Evolution of Post Graduate Curricula in Pakistan

Postgraduate medical training started with the apprenticeship model. This system heavily relied on tradition and subjectivity. In the middle of the 20th century, there was a gradual shift to an objective-based structure which had its roots in the works of Ralph Tyler and Benjamin Bloom. As a result, the curriculum became focused on predefined objectives in the cognitive, psychomotor, and affective domains. This drive was aimed to standardize the learning criteria across various centers and align the tools for assessment for postgraduate medical students.1In our country, the College of Physicians and Surgeons Pakistan (CPSP) has been the main center of postgraduate medical education since its inception in 1962. With both local and foreign-trained faculty members, it was one of the first centers to start training in Medical Education in collaboration with the World Health Organization in 1979.2 Various supervisor workshops and certifications by the Department of Medical Education helped equip the faculty with the tools required for curricular development.3 Thus new curricula in each discipline were developed and were called “structured training programs”. They were based on the objective approach and largely focused on summative assessments with very few formative assessments.4In the last two decades, new evidence and methods of postgraduate teaching and assessment have evolved in the west.5 Due to technological enhancements in patient care and vast development in the scientific pool of medical knowledge, there was a demand to define outcome-based competencies that strongly align with the demands of the workplace. As a result, competency-based curriculum models were developed which “de-emphasized time-based training and promised greater accountability, flexibility, and learner-centeredness”.1 CANMEDS (Canadian Medical Education Directives for Specialists) and ACGME (Accreditation Council for Graduate Medical Education) are two of the most popular systems having a competency-based framework which has been developed and successfully implemented in North America.Competency-based programs differ from objective-based ones in the fact that instead of prescribing how to teach or learn, they focus on the demonstration of various competencies required for practice. A competency-based curriculum must exhibit “teacher-learner relationship and responsibility, workplace-based assessment approach, alignment of competencies with criterion-referenced assessment, and flexible training duration”. 6 The system focuses on the attainment of competencies by the trainee to determine readiness for unsupervised practice rather than the length of their training.The structure of a competency-based curriculum is not based solely on objectives but rather uses defined Entrustable Professional Activities (EPAs) which align the teaching and assessment at the workplace with the competency frameworks. Another key aspect of this curricular structure is milestones which are based on the skill development framework of Dreyfus and Dreyfus.1 Both these key elements ensure that the trainee has attained the desired level of clinical skill to practice.The teaching of these competencies is often done in a workplace setting. Assessments employ Work Place Based Assessment (WPBA) tools such as Directly Observed Procedural Skills (DOPS) for procedural skills, Mini Clinical Evaluation Exercises (Mini-CEX), and Chart Based Recall (CBR) for clinical reasoning skills and 360-degree feedback for professionalism, interpersonal and communication skills. The system also caters to the extent of differential achievement of learners by offering targeted help to trainees in form of regular formative feedback which is an essential component of WPBAs.7As with other, in vogue ideas of medical education, the College of Surgeons and Physicians Pakistan was the first to develop a competency-based curricular framework nearly a decade ago. It was centered on patient care and involved professionalism, pedagogy, and advocacy as essential competencies to be acquired by the specialists.4,8 One key area where the CPSP fellowship program has developed since then is the development of portfolios 9 in the form of an electronic log (e-log) system for regular monitoring of training. The e-log system also includes reflections by supervisors and trainees which is a step in the right direction.10 Other technological solutions such as learning management systems, mobile applications, simulation, and social media if added could further enhance student learning and engagement.11,12 A close inspection of the current fellowship and membership structured training programs of CPSP reveals that despite the claim of running a competency-based framework, none of the key features of this system like defined EPAs, milestones, and WPBA strategies exist. Also, there is a lack of curricular alignment with the core competencies. So, it is difficult to consider it as a competency-based framework of postgraduate medical education in a true sense.Other medical universities in the country have relatively recently developed their Master of Surgery (MS) and Doctor of Medicine (MD) curricula. Wide variations exist in their induction, teaching & learning, assessment, and evaluation criteria. Also, limited literature is available to study their curricular structural design. Instead of adopting the new competency-based framework, most have chosen to retain the archaic objective-based curricular model. Unfortunately, with no guidelines from the nascent Pakistan Medical Commission, most programs tend to evolve in the light of the Higher Education Commission’s curriculum recommendations which are based on the older objective-based approach.13Rawalpindi Medical University right from its inception had the vision to develop a University Residency Program for post-graduate studies in Medicine, Surgery, and allied disciplines based on ACGME competency-based curriculum. Under this program, we train hundreds of trainees with regular monitoring via workplace-based assessment and 360-degree feedback forms. These are evaluated by the Quality Enhancement Cell in 6 monthly cycles with feedback provided to the trainees, supervisors, and administration. The trainee is also required to log cases and activities with reflections in their logbooks. Each clinical case is also added to their online portal for record and evaluation. These regular formative tools with monitoring and feedback help the trainee assess their weaknesses, supervisors plan their trainee's progress and administration take decisions for improvement. Formative assessments are done at the end of each year comprising of MCQ, SAQ, and OSCE formats. At the end of the program, a comprehensive summative assessment is also conducted to certify competence.Nine years ago, Wasim Jafri14 wrote that “The competency-based model provides an exceptional opportunity for Pakistani postgraduate medical institutes”. We believe that today Rawalpindi Medical University is a pioneer among the medical sector universities in providing this excellent opportunity to its trainees and supports other partnering universities in developing competency-based curricula

To Study the Effect of Boundary Conditions and Disorder in Spin Chain Systems Using Quantum Computers

Condensed matter physics plays a crucial role in modern scientific research and technological advancements, providing insights into the behavior of materials and their fundamental properties. Understanding complex phenomena and systems in condensed matter physics poses significant challenges due to their inherent intricacies. Over the years, computational approaches have been pivotal in unraveling the mysteries of condensed matter physics, but they face limitations when dealing with large-scale systems and simulating quantum effects accurately. Quantum simulation and quantum computation techniques have emerged as promising tools for addressing these limitations, offering the potential to revolutionize our understanding of condensed matter physics. In this paper, we focus on the simulation of Anderson localization in the Heisenberg spin chain systems and explore the effects of disorder on closed and open chain systems using quantum computers

A DNA Framework to Predict the Role of Communication in System Reliability

The global business environment involves an extreme level of risk and complexity which is an essential requirement for future growth. Each year, organizations around the world face astronomical project failure rates. A study revealed that on every $1 billion spent on the project,$135 million is at risk. From this $135 million more than half is on the risk due to poor communication. Most of the communication audit tools assessed in the literature, evaluate communication from the organization perspective and does not address how to evaluate communication between the departments and assess the reliability of communication. In this research, Clayton Homes was used as a case study to evaluate the communication between two departments. Sales/Engineering Department was considered as encoders and Production Department was considered as decoders. The attributes of communication were identified to develop the survey questions. One survey was developed for encoders and one for decoders. Analytical Hierarchical Process was used to find the weights of the attributes. T- test was used to compare the mean of two groups. Pearson Correlation was used to identify the correlation between the attributes. Probability Density Function was used to calculate the reliability of communication between two departments. This study will contribute to the current academic research by providing a method to analyze the reliability of communication between two departments

Energy efficiency in heterogeneous wireless access networks

In this article, we bring forward the important aspect of energy savings in wireless access networks. We specifically focus on the energy saving opportunities in the recently evolving heterogeneous networks (HetNets), both Single- RAT and Multi-RAT. Issues such as sleep/wakeup cycles and interference management are discussed for co-channel Single-RAT HetNets. In addition to that, a simulation based study for LTE macro-femto HetNets is presented, indicating the need for dynamic energy efficient resource management schemes. Multi-RAT HetNets also come with challenges such as network integration, combined resource management and network selection. Along with a discussion on these challenges, we also investigate the performance of the conventional WLAN-first network selection mechanism in terms of energy efficiency (EE) and suggest that EE can be improved by the application of intelligent call admission control policies

Barriers to Adopting Electronic Commerce for Small and Medium-sized Enterprises in Emerging Economies

With the availability of the Internet as an Information and Communication Technology (ICT) tool, electronic commerce (e-commerce) has received much attention in many Western and developed countries. However, it has been given little attention in emerging economies, and therefore e-commerce adoption has been particularly difficult for Small and Medium-sized Enterprises (SMEs). The purpose of this review paper is to explore several types of barriers that influence the adoption of e-commerce by SMEs in emerging economies. An exhaustive review of the literature was conducted on the subject. It further evaluates and extends Tornatzky and Fleischer’s (1990) Technology-Organization-Environment (TOE) framework by adding a micro-level context - that of the ‘entrepreneurial (individual) characteristics of owner-managers’ to examine various contextual challenges SMEs face in adopting e-commerce in emerging economies. The paper examines a number of new dynamic and contextual barriers identified in the study, grouping them into four themes: technological, organizational, environmental and extended ‘entrepreneurial (individual) characteristics of owner-managers’. The paper sets up a new conceptual framework and has established a holistic view of contextual barrier themes for the coming years. In addition, this theoretical model provides us with the new barriers related to ‘entrepreneurial (individual) characteristics of owners/managers’ and ‘local business institutions in supporting e-commerce’ that influences the adoption of e-commerce by SMEs in emerging economies. Based on this extended framework, future areas of research can be determined, and owner-managers of SMEs, new entrepreneurs and government authorities in emerging economies will be able to identify emerging concepts in e-commerce

Control and data channel resource allocation in OFDMA heterogeneous networks

This paper investigates the downlink resource allocation problem in Orthogonal Frequency Division Multiple Access (OFDMA) Heterogeneous Networks (HetNets) consisting of macro cells and small cells sharing the same frequency band. Dense deployment of small cells overlaid by a macro layer is considered to be one of the most promising solutions for providing hotspot coverage in future 5G networks. The focus is to devise an optimised policy for small cells’ access to the shared spectrum, in terms of their transmissions, in order to keep small cell served users sum data rate at high levels while ensuring that certain level of quality of service (QoS) for the macro cell users in the vicinity of small cells is provided. Both data and control channel constraints are considered, to ensure that not only the macro cell users’ data rate demands are met, but also a certain level of Bit Error Rate (BER) is ensured for the control channel information. Control channel reliability is especially important as it holds key information to successfully decode the data channel. The problem is addressed by our proposed linear binary integer programming heuristic algorithm which maximises the small cells utility while ensuring the macro users imposed constraints. To further reduce the computational complexity, we propose a progressive interference aware low complexity heuristic solution. Discussion is also presented for the implementation possibility of our proposed algorithms in a practical network. The performance of both the proposed algorithms is compared with the conventional Reuse-1 scheme under different fading conditions and small cell loads. Results show a negligible drop in small cell performance for our proposed schemes, as a trade-off for ensuring all macro users data rate demands, while Reuse-1 scheme can even lead up to 40 % outage when control region of the small cells in heavily loaded

Land Cover Classification using Sentinel-1 Radar Mission Interferometry

Synthetic Aperture Radar (SAR) has been widely used for many years in the field of remote sensing. SAR has valuable contribution due to its ability to provide complementary information to optical systems, penetration of radar waves through volumetric targets and high-resolution. SAR has the ability to operate during day and night. It provides operational services under all weather conditions. SAR imagery has many applications including land cover changes, environmental monitoring, climate change and military surveillance. This work focuses on land cover classification with SAR interferometry (InSAR) technique using Sentinel-1 space radar image pair. Sentinel-1 data were collected over the southern part of Estonia. Two SLC SAR images were acquired from both Sentinel-1A and Sentinel-1B with six days temporal difference. In this study, interferometric coherence and backscattering intensity processing chains have been set up and applied to Sentinel-1 SAR image pair. The Sentinel Application Platform (SNAP) has been used for processing of single pair for Sentinel-1 mission. The SNAP is an European Space Agency (ESA) software. The Sentinel-1 image pair processing has been done using Sentinel-1 Toolbox (S1TBX) which is a part of SNAP. Corine Land Cover (CLC) 2012 database has been used as a reference data with 20 m resolution. The CLC2012 contains land use/cover information for most of the European countries. A single optical image from Sentinel-2A was additionally used for feature extraction. An overall accuracy of 68% to 73% was achieved when performing classification into five classes (Urban, Field, Forest, Peat-land, Water) using supervised classification with k-nearest neighbour (kNN) algorithm. The accuracy assessment was done by using confusion matrices