Indika Karunathilake

AMEE Education Guide no. 28: The development and role of departments of medical education

A department of medical education is becoming an essential requirement for a medical school. This publication is intended for those wishing to establish or develop a medical education department. It may also prove useful to teachers in medicine by providing information on how such a department can support their activities. This will vary with the local context but the principles are generalizable. Medical education departments are established in response to increased public expectations relating to healthcare, societal trends towards increased accountability, educational developments, increased interest in what to teach and how to educate doctors and the need to train more doctors. The functions of a department of medical education include research, teaching, service provision and career development of the staff. The scope of its activities includes undergraduate and postgraduate education, continuing professional development and continuing medical education. These activities may be extended to other healthcare professions. Flexibility is the key to staffing a department of medical education. Various contractual arrangements, affiliations and support from non-affiliated personnel are needed to provide a multi-professional team with a range of expertise. The precise structure of the department will depend on the individual institution. The name of the department may suggest its position within the university structure. The director provides academic leadership for the department and his/her responsibilities include promotion of staff collaboration, fostering career development of the staff and establishing local, regional and international links. Financial support may come from external funding agencies, government or university sources. Some departments of medical education are financially self-supporting. The department should be closely integrated with the medical school. Support for the department from the dean is an essential factor for sustainability. Several case studies of medical education departments throughout the world are included as examples of the different roles and functions of a department of medical education.

The place of the oral examination in today's assessment systems

(2005). The place of the oral examination in todays assessment systems. Medical Teacher: Vol. 27, No. 4, pp. 294-297.

The long case and its modifications: a literature review.

Context  This review provides a summary of the published literature on the suitability of the long case and its modifications for high‐stakes assessment.

Computer literacy among first year medical students in a developing country: A cross sectional study

BackgroundThe use of computer assisted learning (CAL) has enhanced undergraduate medical education. CAL improves performance at examinations, develops problem solving skills and increases student satisfaction. The study evaluates computer literacy among first year medical students in Sri Lanka.MethodsThe study was conducted at Faculty of Medicine, University of Colombo, Sri Lanka between August-September 2008. First year medical students (n = 190) were invited for the study. Data on computer literacy and associated factors were collected by an expert-validated pre-tested self-administered questionnaire. Computer literacy was evaluated by testing knowledge on 6 domains; common software packages, operating systems, database management and the usage of internet and E-mail. A linear regression was conducted using total score for computer literacy as the continuous dependant variable and other independent covariates.ResultsSample size-181 (Response rate-95.3%), 49.7% were Males. Majority of the students (77.3%) owned a computer (Males-74.4%, Females-80.2%). Students have gained their present computer knowledge by; a formal training programme (64.1%), self learning (63.0%) or by peer learning (49.2%). The students used computers for predominately; word processing (95.6%), entertainment (95.0%), web browsing (80.1%) and preparing presentations (76.8%). Majority of the students (75.7%) expressed their willingness for a formal computer training programme at the faculty.Mean score for the computer literacy questionnaire was 48.4 ± 20.3, with no significant gender difference (Males-47.8 ± 21.1, Females-48.9 ± 19.6). There were 47.9% students that had a score less than 50% for the computer literacy questionnaire. Students from Colombo district, Western Province and Student owning a computer had a significantly higher mean score in comparison to other students (p < 0.001). In the linear regression analysis, formal computer training was the strongest predictor of computer literacy (β = 13.034), followed by using internet facility, being from Western province, using computers for Web browsing and computer programming, computer ownership and doing IT (Information Technology) as a subject in GCE (A/L) examination.ConclusionSri Lankan medical undergraduates had a low-intermediate level of computer literacy. There is a need to improve computer literacy, by increasing computer training in schools, or by introducing computer training in the initial stages of the undergraduate programme. These two options require improvement in infrastructure and other resources.

Nursing intensive care skills training: A nurse led, short, structured, and practical training program, developed and tested in a resource-limited setting☆

PURPOSE To assess the impact of a nurse-led, short, structured training program for intensive care unit (ICU) nurses in a resource-limited setting. METHODS A training program using a structured approach to patient assessment and management for ICU nurses was designed and delivered by local nurse tutors in partnership with overseas nurse trainers. The impact of the course was assessed using the following: pre-course and post-course self-assessment, a pre-course and post-course Multiple Choice Questionnaire (MCQ), a post-course Objective Structured Clinical Assessment station, 2 post-course Short Oral Exam (SOE) stations, and post-course feedback questionnaires. RESULTS In total, 117 ICU nurses were trained. Post-MCQ scores were significantly higher when compared with pre-MCQ (P < .0001). More than 95% passed the post-course Objective Structured Clinical Assessment (patient assessment) and SOE 1 (arterial blood gas analysis), whereas 76.9% passed SOE 2 (3-lead electrocardiogram analysis). The course was highly rated by participants, with 98% believing that this was a useful experience. CONCLUSIONS Nursing Intensive Care Skills Training was highly rated by participants and was effective in improving the knowledge of the participants. This sustainable short course model may be adaptable to other resource-limited settings.

Migration of Sri Lankan medical specialists

BackgroundThe migration of health-care workers contributes to the shortage of health-care workers in many developing countries. This paper aims to describe the migration of medical specialists from Sri Lanka and to discuss the successes and failures of strategies to retain them.MethodsThis paper presents data on all trainees who have left Sri Lanka for postgraduate training through the Post Graduate Institute of Medicine, University of Colombo, from April 1980 to June 2009. In addition, confidential interviews were conducted with 30 specialists who returned following foreign training within the last 5 years and 5 specialists who opted to migrate to foreign countries.ResultsFrom a total of 1,915 specialists who left Sri Lanka for training, 215 (11%) have not returned or have left the country without completing the specified bond period. The majority (53%) migrated to Australia. Of the specialists who left before completion of the bond period, 148 (68.8%) have settled or have started settling the bond. All participants identified foreign training as beneficial for their career. The top reasons for staying in Sri Lanka were: job security, income from private practice, proximity to family and a culturally appropriate environment. The top reasons for migration were: better quality of life, having to work in rural parts of Sri Lanka, career development and social security.ConclusionsThis paper attempts to discuss the reasons for the low rates of emigration of specialists from Sri Lanka. Determining the reasons for retaining these specialists may be useful in designing health systems and postgraduate programs in developing countries with high rates of emigration of specialists.

Sharps injuries among medical students in the faculty of medicine, Colombo, Sri Lanka

IntroductionMedical students undertake clinical procedures which carry a risk of sharps injuries exposing them to bloodborne infections.ObjectivesTo study the prevalence and correlates of sharps injuries among 4th-year medical students in the Faculty of Medicine, University of Colombo, Sri Lanka.Materials and MethodsThe survey was conducted among 4th-year medical students to find out the incidence of injuries during high-risk procedures, associated factors and practice and perceptions regarding standard precautions. A self-administered questionnaire was administered to a batch of 197 4th-year medical students.ResultsA total of 168 medical students responded. One or more injury was experienced by 95% (N = 159) of the students. The majority (89%) occurred during suturing; 23% during venipuncture and 14% while assisting in deliveries. Most of the incidents (49%) occurred during Obstetrics and Gynecology attachments. Recapping needles led to 8.6% of the injuries. Thirty-five percent of students believed they were inadequately protected. In this group, adequate protection was not available in 21% of the incidences and 24% thought protection was not needed. Following the injury, 47% completely ignored the event and only 5.7% followed the accepted post-exposure management. Only 34% of the students knew about post-exposure management at the time of the incident. Only 15% stated that their knowledge regarding prevention and management was adequate. The majority (97%) believed that curriculum should put more emphasis on improving the knowledge and practice regarding sharps injuries.ConclusionsThe incidence of sharps injuries was high in this setting. Safer methods of suturing should be taught and practiced. The practice of standard precautions and post-injury management should be taught.

Health changes in Sri Lanka: benefits of primary health care and public health.

The Democratic Socialist Republic of Sri Lanka is an island in the Indian Ocean that has achieved a unique status in the world with health indicators that are comparable with those of developed countries. This is illustrated, among others, by the reduction in both child and maternal mortality in the country. This achievement is the result of a range of long-term interventions, including providing education and health care free of charge, training of health care workers, developing public health infrastructure in rural areas, and adopting steps to improve sanitation, nutrition, and immunization coverage.

Tobacco Smoking Among School Children in Colombo District, Sri Lanka:

Tobacco smoking is an important problem among schoolchildren. The authors studied the patterns of tobacco smoking among schoolchildren in Colombo, Sri Lanka, using a self-administered questionnaire. Multistaged stratified random sampling was used to select 6000 students. Response rate was 90.7% (5446), out of which 53.4% were males. Prevalence rates for males and females, respectively, were as follows: having smoked at least 1 complete cigarette: 27.0% and 13.3%, smoked more than 100 cigarettes: 2.3% and 0.3%, daily smoking: 1.8% and 0.2%. Mean age of starting to smoke was 14.16 years. The tobacco products most used were cigarettes (91.5%) and bidis (3.8%). In univariate analysis, male gender, parental smoking, studying non-science subjects, peer smoking, and participating in sports were significantly associated with smoking of at least 1 complete cigarette (P < .05). In multivariate analysis, the most significant correlates were having close friends (odds ratio = 3.29, confidence interval = 2.47-4.37) or parents who smoked (odds ratio = 1.86, confidence interval = 1.28-2.71). Female smoking has increased from previously reported values. These high-risk groups can be targets for preventive programs.

The adaptive curriculum.

An adaptive curriculum is one that is able to cater for the diverse educational needs of the students. It is part of the move towards a more student-centred approach to health professions’ education that began in the 1970s. Harden et al. (1984) summarized the student-centred approach as follows: ‘‘the student is the central or key figure. Students, under the guidance of a teacher, may decide their own learning objectives, select appropriate learning resources to achieve these objectives, decide the sequence and pace of their own learning and are responsible for assessing their own learning process.’’ In many medical schools, however, the educational programme is still uniform. Tomlinson & Kalbfleisch (1998) reported that the traditional one-size-fits-all curriculum can be harmful by demotivating the students at the extremes. The extremes may be thought of in terms of faster or slower learners according to the length of time required by a student to master a particular unit. Repeated unsuccessful attempts at the examinations can erode the confidence of slower learners and lead to dropout, increasing the attrition rate. Some educational systems allow students who have failed exams to progress to the next part of the course but to ‘carry’ the failed subject, i.e. to continue to study it and to resit the examination at a later date. This seems illogical as it places increased pressure on the slower learners by allowing them to accumulate subjects to be studied, when what they probably need is increased support. Other educational programmes make provision for students who have failed examinations to study during vacation time. This practice may also lead to increased stress either from loss of leisure time or from loss of revenue at a time when many students are required to support themselves through medical school with paid employment at weekends and holidays. At the other extreme the faster learners may feel unchallenged and become bored by the standard pace of learning. The adaptive curriculum acknowledges that students are not a homogenous group but differ in their preferred learning styles, interests and abilities. Provision of a range of educational opportunities and allowing students to select those that best suit their learning style (Harden et al., 1997) caters for different learning preferences. The General Medical Council (GMC) in the UK highlighted the capacity of student-selected components (SSCs) and elective appointments to accommodate the diverse interests of students (GMC, 1993). Catering for different levels of ability is somewhat more complex, however. Lawrence Cremin (1980), the American historian of education, suggested that ‘‘You can evaluate an educational system by the attention it gives to its extremes’’. How does medical education cater for the extremes, i.e. faster and slower learners? Fast-tracking is one option suggested to accommodate faster learners. Leading surgeons have called for a rethink in training to allow high-flying juniors to be fast-tracked to the consultant grade (Royal College of Surgeons of England, 1999). In primary and secondary education curriculum compacting has been suggested as a way to accommodate faster learners. Curriculum compacting consists of three phases: defining the outcomes of a given unit; identifying students who have mastered the outcomes; and providing acceleration and enrichment options for them (Reis & Renzulli, 1992). On the other hand, slower learners may take longer to achieve the required standard. There is, however, no evidence that they will not be adequate doctors. Although Hunt et al. (1987) showed significant differences in the quality of interaction with patients between graduates who had academic difficulties in medical school and those who did not, they concluded that many students who experienced academic difficulties in medical school eventually perform adequately in residency programmes. Weston & Dubovsky (1984), who evaluated the performance of the graduates from a USA medical school using postgraduate year 1 residency evaluations, found that those who had academic problems at medical school performed only slightly lower than the average level. The challenge is how to give more time for slower learners to achieve the required standard. Several approaches have been reported to date, mostly from the USA. In this issue of Medical Teacher, McGrath & McQuail (2004) report on the availability of decelerated options in US medical schools. A decelerated programme enables selected students to spread the highly compressed work of the first year of the medical education programme over two years. Deceleration may also involve the second year. Applicants may be invited to enter the programme if, on selection, they show great promise but present cause for concern because of academic weaknesses or