Basics of faculty-to-faculty mentoring: A process to identify support and challenges.

Faculty mentoring is relatively new in health sciences literature. Faculty mentors are considered to have multiple roles including being a supervisor, teacher, or a coach. Little or no attention to formal mentoring of faculty allows faculty to seek informal mentoring, creating a risk of unexpected outcome. There is dearth of literature with respect to formal mentoring programs from the subcontinent. Although, informal faculty mentoring has been in place but there is no standard faculty mentorship model to be followed at Aga Khan University Medical College (AKU-MC). An observational study was conducted in September 2021 at AKU MC with convenient sampling to share the perceptions of the AKU-MC faculty mentors in a faculty mentorship workshop so that further advanced level faculty development workshops could be planned in this area. Twenty-two faculty mentors participated to share their perspectives on the responsibilities of faculty mentor, faculty mentee and the institution to see faculty grow and to have a sustainable mentorship programme. Challenges faced by the faculty mentors during the process of mentorship were also discussed. Majority of the participants emphasized on the role of the faculty mentor to be supportive, guiding, reflective and formative (respond to the emotional needs, encourage, effective communication, know own limitations, observe, provide feedback). Faculty mentor role modeling, ability to maintain confidentiality, creating and maintaining mentor-mentee relationship, availability of framework of formal mentoring in an academic institution and opportunities within the academic setting to learn mentorship were the main challenges of being a faculty mentor. The process provided valuable training and education to the faculty for the development and strengthening of formal mentoring program. Faculty recommended that institutions should provide the opportunity for development of junior faculty mentors by organizing capacity building activities.

Assessment of Medical Professionalism: Development and psychometric analysis of Professionalism Assessment Tool (PAT) in Pakistani context using Delphi Techniques.

Objective: This study aims to develop and assess the content validity along with the reliability of a Professionalism Assessment Tool (PAT) with an intention to measure professionalism among undergraduate medical students. Methods: This psychometric analytical study validation study was carried out at Rawalpindi Medical University from 1st February to 1st June, 2021 after establishing feasibility and obtaining ethical approval. The non-probability convince sampling was employed to collect data. Using Nunnally's, the ratio of e subjects per item was selected, as our preliminary tool has 48 items so 384 sample size was estimated for scale validation. The preliminary 48-item tool with five subscales(cSS) developed through mutual consensus by the Delphi technique namely Communication skill(cSS1),-7 item, Accountability(cSS2)-8 item, Altruism(cSS3)-13 item, Self-Directed Learning (cSS4)-10 item and Ethics(cSS5),-10 item was labelled as Professionalism Assessment Tool (PAT). The tool was administered to 4th year MBBS students, the data obtained was analyzed by calculating Cronbach's alpha to estimate the reliability. The SPSS version 26 was used for data analysis. Results: The 48-item PAT had an overall reliability (Cronbach's alpha) of 0.783. The Reliability of the new Subscales were communication skills (0.405), self-directed learning (0.527), Accountability (0.378), Altruism (0.486) and Ethics (0.715). Conclusion: The final tool developed for assessment of professionalism had 48 items on a seven point Likert like scale, across five Subscales. Results showed that it was determined as a useful tool in assessing professionalism in undergraduate medical students to generate reliable results for valid decision-making.

The journeys of three ASPIRE winning medical schools toward excellence in student assessment.

Introduction: ASPIRE Excellence Awards in Student Assessment are offered to medical schools with innovative and comprehensive assessment programmes adjudged by international experts, using evidence-based criteria. The journeys of three ASPIRE-winning medical schools toward "assessment excellence" are presented. These schools include Aga Khan University Medical College (AKU-MC), Pakistan, Southern Illinois University School of Medicine (SIUSOM), USA, and University of Leeds School of Medicine, UK. Methods: The unfolding journeys highlighting achievements, innovations, and essential components of each assessment programme were compared to identify differences and commonalities. Results: Cultural contextual differences included developed-versus-developing country, east-west, type of regulatory bodies, and institutional-versus-national certifying/licensing examinations, which influence curricula and assessments. In all, 12 essential commonalities were found: alignment with institutional vision; sustained assessment leadership; stakeholder engagement; communication between curriculum and assessment; assessment-for-learning and feedback; longitudinal student profiling of outcome achievement; assessment rigor and robustness; 360° feedback from-and-to assessment; continuous enrichment through rigorous quality assurance; societal sensitivity; influencing others; and a "wow factor." Conclusions: Although the journeys of the three medical schools were undertaken in different cultural contexts, similar core components highlight strong foundations in student assessment. The journeys continue as assessment programmes remain dynamic and measurement science expands. This article may be helpful to other institutions pursuing excellence in assessment.

Physical activity levels and their correlates among secondary school adolescents in a township of Karachi, Pakistan.

OBJECTIVE: To determine physical activity level and its correlational factors among secondary school adolescents. METHODS: This cross-sectional study was conducted in two public and two private schools in Jamshed Town, Karachi, from March 2012 to June 2013, comprising students aged 10-17 years. The subjects, selected by simple random sampling were students of grades VI, VII, VIII. Physical activity was measured using the Physical Activity Questionnaire for older children. Socio-demographic data was also collected. SPSS 19 was used to analyse the data. RESULTS: Of the total 216 students, 131(60.6%) were girls and 85(39.5%) were boys, with an overall mean age of 13±1.4 years. Of the total, 151(70%) subjects had moderate and 65(30%) had low physical activity levels. Boys educated in public schools and those with parental support for sports were more physically active (p<0.05). CONCLUSIONS: Private school without playgrounds, female gender and lack of parental support for sports were correlates of physical inactivity among the students..

Chart-stimulated Recall as a Learning Tool for Improving Radiology Residents' Reports.

RATIONALE AND OBJECTIVES: Workplace-based assessments gauge the highest tier of clinical competence. Chart-stimulated recall (CSR) is a workplace-based assessment method that complements chart audit with an interview based on the residents' notes. It allows evaluation of the residents' knowledge and heuristics while providing opportunities for feedback and self-reflection. We evaluated the utility of CSR for improving the radiology residents' reporting skills. MATERIALS AND METHODS: Residents in each year of training were randomly assigned to an intervention group (n = 12) or a control group (n = 13). Five pre-intervention and five post-intervention reports of each resident were independently evaluated by three blinded reviewers using a modified Bristol Radiology Report Assessment Tool. The study intervention comprised a CSR interview tailored to each individual resident's learning needs based on the pre-intervention assessment. The CSR process focused on the clinical relevance of the radiology reports. Student's t test (P < .05) was used to compare pre- and post-intervention scores of each group. RESULTS: A total of 125 pre-intervention and 125 post-intervention reports were evaluated (total 750 assessments). The Cronbach's alpha for the study tool was 0.865. A significant improvement was seen in the cumulative 19-item score (66% versus 73%, P < .001) and the global rating score (59% versus 72%, P < .001) of the intervention group after the CSR. The reports of the control group did not demonstrate any significant improvement. CONCLUSION: CSR is a feasible workplace-based assessment method for improving reporting skills of the radiology residents.

Standard Setting Methods for Pass/Fail Decisions on High-Stakes Objective Structured Clinical Examinations: A Validity Study.

UNLABELLED: CONSTRUCT: Authentic standard setting methods will demonstrate high convergent validity evidence of their outcomes, that is, cutoff scores and pass/fail decisions, with most other methods when compared with each other. BACKGROUND: The objective structured clinical examination (OSCE) was established for valid, reliable, and objective assessment of clinical skills in health professions education. Various standard setting methods have been proposed to identify objective, reliable, and valid cutoff scores on OSCEs. These methods may identify different cutoff scores for the same examinations. Identification of valid and reliable cutoff scores for OSCEs remains an important issue and a challenge. APPROACH: Thirty OSCE stations administered at least twice in the years 2010-2012 to 393 medical students in Years 2 and 3 at Aga Khan University are included. Psychometric properties of the scores are determined. Cutoff scores and pass/fail decisions of Wijnen, Cohen, Mean-1.5SD, Mean-1SD, Angoff, borderline group and borderline regression (BL-R) methods are compared with each other and with three variants of cluster analysis using repeated measures analysis of variance and Cohen's kappa. RESULTS: The mean psychometric indices on the 30 OSCE stations are reliability coefficient = 0.76 (SD = 0.12); standard error of measurement = 5.66 (SD = 1.38); coefficient of determination = 0.47 (SD = 0.19), and intergrade discrimination = 7.19 (SD = 1.89). BL-R and Wijnen methods show the highest convergent validity evidence among other methods on the defined criteria. Angoff and Mean-1.5SD demonstrated least convergent validity evidence. The three cluster variants showed substantial convergent validity with borderline methods. CONCLUSIONS: Although there was a high level of convergent validity of Wijnen method, it lacks the theoretical strength to be used for competency-based assessments. The BL-R method is found to show the highest convergent validity evidences for OSCEs with other standard setting methods used in the present study. We also found that cluster analysis using mean method can be used for quality assurance of borderline methods. These findings should be further confirmed by studies in other settings.

Professionalism in medical students at a private medical college in Karachi, Pakistan.

OBJECTIVE: To determine levels of professionalism in undergraduate medical students at a private medical college and assess how changes emerge during their training. METHODS: The study was conducted at Aga Khan University, a tertiary care teaching hospital, during November and December 2011. Freshmen, Year 3 and Year 5 students were requested to fill out a questionnaire. It was designed to assess the participants' levels of professionalism and how they perceived the professional environment around them by incorporating previously described scales. The questionnaire was re-validated on a random sample of practising clinicians at the same hospital. SPSS 17 was used for statistical analysis. RESULTS: The study sample comprised 204 participants. The mean score for level of individual professionalism was 7.72+/-3.43. Only 13 (6.4%) students had a score one standard deviation above the faculty mean. About 24 (11.8%) were one standard deviation and 35 (17.2%) were 2 standard deviations below the faculty mean. The remaining 130 (63.7%) were >2 standard deviations below the faculty mean. Considering the level of education, the mean score for level of professionalism was 8.00+/-3.39 for freshmen, 6.85+/-3.41 for year 3 students, and 8.40+/-3.34 for year 5 students. CONCLUSION: The currently employed teaching practices inculcating the values of professionalism in medical students are serving as a buffer to maintain the pre-training levels of professionalism from declining.

Faculty and patient evaluations of radiology residents' communication and interpersonal skills.

OBJECTIVE: To assess communication and interpersonal skills (CIS) of radiology residents through faculty and standardised patients (SP). METHODS: In this day-long objective structured clinical examination (OSCE) in January 2009, 42 radiology residents took part at six stations in Karachi, each with a standardised patient and a faculty evaluator. Each encounter lasted 15 minutes followed by independent assessments of the residents by both the evaluators. RESULTS: Based on rating-scale evaluations, all cases had satisfactory internal consistency (Cronbach's alpha 0.6 to 0.9). The alpha values were comparatively diminutive against the checklist scores. Correlation among faculty was 0.6 (p<0.001) with the use of both the checklist and the rating scale. Among standardised patient, intra-class correlation was 0.6 (p<0.001) for checklists and 0.7 (p=0.001) for rating scales. Moderate to strong correlations (r=0.6 to 0.9) existed between checklist and rating scores by the same type of evaluator. Correlations among the faculty and standardised patient using the same assessment tool were unimpressive. CONCLUSION: Both checklists and rating scales can serve as satisfactory assessment tools for communication and interpersonal skills using objective structured and clinical examination with the assistance of faculty and standardised patients.

Association of sociodemographic factors with depression in women of reproductive age.

INTRODUCTION: . Women suffer disproportionately from depression, which has a high prevalence in developing countries. Sociodemographic factors are associated with depression, some of which may be modifiable and lead to better outcomes for depression among women. OBJECTIVES: . To determine sociodemographic factors associated with depression among women of reproductive age in Karachi. METHODS: . A case control study was conducted on 376 women in 2 hospitals in Karachi. Patients were diagnosed by psychiatrists and family physicians by Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria and SRQ20. RESULTS: . The odds for women with depression being married for >5 years, being abused by in-laws, spending ≤3 hours per day with their spouses, and being just satisfied or not satisfied with their married life was more than that for controls. CONCLUSION: . The authors' findings highlight the important modifiable risk factors for depression, which if addressed will help decrease the burden of depression among women.

Problem-based learning: Where are we now? Guide supplement 36.2 - viewpoint.

The educational principles of self-directed, collaborative, and life-long learning can be effectively inculcated into the curriculum where PBL is adopted as a major learning strategy instead of PBL as a whole-curriculum-concept. In developing countries, where the entry level of the majority of students is at the high-school leaving level, a guided discovery model may well be the answer. A curriculum that introduces students to carefully constructed problems sequenced according to a matrix design ranging from simple to complex conditions and according to a logical progression of anatomical and/or physiological and/or pathological and/or pharmacological concepts makes learning easier. Centralized curricular governance, conceptualization and management have a very strong impact on the kind of curriculum, or more specifically which variant of PBL, an institution is able to implement. However, decentralized empowerment of a large number of faculty members is crucial for faculty ownership. A curricular change, especially to PBL from a traditional curriculum, demands adequate preparation time of at least 2-3 years. The time between proposing the change to introducing the change should focus not only on faculty development and training, development of the curriculum and its policies, but also on resource development and preparation of the student body.

Educational models and strategies in health education. Introduction.

INTRODUCTION: Effective facilitation of PBL tutorials requires tutors to develop observation skills, cognitive strategies and motor skills. The initial tutor training workshops at Aga Khan University were geared towards providing an understanding of the theory of the PBL process but not hands-on experience in facilitation. OBJECTIVES: To use structured, small group experiential learning (SSGEL) to enhance skills in PBL tutorial facilitation, with opportunities to practice and provide individual feedback. METHODS: The workshop was structured using Gagne's principles of instruction as a framework, making the learning more experiential and systematic. Cue cards were used with trigger statements related to disruptive behaviors and inappropriate feedback statements from students that commonly occur during PBL sessions, to give tutors an opportunity to handle these simulated situations. OUTCOMES: Analysis of the post workshop evaluation forms provided generally positive feedback from participants on the structure and content of the revised workshop. Participants highlighted the session on PBL experience as highly interactive and rated it as a good learning experience, with an average rating of 4.54 out of 5. CONCLUSION: The structured small group experiential learning exercise provided faculty with an opportunity to practice facilitation skills focusing on developing a standard approach in dealing with common, difficult situations in maintaining group dynamics during a PBL session. The structure of the program was designed to enable participants to better understand the rationale and philosophy of PBL and the curricular change in our school, and to prepare them to serve more effectively as PBL tutors.

Validation of the SETOC instrument -- Student evaluation of teaching in outpatient clinics.

PURPOSE: There is a paucity of evaluation forms specifically developed and validated for outpatient settings. The purpose of this study was to develop and validate an instrument specifically for evaluating outpatient teaching, to provide reliable and valid ratings for individual and group feedback to faculty, and to identify outstanding teachers in that setting. METHOD: By literature reviews and pilot studies at the Faculties of Health Sciences, McMaster University (Canada) and Aga Khan University (AKU-Pakistan), a 15-item instrument, Student Evaluation of Teaching in Outpatient Clinics (SETOC), was created with five subscales: "Establishing Learning-Milieu, Clinical-Teaching, General-Teaching, Clinical-Competence, and Global-Rating." Seven-point Likert-type rating scales were used. Students also nominated three "best" outpatient teachers. PARTICIPANTS: 87 faculty members (79%) rated by all 224 third to fifth-year students (clerks) at outpatient departments of the AKU hospital over a one-year period. ANALYSES: Repeated measures generalizability studies, correlations, concurrent validity of SETOC scores with best teacher nominations. RESULTS: Inter-rater G-coefficient and internal consistency of SETOC student ratings were 0.92 and 0.98. Average inter-item and inter-subscale correlations were 0.79 and 0.86. Comparing SETOC scores against "Best Teacher" nominations, sensitivity, specificity, positive and negative predictive values were greater than 0.84. Student ratings ranged from unsatisfactory (fourteen instructors) to outstanding (four instructors). Mean-scores for Learning-Milieu, Clinical-Teaching and General-Teaching were lower than those for Clinical-Competence and Global-Rating (p=0.000 for all). CONCLUSIONS: The SETOC elicited reliable and valid student ratings that can provide specific feedback to individual faculty with weak or outstanding teaching skills, and identify overall group shortcomings for faculty development.

Case studies in outcome-based education.

Outcome-based education is one of the most significant global developments in medical education in recent years. This paper presents four case studies of outcome-based education from medical schools in different parts of the world; Scotland; USA; Pakistan; and Singapore. The outcome-based curricula have either been in place for some time, are evolving or are at the planning proposal stage. The outcomes, change process and implementation of the outcome-based approach are described. Variation in the extent to which each medical school has implemented outcome-based education is discussed and key points for successful implementation are highlighted. This paper is based on the pre-conference symposium "outcome-based curricula: global perspectives" presented by the authors at the 4th Asia Pacific Medical Education Conference (APMEC) in Singapore, 8-11 February, 2007.