Browsing by Author "Chandratilake, M.N."

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Attitudes towards homosexuality, bisexuality and transgenderism among medical students of a Sri Lankan university
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Rajapaksha, J.S.R.L.; Rajapaksha, R.G.D.T.; Ranawaka, A.U.R.; Rangalla, R.D.M.P.; Ranwala, R.D.E.B.; Chandratilake, M.N.
Introduction: Lesbian, gay, bisexual, and transgender (LGBT) patients experience discrimination, insensitivity and ignorance about LGBT-specific health needs among healthcare providers. Developing the correct attitudes among medical students towards LGBT may help provide them with optimal healthcare. Objectives: This study aimed at assessing the attitudes of medical students towards LBGT community. Methods: A cross- sectional descriptive study was among all the medical students in the Faculty of Medicine, University of Kelaniya, Sri Lanka using a validated online questionnaire.3 The questionnaire focused on eight areas. The data was descriptively analysed and the demographic groups were compared. Results: 358 completed the survey. Their attitudes on traditional gender role and comfortability in interacting with LGBT people were moderate and they disagreed with negative LGBT social beliefs. They knew less about the origin of sexuality/gender of LGBT. Although they accepted LGBT as a part of diversity, they discouraged normalizing social practices of LGBT people. Their acceptance and association of LGBT was moderately positive. A minority has encountered LGBT in close social circles and the majority of them were batch-mates. Although males’ knowledge about the origin ot LGBT was higher, they favoured traditional gender roles more. The religious groups showed no differences. The favourability of attitudes towards LGBT reflected respondents' political ideology. Conclusions: Although medical students' knowledge on sexuality/gender basis ot LGBT is poor they have moderately favourable attitudes towards them. They accept LGBT as a part of social diversity but not their social practices. Poor knowledge, lack of encounters, cultural influences and political ideology may have influenced their attitudes.
Attributes of professionalism expected of a medical doctor in Sri Lanka
(Sri Lanka Medical Association, 2016) Ellawala, A.T.; Chandratilake, M.N.; de Silva, N.R.
INTRODUCTION: Professionalism is an essential competency for a doctor. OBJECTIVES: To identify the attributes of professionalism expected of a doctor in the Sri Lankan setting. METHOD: A two-round Delphi study was conducted online with the participation of 158 representatives of various stakeholders in healthcare. In the first round, participants outlined attributes of professionalism expected of a doctor in the local context. Through conventional content analysis, a list of attributes was compiled. These were rated by participants in round II. The most important attributes were identified by calculating the Content Validity Index (CVI) of responses. Kappa value was calculated to determine the adequacy of inter-rater agreement. RESULTS: In round I, 56 attributes of professionalism were identified. These items were compiled into a questionnaire with four distractors (i.e. misperceptions of professionalism) to minimize indiscriminate rating of items. In round II, 46 items received a CVI >0.78 (cutoff value to determine essential items). ‘Possessing adequate knowledge and skills’ received the highest CVI (0.99), followed by ‘displaying a sense of responsibility’ (0.98) and ‘being compassionate and caring’ (0.97). ‘Altruism’ and ‘socio-cultural sensitivity’ were not rated as important. Interestingly, one of the 4 distractors (‘stands for professional autonomy’) also received a CVI>0.78. The K-value was 0.77, indicating adequate inter-rater agreement. CONCLUSIONS: This study enabled the development of a prioritized list of professionalism related attributes expected of a doctor in Sri Lanka. The conceptualization of professionalism in the local healthcare context appears to have both commonalities and disparities with the rest of the world.
Availability and cost of medicines for treatment of non-communicable diseases in private sector drug outlets in Sri Lanka
(Sri Lanka Medical Association, 2006) Kasturiratne, A.; Chandratilake, M.N.; Pinidipathirage, M.J.; Jayaratne, G.S.; Mahawithanage, S.T.; Subhashini, K.A.P.; Jayasekara, D.P.A.R.N.; Wickremasinghe, A.R.
BACKGROUND: Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality in Sri Lanka. Availability and affordability of medicines to treat them determine patient outcomes. OBJECTIVES: To determine the availability and affordability of common medicines for the management of NCDs in private sector drug outlets in four districts in Sri Lanka. METHODS: A descriptive cross-sectional study was conducted in randomly selected private pharmacies in Anuradhapura, Colombo, Matara and Monaragala districts. A pre-tested questionnaire administered to pharmacists/dispensers and direct observations were used to obtain availability and prices of drugs for treatment of ischaemic heart diseases, hypertensive diseases, diabetes mellitus, asthma and cancer by trained data collectors
Availability of drugs for the treatment of non-communicable diseases in the government health care institutions in Sri Lanka
(Sri Lanka Medical Association, 2006) Pinidiyapathirage, M.J.; Chandratilake, M.N.; Kasturiratne, A.; Jayaratna, G.S.; Jayasekera, D.P.A.R.N.; Subhasini, K.A.P.; Mahawithanage, S.T.; Wickremasinghe, A.R.
OBJECTIVE: To assess the availability of commonly used drugs in the treatment of non-communicable diseases in government health care institutions. METHODS: Forty four government health care institutions, representing the 3 levels of health care institutions (level 1 - CD & MH, level 2 - PU, DH, RH, level 3 - BH, GH, PH, TH) were randomly selected from the districts of Colombo, Anuradhapura, Moneragala and Matara. Each of the selected institutions was visited and the availability of a selected list of drugs was ascertained on the day of the visit. Availability was considered satisfactory if the drug was available in at least 75% of institutions of a particular level. RESULTS: Of the drugs that should be available at each level the following results were obtained: Level I -Availability of thiazides, beta-blockers, aspirin and nitrates were satisfactory. Availability of benzathine benzylpenicillin, glibenclamide andprednisolone were unsatisfactory. LevelII- Furosemide, thiazides, nitrates, glibenclamide, metformin andprednisolone were available in all and the availability of methyldopa, nifedipine, beta-blockers and aspirin was satisfactory. Availability of benzathine benzylpenicillin, insulin (isophane/so ruble) and spironolactone were unsatisfactory. Level III - Furosemide, thiazides, metformin, aspirin, beta-blockers, nitrates, nifedipine and prednisolone were available in all while the availability of benzathine benzylpenicillin, captopril, spironolactone, methyldopa, glibenclamide, insulin (isophane/soluble) and timolol eye-drops were satisfactory. Availability of steptokinase, inhalation steroids and salbutamol, ipratropium bromide, losartan, and tamoxifen were unsatisfactory. CONCLUSIONS: Availability of some essential drugs for non-communicable diseases was unsatisfactory at all 3 levels of health care institutions. This may be a reason for patients bypassing smaller institutions and the back referral system not functioning properly in the country. Inadequacy of national stocks cannot by itself explain the non-availability of these drugs as the survey was carried out in July/August.
The Common General Paper at the GCE Advanced Level examination as a predictor of performance in medical school
(Sri Lanka Medical Association, 2006) de Silva, N.R.; Pathmeswaran, A.; Chandratilake, M.N.; Dias, R.
BACKGROUND: Since 2000, all students seeking admission to Sri Lankan universities have to answer a Common General Paper, along with three subjects of their choice, at the GCE Advanced Level (AL) examination. The CGP aims to assess the intellectual ability of students, and their general awareness of the world they live in. OBJECTIVES: To determine the relationship between CGP scores and performance in medical school METHODS: The study sample consisted of medical students in Colombo and Kelaniya entering university in 2002 and 2003. Students were ranked according to the average mark obtained in 2nd year examinations in medical school, and dichotomized according to their presence in the top 30%. The predictive value of CGP scores in determining this outcome was examined using logistic regression in a multivariate analysis that also included AL z-scores, General English grades, sex, year of entry, district of admission and university. RESULTS: AL results and university examination results were matched for 473 students (297 in Colombo, 176 in Kelaniya). CGP marks showed significant positive correlation with AL z-scores and General English grades. All three AL scores and university examination results differed significantly according to university, year of entry, and sex of student, Multivariate analysis showed that higher AL z-scores and female sex were significant predictors of successful outcome, but none of the other variables, including CGP, were significant. All variables together explained only 12% of the variation in outcome (pseudo-R2 = 0.1224). CONCLUSIONS: CGP scores do not predict student performance in medical school.
The dynamics of doctor-patient conversations:A linguistical analysis
(Sri Lanka Medical Association, 2018) Wijesundara, B. M. E.; Karunatilake, K.M.M.G.S.L.; Karunaratne, W.C.D.; Chandratilake, M.N.
INTRODUCTION AND OBJECTIVES: Concerns exist on the communication skills of doctors in medical practice. The aim of this study was to explore the linguistic dynamics of communication between doctors and patients in the Sri Lankan cultural context.METHODS: A qualitative study was conducted in wards of major disciplines in North-Colombo Teaching Hospital. 16 out of 48 audio-recorded patient consultations of intern house officers were subjected to preliminary linguistic analysis of the open vs closed ended questioning, tolerability of silence, time distribution between doctors and patients, use of technical jargon and emotional expressions.RESULTS: The average consultation time was l 7min 40s (Range: 4min, 45s - 30min, 56s) and was distributed between patient 4 min, 57s (Range: 34s - 18mins ,l ls), doctor 2 min (Range: 3ls - 4min, 36s) and other activities like documentation. Therefore, the average time distribution between doctor and the patient during a consultation was 1 :2.5. 74.66% of the doctors' questions were closed-ended. 83% of the time patients provided detailed answers to closed-ended questions. Doctors used repeating and paraphrasing to encourage non-respondents and rarely used technical jargon. Questioning was friendly but the tone of the conversation was hierarchical. However, it enabled developing good rapport with patients. Doctors rarely showed irritation and it was expressed implicitly through hurried questioning and high-toned voice.CONCLUSION: The linguistic dynamics of consultations demonstrated the presence of elements of the Eastern cultural norm of hierarchy. Limited patient-centredness of doctors was not observed negatively by patients. Patients appeared to be more empowered, may be due to the 'narrow power-gap' between junior-doctors and patients.
Expectations and attitudes of first year medical students
(Sri Lanka Medical Association, 2005) Chandratilake, M.N.; Kasturiratne, A.; Wickremasinghe, A.R.
INTRODUCTION: Medical students' expectations of the medical course and their attitude towards the profession may influence educational performance. Such information is useful for re-orientation of the medical curriculum to meet student demands. METHODS: A descriptive cross-sectional study was conducted among 145 first year students at the Faculty of Medicine, University of Kelaniya, using a pre-tested self-administered questionnaire. RESULTS: Of the 145 respondents with a mean age of 20.7 (SD=1.8) years, 40% were male, 90% Sinhalese and 45% resident in the Western Province. 30% and 48% had gained admission at the 1st and 2nd attempt at the A/Level examination, respectively. Among 89% of students entering from Government schools, 71% were from national schools. The commonest reasons for choosing medicine were 1) to serve the country (29%), 2) fulfill personal dreams (19%), and 3) fulfill parents' wishes (17%). Financial rewards were the least common reason (2%). Most students identified their coping ability to adapt to University life and making friends as satisfactory and their ability to deal with academic workload and separation from home as unsatisfactory. 64% expected to work in the government sector, 7% in the private sector, and 6% as academics. 51% of females and 48% of males preferred to marry a doctor. A happy family life was the priority of 69% of males and 60% of females. 43% felt that they had better prospects in life as compared to their currently employed school-mates. CONCLUSIONS: The majority of first year medical students had idealistic attitudes and expectations. Medical curricula should be re-oriented to meet student and national demands.
Exploring the existing situation of teacher-student communication in an undergraduate medical education setup
(Sri Lanka Medical Association, 2018) Chandratilake, M.N.; Rodrigo, S.J. A.Y.; Rathnayaka, R.M.R.E.; Rathnayaka, R.M.S.S.; Rathnayaka, R.M.P.C.; Rinshaf, M.M.M.
INTRODUCTION AND OBJECTIVES: Effective teacher-student communication is a key determinant of teaching-learning in the medical undergraduate context. However, such communication may be influenced by various factors including the attitudes of teachers and students, language barrier, influence of senior students etc. This research aimed to explore the opinions of teachers and students regarding this. METHODS: A qualitative study was conducted using focus-group-discussions (FGD) and individual interviews at Faculty of Medicine, University of Kelaniya. A representative sample of67 students from five academic batches participated in focus-groups. Twelve academic staff members participated in individual interviews. Both FGDs and interviews were transcribed verbatim and thematically analysed. RESULTS: Main concerns of teachers and students regarding communication between the two parties were explored based on their personal experiences and opinions and possible reasons that have led to a communication gap. While teachers believed issues of respect, unavailability of time and limited individual attention per student have limited their communication with students, students had varied opinions including self-confidence of each student as a major determinant of communication with teachers. Use of English as the medium of formal communication, cultural backwardness, influence of senior students creating pre-conceptualized notions regarding teachers and lack of mutual understanding by teachers have led to a 'communication gap' between students and teachers. CONCLUSION: It was realized that individual attention per student by teachers and self-confidence of student in communication had to be improved while influence of culture, use of language and pre-conceived ideas were also main concerns in uplifting the quality of teacher student communication in undergraduate medical education.
Factors influencing the enrolment of doctors in postgraduate courses in Sri Lanka
(Sri lanka Medical Association, 2015) Muwanwella, R.M.S.P.; Mendis, H.K.N.L.P.; Madushan, K.N.C.G.; Mapa, M.M.N.N.; Marasinghe, S.H.K.; Mufaris, M.M.M.; Chandratilake, M.N.
INTRODUCTION AND OBJECTIVES: Sri Lanka produces around 550 medical postgraduates each year. This study describes the current trends and factors influencing the enrolment of doctors in postgraduate training. METHOD: A descriptive cross sectional study was conducted among training and staff grade doctors working in teaching hospitals in Sri Lanka, using a self-administered questionnaire. The responses were analysed descriptively. RESULTS: Of the respondents 41.3% (n=302), were intern house officers. There were representative numbers of graduates from all Sri Lankan medical faculties expect Rajarata and Eastern, both genders were equally represented and 2/3rds were married. 32% were registered in a postgraduate course and 48% intended to register. The top three choices among registrants were medicine (34%), paediatrics (15%) and surgery (12%) 3nd among intenders medicine (24.5%), surgery (15.3%) and paediatrics (11.7%). There was an equal gender distribution among both the intenders and registrants. >50% of registrants were within the first 300 in the merit list. Older the medical school higher the percentage of registrants. There was a positive correlation between extent of undergraduate career guidance and registering for postgraduate training. Reasons for not taking up postgraduate training included family issues, lack of confidence or interest in further education and a dislike for undertaking more responsibilities. 89% of registrants were satisfied with their postgraduate training. CONCLUSION: Position in the merit list, faculty of graduation and extent of career guidance during undergraduate training appeared to be influential factors for choosing postgraduate training. PG trainees are contented with the were registered in a postgraduate course and 48% intended to register. The top three choices among registrants were medicine (34%), paediatrics (15%) and surgery (12%) 3nd among intenders medicine (24.5%), surgery (15.3%) and paediatrics (11.7%). There was an equal gender distribution among both the intenders and registrants. >50% of registrants were within the first 300 in the merit list. Older the medical school higher the percentage of registrants. There was a positive correlation between extent of undergraduate career guidance and registering for postgraduate training. Reasons for not taking up postgraduate training included family issues, lack of confidence or interest in further education and a dislike for undertaking more responsibilities. 89% of registrants were satisfied with their postgraduate training. CONCLUSION: Position in the merit list, faculty of graduation and extent of career guidance during undergraduate training appeared to be influential factors for choosing postgraduate training. PG trainees are contented with the choice they make.
High fidelity simulation in undergraduate medical curricula: experience of fourth year medical students
(South East Asia Regional Association for Medical Education -SEARAME, 2020) Kodikara, K.G.; Karunaratne, W.C.D.; Chandratilake, M.N.
INTRODUCTION: Application of theoretical knowledge to management of critically ill patients is a challenging task for medical undergraduates where opportunities to learn clinical skills with regard to management of emergencies are few. High fidelity simulation (HFS) is widely used globally to learn clinical skills in a safe environment. However, research in use of HFS in developing countries such as Sri Lanka is minimal. PURPOSE: The purpose of this study was to explore the response of medical undergraduates to a high fidelity simulator in the context of management of emergencies. METHOD: A pilot group of 30 fourth year medical students underwent a high fidelity simulator session. They completed a self-administered evaluation, which included both open and close ended questions and participated in a focus group discussion post-simulation. Descriptive statistics were employed to analyze the responses to close-ended questions and the responses to open- ended questions and focus group discussion were analyzed for recurring themes. RESULT: Students rated the simulation-based learning experience with high positivity. The self-competency of 29 (96.6%) students had increased post-simulation while providing a safe learning environment to all students. Majority (63.3%; n=19) felt it helped put theory into practice. Qualitative data gathered from open-ended questions and focus group discussions further confirmed these findings. CONCLUSION: The study demonstrates that HFS can be used to provide a safe environment and a satisfying educational experience for students to learn medical emergencies, and as an educational opportunity of translating theory into practice. Although HFSs are costly they appear to be cost effective in terms of educational outcomes. KEYWORDS: Simulation, Medical students, High fidelity, Competency
High Fidelity Simulation in Undergraduate Medical Curricula: Experience of Fourth Year Medical Students at a Sri Lankan Medical Faculty
(4th International Conference on Advances in Computing and Technology (ICACT ‒ 2019), Faculty of Computing and Technology, University of Kelaniya, Sri Lanka, 2019) Kodikara, K.G.; Karunaratne, W.C.D.; Chandratilake, M.N.
Application of theoretical knowledge to management of critically ill patients is a challenging task faced by medical undergraduates where opportunities to learn clinical skills with regard to management of emergencies are few. High fidelity simulation (HFS) is widely used globally as an adjunct to clinical practice enabling students to learn clinical skills in a safe environment. However, research in the use of HFS in Sri Lanka is minimal. The purpose of this study was to explore the response of medical undergraduates to a high-fidelity simulator (HFS) in the context of management of emergencies. A pilot group of 30 fourth year medical students underwent a high-fidelity simulator session. They completed a self-administered evaluation, which included both open and close ended questions and participated in a focus group discussion post-simulation. Descriptive statistics were employed to analyze the responses to close-ended questions and the responses of the focus group discussion and open-ended questions were analyzed for recurring themes. All participating students responded to the evaluation. Students rated the simulation-based learning experience with high positivity. The self-competency of 29 (96.6%) students had increased following the sessions. The session provided a safe learning environment to all students. 19 (63.3%) students felt it helped put theory into practice while 21 (70.7%) students identified it as good practice for internship. 25 (83.3%) students wished to participate in more sessions. 17 (56.6%) students commented on the realistic nature of the experience. This study confirmed findings of previous studies conducted using HFS among medical undergraduates, confirming that the students highly valued high-fidelity simulation and find the opportunity to apply theoretical knowledge to practice in a safe environment. A high-fidelity simulator is a valuable learning tool in undergraduate medical education.
Impact of teachers on poor communication between medical teachers and medical students in the Sri Lanka context: A qualitative study
(Sri Lanka Medical Association, 2018) Rinshaf, M. M. M.; Rodrigo, S. J. A. Y.; Rathnayake, R. M. P. C.; Rathnayaka, R. M. R. E.; Rathnayaka, R. M. S. S.; Chandratilake, M.N.
INTRODUCTION AND OBJECTIVES: A gap in communication between students and teachers may exist due to how medical students perceive their teachers in the Sri Lankan cultural context. This study aimed to explore the perspective of medical students about the impact of teachers on poor communication between the two parties METHODS: A qualitative study was conducted using focus-group-discussions with a representative sample of 67students from five batches of Faculty of Medicine, University of Kelaniya. The FGDs were transcribed verbatim and thematically analyzed RESULTS: The thematic analysis revealed teacher-related factors for poor communication: the age difference between teachers and students, uncaring attitude of teachers, making students feel inferior in public, scaring students with their behavior, lack of trust towards teachers, and multiple 'fears', e.g. fear of making mistakes in of teachers, fear of teachers being judgmental, fear of teachers being punitive, fear of being highlighted among peers, appeared to be the key factors. Improving mutual understanding between teachers and students through formal and informal means may be effective in overcoming these challenges. “Sometimes our teachers don't take certain matters seriously because for them as those who have graduated long ago, they feel those are very minor issues. But for us who are still undergraduates those little issues are a big deal” (4th-year student) CONCLUSION: The hierarchical cultural context has attributed to create real and perceived negative impacts on poor communication among medical students and their teachers. A partnership approach to the learning process may help reduce negativity and improve mutual communication
Intermediate fidelity simulation to educate emergency management skills
(Penerbit Universiti Sains Malaysia, 2020) Kodikara, K.G.; Karunaratne, W.C.D.; Chandratilake, M.N.
Medical students learn clinical skills related to the management of emergencies during their clerkships, mainly via peripheral participation and observation. Simulation-based training is identified as an adjunct to clinical practice enabling students to learn clinical skills in a safe environment. Nevertheless, simulation-based training is still underutilised in many countries in the developing world. The purpose of this study was to explore the value of simulation-based learning using an intermediate fidelity simulator to train medical undergraduates on the management of medical emergencies. A pilot group of 80 fourth year medical students attended four simulation-based clinical skills sessions. The students completed a self-administered evaluation, which included both open and close-ended questions postsimulation. Descriptive statistics were employed to analyse the responses to close-ended questions, and the responses to open-ended questions were analysed for recurring themes. All participating students responded to the evaluation. Students rated the simulation-based learning experience with high positivity. The self-competency of 74 (92.5%) students had increased following the sessions. The sessions have provided a “safe” learning environment to all students, and 70 (87.5%) felt it helped apply theory into practice. Thirty-three (41.2%) noted the simulation session as an important learning tool for practising clinical skills. Thirty-one (38.5%) wished to participate in more sessions, and 39 (48.7%) felt that simulation should be introduced to the curriculum from the first-year. Students have recognised intermediate fidelity simulators as a valuable learning tool to train on the management of clinical emergencies and should be integrated into undergraduate medical curricula.
Lapses in professionalism in Sri Lankan doctors and their impact on patient outcomes
(Sri Lanka Medical Association, 2015) Chandratilake, M.N.; Ho, M.; Rees, C.; Monrouxe, L.
INTRODUCTION AND OBJECTIVES: Today, the provision of optimal patient care and patient safety are the primary goals of healthcare delivery. Professionalism of doctors has an impact on achieving this goal. METHOD: This study was conducted as the Sri Lankan component of a collaborative qualitative research project with Taiwan on professionalism dilemmas faced by medical students. 64 Sri Lankan medical students described stories (narratives) of lapses in professionalism observed by them in clinical settings, at Focus Group Discussions (FGDs). The FGDs were audio-recorded and the transcripts were thematically analysed to explore the nature of lapses in professionalism and resulting patient outcomes. RESULTS: The students' narratives comprised lapses in communication, respect towards patients, accountability, integrity and probity, interprofessional relationships, compassion and care, acting within limitations, commitment to duty, managing conflicts of interests and ethical conduct in doctors in different grades. Such lapses have seemingly caused a variety of adverse patient outcomes: psychological distress, suboptimal treatment and even suicides and unwanted deaths. In almost all instances incidents were not reported, discussed or reflected upon to prevent future occurrences. Medical students appeared to suffer from high levels of moral distress due to observing such incidents but tended not to express their concerns due to their lowly status within the hierarchy. CONCLUSION: Lapses in professionalism in doctors appear to threaten patient safety and the provision of optimal patient care in Sri Lanka. The situation is unlikely to improve unless the hierarchical working culture changes to help students and doctors challenge such lapses.
Lapses of professionalism occurring among Sri Lankan medical students: How should they be remediated?
(Sri Lanka Medical Association., 2019) Ellawala, A.T.; Chandratilake, M.N.; de Silva, N.R.
INTRODUCTION & OBJECTIVES: Early recognition and correction of lapses of professionalism occurring during 'the undergraduate period is vital. This study aimed to explore the lapses of professionalism occurring among local medical students and identify appropriate remedial measures. METHODS: The study was conducted in two phases. In Phase I, in-depth interviews and focus group discussions were conducted with medical teachers, clinicians, deans, students, nurses and patients (n= 129) to explore lapses they had witnessed. Conversations were audio-recorded, transcribed and analysed inductively. Description by multiple groups was considered an indicator of prevalence of a behaviour. In Phase II, a consensus conference with medical teachers, clinicians, deans and students (n=3 I), was conducted to achieve consensus on remediation strategies for identified lapses occurring as a first-time offence or a repeated behaviour pattern. Degree of consensus was based on modal distribution of responses. RESULTS: In Phase I, over 100 types of misconduct were described. The most common behaviours included, 'not doing allocated ward work', 'not contributing to group work' and 'several students examining a patient at the same time'. In Phase II, it was possible to achieve an acceptable level of agreement (50% or higher consensus) regarding remediation strategies for over 70% of the items, including almost all lapses identified as most common. Strategies ranged from 'ignore' to 'expulsion' and included measures such as discussion with peers, remedial work and counselling. CONCLUSION: Sri Lankan medical students exhibit a wide range of professionalism lapses of varying severity. The value of correcting such behaviour in a standardized manner is recognised.
Peer evaluation of individual effort in student group work
(Sri Lanka Medical Association, 2007) Roshini, A.A.N.; de Silva, D.C.; Chandratilake, M.N.; Pathmeswaran, A.
OBJECTIVE: To assess the feasibility of using a method of peer assessment of individualized effort during group work and to validate it. DESIGN, SETTING AND METHODS: At the end of a module during the 2nd year, 12 groups of medical students (consisting of 13-14 students per group) made a presentation. Foilowing the presentation, the students assessed the contribution of each of their colleagues towards the presentation by using a rating form. This form listed the members of the group and consisted of a global assessment of each student's contribution to group work as well as assessment of contribution in eight different ways. An individualized mark was calculated for each student by summarizing the scores assigned to him/ her by other group members. Each student was given their personal mark and was asked for their reaction. RESULTS: Peer assessment marks were available for all 164 students. Nineteen (11.6%) students had got less than 50 marks. Though 11 of these students were not satisfied with their mark, 12 (63%) accepted that the mark reflected their contribution. Among those who had scored 50 or more marks, 87% were satisfied with their marks and 88% stated that the marks reflected their contribution to group work. CONCLUSION: The second year medical students taking part in this study were prepared to assess their peers and most of them were satisfied with the marks allocated by their peers. Over 60% of those who scored less than 50 marks accepted that their mark was a fair reflection of their contribution to group work.
Practice of cultural remedies for infertility among women in the Western Province, Sri Lanka
(Sri Lanka Medical Association., 2019) Hitige, D.G.; Herath, B.P.B.; Herath, N.M.I.U.; Hasna, M.H.F.; Harshani, H.A.D.; Chandratilake, M.N.
INTRODUCTION & OBJECTIVES: In Sri Lanka, the concept of infertility and its treatment are influenced by cultural norms. This study explored the common cultural beliefs and remedies associated with infertility in Sri Lanka and determined the trends of their practice. METHODS: A mixed-method study was conducted with infertile females participating in sub fertility clinics of four tertiary-care hospitals in the Western Province. The transcripts of focus group discussions with 40 females were thematically analysed and a self-administered questionnaire was developed. It was used to survey 330 infertile females; descriptive and inferential statistical analyses helped determine the trends of practices. RESULTS: The qualitative data revealed that the cultural remedies were related to ones' religion, societal norms and alternative medical practices. As observed in quantitative analysis, every participant has engage in cultural remedies; food habits, kind gestures towards pregnant mothers and/or children, and religious rituals were the commonest. The correlation between the strengths of believing and engaging was high. Stronger beliefs and higher engagement were observed among women who were seeking allopathic treatment for more than two years and who were married for more than four years. The practice of religious remedies increased with years of marriage while the practice of societal norms increased with years of seeking treatment. The belief of "Karma" has impacted on not believing solely in allopathic treatment. CONCLUSION: Infertile females commonly practice cultural remedies. The extent and focus are affected by years of treatment without a success (losing faith in medical measures) and increasing years of marriage (increasing faith on non-medical reasons for infertility).
Professionalism in Medicine; the transition of a movable feast and its implications for clinical and educational practices
(Postgraduate Institute of Medicine University of Colombo, 2016) Chandratilake, M.N.
Quality of informed consent as experienced by patients awaiting surgical intervention in a tertiay care setting in Sri Lanka
(Sri Lanka Medical Association, 2018) Gunathunga, M.H.D.; Hansamali, M.M.P.; Hapuarachchi, H.S.M.; Herath, H.M.T.H.; Herath, H.M.C.J.; Chandratilake, M.N.
INTRODUCTION AND OBJECTIVES: Informed consent is a basic ethical principle. The existing guidelines may not be fully operational in practice. The objective of this study was to identify the common lapses in obtaining informed context METHODS: A cross-sectional descriptive study was conducted in surgical wards of North-Colombo Teaching Hospital. A questionnaire was developed by observing 11 consent-taking encounters. 100 in-ward patients awaiting surgical interventions completed the questionnaire. RESULTS: We observed that the information regarding surgery is provided by different personnel along the process. The gap between information provision and consent taking appeared inadequate for patients to take a well thought-out decision. In most instances, consenting was given by signing/thumb-printing a statement prescribed by the intern house officer. Disturbances to the process of doctor-patient conversation were also observed and privacy was a concern as the setting for doctor-patient conversation was not in an acceptably private space. According to patients, information provision (48% in the clinic; 43% of the time by senior doctors) and expressing (100% in the ward; 86% of the time by most junior doctors and 10% by nurses) have happened as two disjointed processes. Common lapses identified by patients were: alternative treatment options were not explained (85%); a tendency not to discuss risks (50%); confinement to verbal explanation (87%); and not requesting patients to paraphrase to check their understanding (90.9%).CONCLUSION: There were lapses in consent-taking procedure which were largely attributable to poor patient centeredness and respect for patients' autonomy among doctors, and the power gap between patients and doctors.
Quality of informed consent obtained by doctors from patients undergoing surgical interventions in a tertiary care hospital in Sri Lanka
(Sri Lanka Medical Association, 2018) Gunathunga, M.H.D.; Hansamali, M.M.P.; Hapuarachchi, H.S.M.; Herath, H.M.T.H.; Herath, H.M.C.J.; Chandratilake, M.N.
INTRODUCTION AND OBJECTIVES: Respecting patient autonomy and obtaining consent for medico-surgical procedures are basic ethical principles. The objective of this study was to explore the perspective of doctors on lapses of taking consent observed in a surgical setting. METHODS: A qualitative. study using individual interviews was conducted with the participation of eight intern house officers working in surgical units of North-Colombo Teaching Hospital, Ragama. Their perspectives on previously observed lapses in consent-taking were explored. The audio-recorded interviews were thematically analyzed. ·RESULTS: Themes revealed the common lapses as: not explaining the risks and alternatives, checking understanding by paraphrasing, providing varying amounts of information to different patients, getting consent after admitting to the ward for surgery. Amount of information provided differed with perceived level of intellectual capacity of patients. Lack of knowledge on procedures was a challenge for junior doctors to provide information. Wards may not be the best place to provide information, but clinics, as patients have sufficient time to decide on the procedure before admitting. Lack of time and work overload were common barriers for all lapses identified. The basic information regarding risk, benefits alternatives and patient understanding was addressed not by a single doctor but by different doctors along the process. Doctors believed that some of these lapses were not expected by patients in the local context due to the culture and educational level. CONCLUSION: Although consent taking for surgery is adhered to as a practice, certain underlying principals maybe overlooked along the process due to limitations in resources and misperception of patients' expectations