Intrinsic motivation between face-to-face and blended learning in surgical clinical education.

Objective: The variability and opportunistic nature of surgical clinical education is the main problem for effective teaching and training of medical students. Incorporating online mediums including discussion forums, interactive videos/scenarios, static pages, and quizzes is known as blended learning (BL). This study aimed to compare the intrinsic motivation of surgical students enrolled in blended learning to those enrolled in face-to-face teaching (f2f teaching). Methods: A quasi-experimental, cross-over study was conducted in Surgical Unit-I and Surgical Unit-II of Dow University Hospital, Karachi, from March to August 2014. A total of 31 students participated and were exposed to two different teachings. For the first four weeks, Group A was posted in Surgical-I (f2f teaching) and Group B in Surgical-II (BL). Both groups were taught the same contents with the same schedule. The F2F group had clinical exposure to real patients, and small group discussions (SGDs) while The BL group students were exposed to an additional online learning component. Intrinsic Motivation Inventory (IMI) was administered at the end of four weeks and groups were swapped. Exchanged groups were again taught the same contents with the same schedule for another four weeks and IMI was administered. Results: Fifty-eight students completed IMI; 28 in f2f and 30 in BL group. There was a significant difference in all four subscales of IMI between the two groups. In three subscales, students in BL were more motivated as compared to f2f (p<0.01). Students in f2f experienced more perceived tension than in BL (p<0.048). Conclusion: This study concluded that blended surgical learning programs keep medical students more intrinsically motivated to learn. By utilizing online learning, superior educational opportunities for students can be cultivated. It can result in enhanced faculty effectiveness and efficiency as well.

Bioequivalence assessment of two Ticagrelor formulations under fasting condition in healthy Pakistani subjects.

Objective: To investigate the Bioequivalence of Anplag® 90mg (Ticagrelor) tablet and Brilinta® 90 mg (Ticagrelor) tablet under fasting conditions in healthy Pakistani subjects. Method: This was an open-label, cross-over, randomized, single-dose, two-period, single-center Bioequivalence Study conducted at Center of Bioequivalence Studies and Clinical Research (CBSCR), ICCBS, University of Karachi, Karachi, Pakistan from September 2020 to January 2021. This was an open-label, randomized, single-dose, two-period, cross-over Bioequivalence Study. After randomization, a single dose of Ticagrelor 90mg tablet (test or reference drug) were administered orally in 1:1 ratio to each subject under fasting conditions. Seven days washout period was kept between the two periods in order to avoid carry over. Blood samples were then taken up to 48th hours post-dose. Point estimates and 90% confidence intervals (CI) for the ratio of the log-transformed values were calculated. Bioequivalence assessment of both, the reference and the test drugs were based on the primary Pharmacokinetic PK metrics including peak maximum concentration (Cmax), area under the curve (AUC) from zero to last quantifiable concentration (AUClast), and AUC from zero to infinity (AUCtotal) after log-transformation of data with ANOVA. In this bioequivalence study, the primary pharmacokinetic parameters were assessed for both Ticagrelor and its Active Metabolite (AR-C124910XX). Safety endpoints were evaluated by monitoring adverse events (AEs). Results: The 90% Confidence Intervals (CIs) of the Geometric Mean Ratio for primary PK parameters including Cmax, AUClast, and AUCtotal all were within the accepted bioequivalence range of 80%- 125%. In the current study, no serious adverse events were reported. Conclusion: Our results showed that the two tested formulations of Ticagrelor tablets were bioequivalent and well tolerated.Trial Registration: ClinicalTrials.gov Identifier: NCT04941196.

Assessment Of Workplace Related Factors Affecting Tolerance Of Ambiguity Among Trainee Doctors.

OBJECTIVE: To assess workplace factorsinfluencing the tolerance of ambiguity among trainee doctors. METHODS: The sequential mixed-method study was conducted from June 2021 to February 2022 at the Fauji Foundation Hospital, Islamabad, Pakistan, and comprised postgraduate trainee doctors of either gender associated with various specialties.Thebaseline toleranceof ambiguity scorewas establishedusingtheToleranceofAmbiguity in Medical Students and Doctors scale. A group of selected trainees was interviewed face-to-face to examine the workplace factors that they regarded as beneficial or detrimental to their tolerance of ambiguity. Quantitative data was analysed using SPSS 24 and thematic analysis was done for qualitative data. RESULTS: Of the 132 subjects, 59 (21.9%) were males and 73 (55.3%) were females. The overall mean age was 20.95±2.186 years. Of the total, 55(41.7%)subjects were in the first year of training, 28(21.2%) in the second year, 26 (19.6%) in the third year, and 23(17.4%) in the fourth year. There were 78(59.1%)trainees who were married compared to 54 (40.9%) who were unmarried. Against the baseline tolerance of ambiguity score of 132, the overall aggregate mean tolerance of ambiguity level was 71.28 ± 5.81 showing a moderate level. There was no significant correlation between the tolerance of ambiguity and the trainees'age, years oftraining and maritalstatus(p>0.05).The qualitative phase comprised interviews with 9(6.8%) subjects.Thematic analysis suggested that the traineesperceivedautonomy,peersupport,supervisorsupport,manageable workload, and professional development opportunities asfacilitat or softolerance of ambiguity,whilebarrierswere identified as poor physical environment, attitude ofseniors and supervisors, management issues and excessive workload.During the coronavirus diseae-2019 pandemic, excessive workload and fear of infection were identified asfactors affecting tolerance of ambiguity. CONCLUSIONS: The medical trainees were found to have a moderate level of tolerance to ambiguity. Autonomy, peer support, supervisor support, manageable workload, and professional development opportunities contributed positively to this aspect.

ChatGPT - Reshaping medical education and clinical management.

Artificial Intelligence is no more the talk of the fiction read in novels or seen in movies. It has been making inroads slowly and gradually in medical education and clinical management of patients apart from all other walks of life. Recently, chatbots particularly ChatGPT, were developed and trained, using a huge amount of textual data from the internet. This has made a significant impact on our approach in medical science. Though there are benefits of this new technology, a lot of caution is required for its use.

Twelve tips to enhance student engagement in synchronous online teaching and learning.

Synchronous learning is a component of online learning for engaging students in real-time. It is the nearest we can get to a live feeling in the e-environment. These sessions must be designed in a way to keep students continuously involved. This paper aims to provide health professional educators with tips for increasing student engagement in the online synchronous environment. The relevant literature regarding student engagement and synchronous online learning was reviewed and collated with the authors' own experiences, to formulate these tips. Health professional educators can use these tips to enhance student engagement in online synchronous classes.Increased student engagement in online sessions, means better learning. These tips have been tried and tested by the authors as being satisfactory for increasing student interest in synchronous sessions and hence providing an optimal learning experience online.

Lifestyle Habits and Wellbeing Among Physicians in Pakistan: A Cross-Sectional Study.

Introduction Physicians' attitude towards a healthy lifestyle is important as it determines their extent of acceptance of these habits leading to overall well-being. Physicians with healthy lifestyle habits are more confident in advocating the same to their patients and their patients are keener in adopting lifestyle modifications. This study aimed to evaluate the lifestyle habits, wellbeing, and mental health of physicians in Pakistan. Methods A multi-center, cross-sectional survey was conducted with physicians across Pakistan from August to October 2020. A total of 1406 participants were gathered by the non-probability convenient sampling technique. Data were collected physically from the participants. A semi-structured, self-administered questionnaire comprising socio-demographic information, lifestyle habits, mental well-being, and well-being, in general, was filled. Mental wellbeing was assessed using the Warwick Edinburg Mental Wellbeing Scale (WEMWBS) comprising 14-positive items scored on a 1-5 point Likert scale where 1 corresponds to "none of the time" and 5 corresponds to "all of the time." The score ranges from a minimum of 14 to a maximum of 70 points. Higher scores are associated with higher levels of mental wellbeing. Data were stored and analyzed using IBM-SPSS v.23 (IBM Corp., Armonk, NY). Results In this survey, there were 1284 (91.3%) males and 122 (8.7%) females with a mean age of 44.09 ± 11.18 years. More than half (n=768; 53.0%) of the physicians reported their general health as "good," 1045 (73%) were satisfied with their work-life balance, 206 (14%) had seen a physician for their health in the last six months, and 358 (25%) never had a routine medical checkup. When WEMWBS was applied, participants ≤40 years scored significantly higher than the older age group (p<0.01). Male physicians also scored significantly higher on WEMWBS (52.35 ± 8.78) as compared to their female counterparts (p<0.01). WEMWBS scores also varied significantly across various levels of expertise - with consultants scoring the highest (52.67 ± 9.02) and others scoring the lowest (48.63 ± 8.58; p=0.02). Physicians practicing in the public hospitals only (53.05 ± 9.02), scored higher on WEMWBS as compared to those in the private hospitals (51.28 ± 8.12) as well as those practicing in private clinics only (49.57 ± 8.82; p<0.01). Physicians who perceived their health as excellent scored highest on WEMWBS (53.55 ± 9.31), than those who considered their health good (51.68 ± 8.40), poor (50.71 ± 9.27), or fair (48.70 ± 8.15; p<0.01). The correlation analysis showed a significant negative correlation of WEMWBS scores with health in general (2.5% variation) and age (0.92% variation; p<0.01). Conclusion Physicians in our study were mostly satisfied with their general health and work-life balance. Nevertheless, their mental health well-being was not satisfactory, as assessed by WEMWBS. There is a dire need for lifestyle modifications among the medical practitioners who may improve their mental and physical well-being subsequently allowing them to cater to their patients more effectively. It is recommended that physician-patient-specific interventions should be developed to target the health status and mental well-being of a physician and to encourage the physicians especially the fresh medical graduates and young doctors to indulge in healthy activities.

Comparison of OSCE scores of surgical clinical education after face-to-face vs. blended learning methods among undergraduate medical students.

OBJECTIVES: To compare the efficacy of blended learning with contemporary face-to-face teaching among medical students. METHODS: The quasi-experimental, cross-over study was conducted at the Dow University of Health Sciences, Karachi, from March to August 2014, and comprised third year medical students posted in the surgical units who were divided into two groups. In the first month, group A was taught by blended learning (BL), while group B was taught by face-to-face (f2f) teaching. Both groups were assessed using objective structured clinical examination. In the second month, the teaching method was flipped for the groups with new learning contents. Assessment tool remained the same. Data was analysed using SPSS 23. RESULTS: Thirty-one students completed OSCE in group A (BL) and 28 in group B (f2f). The mean score in group B was 78.01±13.29 compared to 85.12±13.77 in group A (p=0.49). CONCLUSIONS: Blended surgical learning was found to be more effective compared to face-to-face teaching.

Technology Enhanced Assessment (TEA) in COVID 19 Pandemic.

Online teaching and learning is not a new phenomenon. For the last many years, it has been mainly used as a part of face to face teaching. Assessment is an essential part of teaching and learning, as it establishes the achievement of course learning outcomes by the students. Computer-based assessment is in place for a long time now, however, online assessments have been less practiced. This is because of the issues of validity, reliability and dishonesty. During the COVID 19 pandemic, the educational environment has taken a paradigm shift in many medical schools, both nationally and internationally. This situation demands a method of assessment that is safe, valid, reliable, acceptable, feasible and fair. This paper describes the different formats of online assessment and their application in formative and summative assessments during and after the COVID 19 pandemic.

Effect of Paper- and Computer-based Simulated Instructions on Clinical Reasoning Skills of Undergraduate Medical Students: A Randomized Control Trial.

Background and objectives Skilled clinical reasoning is a critical tool for physicians. Educators agree that this skill should be formally taught and assessed. Objectives related to the mastery of clinical reasoning skills appear in the documentation of most medical schools and licensing bodies. We conducted this study to assess the differences in clinical reasoning skills in medical students following paper- and computer-based simulated instructions. Materials and methods  A total of 52 sixth semester medical students of the Dow University of Health Sciences were included in this study. A tutorial was delivered to all students on clinical reasoning and its importance in clinical practice. Students were divided randomly into two groups: group A received paper-based instructions while group B received computer-based instructions (as Flash-based scenarios developed with Articulate Storyline software [https://articulate.com/p/storyline-3]) focused on clinical reasoning skills in history-taking of acute and chronic upper abdominal pain. After one week, both groups were tested at two objective structured clinical examination (OSCE) stations to assess acute and chronic pain history-taking skills in relation to clinical reasoning. Results There were 27 students in group A and 25 students in group B. The mean OSCE score for group A (paper-based) was 28.6 ± 9.4 and that for group B (computer-based) was 38.5 ± 6.0. Group B's mean score was statistically significantly greater (p < 0.001) than group A's mean score for clinical reasoning skills.  Conclusion A computer simulation program can enhance clinical reasoning skills. This technology could be used to acquaint students with real-life experiences and identify potential areas for more training before facing real patients.

How to write introduction and discussion.

Scientific writing has a proper format. The anatomical structure or important components of an original article consists of a structured abstract (usually in four sub-headings i.e. objective, methods, results and conclusions with appropriate key words), introduciton, methodology, results and discussion. It is summarized by the acronym IMRAD wherein: I stands for Introduction, M for Methods, R for Results, A for And, D for Discussion. This manuscript describes the information which has to be included in the Introduction and Discussion sections of an original article.