Simulation based team training in surgery - A review

The healthcare environment in surgery is complex, dynamic and often ambiguous. Besides subject knowledge and technical skills, other competencies, such as team work, communication skills and situation awareness, are required to ensure better patient-related outcome. Teams that demonstrate poor non-technical skills make more technical errors, often resulting in patient morbidity or mortality. Different hospital-based locations, such as operating rooms, intensive care units, emergency rooms and surgical wards, are the areas where poor team dynamics prevail. Simulation-based team training is a strategy to provide inter-professional training and experiential learning opportunities for surgeons, anaesthetists and allied health professionals. It helps them to effectively respond in complex situations in complex surgical environment. Simulation-based team training has 3 components; didactics, simulation itself, and debriefing. Literature has shown that simulation-based team training in surgery improves identification of team-based behaviours, improves team performance and overall patient safety

A Moderated Mediation Model of Empowering Leadership and Employees’ Innovative Work Behavior

This study examined the moderated mediation model of empowering leadership and employees’ innovative work behavior (IWB) by analyzing the mediating role of employees’ psychological empowerment and high-performance work system (HPWS). Using the convenience sampling technique, time-lagged data was collected from 433 software engineers working in different software companies operating in Pakistan. Hierarchical regression analysis and PROCESS macro were used to perform the analysis. The findings revealed that empowering leadership impacts employees’ IWB directly as well as through their psychological empowerment, while HPWS moderates the relationship between empowering leadership and employees’ psychological empowerment. The findings further articulated that the moderated mediation effects of HPWS also arbitrate between empowering leadership and employees’ IWB. The results of this study implied that when employees work in the context of a high HPWS, they reciprocate positively to the support and resources received from their leaders. Similarly, in the context of a high HPWS, empowering leadership greatly enhances employees’ psychological empowerment and creativity. In the context of a low HPWS, employees’ IWB depends upon their leaders’ behavior and also on their own psychological empowerment. Hence, the study analyzed when (contextual boundary conditions) and how (the underlying mechanism) empowering leadership enhances employees’ IWB by utilizing the moderated mediation model

Impact of a global pandemic on surgical education and training- review, response, and reflection

The catastrophic effects of the coronavirus disease-2019 global pandemic have revolutionised human society. The unprecedented impact on surgical training needs to be analysed in detail to achieve an understanding of how to deal with similar situations arising in the foreseeable future. The challenges faced by the surgical community initiated with the suspension of clinical activities and elective practice, and included the lack of appropriate personal protective equipment, and the self-isolation of trainees and reassignment to coronavirus patient-care regions. Together, all these elements had deleterious effects on the psychological health of the professionals. Surgical training irrespective of specialty is equally affected globally by the pandemic. However, the global crisis inadvertently has led to a few constructive adaptations in healthcare systems, including the development of tele-clinics, virtual academic sessions and conferences, and increased usage of simulation. The current review article was planned to highlight the impact of corona virus disease on surgical training and institutions\u27 response to the situation in order to continue surgical training, and lessons learnt from the pandemic

Assessing the validity of admission test into the internship programme at a private university in Pakistan

Objective: To report the development and validity assessment of a comprehensive model of assessment method comprising written test and multiple mini interviews for selection in a medical internship programme. Method: The psychometric validation study was conducted at the Aga Khan University, Karachi, and comprised anonymised scores of written admission test, multiple mini interviews and exit written exams for all the interns who completed their internships in 2018 and 2019. Correlation between admission and exit tests, and predictions were assessed. Data was analysed using SPSS 20. Results: There were 160 interns; 80(50%) each in 2018 and 2019. Mean scores were 68.8±4.40% for written tests and 76.7±4.66% for multiple mini interviews. The mean score for exit examination was 68.1±6.84%. The Cronbach\u27s alpha of scores on the written admission test was 0.82 and 0.88 for the two years, respectively, while for the multiple mini interviews, the corresponding values were 0.81 and 0.94. The written admission and exit tests were moderately correlated (0.44) while the correlations of multiple mini interviews scores with written admissions and exit tests were -0.28 and 0.04, respectively. Conclusion: The selection process should comprise multiple measures of assessment to ensure the selection of the best candidate

In a digitally connected world through likes, hashtags and followers - advancing surgical research through a social media: A narrative review

In this era of modern information technology, the world is now digitally connected through various platforms on social media, which has changed the way medical professionals work, communicate and learn. The use of social media in surgery is expanding, and it is now becoming an essential tool for surgical training, research and networking. Articles, journal clubs and surgical conferences are within reach of everyone regardless of geographical location worldwide. Electronic publications have now resoundingly replaced printed editions of journals. Collaborative research through social media platforms helps collect diverse data, enhancing the research\u27s global generalisability. The current narrative review was planned to discuss the importance of social media in advancing surgical research and the use of different social media applications in the context of promoting and disseminating surgical research alongside its evolving ethical challenges

Empathy in clinical practice: A qualitative study of early medical practitioners and educators

Objective: To explore the reasons for decline in empathy among physicians and to identify strategiesfor fostering empathetic clinical practice.Methods: The qualitative study was conducted at the Aga Khan University Hospital, Karachi, from February to June 2017, and comprised focus group discussions involving separate sessions with medical students, residents and clinical teachers. Content analysis was used to analyse the verbatim transcripts for identification of codes which led to derivation of themes from the data. Consolidated criteria for reporting qualitative research was used to assess the quality of the study.Results: Of the 109 subjects, 57(52.3%) were medical students, 30(27.5%) residents and 22(20.2%)clinical teachers. Of the 9 focus group discussions, 4(44.4%) were held with the students, 3(33.3%) with residents and 2(22.2%) with the teachers. Four themes that generated were delineating empathetic clinical practice, reasons for decline, challenges for promoting empathetic clinical practice, and recommendations for developing and facilitating empathetic clinical practice. All the participants unanimously agreed that there was a decline in empathetic clinical practice. Primary challenges included increased workload and time constraints inhibiting empathetic practice..Conclusions: It is essential to teach empathetic clinic practice to students and residents during medical training while continuous professional development should reinforce the significance of empathetic clinical practice among medical practitioners and educators

Knowledge gain of the non-vascular surgeons after attending a course on traumatic vascular emergencies

Objective: To measure the effectiveness of the workshop in enhancing the knowledge and skills of the non-vascular surgeons in dealing with traumatic vascular emergencies.Methodology: It was a Quasi-experimental pre-post design study conducted at Section of Vascular Surgery, Aga Khan University Hospital, Karachi (Pakistan) in February 2019. One-day workshop was conducted to enhance the knowledge and operative skills of the non-vascular surgeons in managing traumatic vascular emergencies. A written test and course evaluation survey were used to evaluate the effectiveness of the course in achieving the desired objectives.Results: Total of 21 participants attended the workshop with mean age of 29 ± 6.06 years. Majority of participants 15 (71%) were surgery residents from different subspecialties. Only 3 (14%) had prior exposure in Vascular Surgery. Mean pretest score was 11.9 ± 4.27 (59.52% ± 21.3) which improved to 16.14 ± 3.69 (81.6% ± 16.6). Gain in knowledge was measured using paired t-test and there was 21% of gain in knowledge of the participants compared between the pretest and posttest score. Overall participants found this workshop to be very useful in refining their skills and learning innovative techniques in managing vascular emergencies.Conclusions: Carefully designed workshop improves the knowledge of non-vascular surgeons in dealing with common vascular emergencies

Developing role models in clinical settings: A qualitative study of medical students, residents and clinical teachers

Objective: To explore how positive role modelling attributes can be developed in students, residents and clinical teachers.Methods: The qualitative study using focus group discussions was held at Aga Khan University, Karachi from March to May 2018, and comprised medical students, residents and clinical teachers. Overall 11 focus group discussions were conducted till data saturation was achieved. Content analysis was used to analyse the data which was transcribed verbatim.Results: Of the 116 subjects, 60(51.7%) were medical students, 35(30.2%) were residents and 21(18%) were clinical teachers. Of the 11 focus group discussions, 4(36.5%) each were held with the students and the residents, while 3(27%) were held with the teachers. Five major themes that emerged from the study included definition of role models, attributes of role models, role modelling as a learnt behaviour, challenges in developing role models, and recommendations for developing positive role models. A number of attributes of positive and negative role models were identified by the participants. All the participants including students, residents and teachers appreciated the importance of role modelling in developing professionalism among health professionals and medical students. Factors hindering development and demonstration of positive role modelling were also identified and possible solutions were suggested.Conclusions: Clinical teachers needed to be made cognizant of their role as positive role models in developing professionally competent physicians. The medical institutions needed to develop and implement policies that would enhance positive role modelling by the teachers and facilitate learning of positive attributes at all levels

Ameliorative Effects of Two Forms of Pomegranate on Glomerular Transvertical Diameter in Steroid- Induced Kidney Damage in Mice

To observe the effects ofPomegranate juice (PJ) and Pomegranate peel extract(PPE) on glomerular transvertical diameter in steroidinduced mice kidney damage.Methods: In this experimental study forty healthyadult mice (BALB/c strain), average weighing 25-30gms were divided into four groups, having ten miceeach. Control group A received only standardlaboratory diet without alteration.Experimentalgroups B, C and D were injected ND (Nandrolonedecanoate) (1 mg/100 gm body weight),intramuscularly (I/M), in the hind limb once a weekfor 8 weeks. Experimental group C was also given PJ(3ml/kg body weight) by oral gavage tube daily for 8weeks and experimental group D was given PPE(200mg/kg body weight) through oral gavagetube,daily for 8 weeks.After the experimental period,the animals were sacrificed and both kidneys of allmice were obtained. Kidneys were processed,embedded and stained for histological study byusing Hematoxylin and Eosin (H&E) and PeriodicAcid Schiff (PAS) stains. The results were compiledand compared.Results: After ND administration, glomerulardiameter was significantly reduced in experimentalgroup B when compared to control groupA.Protective effects were seen when comparison ofexperimental group B was done with PJ and PPEadministered experimental groups C and D,respectively. When results of experimental groups Cand D were compared with each other no statisticalsignificance was present.Conclusion: Both forms of Pomegranate hasameliorative effects on glomerular transverticaldiameter in steroid induced mice kidney disease

Stress and coping among surgery residents in a developing country

Objective: Stress during residency training in surgical disciplines not only hampers professional development but can also compromise patient care and personal health. The purpose of this study was to measure the stress level among the surgical residents, identify factors within the learning and work environment that cause stress, and identify different strategies that the residents use habitually to cope with these stresses.Methodology: This mix method study was conducted in the department of Surgery at Aga Khan University, Pakistan. Residents\u27 stress level was measured using Perceived Stress Scale (PSS); focus group discussions (FGDs) with faculty and residents explored stressors during residency training, while Brief COPE Inventory identified the residents\u27 preferred coping strategy.Results: A total of 68 (83%) surgery residents completed the survey of which 19% had high stress scores while only one resident had perception of low stress. Females had significantly higher stress scores (25.7±3.0; p=0.008) as compared to male counterparts. Planning (87.8%) and Self-distraction (65%) were the most commonly used adaptive and maladaptive strategies respectively. The reliability of the PSS and BCI measured by Cronbach\u27s alpha was 0.73 and 0.82 respectively. Work-life imbalance, workload and contradicting programme and hospital policies were identified in FGDs as major stressors during residency.Conclusions: Although surgical residency programmes are very stressful, coping strategies are not formally taught during surgical training. Academia and hospital should join hands in developing interventions to enable residents cope with the situation