Medical Education Commons^™

Seroprevalence Of Hepatitis B Virus Infection, Anti-Hcv Antibodies And Hiv And Knowledge Among People Who Use Drugs Attending Methadone Therapy Clinic In Tanzania; A Cross-Sectional Study, Semvua B. Kilonzo, Daniel L W Gunda, David C. Majinge, Hyasinta Jaka, Paulina M. Manyiri, Fredrick Kalokola, Grahame Mtui, Elichilia R. Shao, Fatma Bakshi, Alex Stephano

Faculty of Health Sciences, East Africa

Background

Methadone therapy clinics have been recently introduced in Tanzania, aiming at reducing risk behaviors and infection rates of viral hepatitis and HIV among people who use drugs. The objective of this study was to estimate the prevalence, associated factors and knowledge level of these conditions among people who use drugs attending a methadone clinic in Tanzania.

Methods

We enrolled 253 People who using drugs receiving Methadone therapy. Clinical data was retrospectively collected from the medical records and face-to face interviews were conducted to determine the behavioral risk factors and respondents’ knowledge on viral hepatitis and HIV.

Results

An overall …

Preprints In Times Of Covid19: The Time Is Ripe For Agreeing On Terminology And Good Practices, Raffaella Ravinetto, Céline Caillet, Muhammad H. Zaman, Jerome Amir Singh, Philippe J. Guerin, Aasim Ahmad, Carlos E. Durán, Amar Jesani, Ana Palmero, Laura Merson

Section of Nephrology

Over recent years, the research community has been increasingly using preprint servers to share manuscripts that are not yet peer-reviewed. Even if it enables quick dissemination of research findings, this practice raises several challenges in publication ethics and integrity. In particular, preprints have become an important source of information for stakeholders interested in COVID19 research developments, including traditional media, social media, and policy makers. Despite caveats about their nature, many users can still confuse pre-prints with peer-reviewed manuscripts. If unconfirmed but already widely shared first-draft results later prove wrong or misinterpreted, it can be very difficult to "unlearn" what we …

Online Assessment In Undergraduate Medical Education: Challenges And Solutions From A Lmic University, Syeda Sadia Fatima, Romana Idrees, Kauser Jabeen, Saniya Sabzwari, Sadaf Khan

Department of Biological & Biomedical Sciences

Background and objectives: The Covid-19 pandemic has caused large-scale disruption in almost all educational programs across the world. Planning and rapid implementation of assessment through an online format presents the next set of novel challenges that must be addressed by academic administrations across the globe.
Methods: This cross-sectional study was conducted between March to August 2020 at the Aga Khan University Medical College. Two hundred medical students of year 1 and 2 participated in the study. We describe the planning, processes, and outcomes of online assessments using video communication platforms conducted at a private university in Pakistan. Standardized protocols were …

Applying A Mixed-Method Approach To Improve On-The-Job Learning And Job Satisfaction In A Cohort Of Interns At A University Hospital, Amna Subhan Butt, Muhammad Shahzad Shamim, M Asghar Ali, Farah Naz Qamar, Irum Qamar Khan, Swaleha Tariq, Syeda Amrah Hashmi, Quratulain Hafeez, Muhammed Tariq

Section of Gastroenterology

Introduction: Job satisfaction is vital for the optimal functioning of medical practitioners. Herein, we report our experience of restructuring the internship program by identifying the gaps, developing, implementing strategies to overcome gaps and sharing the results of the pre-implementation and post-implementation audit, as an example for establishing a system for improving intern's work-based learning and satisfaction in a university hospital setting.
Methods: Using Kern's six-step instructional model, a prospective mixed-method study was conducted at Aga Khan University Hospital. In phase 1 (2013) gaps were identified by evaluating various aspects of the internship program. Strategies were developed and implemented to overcome …

Expired Carbon Dioxide During Newborn Resuscitation As Predictor Of Outcome, Kari Holte, Hege Ersdal, Claus Klingenberg, Joar Eilevstjønn, Hein Stigum, Samwel Jatosh, Hussein Kidanto, Ketil Størdal

Faculty of Health Sciences, East Africa

Aim:

To explore and compare expired CO2 (ECO2) and heart rate (HR), during newborn resuscitation with bag-mask ventilation, as predictors of 24-h outcome.

Methods:

Observational study from March 2013 to June 2017 in a rural Tanzanian hospital. Side-stream measures of ECO2, ventilation parameters, HR, clinical information, and 24-h outcome were recorded in live born bag-mask ventilated newborns with initial HR < 120 bpm. We analysed the data using logistic regression models and compared areas under the receiver operating curves (AUC) for ECO2 and HR within three selected time intervals after onset of ventilation (0-30 s, 30.1-60 s and 60.1-300 s).

Results:

Among 434 included newborns (median birth weight 3100 g), 378 were alive at 24 h, 56 had died. Both ECO2 and HR were independently significant predictors of 24-h outcome, with no differences in AUCs. In the first 60 s …

Spontaneous Fetal Reduction In Triplets And Prolongation Of Twin Pregnancy For 111 Days As An Outpatient: A Case Report, Davis Rubagumya,, Munawar Kaguta, Ernie Mdachi, Muzdalfat Abeid, Hussein Kidanto

Faculty of Health Sciences, East Africa

Background:

Multiple gestation has been on the rise because of advancement in assisted reproductive technology. Triplet pregnancy is associated with fetal loss and preterm birth as its major complications. Spontaneous triplet pregnancy is rare. In the case of fetal loss, delayed interval delivery has been used to achieve delivery of the retained fetuses. There is no common approach to delayed interval delivery. Case A 31-year-old East African lady with spontaneous triplet pregnancy presented to our institution at gestation age of 19 weeks with features of threatened miscarriage. One fetus was miscarried, and delayed interval delivery was done as an …

The Contribution Of Dysphagia To Acute Stroke Morbidity And Mortality In Nigeria: A Prospective Study, O O. Olajide, Philip Adebayo, F T. Taiwo, M O. Owolabi, A Ogunniyi

Faculty of Health Sciences, East Africa

Background:

The assessment of time-trend morbidity and mortality in acute stroke is critical to clinical policy decisions and resource allocation.

Objectives:

To determine the prevalence of dysphagia in acute stroke and the impact of dysphagia on short term stroke outcome (30 days post-stroke).

Methods:

This was a prospective longitudinal study. Bedside screening for dysphagia modified Rankin score (MRS) and Barthel Index (BI) were performed on acute stroke patients on day 1, day 7, day 14 and day 30 after stroke to determine the frequency of dysphagia. Patients with dysphagia were then compared with age- and gender-matched controls (stroke patients without …

Testicular Torsion Induced By Epididymo-Orchitis: A Case Report, Ali Akbar Zehri, Allyzain Ismail, Philip Adebayo, Authar Ali

Faculty of Health Sciences, East Africa

Introduction and importance:

Acute scrotum is considered a urological emergency requiring early intervention depending on the cause. There are multiple causes of acute scrotum with testicular torsion being the most feared as delayed treatment leads to testicular loss. However, differentiating between epididymo-orchitis and torsion can be very difficult.

Case presentation: We present a case of an 18-year old male patient with 2 separate episodes of acute scrotum. He had epididymo-orchitis as the first presentation followed by testicular torsion 5 days later. To our knowledge this is the first case of testicular torsion secondary to epididymo-orchitis.

Clinical discussion: Differentiating between epididymo-orchitis …

Use Of Simulation Based Technology In Pre-Clinical Years Improves Confidence And Satisfaction Among Medical Students, Muhammad Bilal Mirza, Anjiya Sulaiman, Satwat Hashmi, Samar Zaki, Rehana Rehman, Rozmeen Akbar

Medical College Documents

Objective: To determine perception of medical students about learning from integrated simulated clinical skill sessions as part of the undergraduate curriculum.
Methods: The cross-sectional study was conducted at the Centre for Innovation in Medical Education, Aga Khan University (AKU), Karachi, from July 2018 to February 2019, and comprised first year medical students undertaking the Respiration and Circulation module of the curriculum. Quantitative data was collected using a questionnaire and the responses were assessed on a five-point Likert scale. Data was analysed using SPSS 21. Qualitative data was gathered through focused group discussion with students and an in-depth interview with the …

Growth Of Preterm Very Low Birth Weight Infants Discharged With Weight Of Less Than 1500grams, Yaser Abdallah, Flavia Namiiro, Jolly Nankunda, Jamiru Mugalu, Yvonne Vaucher

Faculty of Health Sciences, East Africa

Early discharge of preterm very low birth weight (VLBW) infants is at times inevitable in low resource settings. The implication of such practice on the growth of this high-risk population is not known. We conducted a retrospective chart review to describe the growth of preterm VLBW infants discharged with a weight of less than 1500 g.

Objectives

To describe the growth of discharged preterm VLBW infants over the first 12 weeks.

Method

Between June 2013 and January 2014; 164 discharged preterm VLBW infants were followed up for 3 months. Among the survivors (132), we identified 111 infant records for this …

Knowledge And Attitude Towards Identification And Management Of Sepsis Among Resident Physicians In A Tertiary Care Teaching Hospital In Pakistan, Ainan Arshad, Abdul Aziz, Ahmed Ayaz, Syed Maaz Salahuddin, Bushra Jamil

Section of Internal Medicine

This study was conducted to determine the compliance and knowledge of sepsis guidelines among resident physicians in a tertiary care hospital of a developing country. A self-structured validated questionnaire was prepared to evaluate compliance and knowledge of the Surviving Sepsis Campaign (SSC) guidelines. A total of 76 resident physicians completed the questionnaire; out of these, 51 (67%) were from Internal Medicine department and 25 (33%) were from Emergency Medicine department of the Aga Khan University Hospital, Karachi. A total of 71 (93%) participants claimed to be aware of the SSC guidelines but only 20 (26%) considered themselves very knowledgeable on …

Simulated Learning In Rural Community Environment: Pushing The Boundary, Burhanuddin Ali Akber, Mehak Ismail Rajani, Farah Khalid, Charles Docherty

Centre for Innovation in Medical Education

Experiential learning through simulation can play a very significant role, not only in hospital settings but also in community contexts (Lubbers and Rossman, Nurse Educ. Today 48:140-144; Wheeler and McNelis, Nurs. Educ. Perspect 35:259-261). This paper discusses the concept of creating a novel simulated village set-up within a modern simulation center, to effectively deliver contemporary learning outcomes. It also highlights the challenges and risks of developing a simulated village set-up and strategies to counteract them. Furthermore, it describes the role of simulation specialists as innovators and explicates the gamut of expertise in education, management, and technologies that are required to …

F-Wave Parameters And Body Mass Index In Carpal Tunnel Syndrome, Philip Adebayo, Rose E. Mwakabatika

Faculty of Health Sciences, East Africa

Background

Severe carpal tunnel syndrome (CTS) readily lends itself to both clinical and electrophysiological recognition. The uncertainty sometimes is in identifying and quantifying motor involvement in mild and, perhaps, in moderate CTS. Our study aimed to evaluate F responses in mild and moderate CTS and determine the contribution of BMI to the F-wave parameters.

Methods A retrospective review of the clinical and electrophysiological data of patients with CTS seen at the clinical neurophysiology laboratory of Aga Khan Hospital, Dar es Salaam, between 1 August 2017 and 31 July 2019 was retrieved. Carpal tunnel syndrome was graded according to the electrophysiological …

Rising Trend Of Women In Gastroenterology: A Paradigm Shift, Lubna Kamani, Jeanin E Van Hooft

Section of Gastroenterology

No abstract provided.

Covid-19 And Teleneurology In Sub-Saharan Africa: Leveraging The Current Exigency, Philip Adebayo, Olusegun John Oluwole, Funmilola Tolulope Taiwo

Faculty of Health Sciences, East Africa

tion residing in rural areas that have poor access to medical experts. Despite having a ridiculously huge, underserved population, very few African countries currently have any form of sustained and organized telemedicine practice, and even fewer have dedicated tele-neurology services. The ongoing COVID-19 pandemic has proved to be one of the most significant disruptors of vital sectors of human endeavor in modern times. In the healthcare sector, there is an increasing advocacy to deliver non-urgent care via telemedicine. This paper examined the current state of tele-neurology practice and infrastructural preparedness in sub-Saharan Africa. Currently, there is over 70% mobile phone …

Strengthening Orthopaedic Care At National Level: Output Of A Structured Residency Programme At Aga Khan University, Fateh Ali Janjua, Shah Fahad, Tashfeen Ahmad, Masood Umer

Section of Orthopaedic Surgery

This descriptive review of the output of the orthopaedic residency programme of Aga Khan University, Karachi, comprised information regarding the number of graduated residents and their educational background which was retrieved from departmental records. Information about their work location, subspecialty, current working status, participation in medical camps and national disaster relief efforts were obtained from various sources, including fellow surgeons, and social media profiles. From 1989 to 2017, a total of 48 residents graduated from the programme, with only 2(4.2%) of them being females. Overall, 19(39.6%) residents hailed from areas outside Karachi; 28(58.3%) belonged to Karachi; 1(2%) came from Kenya; …

Simulation-Based Training In The Paediatric Surgery Population: A Review Of Current Trends And Future Direction, Areej Saleem, Zorays Moazzam, Sohail Asghar Dogar, Saqib Hamid Qazi

Section of Paediatric Surgery

In recent years, simulation-based training in surgery has emerged as a viable accompaniment to traditional teaching methods. Multiple studies have highlighted the benefits of simulation-based training in both learning and teaching aspects of surgical training, with a particular emphasis on the honing of technical skills. However, multiple issues still exist in widespread implementation of simulation-based training, especially in the developing countries. Furthermore, the existing literature needs to be expanded upon in both quantity and quality domains to ensure a more evidence-based transition to simulation-based training in surgery. The current review article was planned to take a look at the existing …

Current Standards Of Postgraduate Surgical Education And Training In Pakistan: Time To Bridge The Gaps In Lieu Of National Necessity, Sabah Uddin Saqib, Abdul Hakeem Memon, Omair Saleem, Amir Hafeez Shariff

Section of General Surgery

The provision of good-quality surgical care is a salient feature of every public health system. Pakistan is ranked among low and middle-income countries where the burden of surgical disease is rapidly increasing, but the capacity of the health system has not expanded at the same pace to cater current needs. One of the key components is the dearth of trained surgical specialists and lack of easy access to surgical care. College of Physicians and Surgeons, Pakistan is the main certifying institution for surgeons, while public and private teaching hospitals bear the burden of responsibility for surgical education and training. The …

Apprenticeship To Simulation - The Metamorphosis Of Surgical Training, Muhammad Rizwan Khan, Saleema Begum

Section of General Surgery

Surgery is a dynamic specialty and surgical competencies are a combination of both technical and non-technical skills. After the inception of the art of surgery, surgical education and training has undergone incredible evolution. The first model of surgical training was introduced in the 19th century and is known as the 'apprenticeship model', followed by the famous 'Halstedian' model. However, a report by the Institute of Medicine challenged the teaching institutions to formulate alternative methods of surgical education to ensure patients' safety and to reduce the fear among patients of them being practised on. Teaching surgical skills outside the operating room …

Mentorship In Surgical Training: Where Do We Stand?, Saleema Begum, Muhammad Rizwan Khan, Madeeha Safa

Section of General Surgery

Mentorship in medicine aims at professional and personal development of trainees in the early stages of their careers. It is more popular in surgical subspecialties since transfer of technical skills is an integral part of surgical training, which makes it distinct compared to other specialties. Effective mentoring in surgery plays a crucial role in academic success, professional development, career guidance and personal growth of residents, and provides guidance and support to mentees to excel in their respective fields, and increases the likelihood of success by enhancing motivation with positive impact on burnout among residents. Efforts have been made by accreditation …

Validation Of The Swahili Version Of The International Prostate Symptom Score At A Private, Nonprofit General Hospital In Dar Es Salaam, Tanzania, Miten Patel, Masawa Klint, Philip Adebayo, Authar Ali, Jasmit Shah, Ali Akbar Zehri

Faculty of Health Sciences, East Africa

Background:

Accuracy in translating the International Prostate Symptom Score (IPSS) into different languages is essential to ensure that it is comparable to the original version and acceptable to the target population. We aimed to develop and validate a Swahili version of the IPSS (sIPSS).

Methods:

We conducted a cross-sectional study involving 53 patients presenting with lower urinary tract symptoms to the Aga Khan Hospital in Dar es Salaam, Tanzania, from April through December 2018. We enrolled 53 patients with confirmed benign prostatic hypertrophy and 32 control patients with suspected or confirmed urolithiasis. We assessed the face validity and discriminative validity …

Morbidity And Mortality Meetings; A New Digital Portal To Enhance Learning And Objectivity, Saqib Kamran Bakhshi, Kiran Ehsan, Gulzar S. Lakhani, Ather Enam

Section of Neurosurgery

Morbidity and mortality meetings have long been part of surgical education and practice. They have undergone several modifications over time to include improvement in patient safety and outcomes as an essential utility of conducting morbidity and mortality meetings. Time and again, it has been proposed in literature that standardisation of case discussion results in the efficiency of these meetings. Learning opportunities can be compiled for system improvement. The current review article was planned to present a newly implemented digital morbidity and mortality portal at the Aga Khan University Hospital (AKUH), Karachi, aiming at homogenising the discussion and to add objectivity …

An Innovation In Flipped Class Room: A Teaching Model To Facilitate Synchronous And Asynchronous Learning During A Pandemic, Rehana Rehman, Syeda Sadia Fatima

Department of Biological & Biomedical Sciences

Objective: To conduct an on line Flipped Class Room (FCR) to facilitate synchronous (in class activity) and asynchronous learning [Virtual Learning Environment (VLE)] and acquire feedback of the learning experience from medical students at Aga Khan University.
Methods: This interventional study was conducted with year II students undergoing Endocrine Reproduction Module at the Aga Khan University during April 13 to May 22, 2020. Pre reading material and pretest was shared with the students via Virtual Learning Environment (VLE) one week before the class. Microsoft Teams was used to conduct online session by two facilitators, where student discussion on case studies …

Parent Training For Autism Spectrum Disorder, Shamaila Ijaz, Farwa Rafaq, Sonia Ijaz Haider

Department for Educational Development

Objective: The main purpose of the present study was to investigate the effectiveness of behaviour therapy training to mothers of autistic children on verbal and non-verbal improvement of their children.
Methods: A total of 33 mothers of autistic children were selected for training based on non-probability purposive sampling procedure. Autism Spectrum Disorder (ASD) Knowledge Scale was used to assess mothers' knowledge about autism and Vineland Adaptive Behaviour Scale was used for assessment of the communication skill in autistic children.
Results: This study revealed that behaviour therapy training significantly improved communication skills of children with autism by training mothers. The results …

Impact Of A Global Pandemic On Surgical Education And Training- Review, Response, And Reflection, Sabah Uddin Saqib, Omair Saleem, Amna Riaz, Qamar Riaz, Hasnain Zafar

Section of General Surgery

The catastrophic effects of the coronavirus disease-2019 global pandemic have revolutionised human society. The unprecedented impact on surgical training needs to be analysed in detail to achieve an understanding of how to deal with similar situations arising in the foreseeable future. The challenges faced by the surgical community initiated with the suspension of clinical activities and elective practice, and included the lack of appropriate personal protective equipment, and the self-isolation of trainees and reassignment to coronavirus patient-care regions. Together, all these elements had deleterious effects on the psychological health of the professionals. Surgical training irrespective of specialty is equally affected …

Inculcating Research Curriculum In Operative Dentistry - Endodontics Residency Programme: Experience And Outcomes, Farhan Raza Khan, Rabia Ghafoor, Fahad Umer, Munawar Rahman

Section of Dental-Oral Maxillofacial Surgery

Incorporating research education and training in residency curriculum increases the understanding of evidence-based decision-making among doctors in training. Evidence suggests that the addition of research is linearly associated with improvement in clinical competence, and encourages the residents to shape their career as clinical investigators. The current paper was planned to share the experience of adding research into the core curriculum of Operative Dentistry-Endodontics residency programme at a tertiary care university hospital, and to evaluate the outcome achieved with that change.

Paradigm Shift In The Surgical Training: The Era Of Innovation, Simulation And Beyond, Syed Shahabuddin, Shiraz Hashmi, Yasir Khan, Shahid Ahmed Sami

Section of Cardiothoracic Surgery

This is an era of transformation of surgical education and training. Modern methods of training are being introduced at a rapid pace and are being adopted in surgical practice not only to improve the outcomes and patient satisfaction, but also to provide an opportunity to develop a new well-structured training curriculum by integrating both traditional and modern approaches to teach and learn surgical skills. Various surgical simulators are in use as training aids and are constantly undergoing further refinement and development. To achieve a smooth transition in surgical training to modern methods, a structured programme has to be developed and …

Workplace Based Assessment: Tools To Assess Competencies In A Clinical Setting, Amber Shahmim Sultan, Rahila Ali, Sara Shakil, Rehan Nasir Khan

Department for Educational Development

The apprenticeship model has been used for long in surgical training. It initially provides opportunity to the trainee to observe the attending surgeon, followed by gradual introduction to surgical technique under direct supervision and later with detached supervision. The attending provides informal feedback at different intervals to the trainee. Several changes have been made in postgraduate programmes with a shift towards using workplace-based assessment tools for formative and summative evaluation of the trainee's clinical skills.

Peer-Led Surgery Education: A Model For A Surgery Interest Group, Muhammad Ali, Shahmir Chauhan, Ayesha Noor, Sadaf Khan, Ather Enam, Sig Core

Medical College Documents

We present a systematic, sustainable, student-led model for a Surgery Interest Group in a low and middle-income country setting to encourage other medical students to establish similar groups in their institutions. Our model was developed at the Aga Khan University Medical College, Karachi, and is comprised of medical students, teaching associates, residents, faculty and alumni. The group focuses on connecting medical students with an interest in surgery with opportunities to help them match in surgery training programs. The opportunities include, but are not limited to, skill development, personal development, mentorship and research. Our model has shown growth and expansion over …

Teaching The 'Comprehensive Dental Care' In Formative Years Of Education And Training: A New Model For Dental Internship, Farhan Raza Khan, Syed Murtaza Raza Kazmi, Syed Sheeraz Hussain, Syed Mahmood Haider

Section of Dental-Oral Maxillofacial Surgery

There is a need of a new model of education and training to be implemented in the Bachelors of Dental Surgery curriculum in the relevant Pakistani institutions. The current review article was planned to suggest such a model in the light of literature aimed at building the capacity of dental graduates in a competency-driven approach with the objective of offering safe, efficient and comprehensive care to dental patients. The outcome of the reforms suggested shall prepare dental graduates suitably geared towards providing community-oriented family dental care right from their formative years. Moreover, the suggested internship model can also help to …