Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Sustainability of innovations in health professions education(John Wiley & Sons, 2022) Ponnamperuma, G.; Olupeliyawa, A.; Chandratilake, M.; Marambe, K.The history of health professions education is replete with innovations in curriculum, teaching and learning, and assessment. Some of these changes have stood the test of time, while others have faded away. Knowledge of the triggering factors that led to the rise and fall of these innovations is helpful when planning future educational innovations, as educators can evade the common pitfalls of unsustainable innovations. This chapter analyses the reasons behind the sustainability of major educational innovations and the demise of the others. In conclusion, the chapter draws on the past sustainability trends to elucidate the features that indicate the long-term viability of innovations in health professions education. Based on the trends in innovations observed throughout history, the chapter attempts to predict what the future holds. Toward this end, the role of technology is featured as a way out, given the possible future restrictions of social contact posed by situations such as the present pandemic.Item Human resources for health in Sri Lanka over the post-independence period: key issues(Sri Lanka Medical Association, 2023) de Silva, D.; Chandratilake, M.; de Silva, N.No abstract availableItem Community as a learning opportunity(College of Medical Educations., 2020) Kasturiratne, A.; Chandratilake, M.No abstract availableItem Reflection and reflective practice(College of Medical Educations., 2020) Chandratilake, M.; Olupeliyawa, A.No abstract availableItem Clinical Reasoning.(College of Medical Educations., 2020) Karunratne, D.; Chandratilake, M.; Dharmaratne, S.No abstract availableItem IMoCC - Measure of cultural competence among medical students in the Malaysian Context.(Informa Healthcare, 2021) Chandratilake, M.; Nadarajah, V. D.; Mohd Sani, R. M. B.ABSTRACT:Cultural beliefs and practices impact heavily on health outcomes of patients. Doctors' ability to deal with such issues in clinical practice, i.e. cultural competence, is widely studied in the west. It has yet to be given due importance in non-western contexts. This study aimed to develop a valid and reliable measure of cultural competence in the Malaysian cultural context and to assess cultural competence among Malaysian medical students. Thirty-five cultural issues faced by Malaysian doctors were identified with a series of interviews to develop a preliminary tool. The responses of students to these cultural issues were evaluated against the extent of inquiry and advocacy based on a theoretical framework of cultural competence. The responses were subjected to statistical analysis to determine the internal structure of the tool and to reduce the number of items in the tool. The final tool (IMU Measure of Cultural Competence - IMoCC) comprised of 22 issues, which deemed to be reliable in the second round of testing. In both tools, student cohorts demonstrated an acceptable level of cultural competence with room for improvement. However, they appeared to learn how to deal with cultural issues primarily through informal means and not in the formal curriculum. KEYWORDS: Cultural competence; health professions; professionalism; undergraduate.Item 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.Item 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.Item 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 manyItem 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.