Conference Papers

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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine

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Author: search.filters.author.Chandratilake, M.Has files: No

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    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.
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    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
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    Using hermeneutic phenomenology approach to explore how junior doctors learn clinical reasoning in practice
    (Sri Lanka Medical Association, 2017) Karunaratne, W.C.D.; Chandratilake, M.; Marambe, K.
    INTRODUCTION & OBJECTIVES: Hermeneutic phenomenology is a qualitative study design to understand individual learning experiences from the beholder’s perspective (phenomenology) while appreciating the subjective interpretation of them by the researcher with essential prejudices for understanding the concept (hermeneutic). Clinical reasoning is a multifaceted, dynamic, individualized and evolving construct. Therefore, how junior doctors learn clinical reasoning in practice was explored using this approach. The aim is to share this methodological experience with prospective researchers to be used for similar purposes. METHODS: A total of 18 junior doctors (Males: 7, Females: 11) from four major clinical disciplines participated in individual in-depth semi-structured interviews. Lived-experiences were encouraged more during the interviews than the perceptions complying with phenomenology. The interviews were audio-recorded, transcribed verbatim and analyzed according to the Ritchie and Spencer framework using the Atlas.ti software. The above framework was chosen to maximize the diversity of interpretation. Three personnel with the same academic background but different levels of experience developed the coding framework. This resulted in identification of codes from participants’ expressions (first-order constructs; layered by the researcher’s interpretations of these constructs (second-order constructs). The second-order constructs gave the impetus for emerging themes for the coding framework. Three frameworks of three coders were compared; consensus and deviations were included in developing the final coding framework. RESULTS: The framework revealed rich and diverse accounts of how junior doctors conceptualized clinical reasoning, the presence of numerous interpersonal and contextual factors driving, facilitating and supporting learning and also hindering the learning process. CONCLUSION: Hermeneutic phenomenology can be used effectively to understand complex phenomena like clinical reasoning.
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    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.
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    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.
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    Focus of an undergraduate professionalism curriculum; perceptions of Sri Lankan medical students
    (Sri lanka Medical Association, 2015) Chandratilake, M.; Samararatne, R.; Ranathunga, D.C.
    INTRODUCTION AND OBJECTIVES: The attempts made by medical schools for professionalism ducation have proven to be challenging. We explored the perceptions of medical students on teaching/learning, and assessment of professionalism in a Sri Lankan medical school. The professionalism curriculum of this medical school; runs for four years, uses interactive but classroom-based activities for teaching, and conducts written assessments and OSCE for the assessment. METHOD: In a qualitative study, twelve focus group discussions with the participation of 64 students were conducted. The responses were thematically analysed? RESULTS: The curriculum as a whole appeared to; reward academic abilities but not the professional soundness of students. They were critical of assessment-oriented professionalism curriculum and focusing more on what students 'know' than what they 'do'. The professionalism curriculum seemed to provide them with sound theoretical knowledge. It is not appropriately supportive in dealing with professionalism dilemmas they face in clinical setting. Students liked to learn professionalism from clinicians in clinical setting rather than being taught. Despite what students learn, their moral principles appear to changes over time to be compliant with the existing culture. Students see a discrepancy between the marks students scored in existing exams and actual behaviour in the ward. They liked to be observed by superiors, patients and peers for their professional behaviour. They had reservations about nurses becoming their assessors of professionalism. CONCLUSION; Students wish for a curriculum which rewards both academic abilities and professional behaviour. The professionalism curriculum should focus on learning over teaching and behaviour over knowledge. The curriculum was revised to incorporate students' feedback.
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    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.