Using participatory research methods to explore residents’ perception of workplace stressors during residency training

Introduction: The culture of the learning environment is a major determinant of behaviours developed by residency trainees. This study explores anaesthesia residents perceptions of workplace stressors which affect behaviour and work performance adversely during the training period. Methods: We used two complementary qualitative participatory research methods based on focus group discussions and semi-structured interviews, with volunteers from each year of residency. The discussions were held in complete privacy and recorded on a digital voice recorder. Report of each discussion was shared with all participants to ensure credibility through member checking. Results: The stressors identified by anaesthesia residents which impaired work performance and generated stress were related to multiple supervisors, conflicting attitudes of different supervisors, workload and unsupportive organizational culture outside the parent department. Conclusion: Tensions due to lack of tolerance for divergent practices, diverse faculty, lack of constructive feedback and respect are the major stressors identified by residents which affect behaviour adversely. This information is a valuable resource for evaluation of workplace culture as perceived by the trainees, and planning self-development programs for faculty members and medicals resident

Problems and issues in implementing innovative curriculum in the developing countries: the Pakistani experience

Background: The Government of Pakistan identified 4 medical Colleges for introduction of COME, one from each province. Curriculum was prepared by the faculty of these colleges and launched in 2001 and despite concerted efforts could not be implemented. The purpose of this research was to identify the reasons for delay in implementation of the COME curriculum and to assess the understanding of the stakeholders about COME. Methods: Mixed methods study design was used for data collection. In-depth interviews, mail-in survey questionnaire, and focus group discussions were held with the representatives of federal and provincial governments, Principals of medical colleges, faculty and students of the designated colleges. Rigor was ensured through independent coding and triangulation of data. Results: The reasons for delay in implementation differed amongst the policy makers and faculty and included thematic issues at the institutional, programmatic and curricular level. Majority (92% of the faculty) felt that COME curriculum couldn’t be implemented without adequate infrastructure. The administrators were willing to provide financial assistance, political support and better coordination and felt that COME could improve the overall health system of the country whereas the faculty did not agree to it. Conclusion: The paper discusses the reasons of delay based on findings and identifies the strategies for curriculum change in established institutions. The key issues identified in our study included frequent transfer of faculty of the designated colleges and perceived lack of: · Continuation at the policy making level · Communication between the stakeholders · Effective leadershi

Assessment of competence for caesarean section with global rating scale

Objective: To establish as reliable and valid the nine-point global rating scale for assessing residents\\u27 independent performance of Caesarean Section. Methods: The validation study was conducted at the Department of Obstetrics and Gynaecology, Aga Khan University Hospital, from April to December 2008, and comprised 15 residents during 40 Caesarean Sections over 9 months. Independently two evaluators rated each procedure and the difficulty of each case. Results: The observations per faculty ranged from 1-8 (mean 4.07± 2.56). The Year 4 residents were observed the most i.e. 32 (40%), followed by Year 3, 30 (37.5%); Year 2; 14 (17.5%); and Year 1, 4 (5%). Mean time required for observation of the surgery was 43.81±14.28 (range: 20-90) with a mode of 45 min. Mean aggregate rating on all items showed gradual progression with the year of residency. The assessment tool had an internal consistency reliability (Cronbach\\u27s alpha) of 0.9097 with low inter-rater reliability. Conclusion: The evaluation tool was found to be reliable and valid for evaluating a resident\\u27s competence for performing Caesarean Section. Training of the assessors is required for a better inter-rater agreement

Evaluation of multiple choice and short essay question items in basic medical sciences

OBJECTIVES: To evaluate Multiple Choice and Short Essay Question items in Basic Medical Sciences by determining item writing flaws (IWFs) of MCQs along with cognitive level of each item in both methods. METHODS: This analytical study evaluated the quality of the assessment tools used for the first batch in a newly established medical college in Karachi, Pakistan. First and sixth module assessment tools in Biochemistry during 2009-2010 were analyzed. Cognitive level of MCQs and SEQs, were noted and MCQ item writing flaws were also evaluated. RESULTS: A total of 36 SEQs and 150 MCQs of four items were analyzed. The cognitive level of 83.33% of SEQs was at recall level while remaining 16.67% were assessing interpretation of data. Seventy six percent of the MCQs were at recall level while remaining 24% were at the interpretation. Regarding IWFs, 69 IWFs were found in 150 MCQs. The commonest among them were implausible distracters (30.43%), unfocused stem (27.54%) and unnecessary information in the stem (24.64%). CONCLUSION: There is a need to review the quality including the content of assessment tools. A structured faculty development program is recommended for developing improved assessment tools that align with learning outcomes and measure competency of medical students

Clinical skills in undergraduate program and Curricular change – does it make a difference?

Background Clinical Skills Laboratory (CSL) was established at Foundation University Medical College (FUMC) in year 2009 with the introduction of integrated modular teaching program. A structured integrated curriculum was introduced from the Class of year 2013 for learning of clinical skills at CSL. This study was conducted to evaluate the effect of introducing the new curriculum on student’s performance in CSL. Methods A comparative analytical study was conducted. The OSCE scores of group A (Class of year 2011) were compared with group B (Class of 2013). Data collection tool was institutional checklist. The OSCE stations were of General Physical Examination (GPE), history taking, systemic examination of Gastrointestinal tract and communication skills. Reliability of the scores was estimated through Cronbach α. Mean scores of the two groups were compared using the independent sample t test and Mann Whitney U-test. Chi-square test was used to compare variables (years, gender and educational background). Comparison of student scores at different components of OSCE using Analysis of Variance (ANOVA) was done.   Results Reliability of scores was 0.65 for group B and 0.52 for group A. comparison of overall scores of the two groups reflected improved performance in the group B (p 0.001). Comparison of scores at different components of OSCE using ANOVA also reflected better performance of group B (p<0.01). OSCE scores of both the groups were also correlated for gender and educational background. No difference was found in the two groups on the basis of gender and educational background. Conclusion To enhance the value of clinical skills training and to make it more effective, skill lab curriculum must be structured and integrated within the undergraduate curriculum. Key words;Clinical skills laboratory, undergraduate integrated curriculum, clinical skills training&nbsp

Nurse teachers’ conceptions and practices of written feedback in Karachi.

Background: Written Feedback (WFB) plays a significant role in student’s learning in terms of improvement of their academic writing skills. However, the quality of WFB may be affected by various personal and contextual factors. This study aimed to identify nurse teachers’ conceptions and practices of WFB on written assignments in nursing degree offering institutions in Karachi, Pakistan. Methods: A cross-sectional descriptive study design was used to answer the study questions. The study was conducted at 11 nursing schools in Karachi by recruiting those teachers who were teaching in nursing degree programs. The sample size of the study consists of 80 teachers. Universal sampling technique was used to select the subjects of the study. Results: The study result consists of demographic information of the participants, teachers’ conceptions and their practices of WFB. Although majority (92%) of the teachers believed that WFB is important for students’ learning, they acknowledged that they were not able to provide WFB at optimum level to their students. This gap in practice is attributed to various personal, contextual, and organizational factors; among them, the highest reported factors were teachers’ lack of training for provision of WFB (84%), distraction in the environment (78%), and constraints of time due to teacher’s workload (74%). Conclusions: The importance of WFB for students’ learning is well established in the literature. However, the preparation of teachers and an enabling environment to facilitate teachers for optimum practices of WFB needs considerable attention by educational institutions

Challenges of providing timely feedback to Residents: Faculty perspectives

Objective To explore faculty\u27s perceptions of challenges in providing verbal feedback to the Residents and suggest ways to overcome the barriers. Methods As part of a larger study on feedback assessment, five focus group discussions were conducted at the Department of Medicine, Aga Khan University Hospital, Karachi, during faculty development workshops held from January to June 2010. Qualitative grounded theory was used to explore faculty perceptions of challenges in providing verbal feedback to the Residents. Results Of the 54 faculty members, 49(91%) participated. Four themes that emerged were \u27time constraint\u27 indicating high patient load; \u27faculty related issues\u27 indicating faculty\u27s apprehension about its own evaluation by Residents; \u27educational issues\u27 indicating that the importance of feedback was not emphasised; and \u27system and logistic issues\u27 indicating that the assessment form used for assessing Residents was ambiguous. Conclusion Work load of the faculty and the expectations with respect to patient care responsibilities may have an impact on the quality, timing, content and delivery of the feedback provided to the Residents

Psychometric analysis and validity of the medical college admission test at the aga khan university

Bibliography: p. 85-98.A few pages are in colour.Includes a copy of Ethics Review form. Original with original copy of Partial Copyright Licence

Relationship between level of empathy during residency training and perception of professionalism climate

Background: Empathy is one of the vital personality attributes for all physicians. It is essential for establishing general interpersonal relationships among doctors and patients. Unfortunately, there is evidence for the decline of physician\u27s empathy during the clinical training phase and is a major concern for medical educators worldwide. One of the major factors reported for the decline of this trait is an unprofessional learning environment.Objective: This study examines the relationship between empathy level and perception of climate of professionalism among residents.Method: The study participants included 70 residents of Obstetrics & Gynecology and Pediatrics departments of a private sector tertiary care hospital in Karachi, Pakistan. Two self-administered internet based surveys - Jefferson Scale of Physician Empathy (JSPE) and Professionalism Climate Instrument (PCI) - were administered to assess the level of empathy among the participants and their perception of professionalism in the learning environment. The relationship between the level of empathy and professionalism was analyzed using Spearman rank correlation.Results: The overall response rate was 81.4% with mean empathy level of 103 ± 13. The internal consistency of each scale measured by Cronbach\u27s coefficient α was 0.76 for JSPE and 0.65 for PCI. No significant difference was observed in the mean empathy scores between senior and junior residents of both specialties. Statistically significant difference in empathy scores existed between female and male residents (p = 0.012; 95% CI, 2.27 to 17.59). The mean PCI score was 106 + 8.88 with no significant difference among residents of two specialties. Professionalism score was not found to vary with either the year of residency or gender. Empathy score and professionalism climate were not found to be correlated (rs = 0.56, p = 0.64).Conclusion: The findings suggested that empathy is a relatively stable trait that remains unchanged during residency training programs. Female residents had higher empathic concern than the male trainees, however, the empathy level of the participants was not found to be influenced by the climate of professionalism