ABSTRACT
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
ABSTRACT
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
ABSTRACT
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