Clinical learning environment: what do house officers say?

Objective: To explore effect of format change in house job training and other factors, hindering or promoting junior doctors' training/learning in their transition to practical life

Study Design: Mixed Method Sequential

Place and Duration of Study: Sir Ganga Ram hospital Lahore, from Nov 2011 to Oct 2012

Material and Methods: Four hundred and ninety two doctors completed the modified PHEEM survey after completion of their house job from November 2011 till October 2012 after institutional ethical review Board's approval. Second phase comprised semi-structured FGD to triangulate findings of the survey with FGD results, to find out, in detail, about doctors' expectations from their house job training and suggestions for future after ensuring confidentiality and anonymity to study participants

Results: The mean overall score for clinical learning environment was 77.67, implying 57.0 percent satisfaction. Themean total scores for autonomy; teaching and social support was 25.6, 31.9 and 20.0 respectively. Satisfaction with regard to autonomy, teaching and social support was 25.6/48 [53.3 percent], 31.9/52 [61.3 percent] and 20.0/36 [55.5 percent] respectively. Patterns emerged from FGD were lack of standardization, nonexistence of formative assessment, opportunistic learning, poor quality feedback and inappropriate teaching by medical officers. Skill learning under supervision, confidence in patient management and part of clinical team were motivating factors while poor accommodation, sanitation, catering facilities and short duration of rotation were hindering factors for learning

Conclusion: Evidence generated has shown that internship year was very challenging. Dissatisfaction was expressed with unstructured opportunistic nature of training. Unstructured training program, role ambiguity, substandard physical environment and short duration of rotations were perceived to negatively influence learning. A valued member of clinical team, confidence in patient management, opportunity to acquire procedural skills under supervision and being supported were the factors perceived to enhance learning

Labial Leiomyoma

Extrauterine smooth muscle tumors are rare. Labial leiomyomas arise from dartos muscle of the genitalia. A 45 years old lady presented with a right labial swelling. It was clinically diagnosed as a Bartholin cyst. The gross appearance of the tissue was that of myoma so it was managed by surgical excision. The definitive diagnosis was confirmed on histopathology as labial leiomyoma. Key Words: Labial leiomyoma. Vulvar leiomyoma. Genital leiomyoma. Extrauterine neoplasm

Fetomaternal outcome in acute hepatitis E

To determine fetomaternal outcome in pregnant women with acute hepatitis E in terms of pregnancy outcome and perinatal mortality. Case series. Department of Obstetrics and Gynecology, Sir Ganga Ram Hospital, Lahore, from July 2012 to March 2013. Serum samples of 38 patients who presented with jaundice in pregnancy were collected to detect hepatitis E IgM antibodies. Demographics, pregnancy outcome and perinatal mortality was noted in hepatitis E positive cases with cause of complications. Cases with jaundice due solely to any other cause were excluded. Twenty five patients had acute hepatitis E with coexistent acute hepatitis A in 1[4%] patient. Their mean age was 25 years and mean gravidity was 2. Among them, 10 [40%] patients were primigravida followed by gravida two in 7 [28%] cases. Twenty four [96%] patients presented in third trimester of pregnancy and in 1 [4%] pregnancy ended in second trimester missed miscarriage. The mean gestational age was 32 weeks. Twenty one [84%] babies were born alive, among them 18 [86%] were preterm. Perinatal mortality was 26%; contributed by intrauterine deaths and early neonatal deaths in 3 [14%] cases each. Total maternal deaths were 5 [20%], 4 [80%] in postpartum period and 1 [20%] in antepartum period due to fulminant hepatic failure in all cases. Prematurity in newborns and fulminant hepatic failure in mothers are major cause of poor fetomaternal outcome in acute hepatitis E in pregnancy

Student's perception of labor room learning environment

To assess the quality of the labor room educational environment as perceived by the final year medical students and to explore students7 justifications for rating the environment in a certain way. Mixed method sequential. Sir Ganga Ram hospital Lahore, Pakistan from Nov 2011 to Oct 2012. During stage 1, one hundred and fifty two final year students completed the modified post graduate environment measure [PHEEM] survey after completion of their maternity duty from November 2011 till October 2012 and Institutional Ethical Review Board's approval. Stage 2 involved semi-structured focus group discussions [FGD] for in depth enquiry to explore students' reasons for rating their learning environment in a certain way after ensuring confidentiality and anonymity to study participants. The mean overall score for labor room educational environment, as rated by students was 65.98, implying 47.8% satisfaction, indicating plenty of problems in learning environment. Mean total scores for autonomy, teaching and social support was 20.5, 28.9 and 16.5. Satisfaction with regard to autonomy, teaching and social support was 20.5/48 [42.7%], 28,9/56 [51.6%] and 16.5/32 [51.5%] respectively. The patterns that emerged from FGD were lack of teaching protocol, inappropriate supervision and feedback, enormous workload and unenthusiastic teachers. Skill learning, authentic real life experience and team work were motivating factors while poor accommodation, sanitation, catering facilities and humiliating attitude of paramedic staff were demotivating factors for learning. Labor room rotation provides an excellent real time practical skill learning opportunity in an environment with plenty of problems. In order to make labor room duty a worthwhile learning experience, all detrimental aspects, as pointed out in this study, can be addressed to enhance students' learning

Diagnostic value of colposcopy in the diagnosis of carcinoma of cervix

Background: Carcinoma cervix is one of the common female cancer worldwide, which has excellent cure rate if diagnosed early

Objective: To determine the accuracy of colposcopy in the diagnosis of early carcinoma of cervix using histopathology as the gold standard

Patients and Methods: Study Design: Comparative cross sectional study

Place and Duration of study: Department of Obstetrics and Gynaecology Unit-1, Sir Ganga Ram hospital, Lahore from 25[th] July, 2006 to 24[th] January, 2007. One hundred patients were included having symptoms of lower genital tract like: chronic vaginal discharge and irregular or post coital bleeding. Women with obvious naked eye lesion of cervix or abnormal Pap smear report were also recorded. Exclusion criteria included pregnant women, asymptomatic women and women on exogenous hormones. Colposcopy findings were noted, along with menstrual, family history and parity. Sensitivity, specifically, positive and negative predictive values were calculated. Data was entered and analyzed by SPSS version 12

Results: The age group ranged from 15-60 years, with Mean +/-SD of 36.7+/-10 years. By age classification the age group 26-35 years were highest in proportion [40%]. Sensitivity, specificity, diagnostic accuracy, positive predicate value [PPV] and negative predictive value [NPV] was found to be 86.6%, 91.7%, 91%, 65%, 97.7%, respectively

Conclusion: Although cervical cancer is a case of significant morbidity and mortality among gynecological malignancies, but with the help of non invasive technique like colposcopy cervical cancer can be detected in its earlier stages where definitive cure is possible. So, it is advocated that colposcopy should become an integral part of all gynecological services, especially in the teaching hospitals as well as in tertiary referral centers of our country

Hydralazine versus glyceryl trinitrate in severe preeclampsia and eclampsia, a comparative study

Background: Hypertension during pregnancy is a common medical condition worldwide, occurring in 12-22% of all pregnancies. In the developed world, the incidence of hypertension and the severity of its complications is reduced markedly, because of the effective and widespread antenatal care services. However, hypertension still remains one of leading cause of maternal morbidity and mortality in developing coutnries.

Objectives: To compare the efficacy and safety profile of hydralazine with glyceryl trinitrate [GTN] in women with severe pre-eclampsia and eclampsia

Patients and Method: This quasi experimental study was conducted in Department of Obstetrics and Gynecology, Sir, Ganga Ram Hospital Lahore, over a period of six months, from July 2006 to January 2007. A total of 100 patients were included in this study. 50 patients were given hydralazine and 50 patients received Nitroglycerine

Results: In groups A and B, mean age was 26.8 +/- 5.6and 25.4 +/- 4.8, respectively. In both groups, the systolic and diastolic blood pressures of patients were not significantly different from each other. Mean time needed to achieve effective blood pressure control in group A [hydralazine] was 31.0 +/- 13.9 minutes and in group B [GTN] was 23.+/- 20.3 minutes. Time interval between effective blood pressure control and new hypertensive crisis was significantly prolonged in group A [96.1 +/- 27.2 Vs 73.8 +/- 18.1, P < 0.05]

Conclusion: GTN takes less time for effective control of blood pressure than hydralazine and safety profile is comparable with hydralazine