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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Intermediate fidelity simulation to educate emergency management skills(Penerbit Universiti Sains Malaysia, 2020) Kodikara, K.G.; Karunaratne, W.C.D.; Chandratilake, M.N.Medical students learn clinical skills related to the management of emergencies during their clerkships, mainly via peripheral participation and observation. Simulation-based training is identified as an adjunct to clinical practice enabling students to learn clinical skills in a safe environment. Nevertheless, simulation-based training is still underutilised in many countries in the developing world. The purpose of this study was to explore the value of simulation-based learning using an intermediate fidelity simulator to train medical undergraduates on the management of medical emergencies. A pilot group of 80 fourth year medical students attended four simulation-based clinical skills sessions. The students completed a self-administered evaluation, which included both open and close-ended questions postsimulation. Descriptive statistics were employed to analyse the responses to close-ended questions, and the responses to open-ended questions were analysed for recurring themes. All participating students responded to the evaluation. Students rated the simulation-based learning experience with high positivity. The self-competency of 74 (92.5%) students had increased following the sessions. The sessions have provided a “safe” learning environment to all students, and 70 (87.5%) felt it helped apply theory into practice. Thirty-three (41.2%) noted the simulation session as an important learning tool for practising clinical skills. Thirty-one (38.5%) wished to participate in more sessions, and 39 (48.7%) felt that simulation should be introduced to the curriculum from the first-year. Students have recognised intermediate fidelity simulators as a valuable learning tool to train on the management of clinical emergencies and should be integrated into undergraduate medical curricula.Item High fidelity simulation in undergraduate medical curricula: experience of fourth year medical students(South East Asia Regional Association for Medical Education -SEARAME, 2020) Kodikara, K.G.; Karunaratne, W.C.D.; Chandratilake, M.N.INTRODUCTION: Application of theoretical knowledge to management of critically ill patients is a challenging task for medical undergraduates where opportunities to learn clinical skills with regard to management of emergencies are few. High fidelity simulation (HFS) is widely used globally to learn clinical skills in a safe environment. However, research in use of HFS in developing countries such as Sri Lanka is minimal. PURPOSE: The purpose of this study was to explore the response of medical undergraduates to a high fidelity simulator in the context of management of emergencies. METHOD: A pilot group of 30 fourth year medical students underwent a high fidelity simulator session. They completed a self-administered evaluation, which included both open and close ended questions and participated in a focus group discussion post-simulation. Descriptive statistics were employed to analyze the responses to close-ended questions and the responses to open- ended questions and focus group discussion were analyzed for recurring themes. RESULT: Students rated the simulation-based learning experience with high positivity. The self-competency of 29 (96.6%) students had increased post-simulation while providing a safe learning environment to all students. Majority (63.3%; n=19) felt it helped put theory into practice. Qualitative data gathered from open-ended questions and focus group discussions further confirmed these findings. CONCLUSION: The study demonstrates that HFS can be used to provide a safe environment and a satisfying educational experience for students to learn medical emergencies, and as an educational opportunity of translating theory into practice. Although HFSs are costly they appear to be cost effective in terms of educational outcomes. KEYWORDS: Simulation, Medical students, High fidelity, CompetencyItem The dynamics of doctor-patient conversations:A linguistical analysis(Sri Lanka Medical Association, 2018) Wijesundara, B. M. E.; Karunatilake, K.M.M.G.S.L.; Karunaratne, W.C.D.; Chandratilake, M.N.INTRODUCTION AND OBJECTIVES: Concerns exist on the communication skills of doctors in medical practice. The aim of this study was to explore the linguistic dynamics of communication between doctors and patients in the Sri Lankan cultural context.METHODS: A qualitative study was conducted in wards of major disciplines in North-Colombo Teaching Hospital. 16 out of 48 audio-recorded patient consultations of intern house officers were subjected to preliminary linguistic analysis of the open vs closed ended questioning, tolerability of silence, time distribution between doctors and patients, use of technical jargon and emotional expressions.RESULTS: The average consultation time was l 7min 40s (Range: 4min, 45s - 30min, 56s) and was distributed between patient 4 min, 57s (Range: 34s - 18mins ,l ls), doctor 2 min (Range: 3ls - 4min, 36s) and other activities like documentation. Therefore, the average time distribution between doctor and the patient during a consultation was 1 :2.5. 74.66% of the doctors' questions were closed-ended. 83% of the time patients provided detailed answers to closed-ended questions. Doctors used repeating and paraphrasing to encourage non-respondents and rarely used technical jargon. Questioning was friendly but the tone of the conversation was hierarchical. However, it enabled developing good rapport with patients. Doctors rarely showed irritation and it was expressed implicitly through hurried questioning and high-toned voice.CONCLUSION: The linguistic dynamics of consultations demonstrated the presence of elements of the Eastern cultural norm of hierarchy. Limited patient-centredness of doctors was not observed negatively by patients. Patients appeared to be more empowered, may be due to the 'narrow power-gap' between junior-doctors and patients.Item 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.Item Usage analysis of student interactions in an online learning platform conducted at Faculty of Medicine, University of Kelaniya: Pedagogical considerations for implementing e-Learning(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Karunaratne, W.C.D.; Chandratilake, M.N.; Heiyantuduwage, S.BACKGROUND: Learning Management Systems (LMS) designed to support teaching and learning has changed how education is offered and consumed in higher education. OBJECTIVES: This study was conducted with the aim of identifying what inferences, educators can make through student usage statistics of the Moodle Learning Management System termed as the VLE (Virtual Learning Environment) on developing a pedagogical model for online learning. METHODS: Student and staff course usage statistics were recorded from the VLE of the Faculty of Medicine, University of Kelaniya for all the modules, and related resources and activities conducted from first to the fourth year students during the year 2015 and analyzed. RESULTS: A majority of students (88-90%) access the materials available in the VLE. The mean student access during the module is higher than following the completion of the module while the frequency of student access during faculty hours is similar to the frequency of use after faculty hours. As expected, student access was increased with availability of more learning materials in the modules and with incorporation of student activities and links to web resources. The mean usage frequency of staff were considerably low and limited whereas the support staff usage being more than ten times higher. CONCLUSIONS: The Virtual Learning Environment (VLE) of the faculty can be used as an effective platform to supplement didactic learning and to promote self-learning among students. It also highlights the necessity to form an eLearning development team for the institution consisting of instructional designers, graphic artists, multimedia developers and instructors with whom the content experts can work together to realize there requirements.