Causal attributions of failure among post graduate medical residents in exit fellowship examination in Pakistan: A qualitative study.

Background and Objective: Causal attributions are reasons given to certain events in life including failure and success. The objective of this qualitative study was to explore the attributions perceived as the cause of failure by post graduate residents, failing the final clinical exit examination of Fellowship of College of Physicians and Surgeons Pakistan (FCPS). Methods: This exploratory study was conducted from July 2021 to July 2022, at Jinnah Hospital, Lahore. Study population was selected by purposeful maximal variation sampling. A total of ten post graduate residents from four specialties, failing in FCPS part two clinical examination were included. After written informed consent, semi structured face to face, in depth interviews were conducted. Data saturation was achieved after eight interviews after which two more interviews were carried out. All interviews were recorded and transcribed verbatim. Thematic analysis of the data was done by synthesizing codes into categories and themes. Results: A total of 17 attributions noted were grouped into five categories namely 'Inadequate exam preparation', 'Personal factors,' 'Exam related factors,' 'Training related factors and 'Luck'. Two main themes of External and Internal factors emerged from these. Common attributions were; lack of effort (8/10), inadequate knowledge (8/10), family commitments (7/10), luck (8/10) and examiner's attitude (5/10). Conclusions: Most of the residents attributed internal, unstable and controllable factors like inadequate knowledge and lack of effort. In addition, external uncontrollable factors of bad luck and harsh attitude of examiners were considered as contributory factors towards failure.

To be or not to be an Obstetrician / Gynaecologist.

OBJECTIVES: This qualitative study aimed to explore motivational sources of physicians, at the time of selection and while pursuing ObGyn career. Secondary aim was to explore challenges and strategies adapted by these physicians to overcome these challenges. METHODS: This is qualitative study with constrictive worldview. ObGyn residents and consultants of Aga Khan University, Karachi, were interviewed from July 2017 till Jan 2019, after ethical approval, using purposeful maximum variation sampling. Analysis were conducted by identifying keywords and phrases, these unedited verbatim with no assumptions provided basis for codes, which then clustered as trends. Emerging findings were discussed among authors and themes were finalized with consensus. Conclusion was formulated by linking these themes. RESULTS: Four themes emerged were, 'grounds for selecting ObGyn as career', 'Motivational Factors', 'Demotivating Factors' and 'Strategies to Cope with Challenges'. Results showed that aptitude and passion not only have pivotal role in career selection but also helped in pursuance. Personal fulfilment and hands-on experience satisfy emotional needs, while family and friends supported participants in maintaining work-life balance and in over-coming challenges. CONCLUSIONS: Considering personal preference and aptitude at the time of career selection helps in endurance and keep motivations high, while challenges in pursuance can be overcome by strong support system.

Non-technical skills training to enhance performance of obstetrics and gynaecology residents in the operating room.

The importance of incorporating non-technical skills in surgical training cannot be understated, however, these remain non-core components of training. The aim of our study was to evaluate the effectiveness of a training course in improving residents' non-technical skills performance in the operating room. Twenty-eight eligible Obstetrics and Gynaecology residents were divided into conventional and experimental groups by using blocked randomisation. The experimental group received a training course comprising of 20 h over 5 weeks as an educational intervention. A blinded assessor assessed non-technical skill performance by using non-technical skill for surgeons rating system while performing two procedures evacuation and curettage and elective caesarean section in pretest and post-test phase. The post-test results of experimental training group improved significantly in all four categories: situational awareness, decision-making, communication and leadership than the conventional training group demonstrating the effectiveness of a training course. Participants found the course useful and relevant to their practices and strongly recommended the incorporation of similar courses in early years of training. Impact Statement What is already known on this subject? Operating room is the mainstay of surgeons and the majority of the studies done in the operating room relate to structured courses to teach residents about non-technical skills, with training and evaluation done on the same day. These either explores the perception of trainees, expansion of the cognitive component and/or feasibility of training for non-technical skills. To date, there is a lack of evidence in the literature to address questions regarding the appropriate time to incorporate non-technical skills in the curriculum, due to study designs. This highlights the need for more randomised control trials with different curricular designs to evaluate effectiveness. What do the results of this study add? The results of our study enable a comparative analysis between learning curves of conventional training, with the experimental group demonstrating the effectiveness of a training course. This strongly supports implementation of non-technical training in postgraduate competency-based curricula. What are the implications of these findings for clinical practice and/or further research? This study shall be used as an evidence-based source to design curricula for teaching non-technical skills to residents.

Developing an Assessment-of-Clinical-Exodontia-Skills (ACES) Rating Scale for Undergraduate Dental Students.

OBJECTIVE: To develop assessment-of-clinical-exodontia-skills (ACES) rating scale for formative and summative assessment of undergraduate dental students performing exodontia. PLACE AND DURATION OF STUDY: Faisalabad Medical University, Faisalabad, from May 2017 to February 2018. METHODOLOGY: A preliminary scale was developed using literature search and informal discussion with experts. In the first round of Delphi, this scale was emailed to oral surgery faculty across Pakistan. Their opinions were sought and the form was modified accordingly. In the second round, the modified form was emailed again to the respondents of first round and thus the form was finalized by obtaining their comments on the modified form. RESULTS: A preliminary 27-point round-1 questionnaire was sent to 42 experts. Out of these, 30 responded (overall response rate 71.4%) and the form was modified according to their response. Frequency, percentage, and mean of Likertbased responses was calculated along with thematic analysis of individual responses. In round 2, the modified form was sent to the 30 respondents of round 1. Out of these, 21 replied (response rate 70%) and form was further modified accordingly. In round 2, primary focus was on marking/scoring strategy. CONCLUSION: ACES form was developed, which can be important tool in assessing exodontia skills of undergraduate dental students. This needs practical application and testing for validity.

Developing professionalism: dental students' perspective.

OBJECTIVE: To explore the undergraduate dental students' insight of their professionalism development through Focus Group Discussions (FGD). STUDY DESIGN: Constructivist approach using qualitative phenomenological design. PLACE AND DURATION OF STUDY: Fatima Memorial Hospital, College of Dentistry, Lahore, from April to June 2011. METHODOLOGY: Four FGDs of 1st year (8 students), 2nd year (6 students), 3rd year (6 students) and 4th year (6 students) enrolled in Bachelor of Dental Surgery (BDS) program were conducted to explore how they have developed various elements of professionalism namely altruism, accountability, excellence, duty and service, honor and integrity, and respect for all; and how professionalism can be further developed in them. The FGDs were audio taped, transcribed and analyzed through thematic analysis. Triangulation of themes and trends were done through content analysis by relating to their respective frequency of quotes. Data verification was done through audit by second author. RESULTS: Role models and social responsibility were the main reasons in the students' professionalism development thus far with personal virtues and reasons; religion; and punishment and reward contributing to a lesser degree. Training contributed least but was deemed most in furthering professionalism. Excessive workload (quota) and uncongenial educational environment were considered detrimental to the cause. CONCLUSION: Formal planning and implementation of professionalism curriculum; selection of students with appropriate attributes; control of hidden curriculum, including effective role models, good educational and working environments will foster professionalism among dental students maximally.

Odontogenic cervical necrotizing fasciitis.

Two cases of cervical necrotizing fasciitis, secondary to dental infection, are presented. It is a potentially life-threatening severe mixed infection with rapidly progressive inflammation and necrosis of the fascia, muscle and fat. Laboratory and CT features are described. CT scan was also useful for progress monitoring during the treatment. Both cases were complicated by mediastinitis with pleural effusions. A successful non-fatal outcome was achieved following multiple surgical interventions, aggressive culture based antimicrobial therapy, multi-specialty approach and intensive supportive care of the patients.