Browsing by Author "Karunaratne, W.C.D."

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Clinical reasoning and its challenges at workplace: A qualitative study with novice medical graduates in Sri Lanka
(Staff Development Center, University of Kelaniya, Sri Lanka, 2015) Karunaratne, W.C.D.; Chandratilake, M.B.N.; Marambe, K.
Background and rationale: Clinical reasoning is a major determinant of clinical competence among medical professionals (Barrows & Feltovich, 1987). However, even after 40 years of research, diverging opinions still persist on the diagnostic decision making process adopt by medical professionals proving the complexed nature of the phenomenon (Eva, 2004). Aim: This study aims to explore how novice medical graduates working at four main clinical specialties (medicine, surgery, paediatrics and obstetrics & gynaecology) learn and perform clinical reasoning during internship training and the challenges encountered. Theoretical underpinning: Theories of diagnostic decision making range from hypotheticodeductive reasoning described in 1970’s to the dual process theory, discussed recently in the medical education literature (Norman, 2005; Pelaccia, Tardif, Triby, & Charlin, 2011). Proposed methodology: Interpretive paradigm research using phenomenology will be conducted on novice medical graduates working in medicine, paediatric, surgery and obstetrics & gynaecology wards at the North Colombo Teaching Hospital, Ragama, Sri Lanka. The study will be conducted in two phases using purposive sampling (a combined total of 16) with gender balance and equal representation of specialties. During the study each participant will undergo three (3) interviews. The first interview will be on their experience of clinical reasoning as an intern and the challenges faced. The subsequent two interviews are based on audio-recorded patient encounters using the technique of stimulated recall. Two experts from each specialty will review the audio-recordings of patient encounters and determine the relevance of questions to the diagnosis. The interviews will be anonymised and transcribed verbatim. A coding framework will be developed using the five-stage process proposed by Ritchie &Spencer (Analyzing qualitative data, 1994). Thematic analysis of the data will be done using ATLASti. Expected outcomes: The study findings will provide meaningful insights in to organizing and re-structuring medical internship training to facilitate learning and on measures for improving clinical reasoning during undergraduate medical training.
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.
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.
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.
A pilot study on virtual patients: Understanding student experiences to facilitate learning
(Faculty of Graduate Studies, University of Kelaniya, 2015) Karunaratne, W.C.D.; Chrandratilake, M.N.; Premaratna, B.A.H.R.
Virtual patients are web-based interactive clinical scenarios and are being increasingly used globally in undergraduate medical training. Despite its value, virtual patients are not been used widely in the local context. Therefore this pilot study examined student experiences of using a virtual patient with the aim of identifying student acceptance and the possibility of integration into the medical curriculum to enhance student learning. A virtual patient having a linear navigation design was developed in the virtual learning environment (VLE) of the faculty paying meticulous attention to instructional designing, medical education principles and content coverage. 12 immediate graduates of the faculty were recruited to the study following informed consent as they have completed the undergraduate curriculum and in a position to provide meaningful comments on the activity concerned. They were given online access to the virtual patient and were requested to complete the case study followed by an 18 item survey designed on the same platform. The results were analysed using MS Excel. All study participants unanimously agreed to the usefulness of virtual patients for medical undergraduate training. It was identified as a means to practice clinical cases, preparation for clinical training in the ward setting, a guide for assessments, to understand practical aspects of patient management and a means to refresh the knowledge. The most useful features were the multiple choice questions integrated to the case study, immediate feedback and learning points. The essay type questions which require text input were discouraged. It was suggested to impose a time limitation as it mimics the reality and to include more practical aspects. The positive student experiences associated with the interaction of the virtual patient during this study highlighted the need for such innovative methods to facilitate medical undergraduate learning. However, a larger study needs to be conducted on different virtual patient designs before adopting them for student learning.
Usage analysis of student interactions in an online learning platform conducted at Faculty of Medicine, University of Kelaniya: Pedagogical considerations for implementing e-Learning
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Karunaratne, W.C.D.; Chandratilake, M.N.; Heiyantuduwage, S.
BACKGROUND: Learning Management Systems (LMS) designed to support teaching and learning has changed how education is offered and consumed in higher education. OBJECTIVES: This study was conducted with the aim of identifying what inferences, educators can make through student usage statistics of the Moodle Learning Management System termed as the VLE (Virtual Learning Environment) on developing a pedagogical model for online learning. METHODS: Student and staff course usage statistics were recorded from the VLE of the Faculty of Medicine, University of Kelaniya for all the modules, and related resources and activities conducted from first to the fourth year students during the year 2015 and analyzed. RESULTS: A majority of students (88-90%) access the materials available in the VLE. The mean student access during the module is higher than following the completion of the module while the frequency of student access during faculty hours is similar to the frequency of use after faculty hours. As expected, student access was increased with availability of more learning materials in the modules and with incorporation of student activities and links to web resources. The mean usage frequency of staff were considerably low and limited whereas the support staff usage being more than ten times higher. CONCLUSIONS: The Virtual Learning Environment (VLE) of the faculty can be used as an effective platform to supplement didactic learning and to promote self-learning among students. It also highlights the necessity to form an eLearning development team for the institution consisting of instructional designers, graphic artists, multimedia developers and instructors with whom the content experts can work together to realize there requirements.
Using hermeneutic phenomenology approach to explore how junior doctors learn clinical reasoning in practice
(Sri Lanka Medical Association, 2017) Karunaratne, W.C.D.; Chandratilake, M.; Marambe, K.
INTRODUCTION & OBJECTIVES: Hermeneutic phenomenology is a qualitative study design to understand individual learning experiences from the beholder’s perspective (phenomenology) while appreciating the subjective interpretation of them by the researcher with essential prejudices for understanding the concept (hermeneutic). Clinical reasoning is a multifaceted, dynamic, individualized and evolving construct. Therefore, how junior doctors learn clinical reasoning in practice was explored using this approach. The aim is to share this methodological experience with prospective researchers to be used for similar purposes. METHODS: A total of 18 junior doctors (Males: 7, Females: 11) from four major clinical disciplines participated in individual in-depth semi-structured interviews. Lived-experiences were encouraged more during the interviews than the perceptions complying with phenomenology. The interviews were audio-recorded, transcribed verbatim and analyzed according to the Ritchie and Spencer framework using the Atlas.ti software. The above framework was chosen to maximize the diversity of interpretation. Three personnel with the same academic background but different levels of experience developed the coding framework. This resulted in identification of codes from participants’ expressions (first-order constructs; layered by the researcher’s interpretations of these constructs (second-order constructs). The second-order constructs gave the impetus for emerging themes for the coding framework. Three frameworks of three coders were compared; consensus and deviations were included in developing the final coding framework. RESULTS: The framework revealed rich and diverse accounts of how junior doctors conceptualized clinical reasoning, the presence of numerous interpersonal and contextual factors driving, facilitating and supporting learning and also hindering the learning process. CONCLUSION: Hermeneutic phenomenology can be used effectively to understand complex phenomena like clinical reasoning.