January 2005 to October 2011. Results of fine needle aspiration cytology of patients with enlarged cervical lymphnodes was recorded. Total number of patients was 150. The male to female ratio was 1.3:1 [86 males and 64 females]. The maximum patients were in 11-20 years [40%], followed by 21-30 years [20%]. The youngest patient was 4 Years and the oldest was 67 years. The FNAC showed chronic granulomatous inflammation suggestive of tuberculosis [43%] as the commonest pathology, followed by reactive hyperplasia [39%], nonspecific lymphadenitis [9%], lymphoma, [5%], and metastatic carcinoma [4%]. All patients with enlarged cervical lymph nodes should be thoroughly investigated. FNAC is a reliable diagnostic tool in evaluation of lymphadenopathy. Chronic granulomatous inflammation suggesting tuberculosisis one of the major causes of enlarged cervical lymphnodes in our country

Early Community and Hospital Contact of Undergraduate Medical Students; Innovating the MBBS Curriculum through DCH [Doctor, Community and Hospital] Module

Transition from traditional to integrated curriculum has been very slow in Pakistan. However in the last few years there has been tremendous increase in the number of medical schools. Early clinical and community exposure is one of the key factors in generating interest of medical students in learning the clinical aspect of the basic sciences. For this purpose [DCH module] was incorporated in the first 3 years of the medical curriculum at Islamic International Medical College. To develop and implement DCH module for early clinical exposure of MBBS students. To determine teachers' and students' perceptions of about its influence on the overall learning of medicine. Action Research. Islamic International Medical College from Jan 2011 to Jan 2014. Initially Wise man approach was used to develop the module. However modifications were brought into the module applying the United Nations approach of designing a curriculum. The module has been incorporated in the curriculum, aligning it with the last 2 years of intensive clerkship of a five year MBBS program. Significant improvement has been observed by the faculty, in students' approach about dealing with the clinical context of the basic sciences. It has also resulted in better communication skills and their reasoning approach in PBL sessions. Early clinical exposure enhances the interest and understanding of medical students of the basic sciences. It lays the foundation of the students towards a professional and clinical approach in dealing with patients, which is in addition to better integration of basic sciences with clinical sciences

Ideal Mentor- Perceptions of Faculty and Students

Mentoring implies a 2-way relationship between the mentor and the mentee. A successful partnership can lead to the professional development of both individuals. Although the significance of mentoring programs has been realized in the developing countries, its role in the holistic development of our students is still not given its due importance. There are important questions to be answered; who should be a mentor? What are the qualities students look for in an ideal mentor? These gaps in research are especially significant in our part of the world, where robust mentoring systems have yet to be established. To compare the perceptions of our faculty and students regarding the qualities of an ideal mentor as measured by Ideal Mentor Scale [IMS]. Cross-sectional study. At Pakistan Railway Hospital, Rawalpindi, Pakistan during July 2013 to August 2013. Seventy participants [faculty members:26, students:44] participated in the survey using the [Ideal Mentor Scale] [Gail Rose, The University of Iowa, 1999] to identify the relative importance of integrity, guidance and relationship in a potential mentor using a 5-point rating scale. Integrity [average sum of means: 58] was considered to be the most important attribute of an ideal mentor followed by guidance [40] and relationship [35] by all the participants [undergraduate: postgraduate: faculty member]. However, in the scale of relationship the undergraduate students gave higher score than the postgraduates and faculty members [3.8: 3.5: 3.3]. Successful mentoring most importantly requires a mentor who can be emulated as a role model due to his/her principled behavior and integrity

Does PBL Make Medical Students Life long learners?

our medical school has switched from traditional to integrated modular spiral outcome based curriculum. Problem based learning has been introduced as one of the main teaching/learning strategies. One of the major benefits of PBL mentioned in the literature is to make student a lifelong learner. However it is not easy to assess that PBL imparts this basic feature of adult learning in students. PBL is used as learning strategy in the first 02 years of medical curriculum, so that the lifelong learning capability can be assessed in the last three years of medical school. To determine the role of PBL in developing lifelong learning ability among medical students. A quantitative cross sectional co-relational study. The study was conducted in Islamic International Medical College in April 2012. Three hundred students from 3rd to final year MBBS were distributed Revised Jefferson scale of Physician Lifelong learning [JeffSPLL] at the start of the lecture. The questionnaire was collected at the end of the lecture. Data was collected from JeffSPLL inventory. This was entered into SPSS 18. Both non parametric and parametric analysis were done. Non parametric analysis included mean, median and mode of ages and gender of the participants. Parametric analysis was based on Pearson Co relation analysis to find a relationship between the PBL and developing the capability of Lifelong learning. Lifelong learning is multidimensional idea. Factors associated with lifelong learning include need recognition, undertaking research, self-motivation, practical abilities and personal motivations. The discussion will be based on the relationship between the development of lifelong learning skill and the process of Problem based learning. The process of PBL makes the students lifelong learners

Our Lectures: What do the Students Think?

The objective of the study was to reveal the perceptions and experience of our students regarding the lectures taken in our medical school. It was a cross-sectional descriptive study. This study was conducted among second year MBBS students of Islamic International Medical College. A questionnaire was developed, validated by piloting among faculty members and then was distributed to the students of MBBS year 2 from June to July 2013. The response rate was 100%. Questions were grouped under various headings and categorization was done [i.e., Excellent, Very Good, Good, Fair and poor] according to responses. Lecture as an instructional strategy and the presentation of lectures was regarded as [Good] by 39% and 42% of students respectively.36% of students commented the Multimedia preparation of lectures as [very good]. Only 23% of students have mostly gone through the learning outcomes of a lecture before coming to attend it. Most of the students regarded lectures as a good instructional strategy. Students were also satisfied with the Multimedia presentations and delivery of lectures

Assessing the Long Case in Undergraduate Medical Students: Development of Structured, Feasible, Valid and Reliable Tool.

To develop structured, feasible, valid and reliable tool in assessing long case in undergraduate medical student. Qualitative Action Research. IIMCT, Aug, 2012 to Oct 2013. An action research approach was used. Problems of un-structured examination in long case were identified. Delphi technique with the senior faculty was used to identify the components of the assessment tool. Final draft of the tool was sent to medical educationists for their input. A structured tool [SLICE] for examining the holistic approach of student towards managing a patient was developed and was found to be reliable [Cronbach alpha 0.87] and valid. SLICE is a feasible, valid and reliable tool to assess long case in undergraduate medical students in our setup

Identifying Learning Styles Among Medical Students: Does Our Assessment Favors Certain Learning Style?

Learning Style is usually identified as an individual's pattern for acquiring information. This study was used to identify the learning style of Medical students and comparing the individual Learning Styles with the Result of Annual Summative Assessment to ascertain any link. Objectives of the study were two-fold: First, to identify the learning style of Medical Students for their sake and for the sake of faculty so that adequate planning in the curriculum could be done. The second aim was to search whether our Curriculum is oriented towards a particular learning style in students through comparison of learning styles with Annual Assessment Result. It was a Cross-Sectional Descriptive Study. The study was conducted among students of 3 year MBBS, Islamic International Hospital. The 80-item Honey and Mumford Learning Style Questionnaire was distributed to a class of 100 students .The result was compiled on MS Excel and compared with the results of Summative Assessment of the students. In our study, Majority of the students were Reflectors [35.5%] [n=32], followed by Reflector-Pragmatists [13.3%] [n=12]. Theorists [12.2%], Pragmatists [11%], Reflector/Theorists [8.8%] and Activists [6.6%] 34% of the students [n=31] had a combination learning style. One student had all four learning styles. Comparison of Assessment result with the result of the Questionnaire was done: on an Average Reflectors have scored higher [73%] as compared to Pragmatists [72%], Theorists [71.5%] and Activists [66%]. Although no gross difference, the Assessment result on an average, was a bit higher for reflectors. This study also shows that most of the students learn more effectively from lectures, project works and independent study

Respiratory distress with urinary ascites; a rare presentation of urinary bladder injury after caesarian section

Respiratory distress with Urinary ascites is a rare diagnosis usually associated with intra-peritoneal bladder perforation. We present a case of a 35 year old female who had her 3[rd] C- section and presented 08 days later with respiratory distress and massive urinary ascites .We have discussed why the diagnosis was missed initially and then how was it made, and then eventually its management. In summary, we show that a combination ascitic biochemistry and CT Urography are essential to make a diagnosis of urinary ascites and to know the site of urinary tract injury