Enhancing Depth of Reflection of Family Medicine Residents: Results of an Intervention

The ability to reflect in professional practice is the cornerstone of self-directed learning. Reflective practice in medicine is an important teaching-learning modality for improving decision-making and clinical reasoning. It is a strategy for self-regulation of clinical and academic performance. This study was undertaken with the aim of improving the reflective ability skills of family medicine residents through the introduction of reflective practice at Aga Khan University. This was a case study using a pre-post design. A questionnaire was administered to assess the baseline level of reflection in family medicine residents, followed by a workshop on reflective practice to orient residents about the process and levels of reflection. Residents were asked to document reflective logs on a blog, feedback was provided. Post-intervention data were collected by re-administration of the questionnaire the change in the reflective level. Pre-post questionnaire data were analysed for comparisons using the Wilcoxin Sign Rank test on SPSS version 19. Out of 15 eligible residents, a total of 13 residents were available during the study period. In a pre-intervention questionnaire, reflective levels across the domains indicated that residents used reflection 50% of the time which increased post-intervention to more than 80% of the time. The degree of pre-post difference was lowest in the ‘Habitual Action Domain’ and largest in the domains of ‘Reflection’ and ‘Critical Reflection’ (4.1-4.8 and 3.8-4.5). Reflective practice is an effective strategy to develop residents as reflective thinkers by increasing their depth of reflection. Facilitation of their reflection through feedback enhances their ability to reflect

Predictive validity of Family Medicine Resident\u27s performance at induction with their future performance during residency.

Objective: To determine the predictive validity of induction assessment scores of family medicine residency program for performance in final year of residency.Study Design: Psychometric (predictive-validity) study.Place and duration of study: The Aga Khan University Hospital, Karachi, from 2008 to 2014.Methodology: All family medicine residents were evaluated. Family Medicine Residency induction assessment scores were used as independent predictor variables, whereas resident assessment scores during the final year residency program were used as dependent or outcome variables. Data was analyzed using SPSS version 19. Linear regression was used to determine predictive validity of induction scores as independent variables with outcome variables at 95% confidence level.Results: There were 33 residents. MBBS scores accounted for 30.1% of variance in final year Objective Structured Clinical Exam (OSCE) scores; whereas, induction written test accounted for 37.1% of variance in final year written test. Induction communication skill scores did not correlate with in-training communication skill scores or with the final year OSCE scores. Induction professionalism scores accounted for 13.7% of the variation in final year OSCE scores, but not with in-training continuous professionalism scores.Conclusion: Induction knowledge scores have acceptable predictive value for future knowledge and its application. Other valid and reliable assessment methods, such as multiple mini-interviews, should be explored for assessment of noncognitive domains at induction

Multiple Mini-Interviews (MMI) and Semistructured Interviews for the Selection of Family Medicine Residents: A Comparative Analysis

Background. Family Medicine Residency Program at the Aga Khan University has applicants for the residency position in excess of the positions offered resulting in formulation of certain selection criteria. The objective of this study was to compare MMI versus semistructured interviews for assessing noncognitive domains in the selection of residents. The secondary objectives were to determine perceptions of the interviewers and candidates for the acceptability and feasibility of MMI as a selection tool. Methods: The candidates underwent semistructured interviews along with MMI and identical attributes were tested in both. The attributes tested were safe doctor, communication skills, professionalism, problem solving, team approach, ethical issues, reasons for selecting family medicine, and commitment to the program. Descriptive statistics were calculated and comparison between ratings for MMI and interview was performed by Wilcoxon sign rank test. Results: Total number of candidates was 14. On comparison between interview and MMI, the scores were not statistically different for all attributes except ethics (mean interview scores: 3.04, mean MMI scores: 2.5, and P value 0.046). Conclusion: The study showed no difference between MMI and semistructured interviews. However, it needs to be replicated in order to determine the predictive validity and feasibility of MMI over time

Factors related to knowledge and perception of women about smoking: a cross sectional study from a developing country

<p>Abstract</p> <p>Background</p> <p>Smoking rates among women are currently low, but they are the fastest growing segment of cigarette smoking population in developing countries. We aimed to assess the knowledge and perceptions towards smoking and to identify the factors related with level of knowledge and perceptions among adult women in urban slums.</p> <p>Methods</p> <p>This was a cross sectional study conducted on 250 adult (≥18 years of age) women attending primary care clinics in three slums of Karachi, Pakistan. A pre-tested and structured, interviewer administered questionnaire was used for data collection. Factors associated with level of understanding about smoking were analyzed with chi-square test.</p> <p>Results</p> <p>Most of the women knew that smoking has adverse effects on women and children's health but the knowledge of specific health effects was limited. About one third of the women knew that active smoking can cause lung disease, but only a small percentage (7%) knew that it could lead to heart disease. None of the women were aware that smoking contributes to infertility and osteoporosis. A small proportion of women were aware that smoking can lead to low birth weight (7%), congenital anomalies (5%) and less than 1% of women knew that it contributes to pregnancy loss, still birth and preterm delivery. The understanding of passive smoking affecting children's lung was low (20%) and a similar proportion voiced concern about the bad influence of maternal smoking on children. Educated women had better knowledge of health effects of smoking. Education was associated with having better knowledge about effects on women health in general (p = 0.02) and specific effects like lung (p = 0.03) and reproductive health effects (p < 0.001). Education was also associated with knowledge regarding effects on fetus (p < 0.001) and children (p < 0.005). Although most of the women disliked being around smokers, more than one third thought that smoking decreases boredom (39%), tension (38%) and also helps to relax (40%). A large proportion (48%) of women had the misconception that smoking helps to reduce weight.</p> <p>Conclusions</p> <p>This study reveals that women are aware of the general ill effects of smoking but fail to identify smoking to be associated with female maladies particularly those who were illiterate and had lower levels of education. Understanding and attitudes needs to be improved by increasing health awareness and education of women in these urban communities with special emphasis on the effects of smoking on women's health.</p

Collagen analogs with phosphorylcholine are inflammation-suppressing scaffolds for corneal regeneration from alkali burns in mini-pigs

The long-term survival of biomaterial implants is often hampered by surgery-induced inflammation that can lead to graft failure. Considering that most corneas receiving grafts are either pathological or inflamed before implantation, the risk of rejection is heightened. Here, we show that bioengineered, fully synthetic, and robust corneal implants can be manufactured from a collagen analog (collagen-like peptide-polyethylene glycol hybrid, CLP-PEG) and inflammation-suppressing polymeric 2-methacryloyloxyethyl phosphorylcholine (MPC) when stabilized with the triazine-based crosslinker 4-(4,6-Dimethoxy-1,3,5-triazin-2-yl)-4-methylmorpholinium chloride. The resulting CLP-PEG-MPC implants led to reduced corneal swelling, haze, and neovascularization in comparison to CLP-PEG only implants when grafted into a mini-pig cornea alkali burn model of inflammation over 12 months. Implants incorporating MPC allowed for faster nerve regeneration and recovery of corneal sensation. CLP-PEG-MPC implants appear to be at a more advanced stage of regeneration than the CLP-PEG only implants, as evidenced by the presence of higher amounts of cornea-specific type V collagen, and a corresponding decrease in the presence of extracellular vesicles and exosomes in the corneal stroma, in keeping with the amounts present in healthy, unoperated corneas

Evaluation of functional dynamics during osseointegration and regeneration associated with oral implants

The aim of this paper is to review current investigations on functional assessments of osseointegration and assess correlations to the peri-implant structure.The literature was electronically searched for studies of promoting dental implant osseointegration, functional assessments of implant stability, and finite element (FE) analyses in the field of implant dentistry, and any references regarding biological events during osseointegration were also cited as background information.Osseointegration involves a cascade of protein and cell apposition, vascular invasion, de novo bone formation and maturation to achieve the primary and secondary dental implant stability. This process may be accelerated by alteration of the implant surface roughness, developing a biomimetric interface, or local delivery of growth-promoting factors. The current available pre-clinical and clinical biomechanical assessments demonstrated a variety of correlations to the peri-implant structural parameters, and functionally integrated peri-implant structure through FE optimization can offer strong correlation to the interfacial biomechanics.The progression of osseointegration may be accelerated by alteration of the implant interface as well as growth factor applications, and functional integration of peri-implant structure may be feasible to predict the implant function during osseointegration. More research in this field is still needed. To cite this article: Chang P-C, Lang NP, Giannobile WV. Evaluation of functional dynamics during osseointegration and regeneration associated with oral implants. Clin. Oral Impl. Res . 21 , 2010; 1–12.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78668/1/j.1600-0501.2009.01826.x.pd

Effect of reflective skills on family medicine resident\u27s clinical reasoning ability

Clinical reasoning is a required skill for competent patient care. Both analytical and nonanalytical processes are involved in clinical reasoning. Reflective practice improves clinical reasoning through internal analysis of practice with correction of biases leading to improvement of clinical practice. This study was undertaken with the aim of improving clinical reasoning skills of Family Medicine residents through the introduction of reflective practice at Aga Khan University. Method: This was a case study using pre-post method. A questionnaire was administrated to assess baseline level of reflection in residents, followed by a focus group discussion to determine the strategies used by residents for clinical reasoning. A workshop on reflective practice was conducted to orient about the process and levels of reflection. Residents were asked to document reflective logs on a blog, feedback was provided. Post-intervention data was collected by re-administration of the questionnaire and focus group. Pre-post focus group data was analysed and themes were extracted. Reflective blogs were analysed for level of reflection and change in practice, discussions were grouped under emergent themes. Pre-post questionnaire data was analysed for comparisons using Wilcoxin Sign Rank test on SPSS version 19.Results: Residents level of reflection increased positively after intervention with the largest increase in \u27Reflection\u27 and \u27Critical Reflection\u27 domain (4.1-4.8 and 3.8-4.5). Residents reported an improvement in clinical reasoning through development of general rules and holistic patient centred approach, use of the bio-psycho-social model of illness, understanding own limits and better communication skills. They also reported personal and professional growth. Conclusion: Reflective practice is an effective strategy to improve critical thinking and clinical reasoning skills

Does a brief education intervention improve comfort level in evidence –based literature search for general practitioners?

Background: Practicing evidence based medicine in developing countries with limited resources, can be cost effective as it reduces unnecessary tests and medications. Lack of knowledge about Evidence Based Medicine (EBM) and skills for the use of internet, search engine and Pubmed hinders keeping abreast with the latest developments in medicine. This in turn creates a barrier for best clinical practice and professional development. The purpose of this study was to evaluate if experiential learning in the form of a workshop improves the comfort level scores in searching for evidence. Methods: A workshop was conducted on the principles of EBM, formulation of answerable questions through keywords, practice on the use of different search engines and evaluation of websites. Completed questionnaire of both pre and post workshop was obtained from 27 participants out of 30. Pre and post self perceived comfort level scores were calculated and compared by paired t test. Results: In the pre workshop questionnaire participants reported being comfortable with using keywords and Google in searching for evidence. The post workshop comfort level scores were statistically significant for practice of evidence based medicine (p = Conclusions: Brief interventions like workshops can significantly improve skills for literature search and hence help in practicing EBM. Key words: Evidence based medicine, literature search, general practic