A review and comparison of post registration midwifery curriculum in Sri Lanka with global standards.

This paper presents the findings of a study comparing the post-registration midwifery curriculum (PRMC) taught in Sri Lanka with the International Confederation of Midwives (ICM) curriculum and five other selected curricula from other parts of the world to train midwifery trained registered nurses (MTRNs). In so doing, we consider the historical origins of post-registration midwifery training and its implications for modern teachings in Sri Lanka and other low-middle income countries (LMICs). Data collected through document review are read, summarized, and compared using checklists across different curricula components, content, and length. The wide variation in terms of length of the programs, content covered, the ratio of theoretical to practical content, and the range of skills and competencies developed has implications for the individual and professional growth of MTRNs. While there is a need to align the PRMC with the ICM standards to ensure safer maternity care in Sri Lanka, implications for developing and promoting the growth of midwifery as a strong independent body in LMIC is discussed.

Knowing so much, yet knowing so little: a scoping review of interventions that address the stigma of mental illness in the Canadian context.

Stigma can have detrimental effects on the health and wellbeing of individuals living with a mental illness. This scoping review describes the nature, range, and extent of intervention research aimed at reducing public and self-stigma of mental illness in the Canadian context. The review was guided by Arksey and O'Malley's framework. A search of databases and relevant websites identified 35 primary studies. Most studies used quantitative research methods and included predominantly youth or middle-aged adults, women, and white Canadian-born people. Guided by different conceptualizations of stigma, direct or indirect contact, education, and advocacy-focused interventions, aimed to provide information, and/or develop skills to address self and public stigma. Most studies evaluated interventions' effectiveness short-term. Of the few studies that followed-up participants long-term, some were able to reduce stigmatizing attitudes post-intervention, however, these targeted only specific groups such as students or health care professionals. Lack of diversity among the samples, and limited evidence of long-term effectiveness of interventions, were some of the studies' limitations. What is currently known about interventions aimed at reducing the stigma of mental illness in the Canadian context is not informed by research among vulnerable groups, such as people living with a mental illness, older adults, immigrants, and people of diverse ethnic backgrounds. Interventions that are informed by clear conceptualizations of stigma and rigorously evaluated in a range of ethno-cultural groups would create a knowledge base that is useful for policy-makers, community leaders, and agencies serving various ethnic communities in Canada.

Interprofessional work in operating rooms: a qualitative study from Sri Lanka.

BACKGROUND: A growing body of research shows links between poor teamwork and preventable surgical errors. Similar work has received little attention in the Global South, and in South Asia, in particular. This paper describes surgeons' perception of teamwork, team members' roles, and the team processes in a teaching hospital in Sri Lanka to highlight the nature of interprofessional teamwork and the factors that influence teamwork in this setting. METHODS: Data gathered from interviews with 15 surgeons were analyzed using a conceptual framework for interprofessional teamwork. RESULTS: Interprofessional teamwork was characterized by low levels of interdependency and integration of work. The demarcation of roles and responsibilities for surgeons, nurses, and anesthetists appeared to be a strong element of interprofessional teamwork in this setting. Various relational factors, such as, professional power, hierarchy, and socialization, as well as contextual factors, such as, patriarchy and gender norms influenced interprofessional collaboration, and created barriers to communication between surgeons and nurses. Junior surgeons derived their understanding of appropriate practices mainly from observing senior surgeons, and there was a lack of formal training opportunities and motivation to develop non-technical skills that could improve interprofessional teamwork in operating rooms. CONCLUSIONS: A more nuanced view of interprofessional teamwork can highlight the different elements of such work suited for each specific setting. Understanding the relational and contextual factors related to and influencing interprofessional socialization and status hierarchies can help improve quality of teamwork, and the training and mentoring of junior members.

Role Models and Teachers: medical students perception of teaching-learning methods in clinical settings, a qualitative study from Sri Lanka.

BACKGROUND: Medical education research in general, and those focusing on clinical settings in particular, have been a low priority in South Asia. This explorative study from 3 medical schools in Sri Lanka, a South Asian country, describes undergraduate medical students' experiences during their final year clinical training with the aim of understanding the teaching-learning experiences. METHODS: Using qualitative methods we conducted an exploratory study. Twenty eight graduates from 3 medical schools participated in individual interviews. Interview recordings were transcribed verbatim and analyzed using qualitative content analysis method. RESULTS: Emergent themes reveled 2 types of teaching-learning experiences, role modeling, and purposive teaching. In role modelling, students were expected to observe teachers while they conduct their clinical work, however, this method failed to create positive learning experiences. The clinical teachers who predominantly used this method appeared to be 'figurative' role models and were not perceived as modelling professional behaviors. In contrast, purposeful teaching allowed dedicated time for teacher-student interactions and teachers who created these learning experiences were more likely to be seen as 'true' role models. Students' responses and reciprocations to these interactions were influenced by their perception of teachers' behaviors, attitudes, and the type of teaching-learning situations created for them. CONCLUSIONS: Making a distinction between role modeling and purposeful teaching is important for students in clinical training settings. Clinical teachers' awareness of their own manifest professional characterizes, attitudes, and behaviors, could help create better teaching-learning experiences. Moreover, broader systemic reforms are needed to address the prevailing culture of teaching by humiliation and subordination.

Intimate partner violence in the post-war context: Women's experiences and community leaders' perceptions in the Eastern Province of Sri Lanka.

BACKGROUND: Exposure to armed conflict and/or war have been linked to an increase in intimate partner violence (IPV) against women. A substantial body of work has focused on non-partner rape and sexual violence in war and post-war contexts, but research about IPV is limited, particularly in Asian settings. This paper presents the finding of a study conducted in the Eastern Province of Sri Lanka. The study explored women's experiences of and responses to IPV as well as how health and social service providers perceive the problem. It also explored the IPV-related services and supports available after the end of a 30-year civil war. METHOD: We conducted in-depth, qualitative interviews with 15 women who had experienced IPV and 15 service providers who were knowledgeable about IPV in the Eastern Province of Sri Lanka. Interviews were translated into English, coded and organized using NVivo8, and analyzed using inductive thematic analysis. RESULTS: Participants described IPV as a widespread but hidden problem. Women had experienced various forms of abusive and controlling behaviours, some of which reflect the reality of living in the post-war context. The psychological effects of IPV were common, but were often attributed to war-related trauma. Some men used violence to control women and to reinstate power when their gender roles were reversed or challenged due to war and post-war changes in livelihoods. While some service providers perceived an increase in awareness about IPV and more services to address it, this was discordant with women's fears, feelings of oppression, and perception of a lack of redress from IPV within a highly militarized and ethnically-polarized society. Most women did not consider leaving an abusive relationship to be an option, due to realistic fears about their vulnerability to community violence, the widespread social norms that would cast them as outsiders, and the limited availability of related services and supports. IMPLICATIONS: These findings revealed the need for more research about IPV in post-war contexts. Women's experiences in such contexts are influenced and may be masked by a complex set of factors that intersect to produce IPV and entrap women in violence. A more nuanced understanding of the context-specific issues that shape women's experiences of IPV- and community responses to it-is needed to develop more comprehensive solutions that are relevant to the local context.

A review of the Sri Lankan health-sector response to intimate partner violence: looking back, moving forward.

Intimate partner violence (IPV) is a major health concern for women worldwide. Prevalence rates for IPV are high in the World Health Organization South-East Asia Region, but little is known about health-sector responses in this area. Health-care professionals can play an important role in supporting women who are seeking recourse from IPV. A comprehensive search was conducted to identify relevant published and grey literature over the last 35 years that focused on IPV, partner/ spousal violence, wife beating/abuse/battering, domestic violence, and Sri Lanka. Much of the information about current health-sector response to IPV in Sri Lanka was not reported in published and grey literature. Therefore, key personnel from the Ministry of Health, hospitals, universities and nongovernmental organizations were also interviewed to gain additional, accurate and timely information. It was found that the health-sector response to IPV in Sri Lanka is evolving, and consists of two models of service provision: (i) gender based violence desks, which integrate selective services at the provider/facility level; and (ii) Mithuru Piyasa (Friendly Abode) service points, which integrate comprehensive services at the provider/facility level and some at the system level. This paper presents each model's strengths and limitations in providing comprehensive and integrated health services for women who experience IPV in the Sri Lankan context.