Disparities in critical care resources across Pakistan – findings from a national survey (preprint)

Background: In response to the COVID-19 pandemic, concerted efforts were made by provincial and federal governments to invest in critical care infrastructure and medical equipment to bridge the gap of resource-limitation in Intensive Care Units (ICUs) across Pakistan. An initial step in creating a plan towards strengthening Pakistan’s baseline critical care capacity was to carry out a needs-assessment within the country to assess gaps and devise strategies for improving the quality of critical care facilities.  Methods: To assess the baseline critical care capacity of Pakistan, we conducted a series of cross-sectional surveys of hospitals providing COVID-19 care across the country. These hospitals were pre-identified by the Health Services Academy (HSA), Pakistan. Surveys were administered via telephonic and on-site interviews and based on a unique checklist for assessing critical care units which was adapted from the Partners in Health 4S Framework, which is: Space, Staff, Stuff, and Systems. These components were scored, weighted equally, and then ranked into quartiles.  Results: A total of 106 hospitals were surveyed, with the majority being in the public sector (71.7%) and in the metropolitan setting (56.6%).  We found infrastructure, staffing, and systems lacking as only 19.8% of hospitals had negative pressure rooms and 44.4% had quarantine facilities for staff. Merely 36.8% of hospitals employed accredited intensivists and 54.8% of hospitals maintained an ideal nurse-to-patient ratio. 31.1% of hospitals did not have a staffing model while 37.7% of hospitals did not have surge policies. On chi-square analysis, statistically significant differences (p<0.05) were noted between public and private sectors along with metropolitan versus rural settings in various elements. Almost all ranks showed significant disparity between public-private and metropolitan-rural settings, with private and metropolitan hospitals having a greater proportion in the 1st rank, while public and rural hospitals had a greater proportion in the lower ranks. Conclusion: Pakistan has an underdeveloped critical care network with significant inequity between   public-private and metropolitan-rural strata. We hope for future resource allocation and capacity development projects for critical care in order to reduce these disparities.

A National Virtual Research Training Workshop for 3800 Medical Students: A Mixed-Methods Evaluation of A Novel Research Education Program (preprint)

BackgroundResearch training is necessary to fill the burgeoning global decline in physician-scientists, which is further pronounced in developing countries. This has generated much interest within institutions across the world to increase research exposure for students as part of medical school curricula. In order to produce a cadre of aspiring physician-scientists, the Student Research Forum (SRF) at Aga Khan University conducted a series of online research workshops leveraging innovative technological solutions during the COVID-19 pandemic. Our study aims to explore students’ perceptions of engaging undergraduate medical students in online research training workshops and to evaluate the effectiveness of such interventions in improving the knowledge and skillset of participating students.Methods‘A Beginners Guide to Research’ was a nation-wide virtual research workshop series conducted for medical students across Pakistan in June 2020. A mixed-methods study design was employed to evaluate course efficacy in terms of course content, duration and strategy. Dissemination of quantitative feedback forms alongside simultaneous conduction of qualitative interviews were used to receive feedback for the workshop and obtain the perspectives of medical students on the effectiveness of educational interventions in improving research-related knowledge. ResultsA total of 3,862 medical students enrolled in the national workshop series. The feedback form was completed by 2,754 participants, hailing from 113 universities across 37 cities in Pakistan. 2,311 (84.0%) participants stated that the course helped them improve their overall research knowledge and 2,333 (84.7%) felt confident that the skills learnt would help them in future research projects. 40 participants from 25 institutions across Pakistan participated in the qualitative interviews. 24 (60.0%) participants had no prior knowledge of research, 23 (57.5%) found virtual screen-sharing to be the most useful learning strategy and 22 (55.0%) students expressed interest in initiating/expanding their institutional research platforms.ConclusionThis nation-wide series presented a way in which alternative pedagogies can be used for the dissemination of research knowledge and skills to medical students with a strong inclination towards research. Efforts must be made by institutions to provide opportunities to medical students for engaging in meaningful scientific research during the COVID-19 pandemic and beyond.