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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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.Item Editorial: Reviews in healthcare professions education(Frontiers Media S.A., 2024) Sethi, A.; Chandratilake, M.No abstract availableItem 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.Item 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.Item 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.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 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.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 Psychological impact of COVID-19 among a cohort of Sri Lankan medical students: Preliminary results(Sri Lanka College of Psychiatrists, 2022) Abayabandara-Herath, T.; Premaratne, I.; Ediriweera, D.; Chandratilake, M.; Hapangama, A.Previous studies report that the COVID-19 pandemic has a negative effect on the psychological wellbeing of medical students. We aimed to determine the psychological impact of COVID-19 and its associated factors among a cohort of Sri Lankan medical students, using online versions of a demographic questionnaire and the validated Sinhala and Tamil versions of the DASS-21. Of the 418 students, majority were females, aged between 20-25 years. In the study group, 40 (9.6%), 105 (25.1%) and 7 (1.6%) of participants scored above the cut-offs for the depression, anxiety and stress subscales of the DASS-21 respectively. The COVID-19 pandemic appears to be associated with a negative impact as measured by the DASS-21 scale among this group of medical students.Item Medical students' and trainees' country-by-gender profiles: Hofstede's Cultural Dimensions across sixteen diverse countries(Frontiers Media S.A, 2022) Monrouxe, L.V.; Chandratilake, M.; Chen, J.; Chhabra, S.; Zheng, L.; Costa, P.S.; Lee, Y.M.; Karnieli-Miller, O.; Nishigori, H.; Ogden, K.; Pawlikowska, T.; Riquelme, A.; Sethi, A.; Soemantri, D.; Wearn, A.; Wolvaardt, L.; Yusoff, M.S.B.; Yau, S.Y.Purpose: The global mobility of medical student and trainee populations has drawn researchers' attention to consider internationalization in medical education. Recently, researchers have focused on cultural diversity, predominately drawing on Hofstede's cross-cultural analysis of cultural dimensions from general population data to explain their findings. However, to date no research has been specifically undertaken to examine cultural dimensions within a medical student or trainee population. This is problematic as within-country differences between gender and professional groups have been identified within these dimensions. We address this gap by drawing on the theoretical concept of national context effects: specifically Hofstede's six-dimensional perspective. In doing so we examine medical students' and trainees' country profiles across dimensions, country-by-gender clustering, and differences between our data and Hofstede's general population data. Methods: We undertook a cross-cultural online questionnaire study (eight languages) containing Hofstede's 2013 Values Survey. Our questionnaire was live between 1st March to 19th Aug 2018, and December 2018 to mitigate country holiday periods. We recruited undergraduate medical students and trainees with at least 6-months' clinical training using school-specific methods including emails, announcements, and snowballing. Results: We received 2,529 responses. Sixteen countries were retained for analyses (n = 2,307, 91%): Australia, Chile, China, Hong Kong, India, Indonesia, Ireland, Israel, Japan, Malaysia, New Zealand, Pakistan, South Africa, South Korea, Sri-Lanka, Taiwan. Power distance and masculinity are homogenous across countries. Uncertainty avoidance shows the greatest diversity. We identified four country clusters. Masculinity and uncertainty are uncorrelated with Hofstede's general population data. Conclusions: Our medical student and trainee data provides medical education researchers with more appropriate cultural dimension profiles than those from general population data. Country cluster profiles stimulate useful hypotheses for further research, especially as patterning between clusters cuts across traditional Eastern-Western divides with national culture being stronger than gendered influences. The Uncertainty dimension with its complex pattern across clusters is a particularly fruitful avenue for further investigation.