Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item 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).Item 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.Item 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.Item 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' expectationsItem 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.Item 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.Item 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 communicationItem 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.Item 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.Item 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.