Browsing by Author "Kodikara, K."

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BIOETHICS TEACHING AND ITS’ EFFECTIVENESS IN UNDERGRADUATE MEDICAL PROGRAMMES: A NARRATIVE REVIEW
(The Library, University of Kelaniya, Sri Lanka., 2024) Godamunne, P. K. S.; Kodikara, K.
Medicine is an art as much as it is a science. Patients wish to consult professional and compassionate doctors, though they rarely meet such. To cultivate professionalism in medical students, bioethics teaching have been incorporated into medical programmes in varying degrees across the world. This reports findings from a narrative synthesis of previously published literature that evaluates the evidence regarding implementation of bioethics in undergraduate medical curricula, with special attention to the Asia, Pacific region. For this purpose, Google Scholar and MEDLINE/PubMed databases were searched for articles on bioethics published between January 2000 to April 2024. Reviews or studies that were published in languages other than English were excluded from the search. The focus was placed on the development of moral competence as the intention of this review was to inform bioethics teaching. The results reveal a high degree of diversity of the curricular structure of bioethics courses and the lack of formalization of bioethics in the curricula specially in the Asia-Pacific region. Bioethics teaching resulted on lowering student indecision when faced with moral dilemmas. The call for use of local cases to enhance bioethics education is prominent, enabling more opportunities for reflection and discussion, to stimulate critical judgment of future clinicians.
Challenges in learning procedural skills: Student perspectives and lessons learned for curricular design
(Routledge, 2024) Kodikara, K.; Seneviratne, T.; Godamunne, P.; Premaratna, R.
PHENOMENON: Developing foundational clinical procedural skills is essential to becoming a competent physician. Prior work has shown that medical students and interns lack confidence and competence in these skills. Thus, understanding the student's perspective on why these skills are more difficult to acquire is vital for developing and reforming medical curricula. APPROACH: This study explored procedural skills learning experiences of medical students with qualitative methods. Through purposive sampling, 52 medical students from the third, fourth, and final years were selected for inclusion. Data were collected using six audio-recorded, semi-structured focus group discussions. Transcripts were manually coded and analyzed using inductive content analysis. FINDINGS: Students provided rich and insightful perspectives regarding their experiences in learning procedural skills that fell into three broad categories: 1) barriers to procedural learning, 2) reasons for learning, and 3) suggestions for better learning outcomes. Students described a range of barriers that stemmed from both patient and clinician interactions. Students were reluctant to make demands for their own benefit during clerkships. The most commonly expressed reason for wanting to learn procedural skills was the desire to be a competent and independent intern. The motivators suggested that students felt empathetic toward interns and visualized a successful internship as a learning goal. Participants suggested peer learning, improved teaching of procedural skills, assessments, and feedback to improve their learning. INSIGHTS: This study generated valuable information to promote critical reflection on the existing curriculum and pedagogical approaches to procedural skills development. Medical educators need to sensitize the clinical teachers to student perspectives and what students are really learning to make impactful changes to teaching and learning procedural skills. Students' self-advocacy skills and self-directed learning skills need to be developed for them to seek out learning opportunities and to promote life-long learning. Lessons from this study may also apply to curriculum design in general, especially in teaching clinical skills. Empowering the learner and embracing a learner-centered approach to teaching and learning procedural skills will benefit future clinicians and their patients.
Clinical simulation for procedural expertise: state of education and application
(The Library, University of Kelaniya, Sri Lanka, 2023) Kodikara, K.
Procedural skills are a core component in the health care practice that extends across all medical practitioners, from novice trainees to specialists. Medical institutions have widely adopted simulation to develop the clinical and procedural skills of health profession students. This review evaluates the evidence regarding simulation-based training for developing procedural expertise among medical students and junior doctors. For this purpose, Google Scholar and MEDLINE/PubMed databases were searched for articles published on simulation-based procedural training between January 2000 and October 2023. Reviews or studies published in languages other than English and research that showed evidence on communication, critical thinking, teamwork, decision-making, and cognitive skills were excluded from the search. The focus was placed on clinical and psychomotor skills as this review intends to inform clinical skills teaching and research practice. The results reveal that simulation-based training has been utilized increasingly to train medical students and junior doctors in procedural skills. Varying levels of fidelity have been incorporated to train psychomotor skills about a multitude of common and rare procedures. The evidence supports the acquisition of knowledge and procedural skills via simulation. Evidence also supports the transfer of skills from the simulated environment to clinical practice and live patients. However, resource intensiveness has limited the implementation of this method of education in developing countries. When used consciously, simulation can complement clinical training to produce competent doctors capable of effective patient care.
Medical student’s experiences of training on simulated and real patients in education: A qualitative exploration
(Penerbit Universiti Sains Malaysia, 2023) Kodikara, K.; Senaviratne, T.; Premaratna, R.
Patient interaction is a key learning experience in undergraduate medical education. An actual or simulated/standardised patient (SP) can be used for this purpose. Although both real patients and SPs have inherent advantages and disadvantages, the value of SPs, as opposed to real patients, is recognised as an important area warranting research. The objective of this study was to explore the students’ perception of using real patients and SPs in their education. Six focus group interviews were conducted using medical undergraduates in the third, fourth, and fifth (final) year batches of the Faculty of Medicine, University of Kelaniya, Sri Lanka, from July to October 2020. The interviews were thematically analysed. All the participants considered real patient encounters more authentic than SP encounters. The students identified many strengths of SP interactions. SP encounters enabled them to prepare for real patient encounters. In particular, the participants appreciated the opportunity to practice communication skills with SPs. Students valued the feedback provided by SPs. The students identified real patient encounters enabled learning physical examination skills and procedural skills. Interestingly, most identified real patient encounters as more instructive, and some students identified that “the nervousness and anxiety” associated with real patient encounters helps improve selfconfidence. Students identified specific strengths and weaknesses in both real patient encounters and SP encounters. Participants appreciated SP encounters explicitly for learning communication skills and preparing for real patient encounters. Real patient encounters were valued for learning and improving clinical skills. The findings of the study support harnessing these specific strengths of each encounter and, thus, incorporating both in undergraduate medical education.
Pre-clerkship procedural training in venipuncture: a prospective cohort study on skills acquisition and durability
(BioMed Central, 2023) Kodikara, K.; Seneviratne, T.; Premaratna, R.
BACKGROUND: The effectiveness of simulation-based training for skill acquisition is widely recognized. However, the impact of simulation-based procedural training (SBPT) on pre-clerkship medical students and the retention of procedural skills learned through this modality are rarely investigated. METHODS: A prospective cohort study was conducted among pre-clerkship medical students. Learners underwent SBPT in venipuncture in the skills laboratory. Assessments were conducted at two main points: 1) immediate assessment following the training and 2) delayed assessment one year after training. Learner self-assessments, independent assessor assessments for procedural competency, and communication skills assessments were conducted in both instances. The students were assessed for their competency in performing venipuncture by an independent assessor immediately following the training in the simulated setting and one-year post-training in the clinical setting, using the Integrated Procedural Protocol Instrument (IPPI). The student's communication skills were assessed by standardized patients (SP) and actual patients in the simulated and clinical settings, respectively, using the Communication Assessment Tool (CAT). RESULTS: Fifty-five pre-clerkship medical students were recruited for the study. A significant increase was observed in self-confidence [mean: 2.89 SD (Standard Deviation) (0.69)] and self-perceived competency [mean: 2.42 SD (0.57)] in performing venipuncture, which further improved at the delayed assessment conducted in the clinical setting (p < 0.001). Similarly, the IPPI ratings showed an improvement [immediate assessment: mean: 2.25 SD (1.62); delayed assessment: mean: 2.78 SD (0.53); p < 0.01] in venipuncture skills when assessed by an independent assessor blinded to the study design. A significant difference (p < 0.01) was also observed in doctor-patient communication when evaluated by SPs [mean: 2.49 SD (0.57)] and patients [mean: 3.76 SD (0.74)]. CONCLUSION: Simulation-based venipuncture training enabled students to perform the procedure with confidence and technical accuracy. Improved rating scores received at a one-year interval denote the impact of clinical training on skills acquisition. The durability of skills learned via SBPT needs to be further investigated.
Prevalence of NS-1 Status of Clinically Suspected Dengue Patients in a Selected Out-Patient Setting
(Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2016) Kodikara, K.; Jayathilake, S.; Kumarasinghe, B.; Muhandiramlage, T.; Gunesakera, D.; Fujii, Y.
Dengue infection is one of the rapidly emerging arboviral infections in the world. It is a cause of significant morbidity and mortality especially in developing countries. Although most dengue infections are asymptomatic, dengue fever can be manifested with or without complications. Early diagnosis of dengue is important both clinicians and the patients, where appropriate management of dengue patients reduces both morbidity and mortality. Traditionally dengue infection is clinically suspected with full blood count aided by clinical features although dengue infection cannot be confirmed by either of these methods. Confirmatory tests for detection of the dengue virus are by virus isolation or by nucleic acid detection. which are not suitable for routine diagnosis. NS-1 rapid antigen test has become available for early detection of dengue NS1 antigen, which can be performed at the point of care. Estimate the prevalence of NS1 positivity in dengue suspected patients with acute febrile illness in a selected study setting Blood samples from clinically suspected patients within the first five days of fever were sent for NS1 diagnosis to the molecular laboratory in the department of Biochemistry Faculty of Medicine Ragama. Clinical diagnosis was made by a medical officer. Serum was used for the NS1 diagnosis using Inbios Diagnostic kit (USA). 22.2% of samples were tested positive for NS-1 antigen in a total of 54 samples collected. There were 53.7% males. 9.2% patients were below 10 years of age, 37% patients between 11-20 years of age, 20.3% patients between 21-30 years and 31.4% patients above 31 years of age. 30 % of patients between 11-20 years were NS-1 positive. 36.3 % of patients between 21-30 years of age and 11.7% patients above 31 years of age were also NS-1 positive. NS-1 antigen prevalence was highest among patients between the ages of 11-30 years. Initial clinical assessment of dengue infections is of low specificity as the disease manifests as an undifferentiated febrile illness. Therefore, the inclusion of an antigen test will improve the specificity of diagnosis in a similar out-patient setting which will enable clinicians to make decisions on the further management of the condition.
Procedural simulation in venipuncture for medical undergraduates and its transfer to the bedside: a cluster randomized study
(Springer, 2024) Kodikara, K.; Seneviratne, T.; Premaratna, R.;
Simulation is accepted as an effective method of learning procedural skills. However, the translational outcomes of skills acquired through simulation still warrants investigation. We designed this study to assess if skills laboratory training in addition to bedside learning (intervention group [IG]) would provide better learning results than bedside learning alone (control group [CG]) in the context of venipuncture training. This prospective, cluster-randomized, single-blind study took place at the Faculty of Medicine, University of Kelaniya, Sri Lanka. Seventeen clusters of second-year medical students were randomly assigned to either IG or CG. The IG trained on venipuncture in the skills laboratory, receiving instruction after modified Payton’s Four Step Method. Following the training, students of both IG and CG underwent bedside learning for one month. Afterward, students of both groups performed venipuncture on actual patients in a clinical setting. An independent, blinded assessor scored students’ performance using the Integrated Procedural Protocol Instrument (IPPI) and a checklist. Patients assessed students’ performance with the Communication Assessment Tool (CAT). Eight and nine clusters were randomized to the intervention and control groups, respectively. IG completed significantly more single steps of the procedure correctly (IG: 19.36 ± 3.87 for checklist items; CG: 15.57 ± 4.95; p < 0.001). IG also scored significantly better on IPPI ratings (median: IG: 27 (12) vs. CG: 21 (8); p < 0.001). Rated by patients, students’ communication skills did not significantly differ between the two groups. Simulation-based venipuncture training enabled students to perform the procedure on actual patients with a higher technical accuracy than students who learned venipuncture at the bedside. Students were able to transfer the skills acquired through venipuncture training at the skill laboratory to the bedside.
Simulation
(College of Medical Educations., 2020) Kodikara, K.; Karunathilake, I.
No abstract available