Browsing by Author "Karunaratne, D."

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Learning clinical reasoning skills during the transition from a medical graduate to a junior doctor
(Centre Medical Education, 2024) Karunaratne, D.; Chandratilake, M.; Marambe, K.
INTRODUCTION: The literature confirms the challenges of learning clinical reasoning experienced by junior doctors during their transition into the workplace. This study was conducted to explore junior doctors' experiences of clinical reasoning development and recognise the necessary adjustments required to improve the development of clinical reasoning skills. METHODS: A hermeneutic phenomenological study was conducted using multiple methods of data collection, including semistructured and narrative interviews (n=18) and post-consultation discussions (n=48). All interviews and post-consultation discussions were analysed to generate themes and identify patterns and associations to explain the dataset. RESULTS: During the transition, junior doctors’ approach to clinical reasoning changed from a ‘disease-oriented’ to a ‘practiceoriented’ approach, giving rise to the ‘Practice-oriented clinical skills development framework’ helpful in developing clinical reasoning skills. The freedom to reason within a supportive work environment, the trainees’ emotional commitment to patient care, and their early integration into the healthcare team were identified as particularly supportive. The service-oriented nature of the internship, the interrupted supervisory relationships, and early exposure to acute care settings posed challenges for learning clinical reasoning. These findings highlighted the clinical teachers' role, possible teaching strategies, and the specific changes required at the system level to develop clinical reasoning skills among junior doctors. CONCLUSION: The ‘Practice-oriented clinical skills development framework’ is a valuable reference point for clinical teachers to facilitate the development of clinical reasoning skills among junior doctors. In addition, this research has provided insights into the responsibilities of clinical teachers, teaching strategies, and the system-related changes that may be necessary to facilitate this process.
Prioritizing service quality dimensions towards faculty development: A case of a Sri Lankan medical school.
(Yong Loo Lin School of Medicine., 2016) Karunaratne, D.; Chandratilake, M.
AIMS: During the last two decades the education sector around the globe was challenged with the need for market orientation in education delivery as a consequence of heightened competition among education institutions and escalating student demands for quality education. This has resulted in many educational organizations to concentrate more on the quality in academic and non-academic services offered to their students more than ever before. Although late to adopt, the same trend has emerged in the developing countries in the recent past. Service quality measurement creates a platform for making informed decisions on service quality improvements which will invariably have a positive impact on the institution and its stake holders. Therefore, this study examined medical undergraduates' perceptions of service quality gaps in selected areas of student support services in a state medical school in Sri Lanka and the influence of student demographic factors on service quality ratings. METHODS: A quantitative study was conducted using the SERQUAL questionnaire, which is a self-administered questionnaire. It is a multiple item scale measuring student expectations and perceptions on service quality along a 7 point likert scale under five dimensions: tangibles (physical facilities, equipment and appearance of personnel), reliability (ability to perform the promised service dependably and accurately, Responsiveness (willingness to help students and provide prompt service), assurance (knowledge and courtesy of employees and their ability to inspire trust and confidence), empathy (caring individualized attention the institution provides its students). Cronbach's alpha, descriptive statistics, t-tests and ANOVA were used to analyse data using SPSS 14.0 software. RESULTS: The mean student perception scores for all service quality attributes measured by the tool were lower than the respective expectation scores, indicating a negative service quality gap. Highest service quality gaps were in tangibles dimension followed by reliability, assurance, empathy and responsiveness. Service quality perceptions on selected dimensions also differed significantly across gender, living setting (urban/ rural) and student seniority. Student perceptions towards reliability and empathy significantly differed across gender, male students perceiving higher than their female counterparts. Student perceptions on tangibles and reliability also differed significantly among urban and rural students, rural students perceiving lower than urban students. Student perception and expectation scores for all dimensions significantly differed according to seniority. Mean student perception and expectation scores were reduced with advancing seniority; highest scores for both expectations and perceptions were among most junior students and lowest among most senior students. Therefore, the most significant service quality gaps were identified among female students from rural areas who were in their final couple of years of study. CONCLUSION: The quality of student support services provided by the medical school does not meet the expectations of medical undergraduates. This has resulted in negative quality gaps for all dimensions measured by the SERVQUAL tool, highlighting the necessity to implement quality improvement initiatives to alleviate quality gaps. Therefore, this tool can be considered by all learning organizations to broaden their understanding of the existing learning environments which may be limited to quantity measures with quality ratings.
Understanding cultural dynamics shaping clinical reasoning skills: A dialogical exploration
(Wiley-Blackwell, 2024) Karunaratne, D.; Sibbald, M.; Chandratilake, M.
Our study examined the influence of national cultural predispositions on training medical professionals and doctor-patient dynamics using a dialogical approach, guided by Hofstede's framework. This framework provided valuable insights into how cultural tendencies shape the learning and application of clinical reasoning skills in different cultural contexts. We found that dimensions such as power distance and individualism versus collectivism significantly influenced clinical reasoning, while other dimensions had more nuanced effects. Junior doctors in Southern nations, despite initially lagging behind, developed advanced clinical reasoning skills with experience, eventually matching their Northern counterparts. The study highlighted the link between cultural norms and educational practices, variations in family involvement during reasoning, adherence to clinical guidelines and doctors' emotional engagement in clinical care between Southern and Northern contexts. Additionally, we recognised that effective clinical reasoning extends beyond technical knowledge, involving an understanding and integration of cultural dynamics into patient care. This highlights the pressing need to prioritise this topic.