Roles of Medical Education Department: What are expectations of the faculty?

Background and Objective: Pakistan like many Asian countries is investing in medical education to address increased societal needs and to meet the requirement of national and international accrediting bodies. Establishing medical education departments is part of this investment. The research question was ''What are the expectations of faculty from medical education department?'' The objective of this study was to explore the Faculty's perception about the roles of medical education department and their suggestions for its future endeavors

Methods: A qualitative case study design was chosen for this study. Heterogeneous group of faculty members from basic and clinical sciences departments of University College of Medicine, Lahore were invited for this study. They represented a variety of disciplines, and seniority levels. They were queried about their perception of the roles of medical education department and were encouraged to give suggestions for better functioning of department. Data was collected by audio recording through focus group interviews. Data analysis was done using NVIVO 11 software

Results: Initially 55 nodes/codes emerged which were then condensed to 35 nodes. Out of these three main themes emerged. The three emergent themes were: 1. Knowledge about the roles of medical education department. 2. Interactions with the medical education department. 3. Future Prospects of the medical education department. Roles of medical education department identified by the faculty were mainly related to faculty development, curriculum planning and implementation, student support, policy making for student induction, improving teaching strategies, student assessment, quality assurance and accreditation of the medical college. Faculty development not only encompassed faculty training but also provision of opportunities for research and curriculum development. Student support was found to be a neglected role and faculty members suggested it to be an important area to be looked upon by medical education departments

Conclusion: Institutions must ensure consultation with faculty members and should take proactive measures to sustain change, including giving ownership and team building among the faculty members

Factors contributing to the lack of interest in research activities among postgraduate medical students

Objective: To determine the factors contributing to lack of interest in research activities among postgraduate residents in pediatric medicine

Methods: This cross-sectional survey was conducted at The Children's Hospital Lahore, Pakistan in August 2017. The questionnaire was distributed to 105 postgraduate residents working in pediatric medicine department and 90 of them returned the completed proforma [response rate; 86%]. Data was analyzed by SPSS version 22

Results: Out of 90 residents' females were predominant [n=58/90; 64.4%]. Mean age of the participants was 28.22 +/- 2.092 years. Majority were unmarried [n=57; 63.3%]. The highest mean score [2.31 +/- 0.697] was regarding ''Lack of proper training for research'', followed by ''lack of previous exposure'' [2.26 +/- 0.728] and ''over loaded curriculum'' [2.13 +/- 0.753]. ''Uncooperative faculty'' and ''funding issues'' as a barrier towards research [p=0.016 and 0.014 respectively] was mentioned by males more than females. ''Social and family commitment'' was a significant perceived barrier in married residents as compared to unmarried residents [p=0.001]. The residents in the younger age group were more reluctant to do research due to ''over loaded curriculum'' [p=0.038]

Conclusion: Lack of proper training of research, lack of previous exposure and time management are the major factors affecting resident's research work, whereas married residents face more social/family constraints as compare to unmarried residents

Personal qualities of brilliant surgeons: a myth or reality

Objective: To explore the qualities of brilliant surgeons that makes them distinctive

Study Design: A qualitative exploratory study

Place and Duration of Study: The study was conducted in Armed Forces Hospitals, Rawalpindi, from Jan to Jul 2017

Material and Methods: A purposive sampling technique was applied for in-depth, semi-structured interviews of 19 members [ten surgeons, six anesthesiologists and three operation room assistants] having experience of surgical environment for more than 20 years in different institutions. Computer Assisted Qualitative Data Analysis Software [CAQDAS] was employed for thematic data anal ysis using software NVIVO 11 Pro

Results: Study participants reported observation of distinctive personality characteristics of a few surgeonshitherto termed as [brilliant]. Multifaceted aspects of their personality were identified and categorized into five major themes: mental, psychological and emotional, social, mechanical, and structural strength. The first three themes were found to be common among brilliant achievers in all other professions as well, however, the mechanical and structural strength domains were considered to have unique and substantial bearing on the achievement of brilliance in surgery

Conclusion: A category amongst the surgeon has been identified and termed as [brilliant]. These brilliant surgeons were gifted in five domains of their personality with a distinct set of qualities which made them outclass their contemporaries

Measuring assessment standards in undergraduate medical programs: development and validation of AIM tool

Objective: To develop a tool to evaluate faculty perceptions of assessment quality in an undergraduate medical program

Methods: The Assessment Implementation Measure [AIM] tool was developed by a mixed method approach. A preliminary questionnaire developed through literature review was submitted to a panel of 10 medical education experts for a three-round 'Modified Delphi technique'. Panel agreement of > 75% was considered the criterion for inclusion of items in the questionnaire. Cognitive pre-testing of five faculty members was conducted. Pilot study was done with 30 randomly selected faculty members. Content validity index [CVI] was calculated for individual items [I-CVI] and composite scale [S-CVI]. Cronbach's alpha was calculated to determine the internal consistency reliability of the tool

Results: The final AIM tool had 30 items after the Delphi process. S-CVI was 0.98 with the S-CVI/Avg method and 0.86 by S-CVI/UA method, suggesting good content validity. Cut-off value of < 0.9 I-CVI was taken as criterion for item deletion. Cognitive pre-testing revealed good item interpretation. Cronbach's alpha calculated for the AIM was 0.9, whereas Cronbach's alpha for the four domains ranged from 0.67 to 0.80

Conclusions: 'AIM' is a relevant and useful instrument with good content validity and reliability of results, and may be used to evaluate the teachers' perceptions about assessment quality

Patient safety awareness among undergraduate medical students in Pakistani Medical School

Objective: To measure the level of awareness of patient safety among undergraduate medical students in Pakistani Medical School and to find the difference with respect to gender and prior experience with medical error

Methods: This cross-sectional study was conducted at the University of Lahore [UOL], Pakistan from January to March 2017, and comprised final year medical students. Data was collected using a questionnaire 'APSQ- III' on 7 point Likert scale. Eight questions were reverse coded. Survey was anonymous. SPSS package 20 was used for statistical analysis

Results: Questionnaire was filled by 122 students, with 81% response rate. The best score 6.17 was given for the 'team functioning', followed by 6.04 for 'long working hours as a cause of medical error'. The domains regarding involvement of patient, confidence to report medical errors and role of training and learning on patient safety scored high in the agreed range of >5. Reverse coded questions about 'professional incompetence as an error cause' and 'disclosure of errors' showed negative perception. No significant differences of perceptions were found with respect to gender and prior experience with medical error [p= >0.05]

Conclusion: Undergraduate medical students at UOL had a positive attitude towards patient safety. However, there were misconceptions about error disclosure among students and patient safety education needs to be incorporated in medical curriculum of Pakistan

Exploring practices of dermatologists in ethical dilemmas in Pakistan: a narrative analysis

Background and Objective: Specialists in dermatology come across ethical issues in their practice. The topic is subjective so dialogue and reflection is required. The main objective of this study was to explore how dermatologists deal with ethical dilemmas in their clinical practice

Methods: This was a qualitative narrative analysis. It was conducted by involving dermatologists working in tertiary care hospitals across Pakistan from January to June 2017. Open ended semi structured in-depth interviews of twelve dermatologists were recorded and transcribed manually through transcribers verbatim. Thematic interactional analysis was done by NVivo 11

Results: Ethical dilemmas were narrated. Thematic analysis showed that compromises in standard medical and ethical practices were made on academics and training. Ethics were left to individual choice. Consultation of patients suffered due to quality of patient physician relationships and breeched patient's confidentiality. In cosmetic dermatology unrestrained role of media, injudicious procedures and improper counseling created difficulties. Pharmaceuticals relation revolved around conflict of interest. In sexually transmitted diseases disclosure were difficult due to sociocultural limitations. In teledermatology practices patient's confidentiality and consent were compromised while consultation remained challenging for dermatologists being visual only

Conclusion: Dilemmas appearing in everyday life needs peer discussion, reflections and protocols that should be role modeled

Analyzing communication skills of pediatric postgraduate residents in clinical encounter by using video recordings

Objective: To analyze communication skills of pediatric postgraduate residents in clinical encounter by using video recordings

Methods: This qualitative exploratory research was conducted through video recording at The Children's Hospital Lahore, Pakistan. Residents who had attended the mandatory communication skills workshop offered by CPSP were included. The video recording of clinical encounter was done by a trained audiovisual person while the resident was interacting with the patient in the clinical encounter. Data was analyzed by thematic analysis

Results: Initially on open coding 36 codes emerged and then through axial and selective coding these were condensed to 17 subthemes. Out of these four main themes emerged: [1] Courteous and polite attitude, [2] Marginal nonverbal communication skills, [3] Power game/Ignoring child participation and [4] Patient as medical object/Instrumental behaviour. All residents treated the patient as a medical object to reach a right diagnosis and ignored them as a human being. There was dominant role of doctors and marginal nonverbal communication skills were displayed by the residents in the form of lack of social touch, and appropriate eye contact due to documenting notes. A brief non-medical interaction for rapport building at the beginning of interaction was missing and there was lack of child involvement

Conclusion: Paediatric postgraduate residents were polite while communicating with parents and child but lacking in good nonverbal communication skills. Communication pattern in our study was mostly one-way showing doctor's instrumental behaviour and ignoring the child participation

randomized controlled trial of intermittent cervical traction in sitting Vs. supine position for the management of cervical radiculopathy

Objective: To compare the effectiveness of intermittent cervical Traction in sitting vs. supine position for the management of cervical radiculopathy

Methods: A randomized clinical trial was done to compare pain and disability modification of cervical radiculopathy patients by using cervical traction in sitting and supine positions. Forty patients [males and females aged between 18-60 years with chronic cervical radiculopathy] were recruited for the trial. Participants were randomized into two homogeneous groups by dice method. The Group-A [n=20] received 3-weeks of intermittent cervical traction in sitting position along with Transcutaneous Electric Nerve Stimulation [TENS] and hot pack. The Group-B [n=20] received the same treatment except the intermittent cervical traction that was applied in supine position. Participants were assessed two times: at baseline [week 0] and at the termination of rehabilitation [week 3]. Neck disability index was used to collect the data before and after the treatment

Results: The mean age of the patients was 43.15+/-8.99 vs. 48.80+/-6.89 years in Group-A vs. Group-B respectively. Mean [+/-S.D.] weight of the patients was 74.75+/-12.11 vs. 74.60+/-11.24 kg in Group-A vs. Group-B respectively. Mean Neck Disability Index score at start of treatment was 30.30+/-7.46 vs. 30.75+/-7.85 in Group-A and Group-B respectively. There was a significant difference in Group-A and Group-B regarding aggregate NDI score at the end of treatment [19.45+/-7.12 vs. 11.05+/-4.40; p<0.0001]

Conclusion: Supine position is better choice for applying cervical traction as compared to sitting position for the management of cervical radiculopathy comparing post interventional NDI score

In vitro antimalarial and xanthine oxidase inhibition of 2-Aminoanthraquinone

In the present research study 2-Aminoanthraquinone were scrutinized for their antimalarial and Xanthine oxidase inhibitor potential. It demonstrated marked concentration dependent antimalarial activity with maximum effect of 89.06% and with IC[50] of 34.17 micro M. Regarding Xanthine oxidase inhibitor activity, it evoked significant effect with 57.45% activity with IC[50] value of 81.57.19 micro M. In conclusion, 2-Aminoanthraquinone showed potent antimalarial and xanthine oxidase inhibitory activity

Readmission to paediatric intensive care unit: frequency, causes and outcome

Readmission to intensive care units is considered to be an important quality indicator in ICU settings. This study was carried out at the paediatric intensive unit [PICU] and step down units of paediatric ward at the Aga Khan University Hospital, Karachi, Pakistan, to assess the frequency, common causes and outcome of patients readmitted in PICU within 48 hours after discharge from unit. During the study period, 1022 patients were admitted in PICU, out of which 24 [2.34%] patients required readmission. Male to female ratio was 1.2:1. The mean length of stay on paediatric floor before readmission was 24 hours. Fifteen [62%] patients were readmitted due to worsening of primary condition while 9 [38%] developed new problems. Respiratory problems accounted for 15 [62.5%] of readmissions, followed by cardiovascular 4 [16.5%] and sepsis related causes 3 [12.5%]. The mortality rate of readmitted patients was 21% [5/24] in this study as compared to overall PICU mortality of 122 [11.93%]

Pneumothoraces in a neonatal tertiary care unit: case series

Neonatal pneumothoraces are associated with high mortality Prompt recognition to minimize its complications is paramount for ultimate outcome of these babies, A retrospective case series study was carried out at Aga khan University Hospital, from January 2010 to December 2010 to determine the etiology and outcome of neonates with pneumothorax in a neonatal tertiary care unit, Ten neonates diagnosed radiologically with pneumothoraces were included. M: F ratio was 1:2.3, Birth weight ranged from 1750-3600 grams with a mean of 2100 grams. The occurrence of pneumothoraces was 50% on the left side, 20% on right, and 30% were bilateral. Primary etiology included pneumonia and sepsis [30%], hyaline membrane disease [20%], meconium aspiration syndrome [20%] and congenital diaphragmatic hernia [10%], Spontaneous pneumothoraces were present in 20% of cases. In our study, the incidence of neonatal pneumothoraces was 2.5/1000 births compared to 10-15/1000 in Denmark, 10-20/1000 in Turkey and 6.3/1000 from Vermont Oxford Group Despite the small number of cases, one incidental finding was the occurrence of pneumothorax, which declined in elective cesarean section after 37 weeks gestation i.e., 1.3 of 1000 births. Mortality was 60% determined mainly by the primary etiology and other co-morbid conditions. The study showed a higher number of mortality cases [60%]. Although, it was difficult to draw a conclusion from the limited number of cases, there may be a benefit on neonatal respiratory outcome to be obtained by better selection of mothers and by waiting until 37 weeks before performing elective cesarean section. Adequate clinician training in soft ventilation strategies will reduce the occurrence of pneumothoraces

Botulism in children: a diagnostic dilemma in developing countries

Botulism is a well-known disease of the neuromuscular junction. It is a rare but curable cause of paralysis in paediatric population. In addition to classical clinical signs and symptoms, the diagnosis of botulism requires laboratory confirmation of intoxication by various biological tests. These include demonstration of botulinum toxin in serum or isolation of the Clostridium botulinum from stool/gastric aspirates. However, it is not always possible to confirm intoxication due to unavailability of technical facilities, especially in resource limited countries like Pakistan. Under these circumstances, electrophysiological studies serve as an excellent diagnostic tool. These studies can provide quick diagnosis of botulism so that early administration of botulism immunoglobulin, if available, can reduce morbidity, mortality and length of stay in hospital. We report a case of botulism from Pakistan diagnosed on the basis of electrophysiological studies

Elective tracheostomy in mechanically ventilated children

Tracheostomy is an important procedure in children requiring prolonged mechanical ventilation. We conducted a retrospective study to assess the frequency, indications, postoperative course and short-term outcome of elective tracheostomy in a Paediatric Intensive Care Unit [PICU] of Pakistan. Twenty-five patients underwent tracheostomy in last 5 years [2.2% of all PICU admissions]. Mean age of patients was 6 years and 60% were male. The most common indication for tracheostomy was prolonged mechanical ventilation secondary to neurological disease [60%], followed by upper airway obstruction [40%]. Major complications included accidental decannulation [20%] and tube obstruction [20%]. Three patients [12%] developed ventilator-associated pneumonia after tracheostomy change while persistent bacterial colonization of trachea was observed in 8 patients [32%]. Decannulation was achieved in 40% [10/25]. There was no mortality related to tracheostomy in this series

Acute necrotizing encephalopathy of childhood: a fatal complication of swine flu

Acute necrotizing encephalopathy of childhood [ANEC] is a rare condition characterized by the presence of multifocal symmetrical brain lesions involving mainly thalami, brainstem, cerebellum and white matter. ANEC is a serious and life threatening complication of simple viral infections. We present a case of a young child who developed this condition with classical clinical and radiological findings consistent with ANEC, secondary to swine flu [H1N1]. He needed ventilatory support and had profound motor and intellectual deficit on discharge. We report this case with aim of raising awareness about this fatal complication of swine flu which has become a global health care issue these days

Anxiety and self-esteem in smokers and nonsmokers

The present study aimed to investigate anxiety and self-esteem among smokers and nonsmokers. It was hypothesized that: [1] The level of anxiety would be different in smokers and nonsmokers, and [2] The level of self-esteem would be different in smokers and nonsmokers. Anxiety and self-esteem were measured by using self constructed questionnaire with 18 items on self-esteem and 8 items related to anxiety. The study sample comprised of 200 students [100 smokers and 100 non-smokers], studying at different departments of University of the Punjab. Purposive sampling was used to select the sample, t-test was used to interpret the data in statistical terminology. Results indicate insignificant difference in the level of anxiety [t- -0.654, df=198, p>.05] among smokers and nonsmokers. However, significant difference was found in the level of self-esteem [t= -3.009, df= 198, p<.05] among smokers and nonsmokers. Implications for the implementation of psychological interventions were discussed