Browsing by Author "Chandratilake, M."

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14 Topics in health professions education: A guide to practical wisdom.
(College of Medical Educations., 2020) Chandratilake, M.; Olupeliyawa, A.
The Anatomy competence score - a new marker for anatomical ability
(Wiley, 2012) Schoeman, S.; Chandratilake, M.
The assessment of students' ability in gross anatomy is a complex process as it involves the measurement of multiple facets. In this work, the authors developed and introduced the Anatomy Competence Score (ACS), which incorporates the three domains of anatomy teaching and assessment namely: theoretical knowledge, practical 3D application of the knowledge, and clinical or bedside application of knowledge on patients. Equal contributions from these tripartite domains were used to synthesize the ACS. The theory knowledge was assessed using MCQs and short answer questions while the knowledge of practical 3D application was assessed using an Objective Structured Practical Examination (OSPE). The clinical or bedside application of anatomy knowledge was assessed by an Objective Structured Clinical Examination (OSCE). In this correlation study, the authors examined the interdomain correlations of the summative marks for the three contributing domains of the ACS, in order to examine the rationality of this new marker. Three cohorts of medical students (n = 538) at St. George's, University of London (SGUL) Medical School in the United Kingdom were included and analyzed. The results demonstrated that the correlations between the three domains were significantly low or moderate. The three domains probably represent unique knowledge and abilities. Therefore, it would appear that the average of the domains scores (the ACS) provide a comprehensive picture of a student's ability in anatomy.
Assessment of teamwork skills of medical students using absolute and relative criteria
(Sri Lanka Medical Association, 2014) Chandratilake, M.; Kasturiratne, A.; Pathmeswaran, A.
INTRODUCTION AND OBJECTIVES: Teamwork is an essential professional attribute of medical professionals which has demonstrated to be directly contributing to improve patient care and safety. The assessment of teamwork ability of medical undergraduates is vital to foster this skill. Peers appear to be an effective source for the assessment. METHODS: This study attempted to develop a peer assessment for assessing teamwork ability of students validly and reliably using the team-based research projects adopted by the Faculty of Medicine, University of Kelaniya. In complying with the literature, the assessment focused on communication, participation, involvement, support, commitment and leadership. Each student scored self and peers (5 or 6) in their group on two scoring systems; absolute (allocation of absolute mark for each peer in the group), and relative (marking the peers relative to self). RESULTS: Out of 164 recruits, 128 completed the assessment accurately. The following observations were statistically significant: poor correlation (Pearson < 0.4) between self and peer scores for both domain and overall assessment levels with either absolute or relative marking; and high correlation (Pearson > 0.6) between absolute and relative scores given by peers. The variability of relative scores, however, was higher than the absolute scores. CONCLUSIONS: A peer assessment tool with a limited number of items and assessment of peers relative to oneself produced credible and discriminatory information about the teamwork skills of medical students. Its use for summative purposes is yet to be determined.
Causes and outcomes of stress encountered by doctors in Sri Lanka
(Sri Lanka Medical Association, 2018) Seenigama, S.O.; Wijeratne, N.G.; Chandratilake, M.; Karunarathne, W.C.D.; Fernando, M.A.M.
INTRODUCTION AND OBJECTIVES: Stress or psychological difficulties faced by doctors in the work place may result in reduced productivity, burnout and negative effects on personal wellbeing among doctors. The aim of this study was to identify causes and the outcomes of stress encountered by doctors in Sri Lanka. METHODS: Individual face to face interviews were conducted with 32 doctors belonging to all categories (Intern house officers, staff-grade medical officers, postgraduate trainees and consultants) and all 5 clinical specialties (Medicine, Surgery, Paediatrics, Obstetrics & Gynaecology and Psychiatry) attached to North Colombo Teaching Hospital, Sri Lanka. The audio-recordings were transcribed verbatim and thematically analysed. RESULTS: High workload, lack ofresources to provide effective patient care, associated legal implications, adverse reactions of seniors in pressure situations, deficiencies in the administrative system and strikes were the main causes of stress experienced by doctors during practice. It was supplemented by patient related challenges such as acuity of presentations, medical and surgical emergencies, death of patients and the need to break bad news. Furthermore, deprivation of personal time due to continued patient commitments, individual responsibility towards patient.care, guilt due to management errors, interpersonal conflicts among healthcare workers appeared to be contributory, These stressors appeared to make doctors frustrated and impede their performance by interfering with work. CONCLUSION: Main causes of stress among doctors were work and patient related, and it was augmented by both personal and interpersonal factors. Stress adversely influenced the performance of doctors thereby compromising both patient care and individual well being.
Clinical reasoning in the age of cyber-physical systems
(Blackwell Pub., 2020) Chandratilake, M.
No abstract available.
Clinical Reasoning.
(College of Medical Educations., 2020) Karunratne, D.; Chandratilake, M.; Dharmaratne, S.
No abstract available
Community as a learning opportunity
(College of Medical Educations., 2020) Kasturiratne, A.; Chandratilake, M.
No abstract available
Coping strategies adopted by Sri Lankan doctors to deal with stress
(Sri Lanka Medical Association, 2018) Wijeratne, N.G.; Seenigama, S.O.; Chandratilake, M.; Karunarathne, W.C.D.; Fernando, M.A.M.
INTRODUCTION AND OBJECTIVES: Doctors face psychological difficulties due to the nature of their occupation. This study was aimed at identifying work-related stress encountered by Sri Lankan doctors during practice and the available psychological support to deal with them effectively. METHODS: Individual face-to-face interviews were conducted with 32 doctors belonging to all categories (Intern house officers (IHO), staff-grade medical officers, postgraduate trainees and consultants) and all 5 clinical specialties (Medicine, Surgery, Paediatrics, Obstetrics & Gynaecology and Psychiatry) attached to North Colombo Teaching Hospital, Sri Lanka. The. audio-recordings were transcribed and thematically analysed. RESULTS: Despite considerable work related stress experienced by doctors, access to help was limited during practice. Deficiencies in the psychological support provided by the healthcare system, inconsistencies in senior support, ignorance of rules and regulations and unhelpful legislations appeared to be contributory. However, several informal means were employed by doctors to relieve their work related stress. The main coping strategies were discussions with seniors and colleagues, teamwork and religious practices. Implementation of a formal system providing professional support and mentorship, reducing the ratio of patients to medical and non-medical staff by proper allocation of human resources, flexible working locations and shift basis for work, were proposed as remedial measures by the participants. CONCLUSION: In Sri Lanka, there is no formal mechanism to help doctors in difficulty and stress. They are satisfied with the informal and inconsistent coping strategies they use, as they have no other choice. Setting-up a formal system is appreciated by many
Cultural beliefs and practices of Sri Lankan public as experienced by clinicians
(Sri Lanka Medical Association, 2017) Chandratilake, M.; Jayarathne, Y.G.S.W.; Karunarathne, D.
INTRODUCTION & OBJECTIVES: Sri Lankan society is culturally diverse. Cultural beliefs and practices impact heavily on health seeking behaviour of the public, their compliance with treatment and the ultimate health outcome. The aim of this study was to explore the cultural practices of the Sri Lankan public as experienced by clinicians. METHODS: The topic warranted a qualitative design. Individual face-to-face interviews were conducted with 30 clinicians, who represented a range of specialties and subspecialties, and worked in teaching hospitals at Ragama and Anuradhapura. They were audio-recorded and transcribed verbatim. The transcripts were thematically analysed using Richie and Spencer framework. RESULTS: Key aspects (themes) of cultural practices among the public were identified. Although they are not exclusive the origin of healthcare-related cultural practices included religious beliefs and societal norms in the community one lives in, personal experiences and traditional medicine. Cultural issues originating from all the above sources were observed across specialties and subspecialties. The existence of beliefs and practices has been influenced by personal conviction, the family and society. The cultural beliefs and practices are related to nutrition, physiological events and disease conditions, which include the origin, the manifestations and the prevention of such diseases. The response of clinicians toward such beliefs and practices appeared to be passive or negative. CONCLUSION: The origin of cultural beliefs appears to be the community. The collectivist nature of Sri Lankan culture appears to facilitate their existence. Cultural beliefs and practices affect both health and disease which could be dealt with more positively by clinicians for a better patient outcome.
Cultural similarities and differences in medical professionalism: a multi-region study
(Wiley-Blackwell, 2012) Chandratilake, M.; McAleer, S.; Gibson, J.
CONTEXT:Over the last two decades, many medical educators have sought to define professionalism. Initial attempts to do so were focused on defining professionalism in a manner that allowed for universal agreement. This quest was later transformed into an effort to 'understandprofessionalism' as many researchers realised that professionalism is a social construct and is culture-sensitive. The determination of culturaldifferences in the understanding of professionalism, however, has been subject to very little research, possibly because of the practical difficulties of doing so. In this multi-region study, we illustrate the universal and culture-specific aspects of medical professionalism as it is perceived by medical practitioners. METHODS: Forty-six professional attributes were identified by reviewing the literature. A total of 584 medical practitioners, representing the UK, Europe, North America and Asia, participated in a survey in which they indicated the importance of each of these attributes. We determined the 'essentialness' of each attribute in different geographic regions using the content validity index, supplemented with kappa statistics. RESULTS: With acceptable levels of consensus, all regional groups identified 29 attributes as 'essential', thereby indicating the universality of these professional attributes, and six attributes as non-essential. The essentialness of the rest varied by regional group. CONCLUSIONS: This study has helped to identify regional similarities and dissimilarities in understandings of professionalism, most of which can be explained by cultural differences in line with the theories of cultural dimensions and cultural value. However, certain dissonances among regions may well be attributable to socio-economic factors. Some of the responses appear to be counter-cultural and demonstrate practitioners' keenness to overcome cultural barriers in order to provide better patient care
Editorial: Reviews in healthcare professions education
(Frontiers Media S.A., 2024) Sethi, A.; Chandratilake, M.
No abstract available
Egyptian medical students' recommended responses to the Dundee Polyprofessionalism I: Academic Integrity
(Informa Healthcare, 2015) Babelli, S.; Chandratilake, M.; Roff, S.
The Dundee Polyprofessionalism Inventory I: Academic Integrity was administered to 219 medical students from three Egyptian medical schools. The results indicate a high level of congruence between the genders in Recommended Sanctions on a scale of 1-10 ranging from Ignore through Reprimand to Expulsion/Report to Regulatory Body. Some variations in Recommended Sanctions occurred among the age groups 17-19 years; 20-24 years, and 25 years and older. The Egyptian responses were more lenient than a Scottish medical school cohort on four lapses of professionalism and stricter on 5. The Dundee Polyprofessionalism Inventory I: Academic Integrity can be used as a 'diagnostic tool' to profile a cohort's recommended responses to 30 lapses of professionalism at undergraduate level in health professions education. That profile can be compared with another cohort to indicate parallels and differences in the importance with which different respondents (perhaps in different countries and cultures) place on generic elements of academic professionalism. This information in turn can be used to target further education in expected standards of professionalism. The process can be used as an e-learning programme as well as for needs analysis, including that for International Medical Graduates moving from one culture to work in another.
An Evaluation of operative self-assessment by UK postgraduate trainees
(Informa Healthcare, 2014) Osborne, A. J.; Hawkins, S. C.; Pournaras, D. J.; Chandratilake, M.; Welbourn, R.
BACKGROUND: Surgeons in training undertake procedure-based assessment (PBA) with their trainers. Time pressures limit when this occurs. Self-assessment would provide additional opportunities but requires evaluation of your own skills and knowledge. AIM: To investigate the validity of a self-assessment PBA in the operating theatre and evaluate learning needs and change in practice identified. METHODS: In a prospective study, postgraduate UK trainees performed a self-assessment PBA after formally reflecting on appendicectomy surgery. Later, they performed their usual external assessment PBA on the same case and outcomes were compared. Learning outcomes were analysed independently by two trainers. RESULTS: There were 25 trainees (14 males), of age 29 years (25-33). They had performed a median of five previous appendicectomies (2-21) after a median three years of speciality training (range 1-4). There were no significant differences in global summary scores, trainee satisfaction or learning outcomes between external and self-assessment PBAs. Construct validity of the self-assessment PBA was demonstrated. The self-assessment PBA was more likely to identify non-technical skills. CONCLUSION: Our results suggest self-assessment PBA is valid for formative assessment. It identified a wide range of learning outcomes.Self-assessment PBA would help trainees maximise every learning opportunity and practice self-assessment skills.
Evaluation of web-based distance education of medicine for undergraduates in Sri Lanka (Brief Report )
(Sri Lanka college of Obstetricians & Gynaecologists, 2021) Silva, D.; Randombage, P.; Gankanda, W.; Abeysekara, N.; Edirisinghe, V.; Chandratilake, M.
INTRODUCTION Purpose: To evaluate distance education via the web facilitates teaching through problem-based learning and incorporating scientific evidence in the context of practical application to medical undergraduates. METHODS: Web-based distance teaching program based on the Zoom video conferencing software was developed and introduced into a selected group of medical students. Current knowledge about handling web-based resources, evaluation of learning activities, and self-evaluation of their involvement and participation of medical students were evaluated. RESULTS: The provision of lectures and relevant notes through the internet was emphasized during this study. A satisfactory response was observed regarding obtaining factual knowledge. This method was considered relatively ineffective with relevance to the application of knowledge, development of clinical skills, and improvement of professional attitudes. Students believed that it helped to improve the ability of critical thinking, refine reasoning skills, and enhance the capacity of mediating subject matter. Students had a general idea regarding using this method as a supplementary education strategy. The majority of the participants demonstrated considerable satisfaction towards this method, and most of them were prepared to recommend this method for another person. The students had disclosed that lectures showed significantly higher skills while teaching through this method, especially they believed that this distant learning method provided an additional benefit for face to face clinical teaching procedures. CONCLUSION: When generally considered, a satisfactory response was received regarding the learning outcomes of using this method, and the quality of participation of students was extremely positive. KEYWORDS: Distance education, Web-based learning, Undergraduates teaching
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.
Exploring the pros and cons of integrating artificial intelligence and ChatGPT in medical education: A comprehensive analysis
(College of Otorhinolaryngologists and Head and Neck Surgeons of Sri Lanka, 2024) Lakshan, M.T.D.; Chandratilake, M.; Drahaman, A.M.P.; Perera, M.B.
The rise of AI and chatbots in medical education is undoubtedly going to impact the traditional ways of learning. Artificial Intelligence (AI) is rapidly evolving and revolutionizing various fields, and the healthcare industry is no exception. The key to success in this new age of AI technologies is for medical educationists to maintain a deep commitment to their students’ learning, while remaining open to new ideas and approaches that leverage the power of AI to enhance the educational process. The use of AI, specifically ChatGPT, in medical education can provide various benefits, including personalized learning, practice of clinical scenarios, access to medical literature, and a research and study aid for medical students. However, it is important to note that AI should not replace traditional learning methods and that students should actively engage with the material and develop critical thinking skills.
Factors affecting career preferences of medical students at the College of Medicine in Malawi
(South African Medical Association, 2012) Yeganeh-Arani, E.; Chandratilake, M.; Muula, A. S.
BACKGROUND: The shortage of doctors in all specialties in Malawi is particularly severe in rural areas. Contributory factors are the low number of students graduating each year, migration of doctors, and the preference of new graduates for practising in urban areas. Attempts to increase the output from Malawi's only medical school are insufficient to meet the country's healthcare needs. METHODS: We studied the factors influencing career choices of medical undergraduates of the College of Medicine in Blantyre, Malawi, who were surveyed by means of a self-administered questionnaire (N=205) and individual interviews (N=17). RESULTS: Most respondents (89.4%) indicated that they intend to specialise abroad, predominantly to study in 'better institutions' and to get the 'experience' of a different country; 87.0% indicated that they intend to live in Malawi long term. Although, in general, the rural lifestyle was unattractive to medical students, respondents from rural areas and small towns, and whose parents were 'non-professionals', were more likely to intend working in rural areas and small towns, and to settle in Malawi, than students from urban and professional families. CONCLUSIONS: The College of Medicine should consider increasing its intake of students with lower socio-economic backgrounds and from rural areas/small towns to increase the number of doctors working in rural areas and settling in Malawi. However, the Ministry of Health may need a multipronged approach to reduce the mismatch between doctors' career expectations and the country's healthcare needs.
Factors associated with the feedback literacy of undergraduate clinical students of three medical faculties in Sri Lanka
(Sri Lanka Medical Association, 2023) Sanchayan, S.; Olupeliyawa, A.M.; Chandratilake, M.
INTRODUCTION: Feedback is an inseparable part of medical education. Development of students’ feedback literacy enables uptake and action based on feedback. OBJECTIVES: Explore the factors associated with feedback literacy of undergraduate clinical students in three medical faculties in Sri Lanka. METHODS: Secondary analysis was performed on focus group discussion data collected for an exploratory study on feedback in undergraduate clinical teaching settings in Sri Lanka which also included observational and interview components. 46 students from the third to final year and 19 recent graduates of three medical schools in Sri Lanka took part in eight focus group discussions. Framework analysis was performed using a model of student feedback literacy as the theoretical framework. RESULTS: The two major themes found to have influenced students’ feedback literacy were: difficulties in forming decisions for improvement based on feedback and difficulties in managing affect related to feedback. Students found it difficult to form judgements as they were novices and when they found variation among the teachers on the substance of feedback. Students found it easier to manage their emotional reactions to feedback when they perceived that the teachers cared about their improvement; with more experience with feedback as they progress through the years and when the emotional burden of feedback was not overwhelming. CONCLUSIONS: Undergraduate students in Sri Lanka need support in making academic judgments regarding the feedback they receive. They attempt to accept and work on feedback if the providers cared for their improvement and the affective load of feedback is manageable.
Feedback practices in undergraduate clinical teaching in Sri Lanka - a qualitative study
(BioMed Central, 2024) Sanchayan, S.; Olupeliyawa, A.; Chandratilake, M.
BACKGROUND Feedback is integral to medical education, enabling students to improve their knowledge, skills, and attitudes. Feedback practices may vary according to prevalent cultural and contextual factors. This study aimed to explore how feedback is conceptualized and practised in the clinical education of medical students in Sri Lanka.METHODS The study was conducted in three medical schools and affiliated hospitals that represent the cultural diversity of Sri Lanka. Purposive sampling was utilized to recruit clinical teachers and students who would provide rich information for the study. The study had three components: an observation study, interviews with clinical teachers and focus group discussions with clinical students. During the observation study, video recording was used as a data collection tool to observe feedback in real-life clinical teaching/learning settings. A constructivist grounded theory approach was adapted for analysis to explore current practices and perceptions inductively.RESULTS Feedback was conceptualised as spontaneous unidirectional provision of information for the improvement of students. It was often provided in public settings and in student groups. Error correction was the primary focus of feedback, but both teachers and students desired a balanced approach with reinforcement and reflection. Although the direct approach to corrective feedback was found beneficial for student learning, participants agreed that harsh feedback was to be avoided. The hierarchical culture and lack of programmed feedback in the curricula influenced feedback practices, suggesting the need for modification.CONCLUSIONS This study highlighted feedback practices in the local context, emphasizing the need to address the hierarchical gap in clinical settings, balance reinforcement and correction, and promote dialogue and reflection in the feedback processes. The findings will help clinical teachers from both the global south as well as the global north to recognize cultural and contextual differences in providing feedback.
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.