CPSP/HSE postgraduate overseas rotational programme: residents' perspective

Objective: to get direct upward feedback from the residents of first batch of CPSP/HSE Postgraduate Scholarship Programme

Study Design: mixed methods qualitative research study

Place and Duration of Study: CPSP, Regional Office, Lahore, in June 2015

Methodology: it is a mixed-method study that was conducted in June, 2015. Data was collected through an email survey with 33 medical residents doing their rotation in Ireland; and focus group discussions were carried out with 8 residents, who had successfully completed their rotation. Data were collected through pre-designed questionnaires comprising of open- and close-ended questions. The data were entered into SPSS version 21 and analyzed

Results: the mean age of residents was 29.9 +/- 1.1 years, 7 [21.2%] were females and 24 [72.7%] respondents were males. Residents agreed that HSE programme has improved their evidence-based decision making [mean score of 3.3 +/- 1.2] and enhanced professionalism [mean score of 3.6 +/- 1.1]. They disagreed that training has polished their procedural skills [mean score 2.4 +/- 1.2]. The identified strengths of the programme are: adopting a systematic approach towards patients, evidence-based decision making, better exposure and opportunities, financial stability and development of communication skills. The weaknesses are: less exposure to procedural skills, difficulty in synopsis and dissertation writing and difficulty in adjustment with rotational schedules

Conclusion: residents of CPSP/HSE Programme believed that CPSP/HSE has improved their professionalism, communication skills and increased their future opportunities for career growth. Better communication between CPSP focal person and residents will help sort out many minor but important issues

Mortality prediction in patients admitted in surgical intensive care unit by using APACHE IV

Objective: To predict the mortality by the mean Acute Physiology and Chronic Health Evaluation [APACHE] IV score of all the patients admitted in a Surgical Intensive Care Unit [ICU] and comparing the score of the survivors and non-survivors

Study Design: Descriptive study

Place and Duration of Study: Surgical Intensive Care Unit, Mayo Hospital, Lahore, from June 2013 to November 2014

Methodology: All adult patients admitted in the Surgical ICU were included in this study. The demographics and other data of the patients were recorded. The APACHE IV scores of all patients were calculated at the time of admission. The scores of the survivors and the non-survivors were compared for prediction of survival and mortality

Results: The age of these patients ranged from 13 to 70 [mean 38.39] years with 86 [55.48%] males and 69 [44.52%] females. The mean APACHE IV score of these patients was 34.96 +/- 14.93 ranging from 11 to 63 years. Eighty-three [53.55%] patients survived and 72 [46.45%] died. With respect to gender, 41 [47.67%] males out of 86 and 31 [44.92%] females out of 69 did not survive. The mortality increased with an increase in APACHE IV score and all the patients with score more than 39 did not survive

Conclusion: The predicted mortality can be assessed by APACHE IV score, so it is good for application among the surgical ICU patients

E-Log system in monitoring of residency program: trainees' perspective

To record residents' perspective about the utility of newly introduced E-Log system at the College of Physicians and Surgeons Pakistan [CPSP]. Sequential mixed method design using survey questionnaire and in-depth interviews. CPSP, Regional Center, Lahore, from March to June 2014. Data was collected from registered trainees through a web-based survey questionnaire on a scale of 1 to 7 about the utility of E-log system. In-depth interviews were conducted with 7 students using non-probability purposive sampling. The interviews were tape recorded and subsequently transcribed. Quantitative data was analyzed using SPSS version 20 and qualitative data was analyzed using content analysis by identifying themes and patterns. A total of 4399 responses were received. Motivation was 4.61 +/- 1.98; 4.33 +/- 2.00 remained acknowledgment of control of one's training by the new system. Ease of use got a mean score of 4.56 +/- 2.15. The overall acceptance of the students regarding E-Log system was high. Scheduling IT workshop at the start of training will add to the student satisfaction regarding utility of E-Log system

Postgraduate trainee performance with structured assessment techniques in competency-based model of training

To determine the effect of changes in curriculum and structured assessment on the performance of candidates at the end the first phase of residency program by comparing pass percentages of candidates with older residency program. Interventional study. From 2007 to 2009 at the College of physicians and Surgeons Pakistan. Results of midterm assessment [intermediate module, IMM] for the years 2006-2007 [Historical group] in 9 specialties were compared with those of years 2008-2009 [Interventional group] after implementation of curricular changes. The changes were evaluated with structured assessment technique. Results for the IMM exams for years 2006 to 2009 were included in the study. Percentage changes in results of both groups were subjected to statistical analysis. The average pass percentage for theory examination in the Historical group was 52.6% +/- 13.87, and 59.96 +/- 14.88 in Intervention group. The pass percentage in old-residency program for the clinical examination was 61.6% [ranging from 48.0% to 78.4%] which was less when compared with the new residency system that was 73.9% [ranging from 61.55 to 82.45%]. The curricular changes and structured assessment at set competency standard resulted in better performance and higher pass percentages of candidates of midterm assessment

Stray bullet in inferior vena cava

A young boy presented in emergency with history of being hit by a stray bullet injuring the right hypochondrium. Ultrasound of abdomen showed hemoperitoneum and the radiograph showed bullet in the pelvis. Exploratory laparotomy showed injuries to liver and cystic duct with tract leading retroperitoneally into the inferior vena cava. The bullet was found wandering inside the vena caval lumen. Stray bullets are presumed to remain limited to the soft tissues. However, the trajectory, impact velocity and the involved region ultimately determine the outcome and influence management