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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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.Item IMoCC - Measure of cultural competence among medical students in the Malaysian Context.(Informa Healthcare, 2021) Chandratilake, M.; Nadarajah, V. D.; Mohd Sani, R. M. B.ABSTRACT:Cultural beliefs and practices impact heavily on health outcomes of patients. Doctors' ability to deal with such issues in clinical practice, i.e. cultural competence, is widely studied in the west. It has yet to be given due importance in non-western contexts. This study aimed to develop a valid and reliable measure of cultural competence in the Malaysian cultural context and to assess cultural competence among Malaysian medical students. Thirty-five cultural issues faced by Malaysian doctors were identified with a series of interviews to develop a preliminary tool. The responses of students to these cultural issues were evaluated against the extent of inquiry and advocacy based on a theoretical framework of cultural competence. The responses were subjected to statistical analysis to determine the internal structure of the tool and to reduce the number of items in the tool. The final tool (IMU Measure of Cultural Competence - IMoCC) comprised of 22 issues, which deemed to be reliable in the second round of testing. In both tools, student cohorts demonstrated an acceptable level of cultural competence with room for improvement. However, they appeared to learn how to deal with cultural issues primarily through informal means and not in the formal curriculum. KEYWORDS: Cultural competence; health professions; professionalism; undergraduate.Item Female victims and female perpetrators: medical students' narratives of gender dynamics and professionalism dilemmas.(Springer Netherlands, 2020) Shaw, M.K.; Chandratilake, M.; Ho, M.J.; Rees, C.E.; Monrouxe, L.V.ABSTRACT: Medicine is a gendered discipline, in which women, both as patients and practitioners, have often held subordinate positions. The reproduction of dominant gender biases in the medical setting can negatively impact the professional development of medical students and the wellbeing of patients. In this analysis of medical students' narratives of professionalism dilemmas, we explore students' experiences of gender bias in hospital settings. Seventy-one students participated in 12 group interviews, where they discussed witnessing or participating in various activities that they thought were professionalism lapses. Within the dataset, 21 narratives had a distinctly gendered component broadly pertaining to patient dignity and safety dilemmas, informed consent issues, and female student abuse. Interestingly, perpetrators of such acts were commonly female healthcare professionals and educators. Although students recognized such acts as professionalism lapses and often expressed concern for patient wellbeing, students did not intervene or report such acts due to hierarchical cultural contexts, and at times even reproduced the discriminatory behavior they were criticizing. This raises concerns about medical students' professionalism development and the extent to which gender bias is ingrained within particular medical systems. The normalization of disrespectful and abusive treatment of female patients poses immediate and future consequences to the wellbeing and safety of women. Furthermore, the same socio-cultural values that sustain these acts may account for perpetrators often being women themselves as they strive to overcome their subordinate position within medicine.Item Exploring the impact of student-led peer assisted learning (‘kuppi classes’) on examination performance and mental, social and emotional development of medical students of a Sri Lankan medical school(Sri Lanka Medical Association, 2017) Chandrasekara, S.; Bandara, H.; Chandrasiri, N.; Choden, T.; Chandratilake, M.INTRODUCTION & OBJECTIVES: Peer-assisted-learning (PAL) is the acquisition of knowledge and skills through active helping and supporting among status equals or matched companions. In ‘kuppi classes’, a local term for an informal form of PAL, students of a junior batch learn from students of a senior batch in a didactic manner. The aims of this study were: to explore the educational environment and the reasons for attending kuppi classes; to determine the correlation between attendance of kuppi classes and student performance at examinations. METHODS: The study focused on kuppi classes for preclinical subjects, the student experience of the first two years, and their performance at the second-year summative examination. Two focus group discussions were carried out with 14 medical students to identify the breadth of the issues related to each objective. The transcriptions were thematically analysed and a selfadministered questionnaire was developed based on these themes. It was administered to 178 third-year medical students. RESULTS: The qualitative component revealed that the learning environment in kuppi classes were much more relaxed and acceptable compared to formal teaching sessions. According to the questionnaire, the main reason for attendance is as a backup for formal lectures. For the tutoring student it is a revision. The attendees expect kuppi classes to be more examination oriented. However, the association between kuppi attendance and subsequent examination performance was not statistically significant. CONCLUSION: Didactic and informal near-peer-learning sessions may provide students with the conducive social and emotional environment to learn. However, it may not have an impact on examination performance.Item Perceptions of Sri Lankan medical students on selecting and pursuing medicine as a career(Sri Lanka Medical Association, 2017) Karunaratne, D.R.INTRODUCTION & OBJECTIVES: Although the choice of pursuing medicine as a career has long been a topic of interest, the rapidly changing socioeconomic environment warrants a revisit. This study explored the current factors which influence this choice among medical students. METHODS: A mixed-method study was conducted among first and fourth year students in the Faculties of Medicine of universities of Kelaniya, Colombo and Sri Jayewardenepura. The perceptions of 30 medical students were explored using focus group discussions. The contents were thematically analysed to develop a valid self-administered questionnaire, which was given to 364 medical students. The responses were analysed both descriptively and inferentially. RESULTS: A total of 63.5% respondents were females and 44% were first-year students. The foremost reason for selecting medicine was to help people (mean= 2.28). The least important reason was parental pressure (mean=1.5). A/L marks (mean=2.19), social status of being a doctor (mean=1.74), job guarantee (mean=1.83) and self-interest (mean=1.98) were ranked in between. The regret of choosing medicine as a career was higher among females (p=0.035) and fourth-year students than their counterparts. The reasons appeared to be the stressfully high workload and external political issues in medical education. The interest on postgraduate studies was higher among 1st A/L attempt entrants than 3rd A/L attempt entrants (p=0.011); the interest appeared to grow along the course. CONCLUSION: Choosing medicine still has an altruistic preponderance. However, a regret of selecting medicine appears to grow along the course. The desire to pursue postgraduate studies is more if entered to medical school in the 1st attempt.Item Taiwanese medical students' narratives of intercultural professionalism dilemmas: exploring tensions between Western medicine and Taiwanese culture(Springer Netherlands, 2017) Ho, M.J.; Gosselin, K.; Chandratilake, M.; Monrouxe, L.V.; Rees, C.E.In an era of globalization, cultural competence is necessary for the provision of quality healthcare. Although this topic has been well explored in non-Western cultures within Western contexts, the authors explore how Taiwanese medical students trained in Western medicine address intercultural professionalism dilemmas related to tensions between Western medicine and Taiwanese culture. A narrative interview method was employed with 64 Taiwanese medical students to collect narratives of professionalism dilemmas. Noting the prominence of culture in students' narratives, we explored this theme further using secondary analysis, identifying tensions between Western medicine and Taiwanese culture and categorizing students' intercultural professionalism dilemmas according to Friedman and Berthoin Antal's 'intercultural competence' framework: involving combinations of advocacy (i.e., championing one's own culture) and inquiry (i.e., exploring one's own and others' cultures). One or more intercultural dilemmas were identified in nearly half of students' professionalism dilemma narratives. Qualitative themes included: family relations, local policy, end-of-life care, traditional medicine, gender relations and Taiwanese language. Of the 62 narratives with sufficient detail for further analysis, the majority demonstrated the 'suboptimal' low advocacy/low inquiry approach (i.e., withdrawal or inaction), while very few demonstrated the 'ideal' high advocacy/high inquiry approach (i.e., generating mutual understanding, so 'intercultural competence'). Though nearly half of students' professionalism narratives concerned intercultural dilemmas, most narratives represented disengagement from intercultural dilemmas, highlighting a possible need for more attention on intercultural competence training in Taiwan. The advocacy/inquiry framework may help educators to address similar disconnects between Western medicine and non-Western cultures in other contexts.Item Feasibility of introducing General English as an university entry requirement for Medicine: results of a national survey(National Centre for Advanced Studies in Humanities and Social Sciences, 2012) de Silva, N.R.; Priyabhashini, G.D.C.; Godage, P.K.; Premakumara, P.; Pathmeswaran, A.The feasibility of introducing General English as an entry requirement for study of Medicine in Sri Lanka was examined through the assessment of General English results at the 2009 and 2010 G.C.E. Advanced Level examinations and through a questionnaire survey administered to principals and General English teachers in 411 type 1AB schools during the period May – June 2011. A significant proportion of students selected for Medicine in the period of study had not passed General English. Student performance was linked to teacher availability, which showed significant regional disparities. Nationally, about one-third of schools did not have enough General English teachers as evaluated by the Principal of the school.Item Selection of medical students in Sri Lanka: time to re-think criteria?(Sri Lanka Medical Association, 2011) Hewage, S.N.; Salgado, L.S.S.; Fernando, G.M.O.; Liyanage, P.L.C.K.; Pathmeswaran, A.; de Silva, N.R.OBJECTIVE: To examine the validity of selected entry level characteristics in relation to the GCE A/L examination as independent predictors of performance of students in medical school. METHODS : A retrospective, analytical study was done at the Faculty of Medicine, University of Kelaniya. Student characteristics at entry were described by sex, the average z-score, General English grade and attempt at GCE A/L examination, and average mark obtained at the English placement test on registration to medical school. Average marks at three summative examinations were used as indicators of performance in medical school. Multivariate analysis using multiple linear regression was carried out using these three outcome measures in relation to four entry point variables as predictors of performance in medical school. Causal path diagrams were constructed using standardised regression coefficients for the whole group and for male and female students separately. RESULTS: The A/L z-score, A/L attempt and English placement test marks were all significant predictors of outcome at the First Examination. Of the variables relating to the A/L examination, the attempt had a much higher path coefficient with performance at the First Examination than the A/L z-score, as did the English marks. Separate path analyses for male and female students showed that while the significance of the relationships remained the same, the magnitude of the correlation was different. CONCLUSIONS: Students who gain admission on their 3rd attempt at the AL examination fare much worse than those admitted to medical school on their 1st attempt. Differences between sexes in examination performance are probably linked to both A/L attempt and English language proficiency.Item Medical students experiences of learning communication skills during a family medicine clerkship in Sri Lanka(Department of Family Medicine, Aga Khan University Pakistan, 2005) de Silva, N*.INTRODUCTION: The teaching of communication skills to medical students was introduced for the first time in Sri Lanka in 1996, during a clinical attachment in family medicine. Setting: The University Family Medicine Clinic which provides a free primary medical care service to the community. A two week family medicine clerkship for third year students in groups of 15-18. Teaching and Learning METHODS: Small group discussions and learning of communication skills through viewing of educational videos and live consultations on a TV monitor. Students received "hands on experience" in communication skills followed by constructive feedback by the teacher and peers on a video tape replay of student-patient encounters and role plays. METHOD: Qualitative research methodology was used. Students from two groups were requested to write down their experiences of learning communication skills through video tape replay and feedback during the family medicine clerkship. RESULTS: The students` narratives of their learning experiences were analyzed. The themes that emerged were: apprehension at being observed by the teacher and peers during student-patient encounters, anxiety about not remembering to ask relevant questions from the patient, enjoyment of the feeling of real doctoring, developing confidence in consulting skills and learning by watching themselves in action on video tape replay. Excerpts of the feelings expressed by the students under these themes were selected to be presented in this paper. CONCLUSION: The learning of communication skills had been an enjoyable experience for the students who appreciated the learning achieved. They had also undergone personal and professional development in the process.Item Selection of students for admission to a medical school in Sri Lanka(Sri Lanka Medical Association, 2004) de Silva, N.R.; Pathmeswaran, A.; de Silva, H.J.OBJECTIVES: To assess the extent to which selected entry point factors predicted success in a Sri Lankan medical school. METHODS: The study sample consisted of all students in two consecutive entry cohorts. Marks obtained at the national university entrance examination in physics, chemistry, botany and zoology; the aggregate marks of these four subjects (the only academic criterion used in selection); the district of entry (the other, non-academic criterion); and gender, were identified as entry point variables. Success in a medical school was measured in five ways, including whether a student had passed all examinations in the medical faculty at first attempt or not. Multiple logistic regression was used to assess the extent to which the selected entry point factors could predict variability in outcome measures. RESULTS: Of 331 students, 6.6% were merit quota admissions, and 19.4% were from 'underprivileged' districts; 46.8% were women. Of the entry point factors, being female and obtaining an aggregate of > or =280 (of a possible 400) were the only independent predictors of success in all outcome measures. Obtaining at least grade B in zoology was also an independent predictor of passing all examinations at first attempt. The aggregate score alone accounted for only 2-5% of variance in a medical school performance. There was no association between admission from an underprivileged district and any of the outcome measures. CONCLUSIONS: The one and only measure of academic performance used for selection of students admitted to our medical schools, is a very weak predictor of success in a medical school.