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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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.Item 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.Item Why are specialists reluctant to reply to referral letters-exploring the views of specialists in Sri Lanka(Lahore Institute of Public Health(liphealth), 2014) Ramanayake, R.P.J.C.; Perera, D.P.; de Silva, A.H.W.; Sumanasekera, R.D.N.; Fernando, K.A.T.; Jayasinghe, L.R.; Athukorala, L.A.C.L.BACKGROUND: The referral letter from General Practitioner and the reply from the Specialist is the interface between the primary and secondary/tertiary levels of care. It facilitates the referral process and is beneficial for optimizing patient care. In Sri Lanka there is no established referral/back referral system. Not receiving a response to their referrals is a common grievance made by most primary care doctors. In this scenario, the views of Specialists were explored on the importance of reply letters and measures to improve communication. METHOD: Conducted in 2013, this study consisted of in-depth interviews using a semi-structured format, with 21 purposively selected Specialists representing a range of specialties. They included clinicians and university academics from both the government and the private sector. Specialists rarely contacting a GP, such as anesthesiologists and microbiologists, were not invited to participate. Analysis was by generating a thematic framework based on the recurrent themes and issues which was then applied to the textual data. RESULTS: Most Specialists identify that it is important to reply to referrals. These reply letters provide the Primary care doctors with a further management plan, enhance continuity of care and is a source of education to the General Practitioner. Despite the above benefits, the practice of writing a reply is dependent on the following factors: time constraints, lack of clerical assistance, known General Practitioner, patient’s condition and the quality of the referral letter. As methods of improving communication between primary and secondary care it was suggested that referrals be made mandatory to be seen by a Specialist, improving informal communication between Specialists and GPs via regional clinical meetings and introducing a structured referral letter with an attached reply form. CONCLUSIONS: Specialists acknowledge the importance of reply letters in the referral process. Further steps need to be taken to improve the reply rates. This includes changes that need to occur in the referring General Practitioners, Specialists and the practicing institutions creating an environment that is conducive to the referral process.Item Best practices of basic life support training in undergraduate medical education: A guide to medical teachers.(Penerbit Universiti Sains Malaysia, 2022) Kodikara, K.G.Basic life support (BLS) is an essential clinical skill that needs to be mastered by graduating medical officers as potential first responders in clinical settings. Inadequate resuscitation skills of healthcare professionals in BLS have been identified as contributing to poor prognosis in cardiac arrest victims. Thus, BLS training has been incorporated into undergraduate medical curricula using various instructional methods to equip their graduates with BLS skills. Despite such training, medical students and junior doctors were found to be under-competent in delivering BLS primarily due to different methods of instruction utilised in BLS training as opposed to simulation-based training, which is identified as the gold standard in BLS training. It is recommended that simulation-based BLS training be conducted, giving more weight to the skill component, in small groups of 3–10 students, complemented by yearly refresher courses and just-in-time training. This article aims to build awareness and inform medical teachers and programme directors on the current best practices of BLS training in undergraduate medical education.Item Factor structure of medical students’ attitudes towards psychiatry: findings from a nationally representative sample from Sri Lanka(Cambridge University Press, 2021) Baminiwatta, A.; Chandradasa, M.; Ediriweera, D.; Dias, S.AIMS : The aim of this study was to examine the factor structure of attitudes towards psychiatry among medical students by using the ‘Attitude towards psychiatry-30’ (ATP-30) scale, which is one of the most widely used psychometric tools in assessing medical students’ attitudes regarding psychiatry. We also aimed to explore the possible existence of meaningful subscales in the ATP-30 scale. METHOD: Secondary data from a survey of 743 final-year medical students from nine medical schools in Sri Lanka were subjected to factor analysis. Models based on empirical evidence were tested with Confirmatory Factor Analysis (CFA) for model fit using Comparative Fit Index (CFI), Tucker Lewis Index (TLI), root mean square error of approximation (RMSEA) and Chi square. To explore the underlying latent structure of the scale, Exploratory Factor Analysis (EFA) with oblique (i.e. Promax) rotation was employed. Horn's parallel analysis and goodness-of-fit statistics for a series of EFA models tested with different numbers of factors were used in determining the number of factors to retain. Items conceptually external to the emerging factors or with factor loadings less than 0.4 were discarded. Gender invariance of the final model was tested by configural, metric and scalar invariance. Internal consistency of subscales was assessed using McDonald's omega (ω). RESULT: Three models based on literature (one-, five-, and eight- factor) were disproved by CFA. EFA revealed a six-factor solution, encompassing 18 out of the 30 items, to be the most theoretically meaningful factor structure. This six-factor model was affirmed by a CFA (CFI = 0.94, TLI = 0.92, RMSEA = 0.036). These factors were, namely, ‘the image of psychiatrists’, ‘psychiatric patients and mental illness’, ‘efficacy of treatment’, ‘psychiatric teaching’, ‘career choice’, and ‘psychiatry as an evidence-based discipline’. This six-factor solution was invariant across gender. ‘The image of psychiatrists’ appeared to be the most salient factor, and formed the most consistent subscale (ω = 0.71). The internal consistencies of the other subscales were modest (ω = 0.55–0.67). The overall 18-item scale showed good internal consistency (ω = 0.78). CONCLUSION: Our findings provide evidence of a multi-dimensional structure in medical students’ attitudes towards psychiatry, endorsing six meaningful subscales of the ATP-30. Future researchers and educators can utilize these subscales in identifying specific attitudinal domains which are more closely associated with students’ future choice of a career in psychiatry, and also in identifying specific areas where attitudes are more stigmatized, so that appropriate interventions can be incorporated into the undergraduate psychiatric curriculum.Item 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, CompetencyItem Usage of cloud storage facilities by medical students in a low-middle income country, Sri Lanka: A cross sectional study(BioMed Central, 2020) Hettige, S.; Dasanayaka, E.; Ediriweera, D.S.BACKGROUND: Cloud storage facilities (CSF) has become popular among the internet users. There is limited data on CSF usage among university students in low middle-income countries including Sri Lanka. In this study we present the CSF usage among medical students at the Faculty of Medicine, University of Kelaniya. METHODS: We undertook a cross sectional study at the Faculty of Medicine, University of Kelaniya, Sri Lanka. Stratified random sampling was used to recruit students representing all the batches. A self-administrated questionnaire was given. RESULTS: Of 261 (90.9%) respondents, 181 (69.3%) were females. CSF awareness was 56.5% (95%CI: 50.3-62.6%) and CSF usage was 50.8% (95%CI: 44.4-57.2%). Awareness was higher in males (P = 0.003) and was low in senior students. Of CSF aware students, 85% knew about Google Drive and 70.6% used it. 73.6 and 42.1% knew about Dropbox and OneDrive. 50.0 and 22.0% used them respectively. There was no association between CSF awareness and pre-university entrance or undergraduate examination performance. Inadequate knowledge, time, accessibility, security and privacy concerns limited CSF usage. 69.8% indicated that they would like to undergo training on CSF as an effective tool for education. CONCLUSIONS: CSF awareness and usage among the students were 56.5 and 50.8%. Google drive is the most popular CSF. Lack of knowledge, accessibility, concerns on security and privacy limited CSF usage among students. Majority were interested to undergo training on CSF and undergraduate Information Communication Technology (ICT) curricula should introduce CSF as effective educational tools. KEYWORDS: Cloud storage; Dropbox; Google drive; Medical students; Undergraduates.Item Evaluation of the undergraduate family medicine programme of Faculty of Medicine, University of Kelaniya: quantitative and qualitative student feedback.(BioMed Central, 2019) Perera, D.P.; Withana, S.S.; Mendis, K.; Kasunjith, D.V.T.; Jayathilaka, W.T.S.; Wickramasuriya, S.BACKGROUND:Worldwide there is an increasing emphasis on the importance of primary care. The ministry of health Sri Lanka issued a directive in 2016 that training of doctors in primary care should be strengthened. Medical students of the Faculty of Medicine, University of Kelaniya follow a 1 month long clinical appointment in family medicine in their fourth year of study. METHODS:Feedback is taken from students on completion of the appointment. Half the students from each group complete a pre tested structured feedback questionnaire that consists of answers to questions based on a likert scale with a space for free comments. The other half provide qualitative feedback. In this evaluation data were gathered from 185 (98%) students from all eight clinical groups throughout the year 2016. Quantitative data were analysed using SPSS version 22. Inductive thematic analysis was used to analyse the qualitative data from the Round Robin activity and free comments from the questionnaire. RESULTS:The qualitative feedback provided a richer indepth overview of student ideas on the appointment compared to the quantitative data. In reflection of a desire for learning to be of relevance students wanted clinically oriented teaching focused on management. They preferred active teaching learning methods such as the opportunity to conduct consultations and receive immediate feedback. Students had a high regard for the teaching sessions by general practitioners at their clinics. The appointment had created an interest in the discipline of family medicine which could have an impact on future choice of career. There were indications to suggest that student attitudes towards patients may have evolved to be more patient centred. Students appreciated the inclusive and low stress ambience of the learning environment. CONCLUSIONS AND RECOMMENDATIONS:Regular evaluation of teaching programmes helps maintain accountability of faculty and paves the way for more student centred teaching through the incorporation of students' views in devising teaching methods. This evaluation found that qualitative feedback provided more descriptive material to reflect on and therefore improve teaching on the programme. It is recommended that more use should be made of qualitative methodologies in programme evaluations.Item Training medical students in general practice : a qualitative study among general practitioner trainers in Sri Lanka(Medknow, 2015) Ramanayake, R.P.J.C.; de Silva, A.H.W.; Perera, D.P.; Sumanasekera, R.D.N.; Athukorala, L.A.C.L.; Fernando, K.A.T.INTRODUCTION: Worldwide Family Medicine has gained an important place in the undergraduate medical curriculum over the last few decades and general practices have become training centers for students. Exposure to patients early in the disease process, out patient management of common problems, follow up of chronic diseases and psychosocial aspects of health and disease are educational advantages of community based training but such training could have varying impact on patients, students and trainers. This study explored the views of General Practitioner (GP) trainers on their experience in training students. METHODOLOGY: This qualitative study was conducted among GP trainers of the faculty of medicine, University of Kelaniya, Sri Lanka, to explore their experience on wide range of issues related to their role as GP trainers. The interviews were recorded and transcribed verbatim. Themes expressed were identified. RESULTS: Altruistic reasons, self-satisfaction, self-esteem and opportunity to improve their knowledge were the motivations for their involvement in teaching. Teachers were confident of their clinical and teaching skills. They perceived that patients were willing participants of the process and benefited from it. There was a positive impact on consultation dynamics. Time pressure was the major problem and ideal number of trainees per session was two. They were willing to attend teacher training workshops to update their knowledge. CONCLUSIONS: GP trainers driven by altruistic reasons were willing participants of student training process. The perceived advantages of involvement of teaching for trainers and patients were an encouragement for potential trainers. University should organize training sessions for trainers which will boost their knowledge, confidence and teaching skills which will eventually benefit students.