Exploring the reasons of unsuccessful attempts in examination during postgraduate clinical training.

Objective: To explore the reasons of unsuccessful attempt in examination during postgraduate clinical training in Pakistan. METHODS: The qualitative, exploratory study was conducted at the Allied Hospital, Faisalabad, Pakistan, from December 1, 2022, to February 25, 2023, and comprised postgraduate trainees from different departments who had at least one unsuccessful attempt in examination during their residency programme. Data was collected through direct interviews that were recorded. The data was subjected to thematic narrative analysis. RESULTS: Of the 14 participants, 10(71.4%) were males and 4(28.5%) were females. The maximum number of unsuccessful attempts were 7(7%), followed by 6(14%), 4(7%), 3(14%), 2(42%) and 1(14%). There were 3 main themes; personal factors, training factors, and exam factors. All the themes had subthemes. Conclusion: At the start of the residency programme, postgraduate trainees must be provided with adequate guidance, and a support system must be present during the programme to help them cope with the stress during training.

Medical students' knowledge about curriculum development and implementation in public and private medical institutes.

Objective: To assess the knowledge of undergraduate medical students about curriculum development and implementation. Methods: A quantitative descriptive study was conducted at a public sector institute and a private sector institute from September, 2022 to December, 2022. Simple random sampling was used and all the undergraduate MBBS students were included in study. Sample size was calculated using open epi and keeping confidence interval at 95% as 316 for FMU students and 218 for AFMDC students. Ethical approval was taken from FMU and permission to collect data was obtained from AFMDC. A Questionnaire was made and distributed among the students and data obtained was analyzed using SPSS 25.0. Results: Two hundred and forty-seven (49.4%) participants responded that the students don't have any say in their curriculum, 400 (80%) were of the view that the students must have their opinion in the curriculum and 397 (79.4%) said that students must be involved in the process of planning and implementation of curriculum. When asked about the areas of deficiencies in the current curriculum, 101 (20.2%) pointed new skill, 84 (16.8%) indicated New information, new skills, teaching Methodology and effective teachers, 68 (13.6%) said teaching methodology while 51 (10.2%) indicated new skills and teaching methodology both. Five main themes were identified from the comments of students regarding curriculum, its development and implementation including; 1. Content revision, 2. Teaching methodologies, 3. Assessment, 4. Guidance and orientation and 5. Teacher student relationship. Conclusion: The undergraduate medical students are aware of the terms related to curriculum, its development and implementation but they are not being involved in any of this process. Content revision, clinical integration from initial years, quality assessment and faculty development are few areas that need improvement from students' perspectives.

Assessment of COVID-19 related preventive measures in medical students across a lower-middle-income country: A cross-sectional study from Pakistan.

Objectives: This study aims to identify the effect of having COVID-19 positive close contact on practices and evaluate practices regarding COVID-19 prevention among medical students and the differences among clinical and preclinical students. Study design: The cross-sectional study included medical students from the Micro-fest++ event held on 30th May 2020. Methods: Participants filled a questionnaire of 15 questions regarding COVID preventive measures practices having satisfactory reliability (Cronbach's alpha = 0.715) and validity. The Statistical Package for Social Sciences (IBM SPSS) 26.0 was used for data analysis. Out of 1342 medical students, the majority were female (N = 881, 65.6%). Greater proportion (47%) of students had good practices (>85.7%) (p < 0.05). Results: Having COVID-19 positive relatives resulted in higher positive responses for practices with 11.86 ± 1.94 (out of 14) compared to 11.78 ± 2.38 for the COVID-19 negative group. Clinical year students compared to preclinical students responded positively to all questions, except one, and had a better score of 11.90 ± 2.28 (out of 14) compared to 11.61 ± 2.37 (p < 0.05). A significant difference was noted for "Information on preventive measures" (p < 0.01), "Avoiding crowds and staying home" (p < 0.05), "Social distancing (maintain 3 feet)" (p < 0.01), and "Practices of disinfection after going outside" (p < 0.05). Conclusions: Overall, medical students showed good practices, but a lack of knowledge in certain areas requires addressing infection during clinical rotations. A greater proportion of clinical students and those having a COVID-19 positive relative showed better adherence to practices.

Introduction of temporal integration in fourth year MBBS curriculum; Students' experience.

Objectives: Rapid innovations in medical science have necessitated the development of an advanced medical curriculum. Taking a step towards this, a temporal integrated system and clinic-pathological conferences themes were introduced in a public sector medical university for fourth year MBBS. This study aims to assess students' perceptions regarding this change. Methods: A cross sectional study was conducted in a public sector medical university from May 2019 to April 2020. A 17 item pre-validated questionnaire was distributed among all students twice, firstly after completion of first module and then again at the end of the academic year. Results were analyzed using SPSS 21. Results: There were 265 and 176 participants in the first and second phase of the study respectively. Majority of the students agreed that it was easier to study a topic when temporally integrated. Most commonly reported advantage was better understanding and concept of the theme under study. Suggestions included revision of the schedule regarding allocation of time for different topics and implementation of this curriculum from first year MBBS. Conclusion: A small step was taken to make improvements in an old traditional method. Students are adapting to this change as they responded positively to various aspects of this methodology. Continuous feedback, evaluation and amendments will help to improve its effectiveness.

Knowledge, attitude, and practice of diabetic patients regarding foot care: Experience from a single tertiary care outpatient clinic.

BACKGROUND: Foot complications are a common problem among the diabetic population globally. Proper preventive education by health care providers should be provided to the diabetic population. This study aims to assess the knowledge, attitude, and practice of diabetic patients regarding foot care. METHODS: This study was carried out in the medicine outdoor patient department of Allied Hospital, Faisalabad. A total sample of 150 diabetic patients was taken. Sampling was done through a non-probability convenient sampling technique. The data was analyzed using SPSS version 20. RESULTS: The mean age of the respondents was 52.49 ± 11.87 years. Most of the patients had moderate knowledge and also practiced a moderate level of foot care. 32.7% of the patients had good knowledge, 51.3% had moderate knowledge, and 16.0% had poor knowledge regarding foot care. 63.3% of the patients had moderate practice; 24.5%, poor practice; and 12.2%, good practice. Patients belonging to urban areas scored better on both knowledge and practice scales. A significant statistical association of education with knowledge (P = 0.012) and practice (P = 0.008) regarding foot care was found. The patients compliant with drug therapy also observed better foot care practices. CONCLUSION: Education had a significant role in positively influencing the behavior of the patients. There was found a gap between knowledge and practice level of patients. Hence patients should be actively engaged in their health care plan with more emphasis on changing their behavior.

The magnitude and determinants of violence against healthcare workers in Pakistan.

Objectives: To determine the magnitude and determinants of violence against healthcare workers (HCWs) and to identify the predominant types and causes of violence experienced by them. Methodology: A cross-sectional survey based on structured questionnaire adopted from previous surveys and qualitative data was conducted in 4 large cities and 12 districts in 3 provinces of Pakistan. The survey covered 8579 from all cadres of HCWs, including doctors, nurses, technicians, support staff, ambulance workers, vaccinators, lady health visitors, midwives and lady health workers (LHWs). The predictors of overall violence experienced, physical violence experienced and verbal violence experienced were separately analysed for tertiary care hospitals, secondary care hospitals, primary care hospitals and field-level HCWs. Logistic regression was used to compute adjusted ORs with 95% CIs for the association of different factors with the violence experienced. Results: More than one-third (38.4%) reported having experienced any form of violence in the last 6 months. Verbal violence was the most commonly experienced form (33.9%), followed by physical violence (6.6%). The main reasons for physical violence were death of patients (17.6%), serious condition of patients (16.6%) and delay in care (13.4%). Among the different types of field HCWs, emergency vehicle operators were significantly more likely to experience verbal violence compared with LHWs (adjusted OR=1.97; 95% CI 1.31 to 2.94; p=0.001). Among hospital HCWs, those working in private hospitals were significantly less likely to experience physical violence (adjusted OR=0.52; 95% CI 0.38 to 0.71; p=0.001) and verbal violence (adjusted OR=0.57; 95% CI 0.48 to 0.68; p=0.001). Conclusion: Violence against HCWs exists in various forms among all cadres and at different levels of care. The gaps in capacity, resources and policies are evident. Specific strategies need to be adopted for different types of HCWs to protect them against violence.*The study was conducted under the framework of ICRC's Healthcare in Danger Initiative for protection of healthcare against Violence.

Factors Influencing Medical Students' Choice For Family Medicine As A Specialty In Pakistan.

BACKGROUND: Multiple factors influence career selection for medical students. In developed countries, training in family medicine is essential to start practice as a general practitioner. In Pakistan, this specialty was introduced by College of Physicians and Surgeons Pakistan in 90's but it has not been yet institutionalized. This study was conducted to identify the factors that influence students' choice for Family medicine as a specialty. METHODS: It was a sequential (quantitative first) mix method study which was conducted in two medical colleges (one public sector and other private) of Faisalabad from April to June 2014. In first phase students' career choices were determined in a sample of 252 students. In second phase 12 students were selected randomly for interviews; six students who selected family medicine as a specialty and six students who had selected some other specialty. In depth interviews and focused group discussion were used to explore the factors that influenced them for selecting the respective specialty. RESULTS: Major factor for not selecting family medicine was lack of awareness about the scope of specialty. Other factors included personal interest, feasibility and family influence. CONCLUSIONS: Lack of awareness and scope of family medicine is the predominant factor in influencing students for choosing family medicine as a career. Career counselling, role modelling and exposure to this specialty during clinical years can play an important role in promotion of this field.