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.

Attitude of undergraduate medical students towards euthanasia and physician-assisted suicide: A cross-sectional study.

Euthanasia is categorically prohibited in Pakistan by Islamic law, but a clash of opinions among doctors and human rights advocates still prevails. As a result, medical students are becoming concerned about its practice and this problem needs to be addressed. A cross-sectional study was conducted at Faisalabad Medical University (FMU), Pakistan, from April 2023 to May 2023, using random sampling and statistical programme SPSS version 25, to assess the attitudes of medical students regarding euthanasia and physician-assisted suicide (PAS). Despite the conditions and scenarios presented to the students, most of them expressed opposition to euthanasia and physician-assisted suicide because of their religious beliefs and optimistic approach to life. Most of them favoured palliative care and passive euthanasia. Some students showed compliance with euthanasia even though it is equivalent to murder in Islam. Such contrasting results can baffle a physician to make wise decisions. Hence, it must be covered in medical curriculum in depth in order to help the future physicians clearly understand its practice under all circumstances.

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 eating habits, lifestyle and physical activity among medical and dental students of Faisalabad Medical University.

Objective: To assess the eating habits, lifestyle and physical activity and their impact on health of students of Faisalabad Medical University (FMU) Faisalabad Pakistan. Methods: A descriptive cross-sectional study was prepared on 328 medical and dental students at Faisalabad Medical University from June, 2022 to October, 2022. Three Factor Eating Questionnaire Revised 21 (TFEQ-R21) was used to assess the eating habits among medical students and physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) short version. A self-constructed questionnaire was used to assess lifestyle patterns. Results: According to the study, 191(58.2%) students out of 328 practiced unrestricted eating. While 229(69.8%) students demonstrated cognitive restraint and 128(39%) students indulged in emotional eating. Less than half of the students, 52(15.9%) lead unhealthy lifestyles compared to 276(84.1%) who had healthy habits. Out of 328 students, 104 (31.7%) engaged in low, 137(41.8%) in moderate, and 87(26.5%) in high levels of physical activity. Whereas a higher proportion of female students engaged in low to moderate physical activity (61.5% and 52.6%, respectively), while a higher proportion of male students (63.2%) were involved in intense physical activity. Conclusions: A large proportion of medical students exhibited poor dietary habits with low physical activity. Obesity and other metabolic diseases are more likely to strike medical students who engage in these unhealthy eating habits. As future health providers, health interventions must be implemented to avert future harm.

Preparedness of Medical Graduates to serve in clinical settings independently: An exploratory qualitative study.

Objectives: To assess the preparedness of fresh medical graduates to perform the duties of an effective house officer in clinical settings independently. Methods: A qualitative exploratory descriptive study was conducted at a public sector tertiary care teaching hospital from September to October, 2021. A total of 14 interviews of the serving house officers were conducted (7 were from Medicine and Allied and seven were from Surgical and Allied). A verbatim Thematic analysis was done. Results: Initial analysis revealed 45 codes which were ultimately reduced to five main themes namely 1. Transition from studentship to house officers with sub-themes (1a) Sense of responsibility, (1b) Hectic and long duty hours, (1c) Proper orientation and guidance, 2. Deficient skill Training during educational journey with, (2a) Deficiency of practical and applied aspects, (2b) inconsistent and varying training patterns, (2c) self-perception and evaluation of preparedness, 3. Lack of awareness about Hospital settings and working system with sub-themes (3a) Support from other doctors, (3b) Being recognized as a doctor in hospital, 4. Inter-professional co-ordination gaps having sub-themes (4a) Communication gap, (4b) Mutual respect as a team and 5. Impact of COVID-19 with sub-theme (5a) Online teaching with no interaction and (5b) segue and progressive skill training. Conclusion: Medical graduates are not confident and well prepared to take the responsibility of patient care independently in clinical settings. Reforms in undergraduate curricula regarding skill training, hospital setup and workings and inter-professional education are advocated by young doctors to enhance their competencies for professional life.

Students' perception about assessment environment of University of Lahore - Dental School: A cross-sectional survey.

OBJECTIVE: To evaluate the perception of undergraduate dentistry medical students about the assessment environment at their institution. METHODS: The cross-sectional descriptive study was conducted at the University of Lahore, Lahore, Pakistan, from April 2017 to September 2017, and comprised undergraduate dentistry medical students who were asked to complete the Assessment Environment Questionnaire. Students' individual perception scores were calculated and the means of both individual domain and global score were compared in terms of different academic years. SPSS 20 was used for statistical analysis. RESULTS: Of the100 subjects, 50(50%) each were from 1st year and 2nd year. Overall, the students perceived their assessment environment positive yielding a global mean score of 49.84}10.84 out of the maximum 80. Second year students scored significantly higher compared to first year students in all domains except feedback mechanism (p=0.0017), learning and performance (p=0.0014), information on assessment (p=0.0064), and total mean score of 53.5}8.24 compared to 46.12}11.7 (p=0.0004). CONCLUSIONS: The students' perception of the assessment environment was more positive than negative.

Learning to cure with care: awareness of faculty and medical students about student's roles related to patient safety.

OBJECTIVE: To explore the awareness of faculty and medical students about students' roles with respect to patient safety and to define the domains that should be made a part of undergraduate curriculum. METHODS: The descriptive exploratory qualitative research was conducted from December 2016 to March 2017 at Islamic International Medical College, Rawalpindi, Pakistan, and comprised faculty members and final year medical students. World Health Organisation patient safety curriculum guideline for undergraduate medical schools was taken as the reference. Initially 12 codes for faculty and 18 for students were formed which were later reduced to 6 themes: importance of patient safety education; importance of strong student-patient relationship; code of conduct; students and effective team; students' part in management plans; and students and medical errors. Sub themes were also defined. Thematic narrative analysis was done using Atlas ti software. RESULTS: Of the 30 participants, 12(40%) were faculty members and 18(60%) were students. All (100%) the participants were of the view that patient safety is an important issue, especially for the future doctors and young professionals. All (100%) the participants were aware of the importance of a strong and trustworthy relationship between the patients and doctors. All (100%) the participants suggested that the students must follow proper code of conduct when they come to the wards. The participants advocated the need of establishing a system and culture where students can go and report an error comfortably. The participants identified defective communication to be one of the leading causes of medical errors. CONCLUSIONS: The need to bring reforms in medical curriculum with respect to patient safety was stressed.

Measuring empathy of medical students studying different curricula; a causal comparative study.

OBJECTIVE: To determine the difference in empathy level of undergraduate medical students studying two different curricula. METHODS: This cross-sectional study was conducted at Independent Medical College of Faisalabad and Islamic International Medical Collegeof Islamabad, both in Pakistan, from July to September 2016. The two medical colleges had two different types of curriculum systems; the integrated modular system and the discipline-based curriculum. The Toronto empathy questionnaire was used to calculate empathy scores. The responses were scored between 0 and 64 by taking sum of all the 16 questions. T-test was used to compare the mean scores and empathy levels between the two groups. SPSS 20 was used for data analysis. RESULTS: Of the 160 students, there were 80(50%) belonging to each institute. In the integrated modular system, 44(55%) students were females, whereas in the discipline-based system 45(56%) students were males. Students enrolled in the integrated modular system had a higher mean empathy score than students in the discipline-based system (44.2±6.59 versus 39.7±6.54, p<0.001). CONCLUSIONS: Interventions during the educational journey about empathy had positive influence on students' personalities and their future practices.

Examining the relationship between international digital trade, green technology innovation and environmental sustainability in top emerging economics.

Ensuring preserving a sustainable environment is a crucial concern for individuals worldwide. In previous research, CO2 emissions have been used to measure environmental deterioration. However, in this study, we have expanded the scope to include carbon emissions and several other gases. This comprehensive measure is referred to as the ecological footprint (EFP). More significant international digital trade (IDT) has the potential to achieve several positive results, including reducing EFP (economic frictions and barriers), stimulating economic growth, and minimizing trade risk and volatility. These benefits can be realized by implementing structural reforms in significant production and development sectors. Green technology innovation (GTI) has the potential to make substantial progress in ecological quality and energy efficiency. Nevertheless, previous studies still need to adequately prioritize examining rising economies in terms of international trade diversification and GTI. This study examined the effects of IDT, GTI, and renewable energy consumption (REC) on EFP in BRICST countries. The study utilized data from the period between 1995 and 2022. The cross-sectionally augmented autoregressive distributed lag (CS-ARDL) model demonstrates that EFP negatively correlates with trade diversification, REC, and GTI in the long and short term. These countries have demonstrated a significant presence of eco-friendly products in their trade portfolios, and their manufacturing processes are shifting towards GTI. The objective is to enhance the REC sources and minimize EFP from consumption. Conversely, the increasing economic growth within this economic group has a compounding impact on the environment's decline since it amplifies the carbon emissions from increased consumption. To reduce the EFP level, the paper suggests increasing investment in GTI, promoting worldwide digital trade, and embracing renewable energy sources.

Outcome Of Laparoscopic Percutaneous Extra Peritoneal Closure Versus Open Repair For Paediatric Inguinal Hernia.

BACKGROUND: Laparoscopic inguinal hernia repair (LIHR) has many benefits like less frequency of metachronous contralateral hernias, minimum complications, comparatively less duration of operation and better cosmetic outcome as compared to the open technique. Objective of the study was to compare the outcome of laparoscopic percutaneous extra-peritoneal closure (LPEC) and open repair for paediatric inguinal hernia in terms of contralateral metachronous hernia, operative time and recurrence. METHODS: A randomized controlled trial was conducted at the Department of Paediatric Surgery, Children Hospital Lahore. Non-probability purposive sampling was used, and 296 cases were divided into group-1(managed with conventional open repair) and group-2 (managed with laparoscopic Percutaneous Extra-peritoneal closure). After taking informed consent, data was collected, and cases were studied for operative time, contralateral metachronous hernia and recurrence till 6 months postoperatively. Data analysis was done through SPSS 22.0. Chi-square and independent sample t-test was used for comparison. p-value ≤0.05 was taken as significant. RESULTS: The mean operative time was statistically less in the LPEC group (24.79±3.44 minutes) when compared to the open repair group (28.71±4.54 minutes), p-value <0.001. In the Open repair group, there were 19 (12.8%) cases that had contralateral metachronous hernia, while in the LEPC group, 2 (1.4%) cases had contralateral metachronous hernia p-value <0.001. In the Open repair group, 4(2.7%) cases had a recurrence, while in LPEC group 1 (0.7%) cases had a recurrence, with statistically same recurrence rate, p-value >0.05. CONCLUSIONS: The LPEC technique is better than conventional open repair in terms of CMIH, operative time, and recurrence rate.