Jafri, Wasim

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eCommons@AKUDepartment of Continuing Professional Education Medical College, PakistanJanuary 2010Continuing medical education : the DCPEperspectiveWasim JafriFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_cpePart of the Medical Education CommonsJournal of the College of Physicians and Surgeons Pakistan  2010, Vol. 20 (12): 839-840 839Sir,A one month old low weight baby had been advisedsupplemental feeds through nasogastric tube (NGT) fora period of one week by certified nutritionist and theparents had been advised to follow-up. But after noticingimprovement in the condition, the parents continuedtube feeding of their own for 5 weeks when they noticedblackish discoloration of nasal tip.The patient wasassessed after removal of feeding tube and pressurenecrosis of nasal tip was diagnosed. The lesion healedspontaneously and resulted in ugly cleft deformityof nasal tip (Figure 1). This patient will require nasalreconstruction in late teens once the facial structure isfully formed.A nasogastric  feeding tubeis one of the commonestdevices used in medicalpractice for providing nutritionto patients. But improper orunnecessary use can leadto a wide range of compli-cations which include gastro-intestinal perforations, pleuro-pulmonary complications,intracranial injuries andeven cardiac and urinarybladder injuries.1-6 Thecomplications related to nose mentioned in litratureinclude epistaxis obstruction and sinusitis,7 but nasaldeformities as a result of NGT are very rare. But giventhe widespread use of tube feedings, even a smallpercentage of such problems can affect a significantnumber of patients and hence need to be prevented byavoiding improper or unnecessary use.REFERENCES1. Sun SC, Samuels S, Lee J, Marquis JR. Duodenal perforation: arare complication of neonatal nasojejunal tube feeding. Pediatrics1975; 55:371-5.2. Filippi L, Pezzati M, Poggi C. Use of polyvinyl feeding tubes andiatrogenic pharyngo-oesophageal perforation in very-low-birthweight infants. Acta Paediatr 2005; 94:1825-8.3. Miller KS, Tomlinson JR, Sahn SA. Pleuropulmonarycomplications of enteral tube feedings. Two reports, review ofthe literature, and recommendations. Chest 1985; 88:230-3.4. Ferreras J, Junquera LM, Garcia-Consuegra L. Intracranialplacement of a nasogastric tube after severe craniofacialtrauma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:564-6.5. Hanafy EEM, Ashebu  SD, Al Naqeeb N, Nanda HB. Pericardialsac perforation: a rare complication of neonatal nasogastric tubefeeding. Pediatr Radiol 2006; 36:1096-8. Epub 2006 Aug 9.6. Mattar MS, Al-Alfy AA, Dahniya MH, Al-Marzouk NF. Urinarybladder perforation: an unusual complication of neonatalnasogastric tube feeding. Pediatr Radiol 1997; 27:858-9.7. Methenya NA, Meertb  KL, Clousec RE. Complications relatedto feeding tube placement. Curr Opin Gastroenterol 2007; 23:178-82.DR. SAJAD AHMAD SALATI AND DR. AJAZ AHMAD RATHERCorrespondence: DR. SAJAD AHMAD SALATILane 2, Bulbul Bagh, Barzullah, Srinagar, Kashmir.E-MAIL: docsajad@yahoo.co.inContinuing Medical Education:The DCPE PerspectiveSir,Continuing Medical Education (CME) are definable andtraditionally distinct educational activities that serve torefresh, improve, or update the knowledge, skills andprofessional development of the physicians and relation-ships used to provide services for patients, the public, orthe profession. It is a professional responsibility for allthe practicing physicians in this fast moving medicalworld to accept the obligation of the CME as a task ofscientific and technological up-grading.1Most of the CME’s as influenced by studies of adultlearning are offered in the form of courses, conferences,journal clubs, grand rounds and workshops. The onlinemode of CME delivery is particularly attractive and isgaining popularity, supported by screen based text andgraphics with different levels of interactivity.  Physicians should view CME holistically in the context ofcontinuous professional development (CPD) and evenmore widely as knowledge translation (KT), whichincludes both CME and CPD.2 Continuing professionaldevelopment entertains traditional CME along with theother skills such as management, teaching, communi-cation, and continuing appraisal, etc. KT mainly focuseson health outcomes and changing behavior and is definedas the process whereby information is transferred tophysicians and applied in practice.2The need for continuous learning as part of a physician’sprofessional development is evident but the best waysof introducing and nurturing this learning have beenCleft Nose Deformity: AnUnfortunate Complication ofNasogastric TubeLETTERS TO THE EDITORFigure 1:  Cleft nose deformity as asequelae of pressure necrosiscaused by nasogastric feeding tube.840 Journal of the College of Physicians and Surgeons Pakistan  2010, Vol. 20 (12): 839-840the subject of much controversy, and is beingquestioned and debated in many countries.3 However,each institution must determine and set its own prioritieswith regard to CME.4 Recognizing the current trendsand the scarcity to maintain the performance andexpectations of the physicians all around in Pakistan, theAga Khan University (AKU) devised an educationsystem and established the Department of ContinuingProfessional Education (DCPE) to promote thecontinuing medical education within the region. Thedepartment is headed by an Associate Dean with amanager and an administrative assistant. The coreresponsibilities of the DCPE encompass: monitoring allCME’s to assure fulfillment of stated objectives andmaintenance of high quality; approving, awarding andrecording continuing education credit(s) as per DCPE-AKU credit awarding system for physicians; coordinatingall programmatic and financial responsibilities associatedwith continuing medical education and acquiring andmaintaining national accreditation.The DCPE facilitates different stakeholders in assessingtheir needs for planning CME activities. It strictly ensuresthat CME programs planned are purely based on theneeds and objectives to be accepted by the medicalcommunity as unbiased and of international standards.These CME programs are further reviewed andapproved by the Continuing Medical Education AdvisoryCommittee at AKU.5Obtaining credit for participating in CME has historicallyserved as an evidence that the physician is engaged inlife-long learning, keeping up with changes in medicineand keeping skills update.4 The rationale for awardingDCPE-AKU credit certificates is to sensitize andencourage physicians to learn and keep up-to-date; andto introduce and built up the standards of the continuingmedical education in Pakistan. DCPE has made itmandatory for the participants to evaluate the programcontent and presentation at the completion of the activityand has kept it as a condition for awarding the credit.The DCPE CME programs cannot be sponsored orjointly sponsored by a pharmaceutical/commercial firm.However, they may provide an educational grant to thedepartment to support an activity, but the DCPE maintainsits individuality and assumes total responsibility for thecontent and quality of the CME program. The challenge of maintaining professional competencein an environment characterized by rapid organizationalchange, information overload, and increasing publicexpectations is forcing the physicians to think hard aboutcontinuing medical education. The ability to workin team is proven.3 It is the key to success for CMEbecoming more visible, integrated and well planned. It ishigh time for health industry in Pakistan to make acollaborative approach to raise expectations for CMEthat has demonstrated an impact on physicians’ behaviorand patient care. Major stakeholders like HEC (HigherEducation Commission), PM&DC (Pakistan Medicaland Dental Council), CPSP (College of Physicians’ andSurgeons Pakistan) and other CME-providers like AKUhave already begun to think on these lines but shouldnow work together closely in the maintenance ofphysicians’ competency by developing effective learningvenues, design methods for periodically assessingknowledge and skills, national accreditation guidelinesand implement strong oversight mechanisms to ensurethat educational activities are free of commercial bias.REFERENCES1. Brigley S, Young Y, Littlejohns P, McEwen J. Continuing educationfor medical professionals: a reflective model. Postgrad Med J 1997;73:23-6.2. Raza A, Coomarasamy A, Khan KS. Best evidence continuousmedical education. Arch Gynecol Obstet 2009; 280:683-7. Epub2009 Jun 3.3. Holm HA. Continuing medical education: quality issues incontinuing medical education. Br Med J 1998; 316:621.4. Davis N, Davis D, Bloch R. Continuing medical education: AMEEeducation guide no 35. Med Teach 2008; 30:652-66.5. The Aga Khan University. Department of continuing professionaleducation [Internet]. 2010. [updated 2010 Jul 6]. Available from:http://www.aku.edu/dcpe/DR. FARHAN VAKANI, DR. MUGHIS SHEERANI AND PROF. S.M. WASIM JAFRICorrespondence: PROF. S.M. WASIM JAFRI70/2 Khayaban-e-Ameer Khosro,Phase 6, DHA, Karachi.E-MAIL: wasim.jafri@aku.edul l l l lOl l l l lLetters to the editor

Continuing medical education : the DCPE perspective

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Continuing medical education : the DCPE perspective

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