Negative faculty role modelling - is it a reflection of deteriorating societal values?

BACKGROUND: Negative faculty role modelling is an area of growing concern especially due to its implications on medical professionalism. The study aims to explore the impacts of negative role modelling on professionalism of medical students in the context of Pakistan. METHODS: This qualitative study is part of a larger study exploring impacts of role modelling on professionalism of students. It is based on Constructivist Grounded Theory involving six semi-structured interviews with clinical faculty and three focus group discussions with 22 students. Initial, focused, selective coding and thematic analysis was used to find the core category. RESULTS: Three overarching categories were developed: traits observed with negative role models; impact of negative role modelling; factors promoting negative role modelling. Subcategories of impacts included negative impact on professionalism, emotional impact, and its paradoxical positive impact. Negative role modelling, a manifestation of declining professionalism, was attributed to deteriorating societal values; further compounded by the lack of required mechanisms by institutions and the regulatory authority at their respective levels. CONCLUSIONS: In the absence of a strong moral platform at societal level, the burden of responsibility rests with the faculty and more importantly with institutions and regulatory bodies to discourage negative role modelling and educate students to recognize, reflect on and avoid negative behaviours and adopt strong professional values.

The blame game- experiences of female residents in obstetrics & gynecology regarding lapses in patient safety.

Objectives: Primary objective was to explore experiences of female residents of Obstetrics and Gynecology (OB/GYN) regarding lapses in patient safety (PS) while secondary objective was to explore factors hampering or favouring improvement of PS in OB/GYN. Methods: In this qualitative narrative study carried out in OB/GYN department of Combined Military Hospital (CMH) Lahore for six months from 1st April to 30th September 2021, six fourth-year residents were asked to write narratives of their personal experiences of medical error (witnessed or committed) in detail and reflect on those experiences, which were then transcribed. Code labels and themes were assigned manually. Interpretation of these themes was done after thematic content analysis. Results: Six, fourth-year female residents with a mean age of 28.6±1.8 participated in the study. Two main themes with sub-themes were identified: 1) Challenges in patient safety (Personal challenges, Workplace challenges, Barriers to PS), 2) Lessons learnt from experiences (Self-improvement and; Promotion of patient safety culture). Heavy workload with long working hours, lack of communication and teamwork, lack of experience and inadequate supervision were major factors involved in PS lapses experienced by residents. Conclusion: Incidents of Patient Safety (PS) lapses had a strong impact on the emotional and professional life of residents. Formal PS training with improvement of working conditions may help promote PS culture.

Optimising Preeclampsia First-Trimester Screening Using Three Parameters.

OBJECTIVE: To evaluate the performance of first-trimester preeclampsia-screening algorithm in predicting preeclampsia (PE). STUDY DESIGN: Observational study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Combined Military Hospitals (CMH) Lahore, Pakistan, between 1st January and 31st August 2022. METHODOLOGY: Data of 100 women of any parity aged 18-35 years at gestational age < 13 weeks based on the last menstrual period (LMP), was analysed. First trimester Fetal Medicine Foundation (FMF) screening algorithm for preeclampsia was used entering maternal characteristics, mean arterial pressure and uterine pulsatility index only, for risk calculation. Patients were followed up till delivery for the development of preeclampsia and fetomaternal outcomes. Clinical characteristics of women with and without preeclampsia were compared using the Chi-square and independent samples t-test. RESULTS: The mean age of patients was 29.29±4.56 years and 60% were nullipara. Seventy-eight patients were placed in the low-risk category and 22 patients were in the high-risk category according to the FMF algorithm. Preeclampsia developed in 13 patients. For a risk cut-off of 1 in 100, the FMF algorithm showed a detection rate of 38% with diagnostic accuracy of 75% and a false positive rate (FPR) of 20%. CONCLUSION: Although the performance of adapted FMF algorithm to predict preeclampsia gestational was low, it was found superior to prediction by maternal risk factors alone. Adjustment for additional factors or ethnicity-specific values may help in further improvement of detection rate. KEY WORDS: Blood pressure, Biomarkers, Biological markers, Preeclampsia, Risk assessment.

Patient Safety Awareness Among Dental Students In Lahore, Pakistan: A Multi-Centre Studye.

BACKGROUND: Awareness of key issues associated with patient safety is vital for improving patient care in all fields of medical sciences including dentistry. This study was done to assess awareness among dental undergraduates towards patient safety in different dental institutions of Lahore, Pakistan. METHODS: It was a cross-sectional analytical study conducted at Combined Military Hospital Lahore Medical College & Institute of Dentistry from 1st May to 30th November, 2020. Two hundred third and fourth year BDS students (149 females and 51males; mean age 21.91±1.08) of 4 dental institutions of Lahore, mostly from private institutions (79.5%) completed Awareness of Patient Safety Questionnaire (APSQIII) to assess awareness of patient safety in dental undergraduates. Data was analyzed through SPSS 21. RESULTS: Teaching and learning about patient safety got the highest item scores while "Team functioning" got the highest 6.1 mean domain score. "Professional incompetence as an error cause" got the lowest 3.1 mean score followed by "Disclosure responsibility" (4.3). No significant difference was seen with respect to gender. Fourth year students were found to be more aware about error disclosure and error reporting confidence with statistically significant difference. All reverse coded items were scored in disagreed range by participants. CONCLUSIONS: Despite positive attitudes towards patient safety, lack of awareness was seen in key issues. Incorporation of patient safety in undergraduate curriculum may help in improving patient care and health services.

Perceptions Of Medical Students About The Educational Environment At The Start And End Of Obstetrics And Gynaecology Rotation And Its Impact On Career Choice.

BACKGROUND: The educational environment can influence students' learning and their attitudes towards various medical specialties, thus affecting their career choices. This study aimed to compare perceptions of medical students about educational environment at the start and end of Obstetrics and Gynaecology (O&G) rotation and to assess if these perceptions influenced their career choices. METHODS: This was a Comparative analytical study carried out in the Obstetrics and Gynaecology Department, Combined Military Hospital Lahore Medical College from 1st February to 30th July 2019. Eighty-eight final year MBBS students (60 females and 28 males; average age 22±1.2 years) completed validated Dundee Ready Education Environment Measure (DREEM) questionnaire at the start and end of three weeks of O&G clinical rotation. Two questions were added post rotation to assess impact of their perceptions on career choice. Data was analysed through SPSS version 21 using independent sample t-test. RESULTS: Mean total DREEM score was 126.68±14.17 and 127.49±15.31 out of a maximum of 200 pre and post rotation (p-value 0.001). The sub-scale which improved significantly (p-value 0.010) was Perception of Environment with average scores of 27.88±4.63 and 28.25±4.64 pre and post rotation. Majority of female students (78.7%) felt motivated for choosing O&G as a career after this rotation. CONCLUSION: Final-year medical students perceived the learning environment to be positive. Clinical rotation helped in improving their perception about O&G learning environment and helped female students get more inclined to choose this specialty as a career.