Current standards of postgraduate surgical education and training in Pakistan: Time to bridge the gaps in lieu of national necessity

The provision of good-quality surgical care is a salient feature of every public health system. Pakistan is ranked among low and middle-income countries where the burden of surgical disease is rapidly increasing, but the capacity of the health system has not expanded at the same pace to cater current needs. One of the key components is the dearth of trained surgical specialists and lack of easy access to surgical care. College of Physicians and Surgeons, Pakistan is the main certifying institution for surgeons, while public and private teaching hospitals bear the burden of responsibility for surgical education and training. The current review article was planned to describe current standards of postgraduate surgical education and training in Pakistan and to highlight the challenges that need to be faced and the existent deficiencies that need to be met to match the nation\u27s demand against the immense burden of surgical diseases

An exploratory case study of interactive simulation for teaching Ecology

This paper explores the effectiveness of interactive simulation for teaching a selected complex subject, Ecology, in higher education. Specifically, we carry out a lab intervention using interactive agent based simulation, to teach the complex concept of spatially-explicit predator prey interaction to undergraduate students of an advanced module: BIOU9CE (Community Ecology & Conservation Applications) at the University of Stirling. We propose use of Netlogo, an interactive agent-based simulation tool, and evaluate its effectiveness for learning and teaching of interactive simulation developed specifically for the classroom, compared with an existing, less interactive, simulation tool (R)

Strategies to cope claustrophobia during magnetic resonance imaging examination

Background: Claustrophobia associated with MRI scan is a well-recognized problem all over the world. The unpleasant psychological experience during MRI can lead to premature cancellation of the study resulting in non-interpretable data. In addition, performing future studies on the claustrophobic patient may not be possible leading to non-utilization of an important diagnostic modality. This study was conducted with the aim to determine a cheap and short intervention which can be applicable to small radiology set up as well.Methods: A prospective study was conducted at a tertiary care hospital from October 2016 to December 2016. Accompanying someone was the first strategy used to coped MR imaging claustrophobia followed by placebo (multivitamin), listening Quran and closed eye (blindfold). All those patients who failed to respond in these strategies were finally labeled as an unsuccessful candidate. Listening of Quran was selected as one of the tools as all the patients were Muslims in present study.Results: Among 84 claustrophobic patients, a closed eye was the most successful strategy found effective in (13) 81.2%, followed by placebo 66.7% patients, listening Quran (7) 30.4%, accompanying someone (15) 17.85% while 4% patients remained claustrophobic after application of all strategies. Significant association of accompanying someone and placebo was observed with education (p-value 0.037) and age of the patients (0.016) respectively.Conclusions: In general, placebo, being accompanied by someone and blindfold were found to be the most effective strategies to cope with MRI related claustrophobia. However, the success of these strategies is also dependent on certain factors like age, education status and socioeconomic status of the patients

A comparison of two methods of using a serious game for teaching marine ecology in a university setting

There is increasing interest in the use of serious games in STEM education. Interactive simulations and serious games can be used by students to explore systems where it would be impractical or unethical to perform real world studies or experiments. Simulations also have the capacity to reveal the internal workings of systems where these details are hidden in the real world. However, there is still much to be investigated about the best methods for using these games in the classroom so as to derive the maximum educational benefit. We report on an experiment to compare two different methods of using a serious game for teaching a complex concept in marine ecology, in a university setting: expert demonstration versus exploration-based learning. We created an online game based upon a mathematical simulation of fishery management, modelling how fish populations grow and shrink in the presence of stock removal through fishing. The player takes on the role of a fishery manager, who must set annual catch quotas, making these as high as possible to maximise profit, without exceeding sustainable limits and causing the stock to collapse. There are two versions of the game. The “white-box” or “teaching” game gives the player full information about all model parameters and actual levels of stock in the ocean, something which is impossible to measure in reality. The “black-box” or “testing” game displays only the limited information that is available to fishery managers in the real world, and is used to test the player's understanding of how to use that information to solve the problem of estimating the optimal catch quota.Our study addresses the question of whether students are likely to learn better by freely exploring the teaching game themselves, or by viewing a demonstration of the game being played expertly by the lecturer. We conducted an experiment with two groups of students, one using free, self-directed exploration and the other viewing an expert demonstration. Both groups were then assessed using the black box testing game, and completed a questionnaire. Our results show a statistically significant benefit for expert demonstration over free exploration. Qualitative analysis of the responses to the questionnaire demonstrates that students saw benefits to both teaching approaches, and many would have preferred a combination of expert demonstration with exploration of the game. The research was carried out among a mix of undergraduate and taught postgraduate science students. Future research challenges include extending the current study to larger cohorts and exploring the potential effectiveness of serious games and interactive simulation-based teaching methods in a range of STEM subjects in both university and school settings

"Liverscore" is predictive of both liver fibrosis and activity in chronic hepatitis C

AIM: To formulate a noninvasive index predictive of severity of liver fibrosis and activity in chronic hepatitis C

Diagnostic efficacy of 0, 30, 45, 60, 90 and 120 min growth hormone samples in insulin tolerance test: utility of growth hormone measurement at different time-points and a cost-effective analysis

Objective: To determine the utility of growth hormone (GH) measurement with the insulin tolerance test (ITT), and to carry out a cost-effective analysis of the diagnosis of GH deficiency. Material and methods: Ninety-nine Patients clinically suspected of GH deficiency were evaluated over a period of 14 months (January 2005 to April 2006). Post-insulin samples of GH and blood glucose (BG) samples were drawn at six different time-points. Serum GH levels of 10 g/L (prepubertal) and 6.1 g/L (adolescents) were taken as cut-off for the normal response. Results: Ninety-nine ITTs were carried out during the study period, and GH levels were found to be deficient in 47 subjects. Specificities at different time-points were 0 %, 54 %, 77 %, 62 %, 39 % and 23 % for 0, 30, 45, 60, 90 and 120 min, respectively, in the prepubertal group, and 5 %, 41 %, 80 %, 87 %, 77 % and 46 % at the same time-points for the adolescent group. Accuracy was highest at 45 and 60 min in both the prepubertal and adolescent groups. The receiver operating characteristic curve showed that the highest area under the curve was found in samples drawn at 45, 60 and 90 min in both the prepubertal and adolescent groups. Conclusion: Our data suggest that 0, 45, 60 and 90 min samples are sufficient for diagnosing GH deficiency, which could lead to potential cost reductions of up to 29.8 %

Evaluation of off-service rotations at National Guard Health Affairs: Results from a perception survey of off-service residents

Context: "Off-service" clinical rotations are part of the necessary requirements for many residency training programs. Because these rotations are off-service, little attention is given to their structure and quality of training. This often leads to suboptimal educational experience for the residents on these rotations. Aims: The aim of this study was to assess medical residents′ perceptions, opinions, and levels of satisfaction with their "off-service" rotations at a major residency training site in Saudi Arabia. It was also to evaluate the reliability and validity of a questionnaire used for quality assurance in these rotations. Improved reliability and validity of this questionnaire may help to improve the educational experience of residents in their "off-service" rotations. Materials and Methods: A close-ended questionnaire was developed, Pilot tested and distributed to 110 off-service residents in training programs of different specializations at King Fahad Naitonal Guard Hospital and King Abdulziz Medical City, Riyadh, Saudi Arabia, between September 2011 and December 2011. Results: A total of 80 out of 110 residents completed and returned the questionnaire. Only 33% of these residents had a clear set of goals and educational learning objectives before the beginning of their off-service rotations to direct their training. Surgical specializations had low satisfaction mean scores of 57.2 (11.9) compared to emergency medicine, which had 70.7 (16.2), P value (0.03). The reliability of the questionnaire was Cronbach′s alpha 0.57. The factor analysis yielded a 4-factor solution (educational environment, educational balance, educational goals and objectives, and learning ability); thus, accounting for 51% variance in the data. Conclusion: Our data suggest that there were significant weaknesses in the curriculum for off-service clinical rotations in KAMC and that residents were not completely satisfied with their training

Why psychiatry as a career: Effect of factors on medical students' motivation

Context: The number of Saudi psychiatrists in Saudi Arabia is not sufficient to keep up with the increasing need.[1] Approximately out of 6873 physicians, only 148 are psychiatrists, which is barely 2.1%.[2] Despite the high number of medical students graduating each year and the high demand for psychiatry physicians, only few medical graduates choose psychiatry as a career option.[3] Aims: To investigate the profile of final year medical students of both sexes at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia. In terms of their decisions regarding specialization, this study aimed to identify the motivators and deterrents that impact the choice of psychiatry as specialty. Subjects and Methods: Students filled in a self-reported questionnaire focusing on the several factors that act as motivators, deterrents, or have no impact on psychiatry career choice. Statistical Analysis Used: Statistical analysis was done using Statistical Package for Social Sciences (SPSS)® version 20. Different factors were expressed in terms of numbers and percentages. Chi-square test was used to compare responses to the questionnaire between male and female students and whether the GPA had an effect on their choice. P value less than 0.05 was considered significant. Results: It was noted that 85% did not choose psychiatry, with the most important deterrent being “Family member is psychologically ill” and “Available job position” being the most common motivator for choosing a specialty. Conclusion: In conclusion, there are many factors that play an important role in career choice. No difference was found among male and female students, and no effect was identified while comparing GPA with career choice