Course enjoyment and learning style of participants of a distance learning program in health professions education [HPE]

Objective: To identify and relate enjoyment levels of various components of MCPS-HPE course and the learning styles of the course participants followed by explanation of the reasons for enjoyment, non-enjoyment and how enjoyment factors can be enhanced

Study Design: Mixed method sequential study

Place and Duration of Study: College of physicians and surgeons, Pakistan, Regional Center, Lahore from January 2013 to April 2014

Material and Methods: Learning style of MCPS-HPE course participants of 2011-13 batch was identified through Kolb's Learning Style Inventory version 3.1; and participant's perception of the most enjoyable areas in the contact sessions and assignment completion were sought on two respective survey forms followed by structured interviews

Analysis of the quantitative data was performed using SPSS version 19. [Framework method] was used for the manual analysis of qualitative data

Result: Learners identified social interaction, team work, knowledge construction, active learning and self-efficacy as enjoyable while cognitive overload, disruptions in learning, and deadlines as factors impeding enjoyment. Acquiring learning skills, contextual simplified learning, addressing disruptions and promoting active learning and proactive mentorship were suggested as measures for improving enjoyment level. Predominantly our participants were convergers who enjoyed the course more than those with other learning styles. Conclusion: Team work along with experiential learning improves learners' self-efficacy and enthusiasm. Ensuring contextual learning and proactive mentoring can address negative impact of cognitive overload, inappropriate facilitator's attitude and deadlines on course enjoyment while taking into account various learning styles

Emergency Peripartum Hysterectomy in Pakistan Railway Teaching Hospital Rawalpindi: Eleven Years Review

Emergency Peripartum Hysterectomy [EPH] is a major surgical procedure. There appears to be a rise in the rate of emergency peripartum hysterectomy [EPH] in the developed world. Peripartum hysterectomy is high risk but a life saving operation. It is usually associated with significant maternal and fetal morbidity and mortality. Obstetricians should identify patients at risk and anticipate the complications, as early intervention and proper management results in optimal outcome. To determine the incidence, indications, risk factors, complications and management of EPH over the last eleven years. A descriptive study. All cases of EPH performed in the period between January 2001 and December 2011 were included in the study. Study was conducted at Railway Teaching Hospital, Rawalpindi [in northern Pakistan]. Data of all the cases of EPH cases operated during the study period was collected from the hospital obstetric record. Data of basic demographics, mode of delivery, maternal and fetal outcome along with associated complications was collected and entered into the Statistical Package for Social Sciences version 14.0 [SPSS Inc., Chicago, IL, USA] for further analysis. Indications, pre-op planning, type of operation, emergency decision, blood loss, transfusion, complications, were compared and cross-tabulated. Statistical analysis included: Chi-square and Fisher exact tests, where appropriate, and two-sample t test. Total deliveries were 13560 in 11 years. Twenty Six EPH cases were performed among deliveries, giving an incidence of 1.8 per 1000 deliveries i.e. one in 566 deliveries. The indications were uterine atony [34.61%], ruptured uterus [23.07%] and cervical/vaginal tears [11.53%], placenta praevia [11.53%], invasive placental adhesion [accreta, increta, percreta [11.53%]]. A significant association between previous uterine surgery and abnormal placentation was shown [p=0.02], especially those with previous caesarean [p=0.003]. One maternal and six perinatal mortalities were recorded. Four perinatal deaths were of non-booked patients, handled by traditional birth attendants/private clinics. Out of two perinatal deaths of booked patients, one was pre-term and other was delivered by forceps. Maternal morbidity was prevalent, including twenty three intensive care admissions, three disseminated intravascular coagulopathies, three bladder injuries, three re-explorations, multiple blood, FFPs and platelet transfusions, two pulmonary embolism and one cardio- respiratory failure. Maternal death was of non-booked patient with previous scar, home delivery, uterine rupture and brought to hospital with un-recordable BP and very weak pulse. Incidence of peri-partum hysterectomy is increasing. It is a major operation, and almost always an emergency with significant blood loss. An early decision should be made to save life of the patient and prevent complications. The most important risk factor for peripartum hysterectomy in our patients is hemorrhage, most notably caused by uterine atony, uterine rupture, placenta previa and abnormally adherent placenta

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

Vicarious learning during Simulations: is it more effective than hands-on training?

This study aimed to investigate whether the type of simulation-based learning [learning by doing versus vicarious learning] and the order in which these activities are carried out [learning by doing ..vicarious learning versus vicarious learning ..learning by doing] have any effect on the acquisition of knowledge on effective doctor-patient communication strategies. A descriptive study. At Obstetrics and Gynecology Department, Islamic International Medical College Trust, Railways Hospital, Rawalpindi from April 2013 to June2013. The sample consisted of 33 undergraduate medical students of 3 batches [25 female, 8 male]. They participated in two separate simulation sessions, each of which was 30 minutes long and was followed by a collaborative peer feedback phase. Vicarious learning led to greater knowledge of doctor-patient communication scores than learning by doing. The order in which vicarious learning was experienced had no influence. The inclusion of an observation script also enabled significantly greater learning in students to whom this script was given compared with students who were not supported in this way, but the presence of a feedback script had no effect. Students appear to learn at least as much, if not more, about doctor-patient communication by observing their peers interact with SPs as they do from interacting with SPs themselves

Maternal and fetal outcome of pregnancies with umbilical cord problems

To seek relationship between cord problems [like long cords, short cords, nuchal cord and cord knots] and its effects on fetus as well as mode of delivery. Descriptive [case series] Obs/Gynae wards Railway hospital, Rawalpindi from September 2006 to August 2007. It was a descriptive case series study. Hundred patients with umbilical cord problems, detected at delivery were included.Effects of these cord problems on mode of delivery and fetal outcome were observed. Twenty two percent patients had long cord, 14% had short cords.41% had single nuchal cord, 22% had double loop of cord around the neck, and 4% patients had triple loops of Nuchal cord. It was observed that 4% patients were having true kanots in umbilical cord and and only 26% patients had false knots in umbilical cord. In the patients with cord problems, rate of SVD was more than 70% and LSCS < 20%. These problems did not show significant effects on birth weight and Apgar scores when present alone.But multiple cord problems in a single pregnancy were associated with fetal complications. Long and short umbilical cords, umbilical cord knots and Nuchal cords had no significant effects on mode of delivery and Apgar score in 5 minutes. But multiple umbilical cord problems in same case may pose problems to the fetus and early diagnosis can prevent fetal harm

External cephalic version [ECV] for breech presentation at term -experience at railway hospital

To assess the effectiveness of ECV in singleton breech presentation at term and to determine its effect on maternal, delivery and perinatal outcomes in women to whom the procedure was offered. Aquasi experimental study. The study was carried out in the Department of Obstetrics and Gynaecology, Railway hospital, Rawalpindi, fromAugust2006 to December2008. Eligible women, presenting with uncomplicated breech, between 37-41 weeks gestation, underwent ECV on day care basis. Fifteen minutes before the procedure, injection salbutamol 0.5 mg was administered. Cases with contraindication to ECV or salbutamol injection were excluded from the study. Success rate of ECV [in terms of conversion from breech to cephalic presentation at the completion of procedure confirmed through ultrasound] along with maternal, delivery and perinatal outcomes were assessed. Maternal and fetal demographic characteristics were also recorded as secondary outcome measures. For statistical analysis, SPSS version 10 was used and Chi-square test applied with a p<0.05 taken as significant. Of the 42 ECV procedures, 25 [59.5%] were successful. None of the patient suffered from serious maternal complications. Seven [16.7%] parturients complained of severe palpitations and 4 [9.5%] of marked discomfort during the procedure. Reversible fetal bradycardia was seen in 1 [2.4%] patient. Reversion to a non cephalic presentation occurred in two cases. Vaginal delivery was carried out in 21 patients out of the 25 who successfully underwent external cephalic version while all the patients with failed ECV underwent caesarean delivery. The 5 minute Apgar score was more than 8 in all except one baby. Adverse maternal and fetal outcomes of breech presentation at term are rare and there was no increased risk of complications after external cephalic version. Findings provide important data to quantify the frequency of adverse outcomes that will help facilitate informed decision-making and ensure optimal management of breech presentation

Managing shoulder dystocia: perceptions of accoucheurs regarding their training

To assess the perceptions of labour ward staff at teaching hospitals regarding their theoretical and practical training for the management of shoulder dystocia as well as their opinion for further need of such trainings. Across sectional survey. At Islamic International Medical College, Railway Hospital Rawalpindi and College of Physicians and Surgeons Regional Centre Islamabad, from October to November 2008. The study was carried out by using a six item questionnaire. Four items were related to the respondent's training regarding the management of shoulder dystocia while two wete about their response to frequently performed actions which are known to increase the incidence of complications associated with the management of shoulder dystocia. Among sixty seven healthy personnel's involved in the management of parturient in the labour ward, 86.6% [n=58] were doctors and 1 3.4% [n=9] were midwives. The years of experience managing labouring patients ranged from 1 to 30 years. Although only 1 8% [n=1 2] thought that they did not have any theoretical training in shoulder dystocia and 40% [n=27] thought that they did not have any practical training, almost 72% [n=48] expressed a need for more theoretical and 91% [n=61] wanted more simulated training to manage shoulder dystocia. However, only 7.5% [n=5] of respondents involved in this survey said they would use fundal pressure and 1 0.4% [n=7] would apply strong traction to the fetal neck. In the opinion of labour ward attending physicians, the current level of their training for the management of shoulder dystocia is inadequate and there is a need for organizing regular practical training programs to improve their skills in managing this obstetric emergency

Characteristics of infertile patients with ovulatory dysfunction and their relation to body mass index

Ovulatory dysfunction is a group of disorders with variable clinical presentations occasionally having serious long-term adverse effects. It accounts for 30% of female fertility problems. Evidence suggests an association between an individual's weight and disorders of ovulation. The objective of our study was to describe the clinical and hormonal profile of subfertile women with ovulatory dysfunction in relation to their body mass index [BMI]. This prospective, descriptive study was carried out in Mother and Child Health Centre, PIMS, Islamabad and railway hospital, Rawalpindi from April 2001 to March 2007. One hundred and thirty eight infertile patients with ovulatory dysfunction were included. The clinical data including BMI of each patient was recorded in addition to reports of investigations comprised of cervical smear, pelvic ultrasound and hormonal profile. Primary infertility was found in 61% while secondary in 39% of the patients. The mean age was 29 years and mean duration of infertility was 6 years. Menstrual pattern was normal in 56.5%. BMI was normal in 30.4% while most patients were overweight and obese. Prolonged cycles, history of systemic endocrine disorders, abnormal vaginal -discharge, hirsutism, polycystic ovarian morphology and hormonal abnormalities are more frequent in overweight than infertile patients with ovulatory dysfunction having a normal BMI

OSCE as an assessment tool: perceptions of undergraduate medical students

To describe the perceptions of undergraduate medical students regarding Objective Structured Clinical Examination [OSCE] and its comparison to Multiple Choice Questions [MCQ], essay questions and viva voce. This cross-sectional survey was carried out at Islamic International Medical College Rawalpindi [Pakistan], from 3 December 2008 to 2 January 2009. We used a questionnaire comprising of a total of 12 items, out of which 8 items were regarding the quality of exam [Liken scale], 3 regarding the difficulty, being educative and fairness of OSCE relative to other methods of assessment and last one regarding its acceptability as a method to assess clinical skills for undergraduate medical students. The questionnaire was distributed to students of 4th and 5th year medical students to be filled and returned for assessment of the responses. One twenty seven students completed the questionnaire. The results of the study showed that the exam was stressful for 51% of the respondents. About 81% thought that performance of tasks during OSCE was interesting and educative. OSCE, essay type, MCQ and oral viva examination were perceived easy by 44, 33, 18 and 5% students, educative by 32, 16, 23 and 30% and fair by 43, 13, 32 and 11% respectively. OSCE is well-received and acceptable to undergraduate medical students of Pakistan as a method to assess clinical skills