RESUMO
Objective: To determine the postgraduate residents perception of their educational environment. Study Design: Descriptive cross-sectional study
Place and Duration of Study: Armed Forces Post Graduate Medical Institute [AFPGMI] Rawalpindi, in October 2014. The postgraduate training [residency] is being imparted in two military teaching hospitals and nine armed forces clinical institutes affiliated with AFPGMI
Material and Methods: Fifty-six residents enrolled with AFPGMI in various postgraduate training programs were included in this study. Twenty-nine residents were from medical and allied [general medicine, psychiatry, dermatology, rehabilitation medicine, military medicine] and twenty-seven from surgical and allied [general surgery, gynecology, ophthalmology, ENT, pathology, radiology] disciplines. An established instrument Dutch Residency Educational Climate Test [D-RECT] was administered to determine residents' perspective on their learning environment. The survey form of each resident was analyzed to determine overall perception of educational climate addition to detailed analyses of perceptions regarding supervision, coaching and assessment, feedback, teamwork, peer collaboration, professional relation between consultants, adaptation of work to residents' competence, role of consultants, formal education, role of specialty tutor/supervisor and patient sign-out. Descriptive and inferential statistics were applied on the data to draw interpretations using SPSS Version 20.0
Results: Overall 64% of residents had positive perception of learning environment. Except 'feedback that was perceived more negative [50%] than positive [32%], other elements perceived positively but having notable negative perception [mean score of less than 3.6 on Likert scale] included work adaptation to residents' competence [25%], coaching and assessment [23%], role of specialty tutor/supervisor [23%] and patients' sign-out [21%]
Educational climate perception by residents in [medical and allied] versus [surgical and allied] disciplines did not reveal any statistically significant difference [p-value > 0.05]
Conclusion: The study highlights an overall positive learning climate at Armed Forces Post Graduate Medical Institute, but finds a need to provide regular structured feedback to residents during their training. To accomplish this end, periodic use of workplace based assessment tools is suggested
RESUMO
To report experience with minimally invasive plate osteosynthesis [MIPO] for comminuted distal tibia fractures with specific reference to fracture union, complications encountered and functional outcome. Descriptive case series using purposive non-probability convenient sampling. Study was conducted in the Department of Orthopaedic Surgery at Combined Military Hospital Multan and Muzaffarabad from March 2006 to October 2010. Twenty three patients underwent MIPO for comminuted distal tibial fractures. Fractures were classified according to AO system. Open fractures were graded using Gustilo and Anderson classification. A 4.5mm Narrow Dynamic Compression Plate [DCP] was used for fixation in 16 cases whereas 7 fractures were fixed with 4.5mm Narrow Locking Compression Plate [LCP]. Post-operative clinical and radiological assessment was done at monthly interval until radiological union and three monthly thereafter. The minimum follow-up period was eight months with a mean of 18 +/- 4.1 months. Functional outcome was assessed in each case at final follow-up. There were 16 males and 7 females with mean age of 30.3 +/- 9.2 years. Radiological and clinical union was achieved in all cases. Twenty one cases [91.3%] achieved union [primary] at mean of 17.5 +/- 2.6 weeks whereas two cases [8.7%] required augmentation cancellous bone grafting before achieving union [secondary] at mean of 33 +/- 2.8 weeks. Unsatisfactory radiological alignment [Coronal > 5[degree]/ Sagittal > 5[degree]] was observed in one [4.3%] case. There was one [4.3%] case of infection treated successfully with antibiotics. Single screw breakage was seen in 2 cases where conventional DCP had been used for fixation but neither led to loss of position nor affected the outcome adversely. Functional results were "excellent to good" in 91.3% cases and fair in two cases. MIPO may be used successfully for treatment of high-energy peri-articular distal tibial fractures. The approach aims to preserve bone biology and minimize surgical soft tissue trauma. The technique certainly provides an answer to treat this challenging group of fractures.