Evaluation of palliative care training program for medical interns in a tertiary care teaching hospital, South India

Introduction: The Department of Community Medicine has been training medical interns for providing hospital-based palliative care (HBPC) and community-based palliative care (CBPC) services with an interprofessional team. This study was done to evaluate the training program on palliative care developed for medical interns. Material and Methods: It was a retro-pre type of program evaluation done among 172 interns between January 2016 and December 2017. One day program was conducted for the interns by faculty trained in palliative care, followed by placement in HBPC and CBPC program. At the end of training, self-perceived improvement in knowledge was collected on a five-point Likert scale. Certificates were issued on completion. Data were entered and analyzed using Epi Info (version 7.2.2.6) software. Wilcoxon signed-rank test was applied between pre- and post-scores. Manual content analysis was done for open-ended questions. Results: The mean age of the participants was 22.5 ± 0.8 years, with 76 (44.2%) males and 96 (55.8%) females. There was statistically significant improvement in perceived knowledge scores after attending the training. Areas of learning, values learned, and uses of learning in future career and suggestions for improving the training program were the categories obtained. Conclusion: The training program improved the self-perceived knowledge on palliative care among medical interns. The exposure to HBPC and CBPC program had a positive effect on their attitude and perceived skills for caring of chronically ill patients. Such programs can be initiated by other palliative care providing institutions for training medical interns.

Pharmacovigilance: The extent of knowledge, attitude, and practice in MBBS interns of rural tertiary health center of Maharashtra

Background: Adverse drug reactions (ADRs) are one of the leading causes of death and are responsible of 5–10% of the hospital costs. Every drug having more or less adverse effects which may leads to medical and economic burdens on patients. Some ADRs are severe enough to increase the risk of death. Pharmacovigilance aims to detect and monitor the ADR, to identify the risk factors responsible of it, and to disseminate the knowledge required for the improvement of prescription of drugs. Aim and Objective: This study aims to assess the knowledge, attitude, and practice (KAP) of pharmacovigilance in MBBS interns of rural tertiary health center of Maharashtra. Materials and Methods: This was a cross-sectional study to evaluate the KAP regarding pharmacovigilance among MBBS interns. KAP questionnaire contained 20 questions along with options and correct answer. For pre-test, 20 min were given to them for answering all questions then a seminar (an educational intervention) was taken on pharmacovigilance and its importance and last, post-test was conducted in 20 min. Results: A total of 75 MBBS interns attended the CME on pharmacovigilance and filled the pre- and post-test questionnaire. Fifty-three (70.66%) participants were not known when the Pharmacovigilance Program of India (PvPI) started and 57 (76%) participants were unaware of regulatory body which is responsible for monitoring ADR in PvPI. Forty-seven (62.66%) participants had no clue that a serious adverse event should be reported within a stipulated time period to the regulatory body. Conclusion: Interns are new budding health care workers and they do not have sufficient knowledge of pharmacovigilance. Inclusion of pharmacovigilance in undergraduate curriculum, conducting CME for doctors, nurses, and pharmacist and motivation of doctors for reporting ADRs are some measures which can improve the spontaneous reporting system, patient safety, and Indian pharmacovigilance program.

Medical internship training during the COVID-19 pandemic ­ A case of 'sacrificial pawns' or not?

Background: Newly qualified medical practitioners in South Africa (SA) are part of the frontline health care workers who face Africa's most severe coronavirus disease 2019 (COVID-19) pandemic. The experiences of interns during the pandemic reflect SA's preparedness to respond in a crisis and inform strategies that could be adopted to balance training and service in resource-challenged contexts. Aim: To explore the strengths, weaknesses, opportunities and threats posed during the first wave of the COVID-19 pandemic as reflected on by interns within the clinical training platforms in SA. Setting: Public hospitals in KwaZulu-Natal. Methods: An online questionnaire consisting of eight open-ended questions based on the SWOT framework related to personal and professional perspectives to clinical training during the COVID-19 pandemic was developed using SurveyMonkey. All data were collected remotely via social media platforms. Data were thematically analyzed. Results: Forty-six interns reflected on personal and systemic challenges as the major threats and weaknesses in intern training during the COVID-19 pandemic. Extrapolating on strengths and opportunities, there were three overarching learnings interns reflected on. These related to being a medical professional, communities of practice and the development and enhancement of clinical and non-clinical competencies. Existing challenges in the environment exacerbated the threats posed by COVID-19 and innovative strategies related to improving support, feedback, broadening the intern curriculum and online training. Conclusion: Although the clinical environment where interns learn and work is often stressful and overpowered by high service burdens, there are unique opportunities to enhance self-directed learning and graduate competencies, even in the midst of the COVID-19 pandemic.

Andragogic principles in case-based discussion among medical interns in a tertiary hospital

Background@#Andragogy, the theory of adult learning is relevant to medical education especially in the clinical internship learning context. It focuses on the students, faculty, and patients interacting together while developing competencies as future practitioners. Medical interns are active adult learners, enhancing their development of knowledge, skills, and positive attitudes, and pursuing professionalism as they participate in case-based discussions (CBD).@*Objectives@#The study sought to identify the basic principles of andragogy while medical interns participate in case-based discussions including the end-of-course satisfaction. It also determined the selected demographic factors associated with the andragogic principles. @*Methodology@#Respondents included 80 interns by convenience sampling who rotated at the Department of Ophthalmology and Visual Sciences in a tertiary referral hospital. The study used a combination of descriptive quantitative and qualitative research design. A valid instrument using the Adult Learning Principles Design Elements Questionnaire (ALPDEQ) was used to measure the medical intern's andragogic orientation as well as end-of-course satisfaction. A direct, non-participant observation of case-based discussions conducted at the department was done by the researcher and research associate. @*Results and Conclusion@#The occurrence of andragogic principles specifically motivation, experience, need to know, readiness, and self-directedness was observed during the conduct of case-based discussion. There was no association between principles of andragogy and demographic factors such as age, gender, civil status, medical school, preparatory medical course, and place of origin. CBD is an effective learning strategy, which provides medical interns adequate venues to be self-directed and apply the principles of andragogy in a workplace-based setting.

Factors Influencing the Postgraduate Training Choices of Medical Interns and Junior Medical Officers at the Georgetown Public Hospital Corporation, Guyana

ABSTRACT Objective: To determine the specialty preferences and the reasons for those choices among medical interns and junior medical doctors at the Georgetown Public Hospital Corporation (GPHC), Guyana. Methods: A cross-sectional study of recent medical graduates at GPHC using anonymous self-administered questionnaires was used. Results: Of the study population of 66, 60 of the questionnaires that were filled were returned (response rate of 91.5%). The females comprised 60% of the respondents and 98% of the respondents were interested in Postgraduate Medical Education (PGME). Paediatrics was the most popular programme (25% of the respondents) followed by internal medicine (21%), and the main reason among the respondents for their choice of training programme was personal interest (69%). Gender differences occurred in paediatrics and ophthalmology where the females were predominant, and in orthopaedics and anaesthesia, where the males were predominant. Conclusion: To ensure an adequate and balanced medical specialists workforce for the future, information on medical graduates' perceptions and preferences of PGME and the factors influencing their choices is important to policy planners and medical educators and efforts must be made to correct any of the maldistributions noted.

Knowledge on breast feeding and its techniques among health care workers in a tertiary health centre

Background: Breast milk is optimum for a neonate as it is a natural food and the best gift a mother can give to her baby. Breast feeding is an art and skill which need to be learnt and mastered by mothers. As health care workers are the first line of contact for lactating mothers, this study was planned to assess their knowledge on breast feeding.Methods: Hospital based cross-sectional study was performed among health care workers at Yenepoya Medical College and Hospital of Mangalore. 100 health care workers consisting of 60 medical interns and 40 staff nurses were enrolled in the study. Health care workers were given a questionnaire that sought responses pertaining to the knowledge on breastfeeding and its techniques. The data were analyzed using Microsoft Access and Excel software.Results: The present study showed 92% of medical interns and 95% of nursing staff had correct knowledge about initiation of breastfeeding. Knowledge on contents of colostrums and its advantage was more among medical interns (85%) as compared to nursing staffs (30%). Knowledge on prelacteal feeds was good among medical interns as compared to nurses. Both medical interns and nursing have poor knowledge on breastfeeding during maternal illness. Knowledge on correct feeding position and good breast attachment was good among nursing staffs.Conclusions: Study showed there is some substantial knowledge gap on breastfeeding among health care workers. Enhancing their knowledge on breastfeeding and the problems associated with it will be useful for the nurturing mothers as well as themselves.

Study on practice of physical activity among medical interns in a private medical college hospital in Chennai

Background: Physical inactivity is one of the leading risk factors for death worldwide. It is a key risk factor for non-communicable diseases (NCDs) such as cardiovascular diseases, cancer and diabetes. Physical activity has significant health benefits and contributes to prevent NCDs. Globally, 1 in 4 adults are not active enough. More than 80% of the world's adolescent population is insufficiently physically active. So the aim of this study is to assess the practice of physical activity among the medical interns, as they are the future doctors.Methods: A cross sectional study was conducted among 124 medical interns. A pre-tested, semi-structured questionnaire was used to collect the data. Microsoft Excel 2010 spread sheet version 14.1.3 and statistical package for social sciences (SPSS) version 21 were used for data entry and analysis. The results are expressed as percentages and proportions.Results: In our study majority of the interns 66 (64.1%) had normal body mass index (BMI). The practice of non-exercise physical activity is more in female than male interns whereas the exercise physical activity is more in males comparing to female interns.Conclusions: Physical inactivity is an urgent public health priority, so long-term follow-up is needed to identify the factors promoting for the practice of physical activity among medical interns.

Prevalence of impostor phenomenon and its association with self-esteem among medical interns in Goa, India

Background: Imposter phenomenon (IP) is an internal experience of intellectual phoniness that those who feel fraudulence and worthlessness have in spite of outstanding academic or professional accomplishment. It is desirable for Medical students and interns to have high self-esteem and low impostor characteristics in order to become successful medical practitioners. This study was carried out among the medical interns of a tertiary care medical college, to determine the prevalence of Impostor Phenomenon and its association with self-esteem.Methods: The present cross-sectional study was conducted among 150 medical interns. Clance’s impostor phenomenon scale and Rosenberg self-esteem scale were used to assess Impostor characteristics and self-esteem respectively. Data was collected using online survey method.Results: The majority (44.7%) of study participants had moderate IP characteristics, followed by 41.3% with high IP characteristics. Hours of sleep was found to be significantly associated with IP characteristics (p value<0.001). Self-esteem was found to be significantly and inversely correlated with age (r=-0.222), and positively correlated with hours of sleep (r=0.225). Impostor phenomenon and self-esteem were found to be moderately and inversely correlated (r=-0.519).Conclusions: A large number of medical interns were found to have high impostor phenomenon characteristics and low self-esteem. Impostor characteristics were found to be significantly associated with sleep, suggesting a relationship between feelings of fraudulence and skewed sleep patterns. A significant negative correlation between self-esteem and impostor phenomenon suggests that individuals with stronger IP characteristics had lower self-esteem, and vice versa. Low impostor phenomenon characteristics and high self-esteem are favourable for efficient medical practice. Measures to increase level of confidence and self-esteem among medical students and interns should be implemented.

Knowledge about epidemiological determinants of rabies and its prevention amongst medical interns of Marathwada region of Maharashtra, India

Background: Rabies is one of the most important zoonotic diseases in India. About 99% of all human deaths from rabies occur in the developing nations. Dogs are the main reservoir of rabies in India. It is invariably fatal if proper treatment is not instituted promptly. One of the important factors associated with successful treatment is the knowledge of the caregiver in the proper management of animal bites and rabies vaccination. Hence the present study was conducted to assess the knowledge about epidemiological determinants of rabies & its prevention amongst medical interns.Methods: A cross-sectional study was carried out amongst 76 interns of a Private Medical College in Marathwada region of Maharashtra during the period of September to October 2018. Pre-designed, pre-structured questionnaire was used for data collection. Data was entered in MS Excel sheet and analyzed accordingly.Results: Out of 76 interns, there were 36 (47.3%) males and 40 (52.7%) females. Majority 61(80.3%) were Muslims followed by 14(18.4%) were Hindus. About 68.4% interns correctly knew that the route of administration of vaccination could be either intra-muscular or intra-dermal (p=0.0220). About 1/4th i.e. 25% interns didn’t know about incubation period of rabies in human (p=0.0079). However, 29(38.2%) interns didn’t know about exact site of administration of rabies immunoglobulin is at wound site.Conclusions: The present study concluded that there were significant gaps in the knowledge about prevention of rabies which needs to be overcome immediately with proper training

A Study to assess the prevalence of Depression, Anxiety and Stress among Interns across the State of Maharashtra, India

Background and Objectives: The primary objective of this study was to determine the prevalence andseverity of Depression, Anxiety and Stress among Interns in Medical Colleges and associated hospitalsacross Maharashtra and to identify the associated factors responsible for the same. The secondary objectivewas to correlate the prevalence of this psychological morbidity with their life style and the probablestressors experienced by them in the course of internship.Methods: This study is an Observational, Cross-Sectional, Questionnaire Based Study which wasconducted online with a sample of 362 interns. The data obtained was entered using Microsoft Excel 2013and analyzed using SPSS 16.0 Software. The Pearson chi square correlation test was used to find out theassociation of various personal and life-style related factors with the levels of depression, anxiety and stressamongst the respondents.Results: Amongst the total respondents, the prevalence of depression, anxiety and stress was found to be59.70%, 63.03% and 38.79% respectively. Many factors specific to the course of internship were found tohave a statistically significant correlation with high prevalence and severity of mental disturbances in theinternsConclusion: There is a very high prevalence of depression, anxiety and stress among interns working inMaharashtra which needs to be effectively dealt with on an urgent basis. The strong association of theprevalence of psychological illnesses with many factors and stressors faced by them will help us highlightthe contributory factors and suggest strategies to deal with them effectively at a personal, institutional andnational level.

A comparative study on positive mentalities between the only-child medical interns and the non-only-child medical interns in a Chongqing hospital / 中华医学教育探索杂志

Objective To investigate the group characteristics of positive mentalities between the only-child medical interns and the non-only-child medical interns in different birth order.Methods By cluster sampling method,Positive Mentalities Scale for university students was applied to test 194 medical interns who enrolled in a Chongqing hospital in 2015 to obtain the score of positive psychological quality of medical students.Descriptive statistics and variance analysis were conducted using SAS 8.2.Results The total scores of the only-child interns' positive mentalities were significantly higher than those of the firstborn interns[(97.26 ± 11.04) vs.(92.30 ± 12.84),P=0.010].The scores of the study-loving factor from high to low were listed as follows:the only-child interns,interns born in other birth order,interns who were the youngest children in the family,and the firstborn interns.Meanwhile,statistical difference was found in those (P＜0.05).The team-spirit factor scores of the interns who were the youngest children in the family were significandy lower than those of others (P＜0.05).All the scores concerning self-discipline factor were relatively low.All the scores of self-discipline factor,modesty factor and thanks-giving factor had no statistical difference (P＞0.05) between the only-child interns and the non-only-child interns.Conclusion The positive mental development of the only-child interns are superior to that of the firstborn interns.The training of positive mentalities of the firstborns and the youngest children in family should be paid attention to and the training of self-discipline should be strengthened among all medical interns.

The correlation between communication skills attitude and general self-efficacy among medical in-terns / 中华医学教育探索杂志

Objective This study is to explore the correlation between communication skills attitude and general self-efficacy among medical interns. Methods Medical intern students of three medical colleges in Shanghai were participated in this study, and questionnaire survey was conducted by cluster sampling of class. SPSS 19.0 was used to process descriptive analysis, t-test, F-test, correlation analysis and hierarchical regression analysis for data analysis. Result 600 questionnaires were handed out and 575 valid samples were collected. The effective rate was 95.83％. The mean score of positive and negative attitude dimension in CSAS were (51.880 ±7.003) and (31.550 ±5.839). The mean score of GSES was (26.230 ±4.820). A positive correlation was found between positive attitude of communication skills and general self-efficacy (r=0.165, P<0.01). Hierarchical regression analysis indicated that school, cognition about importance of com-munication skills and general self-efficacy significantly predicted positive attitude of communication skill.These three variables could explain 21.8％ of total variance and general self-efficacy can explained 2.1％after control other variables. Conclusion Communication skills attitudes of medical interns is positive on the whole. Enhancing their general self-efficacy is beneficial to improving their positive attitude towards communication skills.

Analysis of Present Situation on Medical Interns' Medical Ethics Education and Its Countermeasure / 中国医学伦理学

From the concept of medical ethics,combined with the relationship between medical ethics education and medical intern,this paper faced up to the present situation of medical ethics education of clinical medical interns,analyzed the reasons of problems mainly involved the values,subjective initiative of medical interns and the degree of recognition and direction of the hospital and teachers and put forward that it should take more measures to strengthen the medical ethics education of medical interns from three aspects of medical interns,hospital and teachers.

The key points in inquiry training under different scenes in diagnostics / 中华医学教育探索杂志

Inquiry is the main method of history taking. The training should not be limited to the medical inpatients inquiry. Different training scenes should be taken. The outpatient history inquiry needs a similar clinic room and set time limit, and focuses on key point history inquiry as well as document writing. Some principles in emergency inquiry are introduced, such as SAMPLE principle. The key points of inquiry of different patients including elderly patients, child patients, traumatic patients and drug addiction patients are also introduced. Through the combination of theory and practice mode, the group discussion and role-play, different scenes design and standardized patients application, reasonable design of teaching hours and content distribution, as well as feedback in time, optimal teaching effect can be finally achieved.

La confrontación de la sexualidad en la práctica profesional de los futuros médicos: la mirada de los pasantes de medicina / The confrontation of sexuality in the professional practice of future physicians: the viewpoint of medical interns

El tema de la sexualidad en las instituciones académicas y de servicios se enmarca en perspectivas predominantemente biológicas, desdibujando la subjetividad inmersa en procesos sociales y culturales. Los significados construidos por el personal de salud en torno a la sexualidad impactan su formación y desempeño profesional. Se realizó una investigación cualitativa sobre el significado de la sexualidad en jóvenes pasantes de medicina de la Universidad Autónoma Metropolitana-Xochimilco, entrevistándolos porque sin ser titulados ejercen una práctica profesional autónoma e independiente como parte de su servicio social en comunidades rurales. Al analizar la información con base en la teoría fundamentada emergieron tres dicotomías: biológico-construcción-social; individuo-profesional y aprendizaje teórico-vivencias en la comunidad; estas evidencian el antagonismo del conocimiento adquirido durante su formación universitaria con énfasis biológico y los obstáculos para responder a las demandas de salud sexual y reproductiva de la población que atienden. Ellos se reconocen carentes de habilidades para enfrentar estos tópicos en su práctica profesional. Es relevante integrar la perspectiva subjetiva de este tema en los programas de las licenciaturas del área de la salud.

The subject of sexuality in academic and service institutions is perceived through predominantly biological conceptual perspectives, blurring the subjective component that is imbued in social and cultural processes. The meanings that medical staff construct around sexuality have implications in their professional development and practice. This work presents results from a qualitative study into the meaning of sexuality among medical interns from the Universidad Autónoma Metropolitana-Xochimilco. In-depth interviews were conducted with students during their community service. This group was selected because they had finished their studies and were performing an independent and autonomous professional practice. The results, which were analyzed based on Grounded Theory, revealed three dichotomies: biology vs. social construction, individual vs. professional and theoretical learning vs. experiences in the community. The most relevant aspect revealed was the antagonism found between a medical intern's biology-centered academic knowledge and the challenge posed by their patients' reproductive and sexual health needs. The interns recognize that they lack the necessary skills to face issues of sexuality in their professional practice.

Exploration on approaches to improve quality of lemology practice of medical interns / 中华医学教育探索杂志

Medical interns’ indifferences to clinical practice of lemology and changes in infec-tious disease spectrum were analyzed at present. Practical applicability of lemology knowledge should be defined clearly for medical interns in entrance education. Concepts of disinfectant and isolation should be enhanced. Clinical competence,communication skill with patients and medical ethics of medical interns should be cultured in order to achieve better clinical practice and teaching effect.

Investigation on the rusuits of implementing the tutorial system for medical interns / 中华医学教育探索杂志

ObjectiveTo analyze the results of implementing the tutorial system for medical interns, and to put forward some suggestions. MethodsThe medical interns and the doetors selected as tutors were asked to do questionnaires to study the tutorial system's feasibility and effectiveness. Simultaneously, we adopted the Objective Structured Clinical Examination ( OSCE ) to assess its process and resuits. Results74.3％ of the students and 75.5％ of the doctors think that they need the tutorial system,73.2％of the students think that this system can train better clinical skills,67.9％ of the doetors think that they can review the knowledge learned through teaching. Implemented after one year, students' OSCE scores are improved. ConclusionTutorial system for medical interns has achieved preliminary success, and the preparatory work and related-system building need to be further improved.

To explore the experience of clinical teaching in gastrointestinal surgery based on the expectations of medical interns / 中华医学教育探索杂志

The periods of the medical students' clinical practice is an important transition from medical theory to medical practice.According to the medical interns' expectations,such as the clinical tutor' level,hardware of the department,daily medical process and our department' s experiences,we grope for much better teaching methods that can meet medical interns' expectations and evaluate the new teaching methods.The basic clinical skills of medical students and the teaching level of gastrointestinal surgery department have been effectively improved.

Enhancing medical ethics to foster highly qualified stomatologist / 中华医学教育探索杂志

Medical ethics is the standard ofbehavior toadjust the relationship between medical personnel and patients,medical personnel,medical personnel and society.It is a general social morality in medical field in special performance.Teachers should carry through the ethics education to the end,making students smoothly enter society from the school,cultivating good ethics during the process of learning basic knowledge of oral cavity,and developing high-quality oral physicians for our country.

Comparing resident physicians', post-graduate interns' and medical intern's knowledge, perceptions, beliefs & attitudes towards death and dying at the Vicente Sotto Memorial Medical Center, 2001

OBJECTIVE: This study aims to determine the difference in the beliefs, attitudes, knowledge about death and dying, as well as the perception of physicians responsibility towards the dying patient among the medical interns, post-graduate interns (PGI), and resident physicians of Vicente Sotto Memorial Medical Center (VSMMC). METHODOLOGY: A total of 45 respondents were randomly selected, with each group residents, PGIs and interns- having 15 respondents each. This survey used a 4 part self-administered questionnaire, which was given and collected on the same day. Analysis of variance (F value) was used in determining if there was a statistically significant difference among the 3 groups. RESULTS: Majority (91.1%) of the respondents believed in life after death while 8.9 percent did not believe in life after death. Majority (80%) of the respondents had a positive attitude towards death, while 20 percent had a negative attitude toward death. About a third (64.4%) of the respondents were able to give the correct sequence of the stages of death and dying as described by Kubler-Ross. On the 10-item quiz identifying each stage of death and dying the mean scores were as follows: residents = 8.13, PGIs = 8.33, and medical interns = 7.6. Majority of the respondents either strongly agreed or agreed with the statements identifying the responsibilities of the physician to a dying patient, but one statement about the doctors role in giving hope to a dying patient caused some uncertainty among the interns. Analysis of variance showed that the respondents beliefs in life after death, attitudes toward death, and knowledge about the stages of death and dying did not differ significantly.                                                                                                                               CONCLUSION: The VSMMC residents, PGIs, and medical interns believe in life after death, have a positive attitude towards death, have an adequate knowledge on the stages of Death and Dying as well as have a generally good grasp of the physicians responsibilities to the dying patient.