Correlation between levels for stress with level of empathy in undergraduate medical students.

Objective: To determine the correlation between levels of stress with level of empathy in all five years of undergraduate medical students of a private medical college in Pakistan. Methods: This descriptive correlation study was conducted at Al Tibri Medical College, Karachi from 15th June to 14th November 2021. Of the 500 students in the medical school, 408 participants filled out the questionnaires through online Google Forms. The student's version of the Jefferson Scale of Empathy (JSE-S) estimated the self-reported student's empathy levels. At the same time, Perceived Stress Scale (PSS) was utilized to assess the student's levels of stress. Data was analyzed using SPSS version 22.0 and correlation between empathy and perceived stress was calculated by Pearson's coefficient. A p-value <.05 was considered statistically significant. Results: Out of 408 participants, there were 217(53.2%) males, and 191(46.8%) females. The overall mean JSE-S score was 94.60±11.85, and the mean PSS score was 20.20 ±5.70. Empathy scores improved over the basic sciences years and then significantly decreased in the clinical years of medical college with a significant p-value of .019. The highest stress was present in third year medical students with a p-value of <.001. No statistically significant difference was present between empathy and stress levels (r = 0.04, p = .40). Conclusions: The study showed no statistically significant correlation between empathy and stress. Future research is needed to investigate other main factors for the decline in empathy among medical students.

General practitioner's (GP) home management guidelines for COVID-19 patients: Guidelines.

Carefully developed guidelines for clinical practice serve as an important tool for desirable changes in health care of a country. They act as an important source of information for physicians as well as policy makers and educational institutions thereby improving the quality of care of patients. The outbreak of Novel Coronavirus Disease (COVID-19) in 2019 has placed a huge burden on health care system globally. The first line health care provider bears the brunt of this disease with limited and varying sources of information as most of the patients present to them. Varied presentation of disease along with limited hospital facilities for admission is a huge challenge for appropriate management and referral of these patients. These guidelines, prepared after reviewing the interim guidelines in literature, will serve as a source of guidance for GPs to manage mild cases at home and refer those with moderate and severe disease to tertiary care hospitals.

Reimagining medical education for primary care in the time of COVID-19: a world view.

This article sets out to highlight the challenges and opportunities for medical education in primary care realised during the COVID-19 pandemic and now being enacted globally. The themes were originally presented during a webinar involving educationalists from around the world and are subsequently discussed by members of the WONCA working party for education. The article recognises the importance of utilising diversity, addressing inequity and responding to the priority health needs of the community through socially accountable practice. The well-being of educators and learners is identified as priority in response to the ongoing global pandemic. Finally, we imagine a new era for medical education drawing on global connection and shared resources to create a strong community of practice.

Peer feedback for examiner quality assurance on MRCGP International South Asia: a mixed methods study.

BACKGROUND: The International Membership Examination (MRCGP[INT]) of the Royal College of General Practitioners UK is a unique collaboration between four South Asian countries with diverse cultures, epidemiology, clinical facilities and resources. In this setting good quality assurance is imperative to achieve acceptable standards of inter rater reliability. This study aims to explore the process of peer feedback for examiner quality assurance with regard to factors affecting the implementation and acceptance of the method. METHODS: A sequential mixed methods approach was used based on focus group discussions with examiners (n = 12) and clinical examination convenors who acted as peer reviewers (n = 4). A questionnaire based on emerging themes and literature review was then completed by 20 examiners at the subsequent OSCE exam. Qualitative data were analysed using an iterative reflexive process. Quantitative data were integrated by interpretive analysis looking for convergence, complementarity or dissonance. The qualitative data helped understand the issues and informed the process of developing the questionnaire. The quantitative data allowed for further refining of issues, wider sampling of examiners and giving voice to different perspectives. RESULTS: Examiners stated specifically that peer feedback gave an opportunity for discussion, standardisation of judgments and improved discriminatory abilities. Interpersonal dynamics, hierarchy and perception of validity of feedback were major factors influencing acceptance of feedback. Examiners desired increased transparency, accountability and the opportunity for equal partnership within the process. The process was stressful for examiners and reviewers; however acceptance increased with increasing exposure to receiving feedback. The process could be refined to improve acceptability through scrupulous attention to training and selection of those giving feedback to improve the perceived validity of feedback and improved reviewer feedback skills to enable better interpersonal dynamics and a more equitable feedback process. It is important to highlight the role of quality assurance and peer feedback as a tool for continuous improvement and maintenance of standards to examiners during training. CONCLUSION: Examiner quality assurance using peer feedback was generally a successful and accepted process. The findings highlight areas for improvement and guide the path towards a model of feedback that is responsive to examiner views and cultural sensibilities.

Factors related to knowledge and perception of women about smoking: a cross sectional study from a developing country.

BACKGROUND: Smoking rates among women are currently low, but they are the fastest growing segment of cigarette smoking population in developing countries. We aimed to assess the knowledge and perceptions towards smoking and to identify the factors related with level of knowledge and perceptions among adult women in urban slums. METHODS: This was a cross sectional study conducted on 250 adult (≥18 years of age) women attending primary care clinics in three slums of Karachi, Pakistan. A pre-tested and structured, interviewer administered questionnaire was used for data collection. Factors associated with level of understanding about smoking were analyzed with chi-square test. RESULTS: Most of the women knew that smoking has adverse effects on women and children's health but the knowledge of specific health effects was limited. About one third of the women knew that active smoking can cause lung disease, but only a small percentage (7%) knew that it could lead to heart disease. None of the women were aware that smoking contributes to infertility and osteoporosis. A small proportion of women were aware that smoking can lead to low birth weight (7%), congenital anomalies (5%) and less than 1% of women knew that it contributes to pregnancy loss, still birth and preterm delivery. The understanding of passive smoking affecting children's lung was low (20%) and a similar proportion voiced concern about the bad influence of maternal smoking on children. Educated women had better knowledge of health effects of smoking. Education was associated with having better knowledge about effects on women health in general (p = 0.02) and specific effects like lung (p = 0.03) and reproductive health effects (p < 0.001). Education was also associated with knowledge regarding effects on fetus (p < 0.001) and children (p < 0.005). Although most of the women disliked being around smokers, more than one third thought that smoking decreases boredom (39%), tension (38%) and also helps to relax (40%). A large proportion (48%) of women had the misconception that smoking helps to reduce weight. CONCLUSIONS: This study reveals that women are aware of the general ill effects of smoking but fail to identify smoking to be associated with female maladies particularly those who were illiterate and had lower levels of education. Understanding and attitudes needs to be improved by increasing health awareness and education of women in these urban communities with special emphasis on the effects of smoking on women's health.

"I am not the person I used to be": Perceptions and experiences of menopausal women living in Karachi, Pakistan.

OBJECTIVE: The study aims to explore the perceptions and experiences of menopausal women living in Karachi, Pakistan. STUDY DESIGN: Using qualitative exploratory design, in-depth interviews were conducted with eleven women, aged 35-55 years. The data was collected through face-to-face interviews using semi structured interview guide. Creswell frame work for content analysis was used to analyze the data. MAIN OUTCOME MEASURES: Perceptions and experiences of menopause women living in Karachi, Pakistan. RESULTS: Women described positive and negative experiences of menopause, though predominantly negative intensified by mental distress, lack of support from intimate partner, and misperceptions about menopause. A majority of the women emphasized the need for educating their husbands regarding menopausal changes. In clinical practices, health care professionals should screen the women for menopause challenges when they visit health care facilities and offer education regarding self-care and management to achieve better quality of life and positive coping. CONCLUSIONS: We conducted a preliminary study on women's perceptions and experiences of menopause in the context of Pakistan. Our study offers significant findings from an Asian cultural perspective, in which norms are predominantly patriarchal and male dominated. The study provides useful guidelines for health care providers to better address health care needs of menopausal women.

A Statement of Solidarity on COVID-19 Pandemic 2020 by the South Asian Family Physicians.

The World Organization of Family Doctors (WONCA) is a not-for-profit organization and was founded in 1972 by member organizations in 18 countries. WONCA now has 118 Member Organizations in 131 countries and territories with a membership of about 500,000 family doctors and more than 90 percent of the world's population. WONCA has seven regions, each of which has its own regional Council and run their own regional activities including conferences. WONCA South Asia Region is constituted by the national academies and colleges and academic member organizations of this region namely India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, and the Maldives. In the background of the ongoing COVID 19 pandemic, the office bearers, academic leaders, practitioners, and researchers of primary care from the South Asia Region have issued a solidarity statement articulating the role of primary care physicians.

Self-reported practices of hand hygiene among the trainees of a teaching hospital in a resource limited country.

OBJECTIVE: To determine the compliance of hand hygiene among the trainee physicians of a tertiary care teaching hospital; and to identify physicians' opinion regarding various obstacles in adhering to the hand hygiene principles. METHODS: Cross-sectional survey was conducted among the Interns (House Officers) and Post Graduate trainee physicians of a tertiary care teaching hospital in a resource limited country. Subjects were consented and selected through non probability convenient sampling. A self-administered questionnaire, based on the hand hygiene guidelines laid down by the World Health Organization (WHO) was used. RESULTS: A total of 211 questionnaires were completed. Only 4.7% of the physicians reported to decontaminate their hands before having direct contact with their patients. Only 17% claimed to be aware of the WHO recommendations on hand hygiene. Majority of subjects considered "lack of sinks, soap, water and disposable towel" as a major barrier towards hand hygiene adherence. Overall compliance of hand hygiene was found to be 38.8% but it widely varied as a function of patient care activity. CONCLUSION: Hand hygiene practices among trainee physicians were not in line with WHO recommendations. To make a difference, interventions taken to improve awareness alone, won't be sufficient; they have to be supported with improving facilities for hand hygiene.

Bullying in school children: How much do teachers know?

CONTEXT: Bullying is an emerging serious problem in schools worldwide resulting in physical and mental health problems in victimized children. Teachers play a critical role in identifying the acts of bullying, assisting the children who are victimized, linking up with healthcare providers for managing physical and emotional consequences of bullying, as well as managing bullying at school. AIMS: To determine teachers' knowledge regarding bullying among secondary school children. SETTINGS AND DESIGN: A cross-sectional study conducted in five public and five private schools of Jamshed Town, Karachi, Pakistan. METHODS AND MATERIALS: The study continued from October 2012 to February 2013. Stratified random sampling was used to select teachers. Data were collected through a pre-piloted structured questionnaire. STATISTICAL ANALYSIS USED: Data were analyzed using the SPSS v19.0. Descriptive analysis was done by calculating frequencies and percentages of the categorical variables such as teacher's age, educational level, and presence of adequate knowledge regarding bullying. The outcome variable of interest was knowledge about bullying. RESULTS: Almost half of the153 teachers (n = 82, 53.6%) lacked adequate knowledge about bullying in school children. A statistically significant association was present between knowledge of bullying with gender (P-value = 0.02), educational level of the teachers (P-value = 0.05), years of teaching experience (P-value = 0.04), and educational training of teachers (P-value = 0.01). CONCLUSIONS: More than half of the teachers were deficient in their knowledge about bullying in school children.

Predictive Validity of Family Medicine Resident's Performance at Induction with Their Future Performance During Residency.

OBJECTIVE: To determine the predictive validity of induction assessment scores of family medicine residency program for performance in final year of residency. STUDY DESIGN: Psychometric (predictive-validity) study. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from 2008 to 2014. METHODOLOGY: All family medicine residents were evaluated. Family Medicine Residency induction assessment scores were used as independent predictor variables, whereas resident assessment scores during the final year residency program were used as dependent or outcome variables. Data was analyzed using SPSS version 19. Linear regression was used to determine predictive validity of induction scores as independent variables with outcome variables at 95% confidence level. RESULTS: There were 33 residents. MBBS scores accounted for 30.1% of variance in final year Objective Structured Clinical Exam (OSCE) scores; whereas, induction written test accounted for 37.1% of variance in final year written test. Induction communication skill scores did not correlate with in-training communication skill scores or with the final year OSCE scores. Induction professionalism scores accounted for 13.7% of the variation in final year OSCE scores, but not with in-training continuous professionalism scores. CONCLUSION: Induction knowledge scores have acceptable predictive value for future knowledge and its application. Other valid and reliable assessment methods, such as multiple mini-interviews, should be explored for assessment of noncognitive domains at induction.

Has the inclusion of a longitudinally integrated communication skills program improved consultation skills in medical students? A pilot study.

BACKGROUND: Evidence highlights a lack of communication skills in doctors leading to dysfunctional consultations. To address this deficit, a private medical college instituted curricular reforms with inclusion of a longitudinal communication skills program. A pilot study was undertaken to evaluate the effectiveness of this program by comparing the consultation skills of medical students of this college with a medical college without a communication skills program. METHODS: A 4-station Objective Structured Clinical Examination (OSCE) was conducted in the third and final year. Mann-Whitney U-test was used to compare the difference in the distribution between OSCE stations total and construct scores. RESULTS: At the end of the third year, 21 (31.34%), students of the study site (medical college 1 [college with integrated longitudinal communication skills program]) and 31 (46.26%) students from the comparison site (medical college 2 [comparable college without communication skills program]) consented. Medical college 1 achieved a significantly higher overall mean total station score of 68.0% (standard deviation [SD] =13.5) versus 57.2% (SD = 15.4) (P < 0.001). Significantly higher mean scores were achieved on three stations. At the end of the final year, 19 students (29.3%) from medical college 1 and 22 (34%) students from medical college 2 consented. The difference in overall mean total station score reduced from 9.2% to 7.1% (70.2) (SD = 13.7) versus 63.1 (SD = 15.2) (P = 0.004). The mean scores of both colleges decreased in "Patient presenting with Hepatitis C Report" station (P values 0.004 and 0.775) and in "Patient Request for Faith Healing Therapy in Diabetes Mellitus" station (P values 0.0046 and 0.036), respectively. CONCLUSION: Longitudinal communication skills in an undergraduate curriculum positively impacted consultation skills. Community-based training and faculty development are required to develop effective patient-centered consultation skills.

Distribution of lower urinary tract symptoms (LUTS) in adult women.

OBJECTIVE: To determine the distribution of lower urinary tract symptoms in adult women and the frequency with which the women consulted a health care provider for their symptoms. DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: Community Health Center of Aga Khan University Hospital from November 1st to 30th, 2002. SUBJECTS AND METHODS: A trained interviewer administered a structured questionnaire to women patients or attendants aged 18 years and older coming to the center. RESULTS: Fifty-two percent of the study subjects reported having at least one or more urinary complaints in the past. Stress incontinence was the highest reported complaint (38.4%) followed by burning (34.4%), frequency (26%), painful micturition (20.4%), urge incontinence (18.8 %), incomplete emptying of bladder (14.4%), dribbling (12.4%) and poor stream (8.4%). Forty-three percent of the women with LUTS never consulted a health care provider for their problem. CONCLUSION: Although the distribution of LUTS among females was found to be high, the patients did not consider it important enough to consult a health care provider. There is a need to create awareness among females regarding LUTS and the need to consult a health care provider for their problems.

Are our people health conscious? Results of a patients survey in Karachi, Pakistan.

BACKGROUND: Life style is known to influence health and may be responsible for certain diseases. There is a need to document the life style on health among the Pakistani population. METHODS: The study was conducted on patients visiting the Family Practice Center, the Aga Khan University, Karachi. A questionnaire was used to collect information on the demographic profile, and the life style on health. The ethical requirements for conducting the study were met. RESULTS: 393 patients were surveyed. The majority were young married men, in either private or government service. Preference for consumption of fats/oils, sweets, spicy foods, salt, fruits/vegetables, tea, coffee, cola drinks and alcohol was found among 103 (26%), 84 (22%), 86 (22%), 110 (28%), 239 (61%), 319 (81%), 117 (30%), 253 (64%) and 13 (03%) respondents respectively. Hand washing after defecation, before eating food and after work was seen among 341 (87%), 296 (75%) and 256 (65%) respondents respectively. Brushing of teeth after eating food, before breakfast and bedtime was seen in 56 (14%), 346 (88%) and 176 (45%) respondents respectively. Preventive dental check-up was practiced by 102 (26%) of the respondents. Sleep of less than 6 hours per day among 74 (19%), water consumption of less than 1 liter daily among 84 (21%) and fish consumption on once a week basis among 173 (44%) respondents was found. Tobacco and betel nuts use was found among 69 (17%) and 79 (20%) respondents. CONCLUSIONS: We have documented a clear need to raise public awareness on the issue of life style on health. There is a need and we strongly recommend debate and further research, along with interventional strategies in line with the available evidence on healthy life style.

Comparison of job satisfaction and stress among male and female doctors in teaching hospitals of Karachi.

BACKGROUND: Job dissatisfaction and stress among doctors affect the quality of health care. We assessed the levels of satisfaction for workplace characteristics and job stress among doctors of three teaching hospitals in Karachi. METHODS: A postal-survey was conducted between May to June 2002. Satisfaction for workplace characteristics and stress were inquired and graded by Likert scale (1 = very low to 5 = very high). Questions were also asked about its affect on their lives. In order to calculate the differences in means of job satisfaction and stress score by sex of doctors, chi-square and t-test with 95% confidence interval (CI) were used. Out of 270 doctors approached conveniently, 189 (70%) responded and 182 questionnaires were found complete for analysis. RESULTS: Majority (68%) of the doctors was not satisfied with their jobs. Overall, the mean scores for satisfaction were low for workplace characteristics. Lowest scores were found for pay and benefits 2.12 (SE 0.8), safety and security 2.15 (SE 0.8) and workload 2.69 (SE 0.9). Female doctors had significantly lower satisfaction about workload (mean job satisfaction score difference = 0.60; 95%CI, 0.24-0.97), relation with colleagues (mean job satisfaction score difference = 0.49: 95%CI, 0.11-0.87) and autonomy (mean job satisfaction score difference = 0.45; 95%CI, 0.07-0.82) as compared to their male counterparts. Overall, 48% of doctors graded job stress from high to very high levels. CONCLUSION: Majority of doctors working at these teaching hospitals of Karachi had poor satisfaction level for workplace characteristics and higher levels of job stress. This suggests that immediate steps should be taken for their control and management. This study invites further research to explore, implement and evaluate intervention strategies for prevention of stress and improvement in job satisfaction.

Multiple Mini-Interviews (MMI) and Semistructured Interviews for the Selection of Family Medicine Residents: A Comparative Analysis.

Background. Family Medicine Residency Program at the Aga Khan University has applicants for the residency position in excess of the positions offered resulting in formulation of certain selection criteria. The objective of this study was to compare MMI versus semistructured interviews for assessing noncognitive domains in the selection of residents. The secondary objectives were to determine perceptions of the interviewers and candidates for the acceptability and feasibility of MMI as a selection tool. Methods. The candidates underwent semistructured interviews along with MMI and identical attributes were tested in both. The attributes tested were safe doctor, communication skills, professionalism, problem solving, team approach, ethical issues, reasons for selecting family medicine, and commitment to the program. Descriptive statistics were calculated and comparison between ratings for MMI and interview was performed by Wilcoxon sign rank test. Results. Total number of candidates was 14. On comparison between interview and MMI, the scores were not statistically different for all attributes except ethics (mean interview scores: 3.04, mean MMI scores: 2.5, and P value 0.046). Conclusion. The study showed no difference between MMI and semistructured interviews. However, it needs to be replicated in order to determine the predictive validity and feasibility of MMI over time.

Role and Influence of the Patient's Companion in Family Medicine Consultations: "The Patient's Perspective".

BACKGROUND: Companions often accompany the patient in family medicine clinics and may influence the consultation. This study aims to determine the patients' perspective regarding the role and influence of the companion in the consultation process. MATERIALS AND METHODS: A cross-sectional study was conducted at the family medicine clinics of a university hospital. Adult patients accompanied by companions during the consultation were interviewed through a structured questionnaire. Attributes with respect to role and influence of companion on the consultation were assessed. Data was entered and analyzed through IBM Statistical Product and Service Solutions (SPSS) software version 18 using the Chi-square test. RESULTS: A total of 100 patients accompanied by companions participated in the study. Majority of companions were present to either provide company (90%) and/or emotional support (90%). Immediate relatives had a role in mobility (P = 0.016) and decision making (P = 0.006). Most companions remained passive and did not contribute to the doctor patient relationship (P = 0.058). Male companions were relatively helpful (54% vs. 25%, P = 0.008) in achieving the expectations from the visit. The companion played a supportive role in 62% of the consultations. CONCLUSION: This study signifies a supportive role of companion in a consultation which emphasizes the need of consultation models to include the "companion."

Reasons for migration among medical students from Karachi.

CONTEXT: The subject of economic migration among health care professionals has received intense attention. However, the aetiology of this migration has not been rigorously evaluated in Pakistan. Such knowledge can potentially influence health care and academic policies. Our current study proposes to quantify the relative contributions of various personal, professional and economic variables among final-year medical students in Karachi. METHODS: A self-administered structured questionnaire using a 10-point scale was developed and piloted among Karachi medical students. Additional open-ended questions were included to allow us to capture information not otherwise covered in the questionnaire. SPSS software was used for data entry and analysis. RESULTS: Over 95% of Aga Khan University (AKU) and over 65% of Baqai University (BU) final-year medical students intend to proceed abroad for their postgraduate training. The 2 most important factors behind this intent as pointed out by the students are poor salary structure (AKU mean score 8.94 +/- 1.73, BU mean score 7.14 +/- 2.6) and poor quality of training in the home country (AKU mean score 9.20 +/- 1.20, BU mean score 8.68 +/- 2.03). Other interesting factors captured through the open-ended questions were the poor work environment and lack of rigor in teaching of residents in domestic university hospitals. Over 50% of final-year medical students cited these issues as major reasons behind their decision to migrate.