Challenges of providing timely feedback to Residents: Faculty perspectives

Objective To explore faculty\u27s perceptions of challenges in providing verbal feedback to the Residents and suggest ways to overcome the barriers. Methods As part of a larger study on feedback assessment, five focus group discussions were conducted at the Department of Medicine, Aga Khan University Hospital, Karachi, during faculty development workshops held from January to June 2010. Qualitative grounded theory was used to explore faculty perceptions of challenges in providing verbal feedback to the Residents. Results Of the 54 faculty members, 49(91%) participated. Four themes that emerged were \u27time constraint\u27 indicating high patient load; \u27faculty related issues\u27 indicating faculty\u27s apprehension about its own evaluation by Residents; \u27educational issues\u27 indicating that the importance of feedback was not emphasised; and \u27system and logistic issues\u27 indicating that the assessment form used for assessing Residents was ambiguous. Conclusion Work load of the faculty and the expectations with respect to patient care responsibilities may have an impact on the quality, timing, content and delivery of the feedback provided to the Residents

The learners\u27 perspective on internal medicine ward rounds: a cross-sectional study

Background: Ward rounds form an integral part of Internal Medicine teaching. This study aimed to determine the trainees\u27 opinions regarding various aspects of their ward rounds, including how well they cover their learning needs, how they would like the rounds to be conducted, and differences of opinion between medical students and postgraduates. Methods: A cross-sectional study was conducted on a total of 134 trainees in Internal Medicine, comprising medical students, interns, residents and fellows, who were asked to fill in a structured, self-designed questionnaire. Most of the responses required a rating on a scale of 1-5 (1 being highly unsatisfactory and 5 being highly satisfactory). Results: Teaching of clinical skills and bedside teaching received the lowest overall mean score (Mean +/- SD 2.48 +/- 1.02 and 2.49 +/- 1.12 respectively). They were rated much lower by postgraduates as compared to students (p \u3c 0.001). All respondents felt that management of Patients was the aspect best covered by the current ward rounds (Mean +/- SD 3.71 +/- 0.72). For their desired ward rounds, management of Patients received the highest score (Mean +/- SD 4.64 +/- 0.55), followed by bedside examinations (Mean +/- SD 4.60 +/- 0.61) and clinical skills teaching (Mean +/- SD 4.50 +/- 0.68). The postgraduates desired a lot more focus on communication skills, counselling and medical ethics as compared to students, whose primary focus was teaching of bedside examination and management. A majority of the respondents (87%) preferred bedside rounds over conference room rounds. Even though the duration of rounds was found to be adequate, a majority of the trainees (68%) felt there was a lack of individual attention during ward rounds. Conclusions: This study highlights important areas where ward rounds need improvement in order to maximize their benefit to the learners. There is a need to modify the current state of ward rounds in order to address the needs and expectations of trainees

The learners' perspective on internal medicine ward rounds: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Ward rounds form an integral part of Internal Medicine teaching. This study aimed to determine the trainees' opinions regarding various aspects of their ward rounds, including how well they cover their learning needs, how they would like the rounds to be conducted, and differences of opinion between medical students and postgraduates.</p> <p>Methods</p> <p>A cross-sectional study was conducted on a total of 134 trainees in Internal Medicine, comprising medical students, interns, residents and fellows, who were asked to fill in a structured, self-designed questionnaire. Most of the responses required a rating on a scale of 1-5 (1 being highly unsatisfactory and 5 being highly satisfactory).</p> <p>Results</p> <p>Teaching of clinical skills and bedside teaching received the lowest overall mean score (Mean ± SD 2.48 ± 1.02 and 2.49 ± 1.12 respectively). They were rated much lower by postgraduates as compared to students (p < 0.001). All respondents felt that management of patients was the aspect best covered by the current ward rounds (Mean ± SD 3.71 ± 0.72). For their desired ward rounds, management of patients received the highest score (Mean ± SD 4.64 ± 0.55), followed by bedside examinations (Mean ± SD 4.60 ± 0.61) and clinical skills teaching (Mean ± SD 4.50 ± 0.68). The postgraduates desired a lot more focus on communication skills, counselling and medical ethics as compared to students, whose primary focus was teaching of bedside examination and management. A majority of the respondents (87%) preferred bedside rounds over conference room rounds. Even though the duration of rounds was found to be adequate, a majority of the trainees (68%) felt there was a lack of individual attention during ward rounds.</p> <p>Conclusions</p> <p>This study highlights important areas where ward rounds need improvement in order to maximize their benefit to the learners. There is a need to modify the current state of ward rounds in order to address the needs and expectations of trainees.</p

A 360-degree evaluation of the communication and interpersonal skills of medicine resident physicians in Pakistan

Background: To provide high-quality patient care, effective communication and interpersonal skills are necessary for physicians. A 360-degree evaluation of residents in the department of medicine was conducted to assess their interpersonal and communication skills. The measurement properties and utility of the multi-source ratings were investigated. Methods: A cross-sectional assessment of a cohort of Internal Medicine residents was conducted at the Aga Khan Medical University in Pakistan. Every resident (n = 49) was evaluated by eight raters, including physicians, nurses and unit staff. Each resident also completed a self-evaluation. Evidence to support the validity of the ratings was gathered by exploring performance differences amongst more- and less-experienced providers. Analysis of variance (ANOVA) was employed to test for differences in mean scores, both for rater type and experience (residency year). Generalizability theory was employed to estimate the reliability of the ratings. Results: We received 367/441 (83.2%) completed forms. There was a significant effect attributable to rater source (F = 5.2, P \u3c 0.01). There were no significant differences in mean scores for residents at different levels of training. The mean resident self-assessment scores were significantly lower than those provided by faculty (P \u3c 0.01). Based on eight raters, the reliability of the ratings was moderate (ρ2 = 0.39). Discussion: The 360-degree evaluation technique can be used to measure the communication and interpersonal skills of residents. It can also provide important data to guide resident feedback. Health care providers and staff who interact with residents on regular basis can, as a group provide moderately consistent judgments of their abilities

Marine collagen as a source of bioactive molecules. A review.

Skins, scales and bones are the major by-products of the fish-processing industry. These by-products are not regarded as ordinary saleable products and are usually discarded causing a heavy environmental impact. However, marine by-products are a good source of collagen that could be extracted and further enzymatically hydrolyzed to liberate interesting bioactive peptides. Collagen-derived peptides may exhibit interesting antioxidant activity, potent antihypertensive activity, antimicrobial activity against different strains of bacteria, protective effect on cartilage, capacity to stimulate bone formation, and also other interesting activities (e.g., satiety, calciotropic, or opioid). The bioactive properties of collagen-derived peptides, and also their resistance to protein digestion, make them potential ingredients of health promoting foods.Peer Reviewe

Coronary Artery Disease and Aspirin Intolerance: Background and Insights on Current Management

Aspirin is one of the most widely used medications across the global healthcare system and is the foundation in treating ischemic heart disease, as well as secondary prevention for ischemic and valvular heart disease. Challenges arise in treating patients with cardiovascular disease who have concomitant aspirin intolerance. Through an extensive review of the literature, we provide a comprehensive background on the pharmacology of aspirin, the mechanisms behind aspirin intolerance, the importance of aspirin in cardiovascular disease, and the management of aspirin intolerance in both acute coronary syndrome and stable coronary artery disease. Our review includes a multidisciplinary approach from the internist, allergist/immunologist, and cardiologist when evaluating this important patient population