Factors leading to lapses in professional behaviour of Gynae residents in Pakistan: a study reflecting through the lenses of patients and family, consultants and residents.

INTRODUCTION: Professional behaviour is the first manifestation of professionalism. In teaching hospitals, the residents can be considered vulnerable to lapses in professional behaviour when they fail to meet the set standards of professionalism. Residents of some specialties are more at risk of lapses in professional behaviour due to the demanding nature of work. Research focusing on the behaviour of residents in the field of Gynae and the underlying factors contributing to such behaviour is notably lacking in the literature. Additionally, there is a gap in understanding the perspectives of patients from Pakistan on this matter, as it remains unexplored thus far, which constitutes the central focus of this study. An increase in complaints lodged against Gynae resident's professional behaviour in Pakistan Citizen Portal (PCP) was observed. Therefore, an exploratory qualitative study was conducted to investigate the factors and rationales contributing to the lapses in resident's professional behaviour. The study collected the viewpoints of three stakeholder groups: patients and their families, consultants and residents. The study was conducted in three phases. First, the document analysis of written complaints was conducted, followed by face-to-face interviews (11 per group) conducted by trained researchers from an independent 3rd party. Finally, the interview data was transcribed, coded and analysed. In total 15 themes were identified from the interviews with 3 stakeholders, which were then categorized and resulted in 6 overlapping themes. The most prevalent lapse reported by all 3 stakeholders was poor verbal behaviour of residents. CONCLUSION: The highly ranked factors contributing to triggering the situation were associated with workplace challenges, well-being of residents, limited resources, patients and family characteristics, patients' expectations, lack of administrative and paramedic support, cultural factors and challenges specific to Gynae specialty. Another intriguing and emerging theme was related to the characteristics of patients and attendants which helped in understanding the causes and implications of conflicting environments. The value of competency also emphasized that can be accomplished by training and mentoring systems. The thorough examination of these factors by key stakeholders aided in accurately analysing the issue, its causes, and possible solutions. The study's findings will assist higher authorities in implementing corrective actions and offering evidence-based guidance to policymakers to improve healthcare system.

Development and validation of self-assessment instrument to measure the digital professionalism of healthcare professionals using social media.

BACKGROUND: The use of social media across the globe has risen incrementally. During the COVID-19 pandemic, these sites undeniably provided new avenues for professional networking but also led to a surge in cases of online misconduct. Professionalism instruments and scales do not assess the digital attitude and behaviour of healthcare professionals (HCPs). The purpose of this study was to identify the domains and items of digital professionalism related to social media use and to validate a self-assessment instrument to assess the digital professionalism of HCPs using social media. METHODS: An instrument development multiphase mixed method study (exploratory sequential) was conducted in two phases: item development and qualitative content validation followed by validation of the instrument. Feedback was taken from 15 experts for qualitative content validation in phase 1. In phase 2, content validity was established through three rounds of modified Delphi. Validity evidence was collected for the content (content validity index), response process (cognitive interviews), internal structure (confirmatory factor analysis), and internal consistency (Cronbach's alpha). RESULTS: The 48-item preliminary instrument was reduced to a 28-item instrument with eight domains: self-anonymity, privacy settings, maintenance of boundaries and confidentiality, conflict of interest, accountability, respect for colleagues, and ethics. The content validity index of the scale was 0.91. The reliability and construct validity of the instrument was established by responses from 500 healthcare professionals from multiple hospitals. Confirmatory factor analysis showed a model with a goodness-of-fit index of 0.86, root mean square error of approximation of 0.06, and observed normed χ2 of 2.7. The internal consistency through Cronbach's alpha α was 0.96. CONCLUSION: The digital professionalism self-assessment instrument (DP-SAI) has an appropriate level of content and measures the construct reliably. It can be used by medical doctors, dental clinicians, nurses, physiotherapists, and clinical pharmacists to self-assess and reflect on their social media practices. This will help to address these issues to enhance the quality of online communication through various social media platforms.

Digital teaching: Developing a structured digital teaching competency framework for medical teachers.

AIM: To explore the core competencies needed on part of the medical and dental teachers to carry out effective digital teaching for their students. METHODS: It was a qualitative study which employed phenomenological approach. The data were collected from 12 teachers who were purposively selected for semi-structured interviews. They were all expert digital teachers. The data were transcribed verbatim, coded and analyzed thematically. Textural and structural description of the themes helped to develop a new competency framework. RESULTS: The data yielded 47 selective codes with 15 sub-themes and five themes. The emergent themes included general digital competencies, specific digital teaching competencies, mastery of the subject matter, mastery of pedagogical strategies and proficiency in using innovative digital technologies for teaching. The themes 1, 2 and 5 relate to digital competencies only whereas the themes 3 and 4 are generic competencies which apply to both digital and non-digital teaching. These generic competencies form the basis of all kinds of teaching, hence equally important for digital teaching. CONCLUSION: Medical teachers should possess diverse digital competencies. The competency framework that emerged in the current research encompasses the essential attributes that should be included in any future training program aiming at the digital capacity building of the teachers. This will keep them primed for effective digital teaching. Given its crucial importance, the digital teaching competency should be considered as a cross-cutting competency that applies to almost all of the famous eight roles of medical teacher.

Barriers and Facilitators for Female Healthcare Professionals to Be Leaders in Pakistan: A Qualitative Exploratory Study.

Purpose: Despite being in high numbers in medical colleges, only a small proportion of women join the workforce and even fewer reach leadership positions in Pakistan. Organizations like United Nations and Women Global Health are working towards closing the gender gap. The study aims to explore the enablers and barriers for women in healthcare leadership and to explore the strategies to promote women in leadership positions in Pakistan's specific societal culture. Methods: In this qualitative exploratory study, semi-structured interviews of 16 women holding leadership positions in the health-care profession, ie, medical and dental (basic or clinical sciences) were included. The data were collected until saturation was achieved. The data were analyzed in MS Excel. Deductive and Inductive thematic analysis was done. Results: Thirty-eight codes were generated that were combined in the form of categories. The major themes that emerged from the data were: elevating factors, the shackles holding them back, let us bring them up and implicit bias. Elevating factors were intrinsic motivation and exceptional qualifications, while the shackles were related to gender bias, male insecurities, and lack of political background. It was noteworthy that differences in gender roles were highly defined by culture and religion. Conclusion: There is a need to change the perception of South Asian society and redefine gender roles through media and individual attempts. Women must take charge of their choices and believe in themselves. The institutional policies to help promote gender equality would be mentorship programs for new faculty, gender-responsive training for everyone, equal opportunities for all, and maintaining gender diversity on all committees.

Development and validation of an instrument to measure the Micro-Learning Environment of Students (MLEM).

BACKGROUND: There are multiple instruments to measure different learning environments but no valid and reliable instrument is present for measuring the micro-learning environment. This study aimed to develop and validate an instrument to measure the micro-learning environment of students. Measuring the micro-learning environment can give insight into the real-life experiences of students and enlighten us about the disparity between taught, delivered, and learned curricula. METHODS: Multi-institutional Mixed methods study design with consecutive qualitative and, quantitative components was used based on information processing theory. Literature review, results of semi-structured interviews, and focus group discussion were combined to develop a questionnaire. Content and response process validity were established followed by pilot testing, reliability calculation, and exploratory and confirmatory factor analysis. RESULTS: A forty-nine-item preliminary draft instrument was reduced to a total of twenty-four items final instrument having five themes regarding teaching practices, learners support, competence in teaching, progressive faculty, and teaching environment. The values of SCVI/Ave and S-CVI/UA were calculated to be 0.92 and 0.62 respectively. Reliability was calculated to be 0.94. Fit indices values were within the normal range. CONCLUSION: The instrument for measuring the micro-learning environment has excellent content, construct, response process validity, and reliability.

Language of actions: The effects of teacher's kinesics on student learning and learning environment.

BACKGROUND: A teacher's appropriate use of nonverbal communication skills, mainly kinesics, can play a crucial role in the success of the students. Medical educators are unaware of the effective use of nonverbal communication as an instructional skill that can be used to engage learners, balance learners' participation by controlling the classroom environment, and motivate them to have a passion for learning. The purpose of the study was to explore the students' perceptions regarding the effect of teachers' kinesics on students' learning and their learning environment. This can be helpful for teachers in modifying their teaching styles and delivering quality education. MATERIALS AND METHODS: A qualitative study with an exploratory design was conducted at a private medical institute in 2021 for a duration of 6 months. Fourteen medical students volunteered to participate in the study. Focus group discussions were conducted with the students to explore the experiences of the medical students regarding the use of nonverbal communication skills by their teachers and its effect on their learning in the classroom. The data collected was analyzed manually. RESULTS: The results of the study revealed that teachers' nonverbal behaviors in the classroom significantly influence students' motivation, engagement, and learning in the classroom. Students preferred interaction with the teachers who were friendly and confident and used their nonverbal communication skills (eye contact, facial expressions, hand gestures) effectively, compared to strict and judgmental teachers. CONCLUSION: Teachers need to motivate their students by improving their teaching styles and incorporating nonverbal behaviors positively in the classroom. By creating an impactful learning environment, students' participation and learning will increase, which will, in turn, improve their academic performance.

The kaleidoscope of the glass ceiling: experiences of Pakistani female doctors - a qualitative narrative inquiry.

OBJECTIVE: To explore the extent and factors leading to the glass ceiling for Pakistani female doctors in leadership positions. Method: The qualitative narrative study was conducted the Department of Medical Education, Riphah International University, Islamabad, Pakistan from March to July 2021, and comprised female doctors with 10-15 years of professional experience who were either currently at top leadership position or had retired from such a position in public and private medical clinical setups and medical colleges. Data was collected using in-depth interviews conducted through Zoom due to the coronavirus disease-2019 pandemic. The transcribed data was processed using ATLAS.ti.9 software for thematic analysis with an inductive approach. RESULTS: Of the 9 subjects aged 47-72 years having professional experience of 11-39 years, 4(44.4%) were clinicians, 3(33.3%) had basic medical science background and 2(22.2%) were health profession educationists. In terms of qualifications, 4(44.4%) were PhDs, 4(44.4%) were Fellows of the College of Physicians and Surgeons, Pakistan, and 1(11.1%) had an M. Phil. Besides, 4(44.4%) subjects were from the public sector, and 5(55.5%) from the private sector, 1(11.1%) had retired from service. The extent of experiencing the glass ceiling was common to all but 1(11.1%) participant. Factors identified included 'institutional challenges', 'family support issues', 'personal challenges' and 'societal unacceptance'. Detailed analysis revealed that women in leadership positions faced 'malintent of seniors', 'discrimination', 'stereotyping', 'lack of mentors' and 'ethnic background conditioning' at the institutional level. On the personal front, they faced 'lack of support of in-laws', 'insecurity of husbands', 'need of personal attributes' and 'beauty as a barrier'. CONCLUSIONS: The glass ceiling was found to be a challenge faced by Pakistani female doctors in leadership positions in both clinical settings and academia.

The fate of health professions education as a profession: a road less travelled.

OBJECTIVE: To explore the views of academics about the identity of Health Professions Education as a discipline, its fate and sustainability as a profession. METHODS: The qualitative exploratory study was conducted from February to July 2021 after approval from the ethics review committee of Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan, and comprised both fulltime and part-time health professions educationists of either gender teaching in different institutions of seven cities of Pakistan; Taxila, Kamrah, Rawalpindi, Peshawar, Lahore, Multan and Karachi. Using Professional Identity theory, data was collected through semi-structured one-on-one interviews which were conducted online. The interviews were transcribed verbatim, coded and thematically analysed. RESULTS: Of the 14 participants, 7(50%) had qualifications and experience of other specialities as well, while 7(50%) were pure health professions educationists. Overall, 5(35%) subjects were from Rawalpindi, 3(21%) were serving in multiple cities including Peshawer, 2(14%) were from Taxilla and 1(7.5%) each was from Lahore, Karachi, Kamrah and Multan. Accumulated data led to 31 codes with 3 themes and 15 sub-themes. The main themes were identity of health professions education as a discipline, its fate and sustainability. CONCLUSIONS: Health professions education has established its identity as a discipline in Pakistan, with independent, fully functioning departments in medical and dental colleges across the country.

Factors leading to the academic failure of undergraduate medical students - Predict early to prevent.

Objectives: The main objective of the study was to explore the factors to predict academic failure before the first major assessment. Methods: An exploratory qualitative study was conducted from March 2021 to August 2021 at Riphah International University. Using the purposive sampling technique, 16 students and seven teachers were included in the study. Eight online interviews were conducted with students who were academic failures and two focus group discussions were held with eight high achievers and seven teachers. The data was analyzed and thematic analysis was done. Results: Thematic analyses deduced relevant themes which were: Educational Journey Does past matter? Essential for learning, Personality and psychological make-up, and assessment of behaviour. The factors identified were performance record, learning difficulty, educational dislocation, missionless and purposeless, against free will, tuition, poor self-regulation, low effort, procrastination, non-reflective practice, cognitive load mismanagement, limited remediation, hesitant help-seeking, low self-efficacy, introvert behaviour, demotivation, emotional imbalance, observation of student behaviour, assessment of assigned task. Conclusion: Academic failure can be predicted early and salvaged.

Challenges faced by health professions educationists en route to educational reforms in Pakistan.

BACKGROUND: Since the field of health professions education (HPE) is an emerging trend in the country, educationists face considerable challenges in their workplaces while proposing any changes in the existing systems of academic institutions. The challenges affect the quality of work, hinder innovation, and create a dysfunctional work environment, non-conducive for both personal and professional progress. The study was conducted to explore the various kinds of challenges faced by educationists while bringing changes to the existing systems of academic institutions in Pakistan. MATERIALS AND METHODS: A qualitative exploratory research design was used to explore the challenges faced by health professions educationists in Pakistan during their efforts to bring about changes in the existing systems and structures. Thirteen health professions educationists working in various academic institutions of Pakistan were interviewed through one-to-one semi-structured interviews from March to May 2022. The data obtained were analyzed through manual thematic analysis, and themes and subthemes were identified. RESULTS: Four themes emerged after qualitative data analysis explaining the predominant challenges faced by educationists. These included challenges related to faculty and staff, institutional constraints, challenges from leadership, and stakeholders' apprehension. CONCLUSION: Challenges are inevitable at every workplace but the field of health professions education in Pakistan faces significant challenges in institutions, leading to hindrance in positive developments and innovations in the field. Educationists should be skilled at recognizing the predominant challenges in the workplace and be equipped with strategies to manage conflicts to achieve productive results and to promote the long-overdue reforms in the field.

Enriching operating room based student learning experience: exploration of factors and development of curricular guidelines.

BACKGROUND: Operating Room (OR) is a high-pressure setting where multiple complex surgical, educational, and administrative facets interplay. Contrary to resident training, the dynamics of undergraduate medical students' learning process is highly demanding, opportunistic, unstandardized, and suboptimal owing to many reasons. Upon reviewing the existing published literature regarding the medical students' experience in the OR setting, it was clear that this field is still to date, unstructured, and ambiguous, with many grey areas that need to be worked on. To achieve an optimized and enhanced theatre experience, it is of immense importance to recognize the recurrent themes affecting medical students within this setting and deduce ways to overcome these challenges. This study explores and prioritizes factors influencing OR-based student learning quality and develops guidelines for structured clinical encounters within the OR setting. METHODS: The study involved an extensive literature review and thematic analysis to generate themes and subthemes, which were subjected to a modified Delphi technique where students and teachers participated to identify, debate, and produce a consensus on the relative value of these factors. Finally, expert-validated guidelines were developed for OR curricular designs. RESULTS: Operating theater-based student learning is multifactorial. Structured learning through optimized course planning, content selection, assessment, and administration are decisive in determining the quality of OR learning experience. The teacher's interest, attitude, and students' desire and preparedness to learn play a central role in OR-based student learning, suggesting an enhanced need for adequate faculty training. Similarly, emotional, socio-environmental, and organizational factors can influence students' learning in a significant way. A new model for undergraduate student learning in OR has been proposed based on these factors and the stakeholders' interplay. In this model, the teacher's role is responsible despite OR learning being student- led. Guidelines for the OR curricular designs have been developed. CONCLUSION: Structured learning process within the OR setting can lead to optimized lesson planning, content selection, assessment, and administration for a more meaningful and enriched OR learning experience.

Developing consensus on content and format of e-portfolio for MHPE students: A Delphi study.

OBJECTIVE: To build a consensus on portfolio framework for master's in health professional education students and document programme learning outcomes, tasks for students related to each outcome, and the pieces of evidence regarding the completion of each task. METHODS: The modified Delphi study was conducted from February to July 2020 at Riphah International University, Islamabad, Pakistan, and comprised a three-round electronic-based survey of faculty members associated with the master's in health professional education programme, alumni, and current students as well as portfolio experts. The panellists had to choose from 10 programme learning outcomes, 75 tasks for students to achieve those outcomes, and 510 pieces of evidence to confirm that the tasks had been done to achieve the outcomes. A consensus cut-off of ≥80% was decided to select the item. RESULTS: Of the 45 stakeholders approached, 41(91.5%) responded in round 1. Of them, 31(75.6%) responded in round 2, while round 3 comprised responses from 31(96.7%) subjects. The draft template was originally derived from the master's in health professional education programme guide, expert opinions, and systematic literature review available for portfolios of other higher education degrees. The list of items was refined through a pilot study. The final template was approved by the expert panel after 3 iterations. The final list of items included 59 (78.6%) tasks and 105(21%) pieces of evidence related to all the 10 programme learning outcomes. CONCLUSIONS: The important programme learning outcomes, their related tasks, and the required pieces of evidence to be added in the e-portfolio of master's in health professional education programme students were identified, and recommendations for the format of implementation and assessment were given.

Probing in the complexities of the integrated undergraduate medical curriculum: A qualitative exploratory study.

OBJECTIVE: To explore the perceptions of the faculty regarding the level of curriculum integration and their interpretation of the integration ladder in achieving the complex process. Methods: The qualitative exploratory study was conducted at Islamic International Medical College Islamabad, University College of Medicine and Dentistry Lahore and Rehman Medical College Peshawar, from March to August 2018. The participants were the faculty members involved in the designing and implementation of the integrated curriculum in these institutes. The semi-structured interviews were audio-recorded, transcribed and analysed using Braun and Clarke's thematic content analysis. RESULTS: Of the 18 faculty members, 6 (33.3%) belonged to each of the three institutions. Four themes identified were: curriculum planning, an uphill task; dream versus ground reality; moving up and down the ladder; and teamwork in the paradigm shift. There were different perceptions of the level of integration among faculty members within the same institute. The level of integration ranged from 5-9 in different phases of the curriculum. The processes included all the teamwork steered by the departments of medical education. Conclusion: Although Harden's integration ladder is a useful tool, curriculum integration is an inherently inconsistent and complex process that does not follow a simple hierarchical continuum of integration and requires a teamwork. Identifying the patterns of integration in different phases of the curriculum might be more practical than just determining a single level of integration in the whole curriculum.

Conceptualizing Medical Resident's Journey through Wonderland of Clinical Practice: From transitional shock to role adaptation to independent practice.

OBJECTIVES: To explore experiences of medical residents about stages and nature of transitional journey from induction into residency program to achievement of consultant title. METHODS: Qualitative phenomenological study was conducted at Sir Gangaram hospital and Fatima Memorial Hospital, Lahore for six months from Feb 2019-July 2019 after IRB/ERC approval from Islamic International Medical College (Ref# Riphah/IIMC/ERC/19/0320). Using purposive criterion sampling, 16 semi-structured interviews in four departments, four strata of junior residents, senior residents, newly-qualified consultants, and supervising consultants with four participants each were conducted till theoretical saturation of data was achieved. After informed consent, audio recorded data was transcribed verbatim & analyzed through Atlas.ti 7 using Interpretive Phenomenological Analysis. After Bracketing and horizontalization, data was coded line by line. Codes (324) were merged to categories (19) for structural and textural description. Composite description of phenomenon was done by abstraction of themes (eight for stages and two for nature of journey). RESULTS: Eight themes for stages as merriment, anguish, melancholy, acceptance and efforts, intensive learning, burnishing to shine, identity formation and intra-stage oscillations were identified. Two themes for journey's nature were exponential learning & oscillating journey. CONCLUSION: The transitional journey is a multi-stage complex, oscillating journey. An oscillating electron model is presented upon the findings of this study to explain resident transition.

The effective coping strategies against burnout: Perceptions of Pakistani medical students.

OBJECTIVE: To explore effective coping strategies used by medical students against burnout. METHODS: The mixed method study was conducted at the Al Mizan campus of Riphah International University, Rawalpindi, Pakistan, from March to August 2018, and comprised fourth and fifth year medical students of both genders. Data was collected using the Maslach burnout inventory, which was followed by focus group discussions. Data was analysed using inductive approach. RESULTS: Of the respondents, 34(23.4%) were males and 111(76.5%) were females. Overall, 84 out of 151 (56%) students scored high on emotional exhaustion scale, 35 (23%) scored moderate and 32 (21%) scored low. On the cynicism scale, 93 (63%) out of 147 scored high, 47 (32%) scored moderate and 7 (5%) scored low. On professional efficacy, 42 out of 149 (28%) students scored low,74(50%) moderate and 33(22%) scored high. Seeking emotional support for coping was very common. Parents played the main role in providing support to the students. Turning to religion, acceptance and venting were also common coping strategies. CONCLUSIONS: Emotional exhaustion and cynicism were found in majority of the sample comprising medical students, seeking emotional support was common as a coping strategy.

"Cognitive Peer Coaching"- A workplace-based faculty development approach for problem- based learning facilitators: A qualitative study.

OBJECTIVE: To explore the factors affecting the learning process of novice problem-based learning facilitators trained through Cognitive Peer Coaching. METHODS: The qualitative study with phenomenological design was conducted at the Islamic International Medical College, Riphah International University, Islamabad, Pakistan, from March to August 2018, and comprised problem-based learning facilitators, experts and novices who were given orientation about cognitive peer coaching through workshops. Novice facilitators were trained by experts through cognitive peer coaching cycle comprising pre-observation, observation and post-observation phases following socio-cognitive apprenticeship theory based on modelling, coaching, scaffolding, articulation, reflection and exploration. Data was collected through an observation checklist and semi-structured interviews which were audio-recorded, transcribed and subjected to thematic analysis manually. RESULTS: Of the 15 subjects, 10(66.6%) were novice facilitators and 5(33.3%) were experts. Six themes generated and they were mental growth spurred from within, conscientisation, experiential learning, intrinsic motivation, effective body language, and impediment to success. Learning by observation, learning by doing, increased motivation, autonomy, constructive feedback and reflection augmented the facilitation skills, while unawareness about reflective practices and peer coaching were identified as major obstacles in personal and professional growth of faculty. CONCLUSIONS: Cognitive peer coaching was found to be a dynamic, innovative and feasible faculty development approach that contributed to the learning of facilitation skills from psychological, emotional and social perspective.

Nurturing Grit among Medical Students.

OBJECTIVE: To identify the learning strategies used by the medical students with high Grit for design and implementation of a three months course, to assist the medical students having low Grit. METHODS: A mixed-method study with explanatory sequential design was followed by an intervention to improve Grit amongst first year students at Foundation University Medical College from March to August 2019. Non-probability convenience sampling was used in the Phase-I. In Phase-II, through purposive sampling, students with high score on GRIT were interviewed. The interview questions were validated and piloted for clarity. All interviews were recorded, transcribed verbatim, and thematic analysis was done. The themes generated were used to design an intervention, which was implemented as a part of the curriculum for less Gritty students to see whether it can enhance Grit in them. RESULTS: A total of 133 students participated out of which, 23(17%) had a high, whereas 10(7.5%) had a low level of Grit. Five themes generated from the transcripts, namely Planning, Metacognitive skills, Mastery learning, Cognitive strategies, and Self-regulation, that led the development of an intervention abbreviated as "RESET-P- GOALS". A Wilcoxon signed-rank test showed that the intervention did elicit a statistically significant change in the Grit score in students having low Grit (Z = -2.8, p= 0.005). CONCLUSION: Good planning, Mastery learning and self-regulation are the reasons for success of Gritty students. The learning strategies with the name "RESET-P- GOALS" are effective in enhancing Grit in students with less score on Grit.

A Randomized controlled study to evaluate the effect of flipped classroom relative to a traditional demonstration method on learning of procedural skills in dermatology residents.

OBJECTIVE: To assess the effectiveness of flipped classroom on dermatology residents' learning of procedural skills, and to identify their perceptions about it. METHODS: The case-control study was conducted at Dermatology department of Pak Emirates Military and Combined Military Hospital Rawalpindi from 1/3/2018 to 2/7/2018, and comprised post-graduate dermatology residents training at Pak Emirates Military and Combined Military Hospital, Rawalpindi, Pakistan. The residents were randomised into two equal groups. A pre-test consisting of multiple-choice questions was taken. Group A was emailed the related teaching material 1 week prior to the session. The in the subsequent week, both groups attended a 3-hour hands-on training session. In the first hour, Group A had small group discussion, while Group B attended interactive lecture utilising the same teaching material that was posted to Group A earlier. Both groups then participated in hands-on session with the same facilitators. The process was repeated next week for another topic. Finally, a post-test comprising multiple-choice questions and objectively structured clinical exam at 16 stations was conducted. Group A answered the flipped classroom perception instrument and three open-ended questions. Quantitative data was analysed using SPSS 21, while manual thematic analysis was done for qualitative data. RESULTS: Of the 40 subjects, there were 40(50%) in each of the two groups. There was a significant difference between median pre-test and post-test scores in both groups (p<0.001).. With respect to objectively structured clinical exam, the median score of Group A was significantly different from Group B (p=0.001). CONCLUSIONS: Flipped classroom was found to be an effective teaching strategy for procedural skills in dermatology residents.

How Case Based Learning Promotes Deep Learning In Preclinical Years Of Medical Students?

BACKGROUND: The study was conducted at Army Medical College, Rawalpindi to explore the factors in Case Based Learning (CBL) session responsible for promoting deep learning approach in medical students. METHODS: A mix method research methodology with explanatory sequential design was adopted. In the quantitative part, the data was collected through a survey of second year medical students in which learning approaches were assessed using the Approaches and Study Skills Inventory for Students (ASSIST). Students were scored separately for the three approaches: surface, strategic and deep approach. In qualitative part; semi structured interviews were conducted with deep learners to explore the factors which help in promoting deep learning through Case-Based Leaning (CBL) guided inquiry approach. Interview data was transcribed, coded and thematic analysis was carried out. All quality assurance procedures of qualitative research such as credibility, trustworthiness, transferability, dependability and confirmability were ensured during the research. RESULTS: Deep learners were identified by analyzing the ASSIST-inventory results. Qualitative analysis has revealed six main themes: active participation of the students in the CBL session, relevance of the case with their clinical practice, complexity of the case for future practice, intrinsic motivation, guided inquiry approach with tutor's involvement, role playing and changes in learning approaches of the students were found responsible for inculcating deep learning approach in medical students in their pre-clinical years. CONCLUSIONS: The study concluded that by ensuring the factors that promote "deep learning approach" in medical students through Case Based Learning; it can be used as an effective strategy in teaching the content of basic science subjects during the pre-clinical years of medical students.

Digital professional identity: Dear Internet! Who am I?

Background: There is an emphasis on identity formation to complement the competency-based medical education in tomorrow's doctors, with a focus from "doing" to "being," to deeply learn the role as a health professional. Medical students spend a considerable time on internet-based online social networking platforms. These internet-based avenues can have certain implications in the formation of their identity. Methods: The aim of this article is to discuss a highly significant way to form the professional identity that is through online social networking, which can be labeled as digital professional identity (DPI). Results: DPI is defined as "professional identity that develops through internet-based social interactions by utilizing online platforms and communication tools." Medical students develop certain constituents of professionalism as part of their lifelong professional identity during the course of their graduation. They learn the professional ways and means to communicate on internet-based social media platforms, which affect their professional identities. Discussion: We suggest to provide institutional guidance for the medical students regarding the usage of social networking sites and forming their DPIs as a medical professional by explaining the related advantages and disadvantages. In addition, accreditation bodies need to incorporate the aspect of DPI in their competencies for professionalism.