Medical students' perception and attitudes on operating theatre learning experience in Sri Lanka.

Objective: The operating room is a unique learning experience that has visual, aural, kinesthetic learning stimuli and provides benefits to the medical students such as development of sound clinical knowledge and skills, and gaining personal insight into ones' career choice. However, this can be a challenging place due to the unfamiliar learning environment. We aimed to study the Sri Lankan Medical students' perception and attitudes on operating theatre learning experience. Design and setting: A descriptive cross-sectional survey was carried out among medical students undergoing surgical clinical training on the perspectives of the teaching and learning experience in the operating theatre in Sri Lanka. Participants: Our study group consisted of 390 medical students from four different medical faculties in Sri Lanka representing all levels of surgical clinical rotations. Results: A majority of the students had actively participated in the operating theater. Despite this, the students' clarity of the learning outcomes and expectations in a theatre varied greatly. Majority of the students felt that the surgeons were willingly to teach but also noted that there was no standardization in teaching. This study clearly shows a significant correlation between positive emotions and surgical teams welcoming attitude towards the medical students. Long standing hours were considered a negative emotion by a majority of students. We also observed that theatre environment can be physically and mentally exhausting. Conclusions: Thus, empathy, feeling welcome and giving breaks to refresh can go a long way in making the learning experience better. Regular feedback to trainers on students' perception of the theatre experience is important to value the students' opinion and improve the quality of the surgical theatre. We strongly recommend initiation of clear induction sessions with introduction of well-structured teaching learning activities in the operating theatre.

Breast cancer in lactating mothers: A case series of delayed diagnosis.

INTRODUCTION AND IMPORTANCE: Due to pregnancy related changes in the breast, a breast feeding mother as well as the health care professionals may attribute a change in the breast for lactation resulting in a delay in evaluation and diagnosis. We report a cases series of delayed diagnosis of breast cancer during lactation in three young patients from a developing country who had sought medical attention on time but was unfortunately diagnosed late. PRESENTATION OF CASE: We report three breast feeding mothers aged 38-39 years presenting with breast lump and edema. All patients had an ultrasonography of breast performed at least once and the radiological findings were attributed to physiological changes initially despite non-resolving symptoms for 3-4 months. Triple assessment revealed invasive breast cancers of T4N1M0, T2N1M0, T3N2M1 staging. Two patients were treated with a curative intent and the patient with metastatic cancer was referred for palliative chemotherapy. CLINICAL DISCUSSION: Lactational mastitis, breast abscesses, galactoceles, breast edema are benign conditions that are unique in lactation period, but it is important not to overlook that the lactating women may develop any of the other breast problems seen in the non-lactating female population. CONCLUSION: Our case series represent very similar scenarios of delayed or missed diagnosis of breast cancer in young lactating women. A lactating patient should be referred to a specialist center and/or a complete assessment of the breast should be performed in case of any red flags findings to avoid missing a sinister diagnosis.