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

A comparative analysis of multiple sequence alignments for biological data

Multiple sequence alignment plays a key role in the computational analysis of biological data. Different programs are developed to analyze the sequence similarity. This paper highlights the algorithmic techniques of the most popular multiple sequence alignment programs. These programs are then evaluated on the basis of execution time and scalability. The overall performance of these programs is assessed to highlight their strengths and weaknesses with reference to their algorithmic techniques. In terms of overall alignment quality, T-Coffee and Mafft attain the highest average scores, whereas K-align has the minimum computation time

A review of UAV autonomous navigation in GPS-denied environments

Unmanned aerial vehicles (UAVs) have drawn increased research interest in recent years, leading to a vast number of applications, such as, terrain exploration, disaster assistance and industrial inspection. Unlike UAV navigation in outdoor environments that rely on GPS (Global Positioning System) for localization, indoor navigation cannot rely on GPS due to the poor quality or lack of signal. Although some reviewing papers particularly summarized indoor navigation strategies (e.g., Visual-based Navigation) or their specific sub-components (e.g., localization and path planning) in detail, there still lacks a comprehensive survey for the complete navigation strategies that cover different technologies. This paper proposes a taxonomy which firstly classifies the navigation strategies into Mapless and Map-based ones based on map usage and then, respectively categorizes the Mapless navigation into Integrated, Direct and Indirect approaches via common characteristics. The Map-based navigation is then split into Known Map/Spaces and Map-building via prior knowledge. In order to analyze these navigation strategies, this paper uses three evaluation metrics (Path Length, Deviation Rate and Exploration Efficiency) according to the common purposes of navigation to show how well they can perform. Furthermore, three representative strategies were selected and 120 flying experiments conducted in two reality-like simulated indoor environments to show their performances against the evaluation metrics proposed in this paper, i.e., the ratio of Successful Flight, the Mean time of Successful Flight, the Mean Length of Successful Flight, the Mean time of Flight, and the Mean Length of Flight. In comparison to the CNN-based Supervised Learning (directly maps visual observations to UAV controls) and the Frontier-based navigation (necessitates continuous global map generation), the experiments show that the CNN-based Distance Estimation for navigation trades off the ratio of Successful Flight and the required time and path length. Moreover, this paper identifies the current challenges and opportunities which will drive UAV navigation research in GPS-denied environments

Symmetry-based decomposition for optimised parallelisation in 3D printing processes

Current research in 3D printing focuses on improving printing performance through various techniques, including decomposition, but targets only single printers. With improved hardware costs increasing printer availability, more situations can arise involving a multitude of printers, which offers substantially more throughput in combination that may not be best utilised by current decomposition approaches. A novel approach to 3D printing is introduced that attempts to exploit this as a means of significantly increasing the speed of printing models. This was approached as a problem akin to the parallel delegation of computation tasks in a multi-core environment, where optimal performance involves computation load being distributed as evenly as possible. To achieve this, a decomposition framework was designed that combines recursive symmetric slicing with a hybrid tree-based analytical and greedy strategy to optimally minimise the maximum volume of subparts assigned to the set of printers. Experimental evaluation of the algorithm was performed to compare our approach to printing models normally (“in serial”) as a control. The algorithm was subjected to a range of models and a varying quantity of printers in parallel, with printer parameters held constant, and yielded mixed results. Larger, simpler, and more symmetric objects exhibited more significant and reliable improvements in fabrication duration at larger amounts of parallelisation than smaller, more complex, or more asymmetric objects

Recent Approaches of Forecasting and Optimal Economic Dispatch to Overcome Intermittency of Wind and Photovoltaic (PV) Systems:A Review

Renewable energy sources (RESs) are the replacement of fast depleting, environment polluting, costly, and unsustainable fossil fuels. RESs themselves have various issues such as variable supply towards the load during different periods, and mostly they are available at distant locations from load centers. This paper inspects forecasting techniques, employed to predict the RESs availability during different periods and considers the dispatch mechanisms for the supply, extracted from these resources. Firstly, we analyze the application of stochastic distributions especially the Weibull distribution (WD), for forecasting both wind and PV power potential, with and without incorporating neural networks (NN). Secondly, a review of the optimal economic dispatch (OED) of RES using particle swarm optimization (PSO) is presented. The reviewed techniques will be of great significance for system operators that require to gauge and pre-plan flexibility competence for their power systems to ensure practical and economical operation under high penetration of RESs

Integrating Immunotherapy with Chemotherapy: A New Approach to Drug Repurposing

Triple negative breast cancer (TNBC) is an aggressive breast cancer subtype lacking the three hormonal receptors namely estrogen receptor, progesterone receptor and HER2 receptor, and the only treatment option available for TNBC is chemotherapy. Chemotherapy lacks specificity since it acts on normal healthy cells as well resulting into secondary diseases in TNBC patients. In addition chemotherapy poses recurrence and relapse issues due to the development of chemoresistance among TNBC patients. Immunotherapy remarkably immune checkpoint inhibitors show a great therapeutic potential in TNBC. As TNBC contain an increased TILs (tumor infiltrating lymphocytes) infiltration making it more suitable as a therapeutic target anti-tumor immune strategy. Moreover, evidences have indicated that chemotherapy upregulates the anti-tumor immune response in TNBC. As a result, a combination of immunotherapy with chemotherapy may increase the overall relapse and recurrence free survival of TNBC patients. Therefore, in this chapter we will focus on how the immunotherapy works in TNBC, their effects and consequences. We will further be discussing the clinical studies and the importance of immune checkpoint inhibitors (ICIs) in combination with various therapeutic agents and target. Further, we will explore the processes involved

Electric Vehicle Charging Modes, Technologies and Applications of Smart Charging

The rise of the intelligent, local charging facilitation and environmentally friendly aspects of electric vehicles (EVs) has grabbed the attention of many end-users. However, there are still numerous challenges faced by researchers trying to put EVs into competition with internal combustion engine vehicles (ICEVs). The major challenge in EVs is quick recharging and the selection of an optimal charging station. In this paper, we present the most recent research on EV charging management systems and their role in smart cities. EV charging can be done either in parking mode or on-the-move mode. This review work is novel due to many factors, such as that it focuses on discussing centralized and distributed charging management techniques supported by a communication framework for the selection of an appropriate charging station (CS). Similarly, the selection of CS is evaluated on the basis of battery charging as well as battery swapping services. This review also covered plug-in charging technologies including residential, public and ultra-fast charging technologies and also discusses the major components and architecture of EVs involved in charging. In a comprehensive and detailed manner, the applications and challenges in different charging modes, CS selection, and future work have been discussed. This is the first attempt of its kind, we did not find a survey on the charging hierarchy of EVs, their architecture, or their applications in smart cities