PGD Health Professional Education 

                                      My experience of Feedback on Online Teaching of Final Year MBBS students During COVID-19:

Introduction: 

The COVID-19 pandemic forced a sudden shift in the educational landscape, compelling educational institutions across the world to adopt online learning as a means of continuing instruction. As we reflect on the experiences of our final-year MBBS students with online teaching, their feedback presents a range of positive and negative aspects that help in understanding the effectiveness and challenges of this mode of learning. Analysing these mixed responses sheds light on how online education has impacted student learning, both positively and negatively, and provides useful insights for future improvements in online education delivery.

Positive Aspects of Online Teaching

1. Flexibility of Timing: One of the most frequently mentioned advantages by students is the flexibility in scheduling. Unlike traditional classroom settings, online teaching allows students to access lectures at their convenience. This has been particularly valuable for final-year MBBS students who often have a busy schedule with clinical rotations, hospital duties, and other academic commitments. The ability to review lectures at any time enables them to pace their learning according to their individual needs. This flexibility enhances students’ ability to manage their time effectively, reducing stress and promoting better work-life balance, which is crucial in a demanding academic environment like medicine.

2. Access to Pre-Lecture Notes: Students also appreciated the availability of pre-lecture materials, such as notes, readings, and other resources. This allows students to come prepared for lectures, enhancing their ability to engage with the content more effectively. This proactive approach to learning helps in deepening students' understanding and retention of information, which is essential in the medical field.

3. Friendly and Relaxed Home Environment: Another positive point mentioned was the relaxed home environment in which students attended classes. Without the pressure of formal classroom settings, students could participate in discussions and focus on their learning in a more comfortable, personalized space. The online format allowed students to engage in learning without the usual distractions or pressure of classroom norms, potentially leading to greater concentration and a sense of well-being.

4. Online Quizzes and Assessments: The use of online quizzes and assessments was another highlight in the feedback. Quizzes provide an effective way of testing students’ knowledge in real time and help reinforce what they have learned. They also allow for immediate feedback, enabling students to identify areas for improvement. This mode of assessment proved to be a valuable tool in gauging the students' understanding of the subject matter and providing a more continuous evaluation, as opposed to traditional end-of-term exams.

Negative Aspects of Online Teaching

1. Slow Internet Connectivity: Despite the advantages, several negative aspects of online learning were identified. The most common issue raised was slow or unreliable internet connectivity. Many students, particularly those in remote areas, faced frequent disruptions due to poor internet infrastructure. This caused frustration, leading to missed lectures, difficulty in following live sessions, and even the inability to participate in online discussions. For a program as intensive and specialized as MBBS, reliable internet access is crucial for effective learning. Technical issues disrupt the flow of lessons, hindering students’ ability to grasp critical concepts in real time.

2. Electricity Load Shedding: Alongside connectivity problems, electricity load shedding or power outages posed a significant challenge. In regions where electricity supply is unstable, students struggled to attend classes or access online materials during scheduled sessions. This issue, in particular, highlights the socio-economic disparities that affect students' ability to participate in online education equitably.

3. Lack of Eye Contact and Personal Interaction: One of the most significant drawbacks of online teaching highlighted by students was the absence of personal interaction with instructors and peers. In a traditional classroom, eye contact and non-verbal cues are integral to communication and the learning process. Online teaching, by nature, reduces these interactions, making it more difficult for students to establish rapport with their instructors. Moreover, students often felt less engaged and less motivated, as the lack of in-person interaction reduced the feeling of being part of a community. This absence of physical presence also led to difficulties in seeking immediate clarification from instructors, which is especially important in complex medical topics.

4. Limited Clinical Exposure: While this feedback was not explicitly mentioned in the survey, it is important to note that online learning significantly reduces opportunities for practical, hands-on experiences that are essential in a medical curriculum.

Conclusion

The feedback from final-year MBBS students reflects the complexity of online teaching in the context of higher education. While the flexibility, availability of pre-lecture resources, and the convenience of a relaxed home environment were seen as significant positives, the challenges related to internet connectivity, electricity issues, and reduced personal interaction were substantial hindrances to their learning experience.

As we move forward, it is crucial to address these challenges to improve the quality of online education. For example, enhancing internet infrastructure, especially in remote areas, and providing backup power solutions could mitigate the technical issues students face. Additionally, integrating hybrid learning models that combine the best of online and face-to-face instruction could offer a more balanced approach to medical education. Medical institutions could also explore virtual reality (VR) and other technologies to replicate clinical experiences in a more interactive and engaging manner.

FEEDBACK OF SUPERVISOR TO A POSTGRADUATE RESIDENT ON HIS PRESENTATION ON BREAST CANCER AWARENESS ON THE EVE OF WORLD BREAST CANCER DAY

Postgraduate Resident: Dr. Mamoon Ali Level III

Overview:

Dr. Mammon Ali delivered an insightful and well-structured presentation on Breast Cancer in observance of World Breast Cancer Day. The session was arranged by Department of Surgery Aziz Bhatti Shaheed Teaching Hospital Gujrat. The objective of this activity was raising awareness about the condition, its early detection, prevention, and the role of healthcare professionals in improving patient outcomes.

Content and Structure:

Dr. Mammon effectively covered a comprehensive range of topics, including the pathophysiology, risk factors, clinical signs and symptoms, diagnostic modalities, and treatment options available for breast cancer. The presentation was logically organized, starting with the basics of breast cancer and progressing to more specific details. He emphasized on key facts such as the importance of early detection, the role of self-breast examination, and the recent advances in treatment of breast cancer. The selection  photographs of  local patients  with breast cancer were an excellent addition, however identity of patient in few pictures was not properly protected.

The inclusion of statistical data on local, regional & international breast cancer incidence and mortality was particularly beneficial for the awareness of the audience. Furthermore, his stress on the social, psychological and emotional aspects of breast cancer, including the impact on patients and their families, was an excellent addition.

Presentation Skills:

Dr. Mamoon showed confidence and clarity in delivering the presentation. His use of visual aids such as slides, charts, and diagrams were clear, simple, and was effective in enhancing understanding of the audience.  The slides were well-designed, with clear bullet points, relevant images, and graphs to support key concepts. He has practice control on his voice pitch and should have more eye contact with the audience. His time management skills were good ensuring that the presentation was concise but informative, allowing adequate time for a productive Q&A session at the end.

Audience engagement & participation:

Dr. encouraged active participation by asking the audience thought-provoking questions and prompting them to consider the practical aspects of breast cancer care. He also provided real-life case examples, which helped to personalize the discussion and made the topic more interesting to the audience. His ability to engage the audience by encouraging questions and discussion, the activity turned out to be an excellent interactive session.

Strengths:

1: clear objective and concise introduction

2: Covered key aspect of breast cancer

3: Engaging tone and audience interaction

4: Optimum use of audio video aids / multimedia

Areas for Improvement:

• While the content was generally comprehensive, a deeper focus on the latest guidelines for breast cancer screening, particularly in high-risk populations, could have been included.

• A brief mention of the role of multidisciplinary teams in the management of breast cancer would have further enriched the discussion, particularly for the paramedical staff in attendance.

• Dr. Mamoon could have included more practical examples of how paramedical staff can contribute to breast cancer care, such as in the areas of patient education, nursing care, and psychosocial support.

• Video presentation of Breast Self-Examination with simulation for female participants would have longer lasting impact

• The role of paramedical staff particularly the nurses must have been more specific to highlight their responsibilities in primary prevention and early detection of breast cancer.

• Complex technical terms should have avoided for better understanding of  the target audience.

Suggestions for Future presentations:

·        Invite a breast cancer survivor for interaction with audience on her experience of passing through this tough journey of life.

·        Discuss hospital specific protocols and local guidelines

·        Provide handouts and notes for future learning

·        Consider including interactive elements such as quizzes or case studies to further engage the audience

·        Expand on how early detection and screening programs can be implemented within the hospital setting. Develop a hospital -wide breast cancer awareness program, levering this presentation as a starting point and gradually extend it to female community of population including female colleges / universities / workplaces.

Overall Assessment:

The Trainee demonstrated a good understanding of basic concept of   breast cancer and effectively conveyed key message. Dr. Mamoon provided an excellent and informative presentation on breast cancer awareness. The session successfully raised awareness of the disease, its risk factors, and the importance of early detection, which is crucial for both residents and paramedical staff. The presentation was both educational and engaging, fostering an environment conducive to learning and discussion. I commend Dr. Mamoon for his r effort and professionalism, and I encourage continued focus on such important topics to improve patient care outcomes in the future.

                                                                                                                                                                      Dr Muhammad Ateeq

                                                                                                                                                                        Professor of Surgery

                                                                                                                                                                          NSMC/ ABSTH Gujrat

                                                                                                                                                                           Dated. 14th December 2024

 Reflective writing 03:     Hands on workshop  Basic Principles of Trauma Management  ABSTH Gujrat  14th 17th December 2024 

REFLECTIVE WRITING ASSIGNMENT 03

PGD HPE HSA

Reflective Feedback on the 4-Day Hands-On Skills Workshop on basic Principles of Resuscitation and Management of Trauma Patients

 VENEUE:   Trauma Center Department of Surgery Nawaz Sharif Medical College / Aziz Bhatti Shaheed Teaching Hospital Gujrat

I am pleased to reflect on the recent 4-day hands-on skills workshop held in the Trauma Centre of our hospital.  This activity was postgraduate residents of Department of Surgery ABSTH Gujrat. This workshop, which focused on the basic management principles of trauma patients, was designed to enhance the clinical skills and knowledge of our residents, doctors, and paramedical staff. The facilitator for this event was Dr. Hanzla Tariq, a highly skilled Consultant in Emergency Medicine from Canada, whose expertise and experience played a pivotal role in making this workshop a success.

The workshop provided an excellent platform for participants to engage in real-time, hands-on training, addressing the core aspects of trauma care. It was tailored specifically for healthcare professionals involved in the initial assessment and management of trauma patients, and it covered critical areas such as resuscitation, airway management, triage, and patient prioritization. The interactive nature of the workshop allowed participants to actively engage in practical activities and simulations, reinforcing the theoretical knowledge with practical application.

One of the most valuable aspects of this workshop was the real-time scenario training within the trauma centre and emergency department. The participants had the opportunity to practice in a controlled yet realistic environment, which enabled them to gain confidence in managing trauma patients under pressure. The emphasis on teamwork, clear communication, and decision-making skills in high-stress situations was a key takeaway for all involved.

I believe that such skill-based training is essential for improving the efficiency and effectiveness of trauma care in our institution. Trauma care often requires quick, decisive action, and this workshop helped to ensure that our healthcare workers are well-prepared to handle such critical situations. Furthermore, the hands-on nature of the workshop ensured that the participants were not only familiar with the theoretical aspects of trauma management but also capable of performing essential procedures and interventions.

The feedback from participants has been overwhelmingly positive, with many expressing appreciations for the opportunity to learn from a distinguished expert and gain practical insights into trauma care. The interactive format, along with the real-world applicability of the training, was highly appreciated by all attendees.

At the conclusion of the workshop, participants were awarded certificates, which not only served as a recognition of their commitment to professional development but also as a reminder of the skills they gained during the workshop.

In conclusion, this workshop was an invaluable learning experience for everyone involved. I commend Dr. Hanzla for his exceptional facilitation and the entire organizing team for their efforts in making this event a success. Moving forward, I would recommend the continuation of such training programs to further enhance the competencies of our healthcare professionals, ensuring we continue to provide the highest standard of care to our trauma patients.

This workshop has significantly contributed to the growth and development of our medical team, and I am confident that the skills acquired during these four days will have a lasting impact on the quality of care we deliver.

Dr Muhammad Ateeq

Dated:  21st December 21, 2024

ASSIGNMENT:    04            REFLECTIVE WRITING 4   PGD HPME HSA

Reflective Write-Up on the TOCAS Mock Clinical Examination for Postgraduate Residents in General Surgery

As the Professor and Head of the Department of Surgery at Aziz Bhatti Shaheed Teaching Hospital, Gujrat, arranged and coordinate the TOCAS mock clinical examination for the postgraduate residents in General Surgery. This activity was specifically designed to provide our residents with a structured and realistic experience in preparation for their forthcoming final examinations. The event was, aimed to enhance both the clinical competencies of the residents and provide a collaborative and supportive learning environment among faculty and students.

The concept of the TOCAS mock examination was to the structure of the final  examination would allow the residents to gain insight into the practical aspects of the examination process. To achieve this, faculty members from General Surgery and allied specialties contributed one TOCAS station each, which adhered to a table of specifications. This ensured that all stations were not only discipline-specific but also task-oriented, providing the residents with a comprehensive and relevant experience.

The organization of the activity in the demonstration hall was done with meticulous attention to detail. The set-up closely resembled that of a real final examination, giving the residents a sense of the environment and expectations, they would face. With 10 interactive and task-specific stations, each designed to assess critical clinical skills, the residents were given an opportunity to apply their theoretical knowledge in a practical activity. The duration of 1 hour and 40 minutes, with each station lasting 10 minutes, was sufficient to evaluate each resident's proficiency in a variety of surgical scenarios. The stations were supervised by senior faculty members who acted as examiners, ensuring that the assessment was both fair and rigorous.

A total of 20 postgraduate residents from the MS/FCPS Surgery program participated in the mock examination. Each candidate demonstrated considerable effort, applying their clinical knowledge and skills under the pressure of an exam-like environment. This simulation provided them with a valuable opportunity to identify areas of strength and areas for improvement.

The process of feedback, both from the students and examiners, was an essential component of the activity. The results were tabulated and shared with the residents promptly, allowing them to reflect on their performance in a constructive manner. The feedback proforma enabled both examiners and students to voice their perspectives, which was instrumental in identifying opportunities for further academic development and growth.

As a faculty member and administrator, I have seen firsthand the positive impact such initiatives can have on the professional growth of our residents. The TOCAS mock examination allowed the residents to gain a deeper understanding of the types of tasks and scenarios they will encounter during their final examinations. The interaction with faculty in a structured, evaluative setting also helped to strengthen the rapport between students and mentors. Additionally, the collaborative nature of the event – with faculty members from different specialties contributing created a multidisciplinary approach to surgical education, reinforcing the importance of teamwork in clinical practice.

In conclusion, the TOCAS mock clinical examination was a resounding success in fulfilling its objectives. It not only provided the residents with a realistic examination experience but also highlighted areas where additional focus and preparation may be required. The feedback gathered will serve as a foundation for future academic activities and will be used to continuously refine and improve the educational experience for our postgraduate residents. As the Head of the Department of Surgery, I look forward to continuing to support and enhance such initiatives, ensuring that our residents are thoroughly prepared for the challenges of their final examinations and future careers as skilled surgeons.

 ASSIGNMENT:  DISEASES OF CURRICULUM PERSONAL OBSERVATIONS

I have been involved in teaching & training of MBBS & postgraduate students for the last 24 years. I have observed some flaws in the MBBS curriculum & in the postgraduate training program.  Moreover, considering retrospectively as a prospective of medical student back in 1980s MBBS curriculum was outdated. Few contents were repeated in different years syllabus. Few diseases are included which were no more prevalent in Pakistan. Broadly the MBBS curriculum was not aligned with community need of our population. PMDC the regulatory body of medical education in Pakistan recently in 2022 reviewed the MBBS curriculum and made it aligned with needs of our population. However still there is room to improve. Various flaws/ diseases observed by me in curriculum are at various stages of teaching career.

1: Intercurrent Curriculitis

2: Curriculumm sclerosis.

3: Departmentalization

4: Curriculum Dyseesthesia / arthritis

5: Curriculum Hypertrophy.

More or less all these diseases of curriculum result in to a one outcome in the form of   stagnation of curriculum, no innovation, outdated frustrated contents both for students & faculty.

OBSERVATIONS:

1: Intercurrent Curriculitis

Study of Morbid anatomy of human body is included in first and second years MBBS All Students have to study it in depth. Over the years it is observed that every student doesn’t need to study anatomy of whole human body in details as students are going to pursue their careers in different specialities. So, student who want to be an ENT specialist after MBBS do not have need to study the whole anatomy in depth rather course content should be designed in such a way that student only study specialty specific contents in details in addition to general anatomical concepts. The irrelevant content led to curriculum hypertrophy and overburden the students in early MBBS classes. frequent interruptions, poorly integrated content, and a chaotic flow of subjects or topics, leads to frustration, confusion, and academic fatigue among students and faculty.

2. Curriculum sclerosis.

 It implies that the curriculum becomes outdated, fails to incorporate contemporary knowledge or skills, and does not meet the needs of evolving industries, societies, or learners. particularly in institutions resistant to modernization or change This "sclerosis" can have several adverse effects, such as: oobsolete ccontent, lack of Innovation, mmismatch with Job mmarket, rresistance to rreform:

3. Curriculum Departmentalization. We have some issues due to rigid attitude of some faculty members eg. minor clinical specialities like ENT etc. They demand more teaching hours as compared to their course syllabus. They don't cooperate and show willingness to review and rationalise the syllabus.  Few course contents are irrationally included in disciplines like community medicine. Thus make the subject more theoretical than community cantered. Subject specialist of a particular subject considered their subject is more important and resist in modifications and updating the course content. This makes the curriculum slow, stagnated labelled as curriculum arthritis.

SPICES MODEL OF LEARNING EXPERIENCE AS A MEDICAL TEACHER

This model of teaching is a widely recognized educational framework that emphasizes a shift from traditional teacher-cantered methods to more student-cantered, interactive learning environments. Developed by Dr. H. R. Barrow in 1982.

SPICES STANDS FOR:

1. Student-cantered learning

2. Problem-based learning

3. Integrated approach

4. Community-based education

5. Elective opportunities

6. Systematic approach

 It aims to improve the quality of education by focusing on active learning, critical thinking, and holistic development.

Advantages of the SPICES Model:

• Active learning

• Enhanced critical thinking

• Collaboration and teamwork

• Holistic development

• Student motivation

All the components / teaching modalities of SPICES model revolves and encourages shift of teaching methodology towards more student centered.  Instead of remain passive, here students critically analyze the provided data, provoke critical thinking, apply their knowledge, interactive with each other and solve the problem with collective integrated efforts as a team. 

Role of teacher is to put a question / scenario / clinical case history before a group of students and start is discussion with a opening question.  This is just like a talk shows we watch on TV now adays. Teacher acts as an anchor to keep the discussion in right direction on the topic under discussion. 

Personal experience on the Adoption of the SPICES Model in Clinical General Surgery Teaching

As a medical educator in the field of clinical General Surgery, my experience with the adoption of the SPICES model of teaching has been a  very pleasant experience. This shift towards student-cantered learning, beginning in 2007 at Rawalpindi Medical College and continuing at Nawaz Sharif Medical College Gujrat from 2010 onward, has allowed me to witness firsthand the significant impact of active, problem-based learning (PBL) on the development of medical students' clinical reasoning, problem-solving skills, and professional attitudes.

 I observed how student participation became a pivot of the learning process. In the conventional lecture style where students are passive recipients of information, PBL provides an opportunity to them to actively involve with clinical discussion. As a facilitator, my role shifted from a traditional "lecturer" to that of a host or anchor, guiding the discussion and encouraging the students to think critically about the clinical situations presented. My experience of the adoption of the SPICES model of teaching, through Problem-Based Learning, has had a profound impact on both my students and my own approach to teaching. The focus on student-cantered learning has created a dynamic and interactive environment. There is active participation of students, they critically think, apply their knowledge and make a treatment plan for the patient. Facilitator / teachers role in this activity is just like an anchor to redirect the students whenever they detract from the topic. 

 ASSIGNMENT NO 5 REFLECTIVE WRITING PGD HPME HSA

                                                 ACTIVITY:  PRESCREPTION WRITING HANDS ON WORKSHOP FOR RESIDENT DOCTORS

VENUE: DEPARTMENT OF SURGERY NSMC /ABSTH GUJRAT

Department of Surgery Aziz Bhatti Shaheed Teaching Hospital Gujrat arranged a small group activity for House Surgeons / resident doctors. Idea was to how to write a standard prescription for a patient. This idea raised due to a very often observations that our doctors are not much aware of proper prescription writing. The common shortcomings in prescription are of large range from not writing biodata of patient to proper readable dosage of drugs. Moreover  doctors are not well aware with medicolegal implications of a  medical prescription in the court of law.  Prescription of a doctor is considered to be the whole reflection of the treating doctors. Activity was conducted in demonstration room of the department. About 30 residents of the surgery department participated in the activity. To start with, a hypothetical scenario was given to participants to write a prescription for a patient with Diabetic foot ulcer and uncontrolled diabetes in a 56 years old male for last 14 years. Prescriptions written by participants were collected. Afterwards, there was a power point presentation by a faculty member on prescription writing in which all aspect of standard prescription for a patient were highlighted. After presentation, participants were asked to write again prescription for same patient. Both pre test and post test prescriptions were analysed and discussed with participants. Feedback of participants was very useful all admit that this was a very useful activity for their training as a doctor and will be helpful for there career as a doctor.

 Reflective Feedback as a Mentor

As a mentor conducting the small group activity on writing a standard prescription was a very interesting and useful activity both for faculty and residents. The initiative to arrange this activity was raised by the frequent observation of common shortcomings in prescription writing among our doctors, a critical skill that forms the foundation of patient care and reflects the competence and professionalism of the treating physician.

The participation of 30 house surgeons/ resident doctors in this activity was encouraging and reflects their interest to learn and improve. The hypothetical scenario of a patient with a diabetic foot ulcer and poorly controlled diabetes was given to participants. The initial prescriptions written by participants highlighted the gaps in knowledge and practice, which is reflection of need of this training.

The PowerPoint presentation on prescription writing served as a structured guide to emphasize the essential components of a standard prescription, such as patient biodata, legible drug dosages, and clarity in instructions. Following the presentation, participants had the opportunity to apply their newly acquired knowledge by rewriting the prescription. The noticeable improvement in the post-test prescriptions underscored the effectiveness of the session.

 Pre-test and post-test prescriptions allowed for a deeper understanding of the challenges they face and provided insights into how these can be addressed. The feedback received from the participants was overwhelmingly positive, with many acknowledging the significance of this activity for their training and future careers.

As a mentor, this experience has reinforced my belief in the importance of hands-on, practical learning. It was rewarding to see the participants recognize the value of standard prescription writing and express their commitment to improving their skills. Moving forward, I am motivated to continue organizing such activities that address critical aspects of medical training and contribute to the development of competent and conscientious healthcare professionals. It is suggested that this type of practical activities and other such activities like medicolegal documentation, interdepartmental communications, & referrals of patients, consent of a procedure/ intervention   etc. must be introduced and incorporated in curriculum of foundation year of medical graduates.  Including   prescription-writing workshops as part of the monthly or quarterly training curriculum at each clinical department level is another option to improve this skill in resident doctors.

Introduction of an electronic prescription-writing module for interns to practice should also be included, this could simulate real-life scenarios and offer instant feedback on errors. At the end of the training, award certificates to residents who excel in prescription writing could motivate others to take the activity seriously.

Dr Muhammad Ateeq

Professor of Surgery NSMC/ABSTH

Gujrat

Dated: 04th January 4, 2025

DEPARTMRNT OF SURGERY NSMC AZIZ BHATTI SHAHEED TEACHING HOSPITAL GUJRAT

PGD HPME HSA ASSIGNMENT

ACTIVITY BASED ON THE CONCEPT OF MICROTEACHING IN EDUCATION

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ACTIVITY TITLE:   DEMONSTRATION ON CLINICAL EXAMINATION OF THYROID SWELLING

VENUE:  CONFERENCE ROOM DEPARTMENT OF SURGERY ABSTH GUJRAT

AUDIENCE:            CLINICAL RESIDENTS & FACULTY OF DEPARTMENT OF SURGERY

TEACHING METHODOLOGY: MICROTEACHING/ INTERACTIVE/ DEMONSTRATION OF CLINICAL SKILLS

TEACHER/ FACILITATOR: DR MUHAMMAD ATEEQ

DURATION: 20-30 MINUTES

 OBJECTIVES OF ACTIVITY

By the end of this session, surgical residents should be able to:

·        Understand the steps involved in the clinical examination of thyroid swelling

·        Identify key clinical features that differentiate different types of thyroid swellings benign vs malignant etc.

·        Interpretate clinical findings in the context of patient history 

Material needed:

1.  Patient with thyroid swelling

2.  Clinical examination kit

3.  White Board

4.  Pen & preformed Performa for feedback from participants

FORMAT OF ACADEMIC SESSION

A: Introduction (5 minutes)

·        To set the context and explained the purpose of the activity and its importance in future clinical examination and clinical practice of participants

·        Welcomed the participants and did self-introduce and asked the participants about their base line knowledge and familiarity with thyroid diseases.

·        Provided overview of the thyroid swellings in terms of epidemiology, pathophysiology, types of goiters and importance of clinical examination in diagnosis & management

B: Presentation / Demonstration of Clinical Examination of Thyroid   (10 Minutes)

Step by step Demonstration in following sequence:

·        Greet the patient

·        Exposure & Privacy of patient

·        Examination divided in to two parts

1: Structural / Anatomical evaluation of thyroid

·        Site, Size, Consistency, Morphology, Diffuse/ Nodular, Retrosternal extension/ Suspicious nodule if any?

2: Functional status of thyroid gland, that includes

·        Hypo/ Hyperthyroidism

·        Eye signs, Cardiac signs etc.

C: Interactive engagement of participants: (5 Minute)

Selected residents were allowed to perform clinical examination of thyroid on patient. They were observed and guidance was provided where ever they need to correct their technique.

D: Case Discussion: (5 Minutes)

After the practice, patient problem was discussed briefly. Clinical finding was interpretated and clinical diagnosis was made. Management plan was discussed briefly.

D:  Closing of activity:

·        Recap of key points

·        Emphasized the importance of correct & systematic clinical examination in the management of disease 

·        Answered remaining questions of participants

·        Activity was concluded with positive note

E: Feedback & Reflection (5 Minutes)

Objective was to get the feedback of residents & peers on different aspect of the activity from feedback regarding the teaching methodology of the teacher, contents of the presentation, format, sequence and logistics. Two separate feedback proformas each for resident & peers were distributed among the participants

FEEDBACK OF SURGICAL RESIDENTS

Following structured proforma was distributed among the surgical residents for their feedback

A:  Clarity of instructions:  How clear were the instructions provided during the activity/ demonstration?

Very clear

Clear

Somewhat clear

Not clear at all

B: Practical application:  How helpful was the hands-on-practice session for you?

Very Helpful

Helpful

Somewhat helpful

Not Helpful

C:  Engagement & Interaction:  Did you feel engaged during the session?

Highly engaged

Engaged

Somewhat engaged

Not engaged

D: Methodology of presentation: Did you feel methodology of presentation was helpful in achieving the objectives?

Very helpful

Helpful

Somewhat Helpful

Not at all

E: Content Understanding:  Do you feel that teachers has successfully made you understand the key steps with clinical signs associated with thyroid swellings?

Excellent understanding

Very good understanding

Good

Fair

F: Usefulness of case discussion: Was the case discussion was relevant and helpful in understanding the clinical approach to thyroid swelling?

Very Helpful

Helpful

Somewhat Helpful

Not Helpful

G: Confidence & Presentation skills of presenter:

Excellent

Very good

Good

Fair

 H: What did you think most useful about today’s activity?

The opportunity provided during this session to examine the thyroid gland in systematic way and correlations of clinical findings with patients’ symptoms and art of framing clinical diagnosis of various types of goiters was an excellent experience for us.

I: Suggestions for improvement:

 A short video presentation of clinical examination of thyroid swelling will be a good addition in methodology of this activity.  Video Recording of the activity will be helpful in maintaining the digital library of the department and can be shared on academic forum on social media account of the department. 

 FEEDBACK PROFORMA FOR PEERS

Name of Peer:  Dr Sajid Aziz Associate Professor Surgery

Date: 7th January 2025

A:  Teaching effectiveness:  How effective the teaching methods used?

1.  Very effective

2.  Effective

3.  Somewhat effective

4.  Not Effective

B: Clarity of Explanation: Was the demonstration of clinical examination clear and easy to follow?

1.  Very clear

2.  Clear

3.  Somewhat clear

4.  Not clear

C: Time management:  How well was time managed during the session ( Balance between theory & practice)

1.  Very well managed

2.  Well managed

3.  Somewhat managed

4.  Poorly managed

D: Interaction / Engagement with participants: How well did the teacher engage with the participants during the session?

1.  Highly engaged

2.  Engaged

3.  Somewhat engaged

4.  Not engaged

E: Handling feedback & questions? How effectively did the instructor handle participants questions and  gathered feedback?

1.  Very effectively

2.  Effectively

3.  Somewhat effectively

4.  Not effectively

F: Content Accuracy:  Was the content presented accurately & comprehensively?

1.  Very accurate

2.  Accurate

3.  Somewhat accurate

4.  Inaccurate

G: Suggestions for improvement:

1.  This activity should have been the regular feature of the academic activities of the department. This will be helpful in faculty development and teaching & training of not only future doctors also for medical teachers.

2.  Video recording of such activities for development of digital library of the surgery department

  REFLECTIVE FEEDBACK ON MICROTEACHING SESSION: CLINICAL EXAMINATION OF THYROID SWELLING

1.      Where the learning objectives were achieved?

The goals of the academic session and outcome  and learning objectives were achieved. The primary goal of this academic activity was to make the residents familiar with the importance of clinical examination in the management of patients. Secondly, they become able to do systematic and focused clinical examination of thyroid swellings. At the same time, they can apply their knowledge, interoperate and correlate the clinical signs with the symptoms of the patient to frame clinical diagnosis.

2.  What went well in this session?

The demonstration of the clinical examination technique was well received with residents expressing confidence in their ability to replicate the steps. The hands-on session directly apply the core theoretical knowledge reinforcing their learning. The case discussion provided an opportunity to interact with each other, participate in group discussion and fill in the gaps in their understanding.

3.  Was the teaching methodology being effective?

The teaching methos, particularly the microteaching concept adopted in this activity was effective in creating a focused learning environment. Demonstrating the clinical examination followed by a practice was a good strategy for reinforcing the content.

4.  What could have been improved?

One thing is need improvement is time management. This is time bound activity lasts for 20-30 minutes. All residents not get an opportunity to practice clinical examination on a real patient. We have to keep in mind the privacy & comfort of the patient.  Examination of purpose build dummy is a good option to overcome this shortcoming. Video presentation of clinical examinations  on multimedia before hands on practice will add in better understanding.

Video recording of session and for development of digital library of the department will a step forward in this direction. 

5.  Conclusion:

In conclusion, the microteaching session on thyroid swelling examination was largely successful in achieving its learning goals. The hands on nature and peer feedback added significant value to the session. Moving forward, I will focus on time allocation for practice and ensuring more engagement from all participants.

Professor Dr Muhammad Ateeq

NSMC Gujrat

9th January 9, 2025

 PGD HEALTH PROFESSIONAL EDUCATION HSA

Assignment No 6

Self-Reflective Feedback – Morbidity & Mortality Meeting   ABSTH Gujrat

Last week, I had the opportunity to chair the monthly Morbidity & Mortality (M&M) meeting at Aziz Bhatti Shaheed Teaching Hospital, Gujrat. The committee, constituted by the Principal of Nawaz Sharif Medical College on the direction of by the Specialized Health Care & Medical Education Department Lahore. This clinical audit activity plays a crucial role in reviewing the hospital's mortality statistics and identifying areas for improvement in patient care.

The meeting took place on the 6th January 9, 2025 in the hospital's conference room. Ccommittee composed of clinical coordinators from various departments. The primary aim is to evaluate the hospital's mortality cases for the preceding month, analyse specific cases, and identify any underlying factors contributing to mortality, with the goal of improving overall patient care.

As the chair, my responsibilities included leading the discussions, ensuring that each case was examined in-depth, and guiding the members through the process of identifying contributing factors, both systemic and human, in-patient outcomes. I observed that cases were tagged with colour codes (green, yellow, and red) based on the extent of clinical or system-related shortcomings, and that recommendations were provided to improve clinical practices and patient management.

Throughout the meeting, I reflected on both the positives and areas for growth. I believe the meeting provided a useful platform for discussing case specifics and promoting open discussions on clinical shortcomings. However, I also noted a recurring challenge in engaging the clinicians during the meeting. The lack of interest and reluctance among some clinicians to openly discuss potential areas of negligence in patient management was apparent. This fear of being identified for errors is a concern that I believe hinders the effectiveness of the clinical audit process. Addressing this issue is crucial for improving the quality of healthcare service delivery.

Looking back, I recognize that while the meeting structure was sound, my approach to encourage a more open and constructive dialogue could have been stronger. I could have introduced more interactive discussions or provided additional reassurance to clinicians about the constructive nature of the review process, emphasizing that the goal is to learn and improve, not to penalize.

Moving forward, I intend to work on creating an environment in future meetings where clinicians feel more comfortable discussing errors and areas for improvement. This could involve focusing on building trust, ensuring that the purpose of the meeting is clearly communicated, and demonstrating how clinical audits contribute directly to improving patient outcomes. Additionally, I plan to encourage more active participation by reinforcing the importance of collaboration among departments and the collective responsibility of improving healthcare quality.

In conclusion, this experience allowed me to recognize the complexities of leading such a critical meeting, and I am committed to improving both the process and the atmosphere in future M&M meetings. This will, I believe, foster a more open and productive discussion that ultimately leads to better patient care and fewer preventable deaths.

Professor Dr Muhammad Ateeq

NSMC Gujrat

9th January 9, 2025

 ASSIGNMENT NO 7 SELF-REFLECTIVE WRITING PGD HEALTH PROFESSIONAL MEDICAL EDUCATION

Self-Reflective Writing on the Implementation of Minimum Health Delivery Standards (MHDS) Indicators in Aziz Bhatti Shaheed Teaching Hospital Gujrat

Last week, during a meeting chaired by the Principal of Nawaz Sharif Medical College Gujrat, with the faculty and administration of Aziz Bhatti Shaheed Teaching Hospital, I was entrusted with an important administrative assignment. I was appointed as the chairman of the committee tasked with implementing the Minimum Health Delivery Standards  (MHDS) indicators across various departments of the hospital. This task was initiated by a directive from the Punjab Health Department, which emphasized the need for hospitals to comply with MHDS standards. Unfortunately, over the years, there has been little awareness or emphasis on these standards within the hospital, and the principal felt it was necessary to address this issue. Hence, I was given the responsibility to make strategy & the implementation of these standards.

My first step in this process was to convene the committee, where we developed a comprehensive plan and execution strategy. I thoroughly reviewed the support material and guidelines provided by the Health Department, which included a set of indicators. These indicators, however, were not easily understandable by all hospital staff, including doctors, nurses, and paramedics. To address this challenge, I created a simplified checklist that would be easier for all staff members to understand and implement. I recognized that the original checklist lacked clarity, making it difficult for the staff to grasp the full scope of the implementation.

To raise awareness and build understanding of the MHDS program, I organized a two-day series of preliminary visits to the various clinical departments. The goal of these visits was to sensitize the doctors and paramedical staff about the significance of the MHDS program and ensure they understood the indicators and the expectations of the program. During these sessions, I took time to elaborate on the checklist, clarifying any points of confusion, and provided a detailed explanation of the implementation strategies.

The second phase of this initiative will begin on 24th January 2025, when the departments will be revisited to assess the progress of implementation. A scoring system will be used to evaluate how well the departments have adhered to the MHDS indicators. The final phase will involve surprise visits to ensure the indicators are being followed consistently and effectively.

As I reflect on this experience, I encountered some challenges that I had not anticipated. One of the most significant observations was the limited participation of senior faculty members. Many senior doctors were either absent or did not attend the sessions in their departments, which was disheartening. On the other hand, the nursing staff was much more receptive and engaged in the process. This discrepancy in involvement was particularly striking and led me to conclude that young doctors in our institution may not be sufficiently trained in non-technical clinical skills. These skills, such as ward administration, proper documentation, and the planning and implementation of healthcare delivery strategies, are crucial to the effective running of a hospital. It became evident that these aspects are often overlooked in medical education, as the focus tends to be predominantly on clinical skills.

I strongly believe that there should be a structured module within the training of young doctors to equip them with these non-technical clinical skills. The role of a doctor is not only that of a clinician but also that of a planner and facilitator in the hospital environment. Effective healthcare delivery requires not only technical expertise but also administrative and organizational skills. Young doctors should be trained to become effective leaders and managers in the clinical setting, ensuring that programs like the MHDS indicators can be successfully implemented and maintained.

In conclusion, this assignment has been an enriching experience. It provided me with the opportunity to interact with various members of the hospital staff and understand the challenges they face in adhering to healthcare standards. I am hopeful that this initiative will bring about positive change in the hospital. However, this will only be possible if the hospital staff is fully sensitized to the importance of these standards and if self-motivation is encouraged within the team. The journey towards improving healthcare delivery is ongoing, and I look forward to continuing this process with renewed determination and collaboration from all staff members.

Dr Muhammad Ateeq

Professor of Surgery

NSMC/ABSTH Gujrat

Dated. 18th January 2025

PGD Health Professionals Education HSA

Problem-Based Learning (PBL) Session

Venue:  Department of Surgery ABSTH Gujrat                     

Title: A 25-year-old female with right iliac fossa pain.

Introduction: 

An academic session for postgraduate residents of General Surgery, on the concept of Problem Based Learning (PBL) was arranged in the demonstration room of Department of Surgery. This activity held on 23rd January 2025 at 11:00 AM.  I myself act as Facilitator of the said session. Ten surgical residents of Department of surgery participated in the PBL session.  First of all, format of PBL session was briefed to the participants after a quick review of textual details of PBL.  Learning objective of this activity were clearly framed so that we can evaluate whether these objectives are achieved or not on the basis of feedback of students and reflective feedback of myself as a facilitator.

A power point presentation was prepared and the format, sequence of case as we move forward in discussion was displayed in slides. (Anx I)

Title: Right Iliac Fossa Pain

Learning Objectives of the academic activity:

1. To understand the anatomy, physiology, and differential diagnoses of pain in the right iliac fossa (RIF).

2. To critically analyse clinical presentation, history, physical examination, and investigations for diagnosing right iliac fossa pain.

3. To formulate a management plan for the most likely diagnosis.

4. To recognize the importance of timely intervention and complications of misdiagnosis.

Case History:

 A 25-year-old female presents to the Emergency Department with a complaint of acute pain in the right iliac fossa (RIF) for the last 6 hours. She describes the pain as sharp and constant, gradually increasing in intensity. She is also experiencing nausea and mild vomiting. The patient denies any significant past medical history, and she is not on any medication. She is sexually active, using oral contraceptive pills.

Opening of Discussion:

FACILITATOR put following initial questions to the participants and started the discussion.

A: What are the possible anatomical structures that could be the source of pain in the right iliac fossa?

·       Consider organs and structures in the region including the appendix, cecum, right ovary, right fallopian tube, ureter, and others.

B: What is the significance of the patient’s gender and age in your differential diagnosis?

·       Consider common conditions for this demographic group.

C: What is the importance of a detailed history in evaluating RIF pain?

·       Investigate potential red flags, onset, duration, progression, associated symptoms, and relevant past medical history.

                          Group Discussion was started among the participants

Step 1:  Participants were asked to ask her clinical Information, by asking more questions in history and examination of the patient.
In groups, students formulated the questions to gather more clinical information from the case. Possible questions were:

• For History:

  • When did the pain start, and how has it progressed?

  • Is there a history of gastrointestinal, gynaecological, or urinary issues?

  • Is there any fever, chills, or change in bowel habits?

  • Any recent trauma or surgical history?

  •  

• For Physical Examination:

  • What are the key findings on abdominal examination that would suggest appendicitis versus other conditions?

  • How would you assess for signs of peritonitis?

  • What is the significance of a positive or negative rebound tenderness?

Step 2:  On the basis of clinical information collected by the students they were asked to make a list of Differential Diagnosis of these cases.

Following possible differential diagnoses based on the clinical information provided, were framed by the sstudents:

• Acute appendicitis

• Ovarian cyst rupture or torsion

• Ectopic pregnancy

• Pelvic inflammatory disease

• Ureteric colic (kidney stones)

• Inflammatory bowel disease (e.g., Crohn’s disease)

Step 3:  Justification of Differential Diagnosis

Students were asked to justify their list of D/D. Why you placed Acute Appendicitis at the top of list and Inflammatory Bowel Diseases at the bottom. Similarly, all the differential diagnosis were discussed among the participant. Once the consensus was made that the most probable clinical diagnosis is Acute Appendicitis, they were asked to suggest investigations.  
What investigations would you order to confirm or rule out your differential diagnoses?

Step 4:   Suggest relevant Investigations:

Following investigations were suggested by participants

• Laboratory tests: Complete blood count (CBC), C-reactive protein (CRP), pregnancy test (urine or serum)

• Imaging: Abdominal ultrasound, CT abdomen (if appendicitis or other serious conditions are suspected)

• Urinalysis

Step 5: Interpretation of Investigations

Based on the chosen investigations, students were asked to  analyse the possible results and interpret how they would guide further management.

Step 6: Participants were asked to summaries their patient:

The patient’s History of pain right iliac fossa of short duration, physical examination reveals tenderness in the right iliac fossa with rebound tenderness and guarding. Vital signs are stable, and the laboratory investigations show a mild leucocytosis.  A urine pregnancy test is negative. Abdominal ultrasound does not reveal any free fluid or masses, but a CT scan of the abdomen suggests acute appendicitis.

Final Diagnosis: Acute Appendicitis

Management Plan

Students were asked to give management plan for her?

Students gave following management plan for her

1. Immediate Management:

   • Intravenous fluids (normal saline or Ringer’s lactate)

   • Analgesia (NSAIDs as needed)

   • Antibiotics (Broad-spectrum antibiotics to cover possible peritonitis)

2. Surgical Intervention:

   • Appendectomy (open or laparoscopic) as the definitive treatment.

3. Post-Operative Care:

   • Monitoring for post operative care related to Anesthesia, post op pain etc.

   • Intravenous fluids

   • Gradual reintroduction of diet and ambulation.

 Reflective questions to the students, considering if the diagnosis is other then Acute Appendicitis?

1. How would the management change if the patient was found to have an ectopic pregnancy instead of appendicitis?

2. What are the potential complications of an appendectomy, and how can they be prevented?

3. What are the limitations of imaging in diagnosing appendicitis, and how can you overcome these challenges?

Feedback of the participants:

At the end of activity, students were asked to give their views regarding experience of PBL activity and also give feedback on overall proceedings of this academic session.

The postgraduate residents, expressed their views and paid gratitude for the opportunity to engage in this Problem-Based Learning (PBL) session. The case of the 24-year-old female with right iliac fossa pain for the past six hours was an excellent choice as it provided an in-depth and relevant scenario to enhance our clinical reasoning skills.

The session allowed us to actively participate in problem-solving and critical thinking, which are essential components in our development as future surgeons. The collaborative approach provoked meaningful discussions and encouraged us to interact each other and share our   both theoretical knowledge and clinical experience. We were able to consider a wide differential diagnosis, suggest relevant investigations, and discuss management plans in a structured manner, which will undoubtedly be valuable in real-world clinical practice.

The facilitator's guidance and timely interventions helped clarify important concepts and ensured we remained on track throughout the session. Their ability to stimulate thought-provoking questions and lead discussions in a patient-cantered way was highly appreciated.

In future sessions, we would appreciate a bit more time to explore certain differential diagnoses and management options in greater detail. Additionally, it would be beneficial to include more interactive elements, such as physical examination demonstrations or simulated patient scenarios, to further strengthen our hands-on clinical experience.

Conclusion: / Reflective feedback:

This PBL format fosters critical thinking and collaborative learning while addressing a common clinical scenario encountered in medical practice. This PBL activity encourages students to develop a systematic approach to evaluating right iliac fossa pain by considering anatomy, differential diagnoses, clinical examination, and investigation results. The activity also emphasizes the importance of timely diagnosis and appropriate management, especially in acute surgical emergencies such as appendicitis.

Dr Muhammad Ateeq

Professor of Surgery NSMC/ ABSTH

Gujrat   Dated: 25th January 25

 ASSIGNMENT NO 08

REFLECTIVE WRITING PGD HEALTH PROFESSIONAL EDUCATION HAS

HANDS ON WORKSHOP BASIC SURGICAL SKILLS

Knotting & Suturing

The recent hands-on workshop on Surgical Suturing & Knotting, organized by the Department of Surgery for newly joined House Surgeons, proved to be an invaluable initiative for the professional development of our interns. This workshop is part of a regular training program that ensures our House Surgeons are equipped with the basic surgical skills necessary for their internships. It is an essential part of their training to gain proficiency in knotting and suturing from the outset of their surgical careers.

The activity, held in the Demonstration Room, was made possible by the generous logistical support of SAMI Pharmaceuticals, and we were able to provide an enriching learning experience for 18 newly inducted House Surgeons. The presence of three senior faculty members and two senior Postgraduate Residents as facilitators ensured a high level of expertise and supervision. The educational approach was multifaceted, incorporating a PowerPoint presentation on suture materials and needles, a video demonstration of various suturing and knotting techniques, and most importantly, practical hands-on training.

The workshop was structured to foster interactive learning, with the participants divided into four groups, each supervised by a faculty member. This allowed us to provide personalized attention to each participant, ensuring that every House Surgeon had ample time to practice and refine their skills. The feedback received from the participants was overwhelmingly positive, with many expressing their satisfaction and eagerness to engage in similar activities in the future.

As the supervisor of this workshop, I firmly believe that incorporating such hands-on practical sessions into the curriculum of the foundation year for all new doctors is critical. These workshops serve as an introduction to the essential technical skills that every House Officer, particularly those in Surgical and Allied disciplines, must master. It is crucial to create an environment where new doctors can develop their confidence and competence in basic surgical skills before they move on to more complex procedures.

Furthermore, I strongly recommend that skills labs become a core component of every clinical department within the hospital. These labs provide a controlled environment for House Surgeons to practice, learn, and refine their skills with guidance from experienced faculty members. Regular workshops like these, integrated into the medical curriculum, will not only enhance the overall quality of training but also ensure that our interns are better prepared for the challenges they will face in their surgical careers.

In conclusion, the Surgical Suturing & Knotting workshop was a great success, and I look forward to making it a regular feature in the training program for all future batches of House Surgeons. I am confident that this initiative will contribute significantly to the development of our House Surgeons and ultimately improve the standard of surgical care provided at our hospital.

Professor Dr Muhammad Ateeq

NSMC/ ABSTH Gujrat

22nd January 22, 2025

ASSIGNMENT NO:09   PGD Health Professional Education HSA

Reflective Writing on the Surgical Resident’s Performance in a Critical Trauma Case

Department of Surgery NSMC/ Aziz Bhatti Shaheed Teaching Hospital Gujrat

As a supervisor, moments such as the one incident faced by my surgical residents in the trauma centre of Aziz Bhatti Shaheed Teaching Hospital bring immense pride and satisfaction. A tragic event, a road traffic accident resulting in a patient with a severe head injury and a Le Fort III fracture of the skull bone brought in the ER department. postgraduate surgical residents           (Dr. Haseeb & Dr Farhan) attended the patient.  Patient was in respiratory distress, cyanosed & laying listlessly. This was an opportunity for my residents to demonstrate not only their technical skills but also their ability to make split-second decisions under extreme stress. The actions that followed were nothing short of extraordinary.

 It was clear that time was of the essence. With neurosurgery unavailable at the moment, my residents stepped up in to the field and made a critical decision: securing the patient’s airway through a surgical procedure despite the constraints of the situation.

As I reflect on the incident, what stands out most is the decision-making process that unfolded. Without the specialized equipment typically available for tracheostomy, they exhibited ingenuity and resourcefulness. They knew the urgency of the situation and recognized that the patient’s life depended on swift action. In a split second, they opted for a surgical approach and made an incision in the midline of the neck, demonstrating not only their technical acumen but also their cconfidence under pressure. The patient immediately began to breathe, and his complexion transformed from blue to pink, a visible sign of the team’s successful intervention.

The use of an endotracheal tube in place of the missing tracheostomy tube was a quick-thinking, alternative solution that allowed the team to continue ventilating the patient and stabilize his condition. Their execution of this plan was not just about saving a life—it was a reflection of the training, mentorship, and development that had taken place over time. My residents had absorbed the essential skills and lessons I had taught them, not only in terms of surgical technique but also in maintaining composure, adapting to unexpected situations, and acting with confidence in a high-stress environment.

In his presentation next day in clinical meeting of the department, the resident did an excellent job of narrating the incident, conveying the urgency and complexity of the situation while also describing the anatomical landmarks for securing the airway. This demonstration of technical knowledge, with the ability to function effectively without standard equipment, was an excellent display of the surgical mindset I always strive to install in my trainees. It was heartening to hear him discuss the importance of decision-making and execution under stress, particularly the alternatives available in compromised situations. The patient's revival was not just a matter of medical expertise—it was a testament to the resilience, innovation, and commitment of the surgical team.

As a trainer and supervisor, there are few moments more gratifying than seeing your residents grow into competent, confident professionals who can handle complex, high-stakes scenarios with grace and skill. This particular incident was a real reminder of the profound impact we can have as medical professionals—how we are entrusted with the responsibility of life and death, and how our training and experiences shape us to rise to such challenges.

The words of the Quran resonate in my mind as I reflect on this event:

“And whoever saves one [life]—it is as if he had saved mankind entirely.” (Quran 5:32).

In moments like this, the true essence of our work as healthcare providers becomes clear. Saving a life is not only an act of medical intervention; it is a spiritual and human achievement. I take immense pride in the growth of my residents and the success of our efforts. This incident was a profound affirmation of the importance of not just knowledge and technique, but resilience, critical thinking, and ethical decision-making in our future doctors. It is moments like these that make the rigors of training and supervision deeply rewarding.

   Dr Muhammad Ateeq 

Professor of Surgery NSMC 

Dated 31st January 2025

PGD Health Professionals Education

Program Evaluation by applying any one model of Program / Training evaluation:

Textual briefs   on different models of Program/ Training evaluation

Key points about these models:

·        CIPP Model:

A comprehensive approach that examines the context, inputs, processes, and products of a program, providing information for decision-making at various stages of program development. 

·        Kirkpatrick Model:

Widely used in training evaluation, it looks at four levels of evaluation: participant reactions, learning acquired, behaviour change, and organizational results. 

·        Logic Model:

Visual representation of a program's theory of change, mapping inputs, activities, outputs, outcomes, and impacts to understand the causal chain. 

·        Anderson Value of Learning Model:

Emphasizes aligning a learning program's goals with the strategic goals of the organization to assess its effectiveness. 

·        Brinkerhoff Success Case Method:

Focuses on analysing extreme cases of success or failure within a program to identify key factors impacting outcomes. 

Other important program evaluation models:

·        Formative Evaluation:

Conducted during program implementation to identify areas for improvement and make adjustments as needed. 

·        Summative Evaluation:

Evaluates the overall effectiveness of a program at its conclusion to determine whether goals were achieved. 

·        Process Evaluation:

Examines the program's activities and implementation process to ensure fidelity and identify potential issues. 

·        Outcome Evaluation:

Measures the changes or impacts on participants as a result of the program. 

(216 Words)

ASSIGNMENT:   Apply any model top evaluate any educational program and write a report of not more than 1000 words to be placed in your portfolio:

Plan: Evaluation of Five years MBBS in Pakistan by applying  CIPP model of program evaluation.

CIPP PROGRAM EVALUATION MODEL:  CONCEPT BRIEF

The CIPP model which stands for Context, Input, Process & Product, is an evaluation framework that can be applied to assess the effectiveness of a program like MBBS (Bachelor of Medicine & Bachelor of Surgery) curriculum.

Planning of evaluation of MBBS Program on CIPP model:

I break up the each of component of CIPP model and applied to evaluate MBBS program.

1: CONTEXT EVALUATION:

Following 3 objectives were framed to evaluate the context of MBBS program.

1.1.   Relevance to heath care needs of the community of Pakistan:

Is the curriculum of 5 years MBBS program is aligned with the present, and future health care needs of Pakistani papulation? Secondly weather this curriculum / program is making ready our future doctors to manage healthcare challenges & evolving medical practice.

Recent amendments made in revised MBBS program; this aspect of future needs related to health care of community are very well emphasized. I think there is adequate modules spread over 5 years program to prepare our future doctors to face these challenges effectively.

1.2.   Societal Demands: Present MBBS program is adequately addressing the need of national & global health care challenges, e.g., Focused on chronic diseases, public health policies etc.

1.3.   Institution Goals: Present MBBS program is aligned with the intestinal goals like providing competent health care professional who can contribute to improve quality of health care.

2:   INPUT EVALUATION:

Input evaluation assesses the resources, strategies, execution plans to deliver MBBS program. It includes the 4 components like, Curriculum content & Design, faculty qualification & training, provision of adequate learning resources to students & teaching methodologies uniformly in all medical colleges of the country.  There is gross variation in public sector & private medical colleges. Strict compliance & standardization is lacking especially in new public sector & most of private medical colleges.  The MBBS curriculum currently implemented in Pakistan addressing this aspect comprehensively and Pakatan Medical & Dental Council is now started implementing this policy. Discrepancy in provision / availability of gadgets/ infrastructure, human resources required to implement is not a hidden reality. Without implementing this uniformly the goal achieving graduates to face the health care challenges can not be achieved. The colleges, irrespective of public or private status shall not to be allowed to continue unless they ensure provision of all required input in terms of infrastructure / learning rehouses to the students.   Adaption of various teaching methodology like PBL, TBL, case -based learning should be done in all medical colleges in both preclinical and clinical settings.

3: PROCESS EVALUATION:

This objective of this parameter to evaluate how MBBS program is implemented in terms of teaching & learning practices, students’ participation, adequate clinical exposure and practical hands-on training programs in clinical settings and with use of simulators.  This aspect is not uniformly addressed in public & private sector medical colleges. The private medical colleges there is less number & variety of patients is available due paid health care services. On the other hand, in public sector colleges patient load is more as compared to available faculty and multiple commitments of faculty in public sector hospital. Implementation of strict compliance to provision of Skill labs in all medical colleges is the way forward to achieve this goal. PMDC the regulatory body of medical education in Pakistan recently working effectively to get 100% compliance of medical colleges to achieve desired objective of curriculum.

4: PRODUCT EVALUATION:

It focuses on the outcome of the MBBS program, specifically whether it meets the objectives in terms of competence of Graduates, employment opportunities of employment of new doctors, satisfaction of all stakeholders (Hospitals / Clinics) satisfied the performance of new graduates. Reflective feedback of graduates, do they themselves feel that they were well prepared by the program. Presently there is no such tools of product evaluation are in practice in field. An indirect evaluation in terms of application of standards of healthcare uniformly in all hospital & clinic, adverse events / complications / mortality etc. reporting is in practice under the Heath Care Commission. Structured feedback of stakeholders & reflective feedback of doctors working is required to assess part of the MBBS curriculum.

Different tools of assessment evaluation like written tests, practical exams, TOCAS, OSPE etc. must be practiced and recorded mere reflection in curriculum is not the answer, practical implementation and continuous monitoring is suggested.

CONCLUSION:

The CIPP model offers a comprehensive framework for evaluating an MBBS program being practiced in Pakistan. By assessing the context, input, process and product of the curriculum, faculty and administrators can identify area for improvement and take further measures to ensure the program is responsive to the needs of the society and produce well prepared graduates trained adequately to meet the challenges of modern healthcare.

Five-year MBBS program in Pakistan is adequately covers the all aspect need to be included in the teaching and training of future doctors. The issue is the lack of implementation of all components due to diversity of infrastructure, faculty availability, patient load, variety of clinical cases in hospitals affiliated with public & private medical colleges.  Mandatory provision of Skill labs in all medical colleges with trained facilitators is the only way forward to achieve a product of graduate well trained & prepared to face the present & future challenges of healthcare in Pakistan.

Regular evaluation using the CIPP model will allow for continuous refinement of the curriculum to keep it relevant, effective, and aligned with both academic standards and health care requirements. 

Professor DR Muhammad Ateeq  (959 words)   Total 1178 words

ASSIGNMENT 10: PGD HEALTH PROFESSIONLAS EDUCATION HSA

Reflective Writing on the 30th January 2025 Hospital Morbidity & Mortality Committee Meeting

On 30th January 2025, I faced an unexpected and challenging situation as the Chairman of the Hospital Morbidity & Mortality (M&M) Committee. The meeting was meant to fulfill the purpose of reviewing mortality cases, a process that is fundamental for improving the quality of care provided by the hospital. However, the day unfolded in a way I did not anticipate, creating a difficult and awkward moment for me as a leader and for the committee itself.

Prior to the meeting, there had already been ongoing reservations from the departments of Medicine and Gynaecology. Both departments had expressed concerns about the continuation of the M&M meetings at the hospital level, as well as doubts about the composition and functioning of the committee. Their reservations were based on a fear that their shortcomings in patient care might be highlighted, potentially leading to negative consequences for the faculty members involved. This fear of exposure seemed to be driving their resistance to the forum and its processes.

Despite my efforts to address their concerns during the previous meetings and through the official minutes shared with the Principal NSMC, the objections were brought up again during the meeting on 30th January. The head of the representatives faculty members of  Medicine and  Gynaecology raised concerns about the need for these meetings, questioning the structure and objectives of the forum. I attempted to reassure them by reiterating the primary aim of the M&M meetings — to promote self-analysis, audit patient care, and identify gaps in healthcare delivery, with the intention of improving future practices, not to place blame or assign responsibility for individual mistakes.

However, despite my explanations and references to international best practices and the broader goals of the M&M meetings, the participants continued to steer the conversation off-course. It was evident that their concerns were rooted in an internal fear of exposure, and no amount of reassurance seemed to ease their anxieties. This led to a breakdown in the meeting's flow, and I made the decision to adjourn the meeting, seeking further guidance from the Principal NSMC before proceeding.

Reflecting on the situation, I recognize several key takeaways.

First, the underlying issue was not the structure or objectives of the M&M meetings, but rather the deep-seated insecurities within the departments about potential exposure and accountability. The faculty’s reluctance to engage with the process in a constructive way highlighted a need for better communication and trust-building. The meetings are designed to provoke  a culture of continuous improvement, not one of blame or punishment. It is crucial that all members of the medical staff understand and embrace this philosophy for the meetings to be effective in improving patient care and hospital operations.

Second, I acknowledge that I could have done more to create a more open dialogue before the meeting to address these fears. While I did my best to communicate the purpose of the M&M forum in the previous meetings, it was clear that the concerns were not fully addressed or alleviated. I believe that engaging in more one-on-one conversations with key stakeholders beforehand might have helped mitigate some of the resistance during the meeting.

Lastly, this experience has highlighted the need for clear guidelines and more structured communication from the Principal NSMC. Their involvement is crucial in setting the tone for these meetings and reinforcing the importance of the M&M forum as a tool for self-improvement, rather than a mechanism for blame. I hope that moving forward, there will be greater support and alignment from leadership to ensure that these meetings can serve their intended purpose.

In conclusion, while the meeting on 30th January 2025 did not go as planned, it provided valuable insights into the challenges of leadership in creating a culture of accountability and improvement. I am committed to working through these challenges, with a renewed focus on building trust and transparency across departments, and ensuring that the M&M meetings fulfill their purpose of enhancing the quality of patient care at the hospital.

Professor Dr Muhammad Ateeq

Dated: 06th February 2025 

Assignment No 11: PGD Health Professionals Medical Education HSA

REFLECTIVE WRITING

A Memorable Day: Welcoming My Mentor and Teacher

On 13th February 2025, I experienced one of the most significant moments of my career as a surgeon and a teacher—a day that will forever be remain in my memory. On that day, my teacher, mentor, and the person who has had an immense influence on my life and career, Professor Dr. Asif Zafar Malik, visited the Department of Surgery at Aziz Bhatti Shaheed Teaching Hospital, Gujrat.

Professor Zafar, an esteemed Consultant Urological Surgeon at Youvil Hospital in Summerset, UK, and former Professor of Surgery at Rawalpindi Medical College, graciously accepted my invitation to visit. Reflecting on this, I couldn't help but feel a profound sense of gratitude, knowing that our association spans over 32 years. My journey began as a House Surgeon in 1993 under the mentorship of the late Professor Khalid Cheema, with Professor Zafar serving as an Assistant Professor at the time. To have him return as a mentor and guide, at this stage of my career, filled me with deep emotion and pride.

As the Head of the Surgical Unit at the very hospital where, welcoming Professor Zafar felt like a dream. The excitement of my residents, who were eager to meet the teacher of their teacher, added to the anticipation of this special occasion. It was a moment I had longed for, one that marked a significant milestone in my professional life.

On that Thursday, 13th February 2025, we organized a full-day event to honour his visit. Accompanying Professor Zafar was his wife, Professor Dr. Tahira Zafar, a renowned haematologist and founder of the Hemophilia Patient Welfare Society Pakistan. She delivered an insightful presentation on managing surgical patients with bleeding disorders, a valuable session for our young surgeons and residents. Her expertise in the field of hematology was truly inspiring, and the knowledge shared was of immense benefit to everyone present.

Professor Zafar's keynote address was a highlight of the day. He shared his experiences and achievements, emphasizing the importance of technology in modern medicine. As a pioneer in introducing telemedicine and robotic surgery to Pakistan, he spoke about his efforts in launching hands-on training workshops on minimal invasive and laparoscopic surgery at Holy Family Hospital Rawalpindi. His words resonated deeply with the young surgeons in the room, as he not only reflected on his own journey but also provided invaluable guidance on career planning. His motivational speech encouraged us all to embrace technology, innovation, and the evolving landscape of medicine.

The residents and young surgeons were deeply inspired by Professor Zafar’s personality, his accomplishments, and his passion for advancing the field of surgery. His visit left an indelible impression on everyone. As a token of appreciation, I had the honour of presenting a souvenir to both Professor Zafar and Professor Dr. Tahira Zafar.

Looking back, it was a moment of profound fulfillment for me—welcoming my teacher and mentor to my department. It was a day that not only highlighted my personal and professional growth but also reaffirmed the enduring impact that great mentors have on our lives. It was truly one of the most memorable days of my life.

 ASSIGNMENT No 12. PGD HEALTH PROFESSIONALS’ MEDICAL EDUCATION HSA

Critical Appraisal of the Qualitative Research Paper

Title: A Qualitative Study of the Psychological Impact of Unemployment on Individuals

Citation: Conroy, M: A Qualitative study of the psychological impact of unemployment on individuals. Masters Dissertation, Dublin, DIT, September 2010

1. Introduction:

Aim & Objectives: The research aim is clearly articulated: to explore the psychological and financial impacts of unemployment on individuals. The study’s focus on the psychological effects on well-being, alongside the financial implications, is highly relevant given the increasing prevalence of unemployment globally. While the aim and objectives are well-defined and achievable, the study would have benefited from more specific research questions to further guide the inquiry and provide greater clarity in how the results can be interpreted. The relationship between the aim and the chosen methodology is evident, but specific research questions could offer deeper insights into specific psychological phenomena.

2. Methodology:

Study Design: The study design is appropriate for the research topic, employing qualitative methods to explore the effects of unemployment on individuals. A qualitative approach allows for the depth and richness necessary to understand the complex psychological experiences of the participants. The use of semi-structured interviews is well-suited for this context, allowing participants to express themselves freely, while still maintaining focus on the research aims.

Sampling: The purposive sampling method is a reasonable choice, given that the researcher sought individuals who have been unemployed for at least six months. This criterion ensures that participants have experienced the psychological impact of unemployment over a significant period. The age range of 30-40 years provides a focused sample, which allows for more direct comparisons. However, the narrow age range limits the diversity of the sample, potentially restricting the ability to generalize findings to younger or older populations.

Data Collection: The use of a Dictaphone for recording interviews and transcribing them verbatim is a standard and effective approach for ensuring accuracy in data collection. The choice of conducting interviews in participants’ homes is commendable, as it helps create a comfortable environment, which may facilitate more honest and open discussions.

Ethical Considerations: Ethical considerations are addressed in terms of informed consent, but the paper would benefit from a more detailed discussion of how participant confidentiality and anonymity were ensured, especially considering the sensitive nature of the topic.

3. Data Analysis:

Analysis Technique: Thematic analysis is an appropriate method for identifying, analysing, and reporting patterns within qualitative data. However, more detail on the specific procedures for coding, identifying themes, and verifying findings would strengthen the study’s methodological transparency. It would also be helpful to include information about inter-coder reliability or triangulation techniques, which can help enhance the trustworthiness of the results. While the absence of statistical analysis aligns with the qualitative nature of the study, further discussion of validation strategies would increase confidence in the findings.

Results: The results are presented clearly, and they are aligned with the study’s aim of understanding the psychological and financial impacts of unemployment. The paper uses tables and figures effectively to make the data more accessible. While the psychological effects are significant, the study could have benefitted from a deeper examination of how family dynamics influence these effects, as it only briefly touches on these aspects.

Limitations: The study acknowledges its small sample size as a limitation, but it does not fully explore how this limitation might affect the interpretation of the results. For example, a small sample size could introduce biases, and a lack of diversity might hinder the study’s generalizability. Furthermore, the study does not address potential researcher biases or how they were managed during data collection or analysis. This is an important aspect to consider in a qualitative study, where the researcher’s perspective can influence the interpretation of findings.

4. Discussion:

Interpretation of Results: The interpretation of the results is logical and justified, linking the findings to the broader psychological theories of unemployment. However, the discussion would have benefitted from a deeper analysis of how environmental and individual factors contribute to the psychological effects of unemployment. A more thorough examination of how long-term unemployment interacts with other socio-economic factors (e.g., family responsibilities, social isolation, housing conditions) could provide a more comprehensive understanding of the phenomena.

Comparison with Existing Literature: The study does well to compare its findings with existing national literature, providing context and helping to frame its results within a broader framework. However, a comparison with international literature could enrich the discussion, offering a more global perspective on unemployment’s psychological impacts, especially in different socio-economic and cultural contexts.

Implications for Practice / Policy: The study presents practical recommendations for clinical practice and future research, focusing on the need for a deeper understanding of the psychological effects of unemployment. While this is important, the paper could have expanded on the potential for policy-level interventions, such as public support campaigns, rehabilitation programs, or targeted employment services. These kinds of policy-level suggestions would strengthen the broader impact of the research.

5. Strengths:

Contribution to the Field: The study makes a valuable contribution to understanding the psychological and financial effects of unemployment. Its findings could be useful for policymakers, particularly in designing interventions that address both the personal and social consequences of unemployment. By exploring these effects in depth, the study highlights the need for more targeted policies to support unemployed individuals.

Robust Methodology: Although the study uses a relatively straightforward methodology, it is nonetheless suitable for the research aim. The sampling, data collection, and analysis are generally well-executed. The methodological approach supports the reliability and validity of the findings, though there is room for improvement in the transparency of some aspects (e.g., coding process, inter-coder reliability).

6. Conclusions:

Summary & Findings: The conclusion is a succinct summary of the key findings, which are meaningful and provide significant insights into the psychological and financial effects of unemployment. The findings are well-aligned with the research aim and offer valuable perspectives for both theory and practice.

Suggestions for Further Research: The suggestion for future research involving larger sample sizes and studies across multiple centres is appropriate and could strengthen the generalizability of the findings. Additionally, incorporating a broader range of age groups, geographic regions, and socio-economic backgrounds would offer a more comprehensive view of the psychological effects of unemployment.

Conclusion: This study is a valuable addition to the literature on the psychological and social impacts of unemployment. It provides important insights, particularly in relation to individuals’ psychological well-being. However, the study’s limitations, particularly regarding sample size and diversity, should be considered when interpreting the findings. Expanding the study to include a more diverse sample would enhance its applicability and contribute to a broader understanding of the issue.

7. References:

The references provided are generally relevant and support the context of the study. However, the inclusion of more international references would help broaden the scope of the research and increase its global relevance.

 Dr Muhammad Ateeq 

20th Feb 2025 

Assignment No 12. PGD Health Professionals Education HSA

Reflective Feedback on Surgical Audit & Mortality & Morbidity Meeting - 21st February 2025

Department of General Surgery NSMC/ ABSTH Gujrat

The Surgical Audit & Mortality & Morbidity meeting held on 21st February 2025 provided a comprehensive and structured platform for reviewing the department’s performance, patient care, and overall clinical outcomes. It is an essential weekly activity that allows the Department of Surgery to engage in reflective practice, identify areas of improvement, and strengthen patient management protocols.

The format used for the meeting, involving a PowerPoint presentation with simple yet detailed tabulated data, effectively communicated the week's surgical cases, including admissions, operations, discharges, and follow-up care. Dr. Aqsa Maryam, who presented this week, did an excellent job organizing and explaining the cases under review. The careful examination of each patient’s treatment journey, identifying issues and addressing them, demonstrated a high level of commitment to improving patient outcomes.

One of the key strengths of this meeting was its collaborative nature. Faculty, residents, and house surgeons actively participated in discussions, contributing valuable insights and suggestions. The inclusion of the histopathology reports for available cases ensured that every aspect of the patient’s journey was thoroughly reviewed. This holistic approach to patient management was particularly beneficial for the younger residents and house surgeons who were guided with practical advice and expert feedback.

The detailed discussion on morbidity was insightful, with gaps in patient care being identified and addressed. The collective wisdom of the faculty members in formulating management plans for complex cases was especially valuable, as it provoked an environment of shared knowledge and teamwork. Additionally, reviewing cases referred to other hospitals highlighted the importance of justification for referrals, which is vital in ensuring that patients receive the appropriate care in a timely manner.

Perhaps the most critical aspect of the meeting was the discussion of mortality. The open analysis of the causes of death, including contributory factors such as system failures, lack of support facilities, or logistical issues, reflected the department's commitment to learning from adverse outcomes. This honest reflection is crucial in developing protocols that not only address medical issues but also system-wide inefficiencies that can affect patient care. By identifying these factors and formulating recommendations, the department is taking proactive steps toward preventing similar issues in the future.

Finally, the inclusion of personal feedback from the participants regarding workplace environment, working hours, and logistical challenges was a valuable aspect of the meeting. It demonstrated a commitment to not only improving patient care but also fostering a supportive and efficient working environment for the team. These discussions can help address issues that may affect staff well-being and performance, ultimately contributing to better patient care.

The department maintains a comprehensive record of all meetings, both in hard and soft formats, including a list of participants. This process is crucial for documenting every academic and clinical activity, ensuring that the department’s records are consistently updated for future reference. These records serve as valuable resources when presenting information to health regulatory authorities such as the Pakistan Medical and Dental Council (PMDC), the University of Health Sciences, and the College of Physicians & Surgeons of Pakistan. The documentation plays a key role in validating the department’s undergraduate and postgraduate programs.

Additionally, a copy of the minutes from selected meetings is forwarded to the administration when facilitation is needed in terms of logistical support or to address administrative challenges faced by staff. This ensures that any issues related to the provision of necessary support facilities or operational concerns are communicated to the relevant authorities for timely resolution.

In conclusion, the Surgical Audit & Mortality & Morbidity meeting is an essential and effective part of the department’s continuous quality improvement process. It promotes transparency, collaboration, and accountability, all of which contribute to better clinical outcomes. The department’s commitment to learning from both successes and challenges ensures that patient care standards are constantly evolving, while also fostering an inclusive, team-oriented atmosphere.

ASSIGNMENT NO:13 PGD HEALTH PROFESSIONAL EDUCATION HSA

Reflective Writing on the Paramedical Staff Event at Aziz Bhatti Shaheed Teaching Hospital, Gujrat – 27th February 2025

On February 27th, 2025, I had the privilege of attending a truly memorable event at Aziz Bhatti Shaheed Teaching Hospital (ABSTH), Gujrat. This event, organized by the nursing staff, arranged both a farewell to a retiring staff nurse and a warm welcome to two newly recruited staff nurses. The ceremony, held in the conference room of the Surgery Department, was a celebration of dedication, service, and the spirit of teamwork that defines the paramedical workforce at ABSTH.

Additional Medical Superintendent Dr. Naeem Khawar, was the chief guest who contributed to the event with his insights and support. It was an honour to be invited as a Guest of Honour. Being the only faculty member from Nawaz Sharif Medical College, Gujrat, and ABSTH to be a part of this gathering was deeply humbling. The affection shown by the nursing staff towards me truly touched my heart and highlighted the strong bonds of respect and affiliation that exist within the hospital.

The retiring staff nurse, during her farewell speech, expressed her deep gratitude and shared her personal experiences of working at the hospital. Her words were filled with emotion and reflection of a dedicated healthcare professional who had devoted years to serving patients.

One of the most emotional moments of the event was the farewell and welcoming address by Nursing Superintendent Ms. Shanaz. Her speech resonated with emotion and sincerity, reflecting the love and dedication she feels for her team. It was the heartfelt words of a leader who not only acknowledges but genuinely cares for the well-being and contributions of every member.

When it was my turn to address the gathering, I was filled with gratitude and admiration for the nursing team at ABSTH. Over the past 15 years, I have had the privilege of working alongside them and witnessing their professionalism and dedication to patient care. The nursing staff at ABSTH is exceptional—well-trained, highly skilled, and always willing to go the extra mile. Their ability to think outside the box and adapt to the demands of patient care and ward management is remarkable. They are an invaluable asset to the healthcare system, and I am proud to have been part of their journey.

The event concluded with remarks from the Medical Superintendent, who gave a summary of the significance of the day. Cake ceremony symbolizing the sweet memories created and the new beginnings ahead. The distribution of souvenirs and gifts further highlighted the warmth and gratitude the hospital administration holds for its paramedical staff.

As the event came to an end, we all gathered for a group photo, which will serve as a memory and an archive of the day’s significance. This event was not just a celebration of the past and present, but a testament to the commitment of the paramedical staff of ABSTH in providing exemplary patient care and support to the hospital’s operations.

Reflecting on this event, I feel deeply privileged to have been part of such a heart-warming occasion. It reinforced the value of teamwork, the importance of recognizing each individual’s contributions, and the emotional connection that binds healthcare professionals together. I am grateful for the opportunity to witness such a celebration of service and commitment for achieving excellence in patient care.

In conclusion, this event was a reminder of the profound impact that dedicated professionals have on the lives of those they serve. The nursing staff at ABSTH exemplifies the true meaning of compassion, and I am proud to continue working alongside them in the pursuit of better healthcare for all.

Dr Muhammad Ateeq 

28th Feb 2025 

ASSIGNMENT NO 14:  PGD HEALTH PROFESSIONALS MEDICAL EDUCATION HSA

Reflective Feedback on White Coat Ceremony – Welcoming the New MBBS Class (Session 2024-2029)

The White Coat Ceremony, held on 3rd March 2025, was a mmemorable    and emotional event for the newly enrolled MBBS students at Nawaz Sharif Medical College (NSMC), Gujrat. This annual tradition is not just a symbolic induction into the medical profession, but also an opportunity to honour the significance of the medical field, the commitment to service, and the promise of a future in healthcare.

The students of second-year MBBS host and organized the event.  We as the faculty had the responsibility of making this ceremony memorable for both the students and their proud parents. The program took place at the newly inaugurated campus of NSMC, which added an extra layer of excitement and pride for all involved. The ceremony was a beautiful blend of formal proceedings and heartfelt moments.

The event started with the recitation of verses from the Holy Quran and a Naat-e-Rasool (PBUH), setting a calm and respectful tone for the occasion. I was assigned the task of welcoming the new students on behalf of the faculty of Nawaz Sharif Medical College. This was a meaningful moment, as I reflected on my own journey in medical school and the path these students were about to embark on. Welcoming them into the medical college reminded me of the challenges and joys that come with studying medicine.

Professor Dr. Habib Ur Rehman’s address provided valuable insight to the first-year students. He offered a thorough overview of the new session and the orientation program, laying the foundation for the academic journey that lies ahead.

The most significant address came from Professor Dr. Tahir Sadiq, the Principal of NSMC. His speech was both inspiring and informative. He spoke at length about the nature of the MBBS curriculum, its demands, and the commitment required to excel in the program. He also acknowledged the vital role that parents play in supporting their children throughout this challenging yet rewarding journey. Dr. Sadiq’s advice was not just for the students but also for the parents, encouraging them to understand the rigorous nature of medical studies and the commitment required to succeed.

An important part of the ceremony was the interaction with the parents. The Head of the Department of Basic Sciences and Hostel Warden addressed the parents' queries about lodging, boarding, and student life, ensuring them that their children would be well taken care of during their time at the college. This session was particularly useful, as it provided the parents with the reassurance they needed regarding their children’s well-being.

Reflecting on the event, I felt immense pride in being part of an institution that values tradition, professionalism, and a sense of community. It was heart warming to see the enthusiasm and commitment of the incoming students, as well as the pride and support of their families. This ceremony not only marked the beginning of a new academic journey for the first-year students but also reaffirmed the significance of the medical profession and the noble duty that comes with it.

In conclusion, the White Coat Ceremony was a remarkable experience, not just for the new students, but for all those involved in organizing and participating in it. It reminded us of the challenges, sacrifices, and responsibilities that come with being a part of the medical community. It was an event that beautifully embodied the spirit of care, service, and dedication that defines the medical profession. I am confident that the incoming class will rise to the occasion and contribute to the legacy of excellence at Nawaz Sharif Medical College.

Dr Muhammad Ateeq 

Professor of Surgery 

NSMC Gujrat 

 3rd March 2025 

ASSIGNMENT PGD HEALTH PROFESSIONALS’ EDUCATION HSA

WORKBOOK ON QUALITATIVE RESEARCH

PRECPTION OF FINAL YEAR MBBS STUDENTS ON ONLINE TEACHING DURING COVID-19 PANDEMIC

BY

PROFESSOR DR MUHAMMAD ATEEQ

NSMC / ABSTH GUJRAT

WORKBOOK ON QUALITATIVE RESEARCH:  PRECPTION OF MBBS MEDICAL STUDENTS ON ONLINE TEACHING DURING COVID-19 PANDEMIC

SYNOPSIS OF A QUALITATIVE RESEARCH

1: Introduction to Qualitative Research

·   What is Qualitative Research? 

Qualitative Research is a type of scientific research that seeks to understand phenomena in natural settings. In the context of Medical Education, qualitative research could help us understand how students experience and perceive learning. 

·   Characteristics of Qualitative Research?

Focus on depth rather than breadth, it collects non-numerical data, it aims to understand perceptions, motivations & experiences. It relies on open ended questions. It involves like interviews, focus group and observations.

·   Importance of Qualitative Research in Medical Education

Qualitative research can shed light on medical students’ perceptions of various teaching methods, especially during crisis like COVID-19 pandemic.

·   Overview of the COVID—19 Pandemics impact on education

The COVID-19 pandemic forced educational institutions worldwide to shift rapidly to online platforms. This drastic change in the delivery of medical education brought about new challenges for both educators and students. Understanding how medical students perceive and adopt to online learning is vital to improve future teaching strategies.

2: The Research Question

·   Defining the Research Question

A research question is the foundation of a qualitative study. It should be specific, clear and feasible.

·   Example Research Question: 

What is the perception of medical students ON Online teaching during COVID-19 pandemic?

3: Study Design & Methodology

·   Choosing a Qualitative Approach

For this study, a phenomenological approach would be most appropriate, as it focuses on understanding participants lived experiences and perceptions. This approach is particularly useful for capturing how medical students perceive the change to Online teaching.

·   Data Collection Methods

 In depth Interviews, focus groups and Online Surveys & Questionnaires can be used to collect the data.

·   Ethical considerations in Qualitative Research

Should obtain informed consent from participants, it ensures confidentially of responses. Participants can withdraw themselves at any time.  Autonomy & dignity of participants must be respected

4: Data Collection Process

·   Designing an interview Guide

Create a list of open-ended questions like, what are your experiences with Online medical education during the pandemic?

·   Conducting In-Depth Interviews

Begin with introductory questions to establish rapport. Ask open-ended questions to allow the participant speak freely however probe deeper when necessary to explore important topics further.

·   Focus Group Discussion

Ask participants to share their perspectives on Online teaching. Allow for natural discussion and group interaction.

·   Case Study Approach

Select specific students that exemplify broader trends. 

·   Gathering Data through Online Platform

Due to the pandemic, online interviews and surveys are likely the most practical. Tool such as Zoom, Google Meet, or Microsoft Teams can be used for virtual meetings.

5: Data Analysis in Qualitative Research

·   Coding & Categorizing Data

Start by transcribing interviews and focus groups. Then break the text into smaller chunks of meaning (codes) and categorize them into themes.

·   Thematic Analysis

Group the codes into overarching that capture the main ideas related to students experience.

·   NVivo Software for Qualitative Analysis

NVivo is a popular software used to manage and analyses qualitative data. It helps in organizing codes and themes and track patterns across data.

·   Interpreting Themes & Patterns

Look for recurring themes in the data, such as challenges, benefits or adaptations to online teaching.

·   Ensuring Validity & Reliability

Member checking: Validate findings with participants to ensure accuracy. Triangulation to use multiple data sources to confirm results.

6: Interpreting Results

1. 1. ·   Understanding Students Experiences, focus on unique experiences, including their feelings of isolation, difficulty accessing resources, or struggles with technical issues.

   2. ·   Exploring Perceptions of Online Teaching Effectiveness: Evaluate how students perceive the quality of online learning, such as interaction with instructors and engagement with course material.

   3. ·   Identifying Strengths & Challenges of Online Teaching: Analyze the positive aspects eg. flexibility and negative aspects like lack of hands-on experience of online learning.

   4. ·   Analyzing Impact on Student Well-Being & Mental Health: Consider how the transition to online education affected students’ mental health, stress levels and overall well-being.  

   5. ·   Impact of Online Learning on Academic Performance: Explore whether students believe their academic performance was affected by online teaching methods.  

7: Reporting & Presenting Findings

·   Structuring a Qualitative Research Report

1.     Introduction: provide background and research questions

2.     Methods: Detail the data collection and analysis process

3.     Results: Present key themes and findings

4.     Discussion: Interpret the findings and suggest implications

·       Including Direct Quates from Participants: Use quates to provides rich, authentic examples that represents students’ experiences.

·       Presenting findings in themes: Organize the results around the main themes identified during analysis.

·       Visual Aids: Graph & Word Cloud: Use visual aids to summarize data. A word could can highlight common terms or themes that emerged.  

·       Discussing implications of Online Teaching on Medical Education: Discuss how the findings can inform future medical education, especially in the context of online learning.

8: Practical Application

·       Reviewing existing literature on Online Teaching in Medical Education: Study existing research on medical education to identify gaps and build on previous findings.

·       Conducting your own Research Project: Design research project by defining a clear, selecting appropriate methods and ensuring ethical standards.

·       Identifying Key Stakeholders:  Faculty, Students, Administrator: Identify how will benefit from findings of the study, students, faculty, administrator and tailor research to their needs

·       Using findings to improve Online teaching: Use the results to propose improvements in the delivery of online medical education addressing identified challenges.

NAWAZ SHARIF MEDICAL COLLEGE GUJRAT

DEPARTEMNT OF GENERAL SURGERY

STUDY PERFORMA

 PRECPTION OF FINAL YEAR MBBS STUDENTS ON ONLINE TEACHING DURING COVID-19 PANDEMIC

Introduction and Informed Consent

• Purpose of the Study:

The purpose of this survey is to understand your experiences, challenges, and perceptions regarding online teaching during the COVID-19 pandemic. Your feedback will help assess the impact of online education on medical training and suggest areas for improvement in future educational settings.

• Informed Consent:

Your participation in this study is voluntary. You may withdraw at any time, and your responses will remain anonymous and confidential.

Please sign below to indicate your informed consent to participate in this survey.

Participant Name (Optional)

Signature

Demographic Information

Please provide the following information to help us understand the context of your experience:

1. Age:

2.     Gender:

2. • Male

   • Female

   • 
     
   • 
     

3. Location of Study (City):

4. Have you attended a medical school that shifted entirely to online teaching during the COVID-19 pandemic?

   • Yes

   • No

5. Do you have access to reliable internet and the necessary technology for online learning (e.g., laptop, smartphone)?

   • Yes

   • No

   • Sometimes

3: Experience of Online Learning

Please reflect on your experience of online teaching and share your thoughts for each of the following areas:

1. Transition to Online Teaching:

   • How did you feel when your medical school transitioned to online learning during the pandemic? (e.g., shock, relief, stress, etc.)

2. Effectiveness of Online Teaching:

   • How would you rate the effectiveness of online teaching for your medical education during the pandemic? Were there any challenges or benefits that you noticed?

3. Technology and Tools:

   • How effective was the technology (e.g., video conferencing platforms, digital learning tools) used for your online education? Were there any technical issues that impacted your learning experience?

4. Access to Learning Resources:

   • Were you able to access necessary resources (textbooks, journals, clinical case studies, simulations) online effectively? Please share any difficulties you encountered.

5. Interaction with Faculty:

   • How did your interaction with faculty members change in the online environment? Were you satisfied with the communication and support provided?

6. Interaction with Peers:

   • How did you maintain interaction with fellow students during online learning? Did you miss any aspects of in-person interactions, such as group work or clinical practice?

4: Impact on Learning and Skill Development

Reflect on the following aspects of your learning experience:

1. Clinical Skills and Practical Training:

   • How did the lack of in-person clinical training and practical sessions impact your medical education? Were alternative methods (e.g., virtual simulations) sufficient for developing your clinical skills?

2. Self-Directed Learning:

   • Did online learning require you to be more self-disciplined and proactive in seeking out learning materials? How did you manage self-directed learning?

3. Mental Health and Well-being:

   • How did the shift to online learning affect your mental health and overall well-being? Did you face increased stress or feelings of isolation?

4. Motivation and Engagement:

   • Did you find it challenging to stay motivated and engaged during online classes? What strategies did you use to stay focused?

5:  Overall Experience and Suggestions for Improvement

Please share your overall perception of online education during the pandemic and any suggestions you have for future online learning in medical schools:

1. Overall Perception of Online Teaching:

   • What were the main advantages and disadvantages of online teaching for your education?

2. Suggestions for Improvement:

   • What recommendations would you provide to improve the online medical education experience for future students?

3. Would you prefer to continue online learning, return to in-person education, or have a hybrid model after the pandemic ends?

   • Online only

   • In-person only

   • Hybrid (both online and in-person)

Please explain your choice:

6:  Final Thoughts

Feel free to provide any additional thoughts, comments, or reflections about your experience with online learning during the COVID-19 pandemic:

Your valuable feedback will contribute to a better understanding of the impact of online education on medical training. If you have any further questions, please feel free to contact.

Dr Muhammad Ateeq Professor of Surgery

NSMC Gujrat 03225344622

 ASSIGNMENT NO 15: PGD HEALTH PROFESSIONALS EDUCATION HSA

     Reflective Writing on Farewell Event for Colleagues at Department of Surgery, NSMC/ABSTH Gujrat

The 13th of March, 2025, marked an unforgettable day in the history of the Department of Surgery Nawaz Sharif Medical College (NSMC) and Aziz Bhatti Shaheed Teaching Hospital (ABSTH) Gujrat. It was a day filled with mixed emotions—joy, gratitude, and a sense of bittersweet farewell—as two esteemed colleagues embarked on new journeys. Professor Dr. Imran Khokhar, who had joined our department in August 2024 as a Professor of Surgery, was transferred to Gujranwala Medical College. Alongside him, Dr. Umair, one of our postgraduate residents, completed his four-year clinical training for the FCPS final examination.

The timing of this event during the holy month of Ramadan gave it an extra layer of significance. To honour the contributions and achievements of our colleagues, a farewell Iftar dinner was organized at the Marinate Restaurant on GT Road, Gujrat. The event was attended by all the residents and faculty members from the Department of Surgery at NSMC/ABSTH, creating an atmosphere of affection and mutual respect.

 It was a moment to reflect on the collective journey we had shared, while also looking forward to the new chapters unfolding for our colleagues. After breaking the fast and offering Maghrib prayers, we enjoyed a delicious dinner, and the informal interaction among senior and junior colleagues was both interesting and meaningful.

During the evening, Dr. Umair was invited to share his thoughts on his four years of training. His words reflected genuine excitement and gratitude for the experience. He described his time with us as the most enjoyable period of his life. Dr. Umair acknowledged the support and mentorship of both his fellow residents and the faculty, emphasizing the invaluable guidance that had shaped his growth as a professional. His speech resonated with a sense of pride and fulfillment, not only for the personal milestones he had achieved but also for the relationships he had built with his colleagues.

Professor Dr. Imran Khokhar also took a moment to reflect on his time with us. Despite his relatively short stay, he spoke affectionately of the department and the people he had met. He labelled his experience at NSMC as a "beautiful journey," one that allowed him to adapt to a new environment and build meaningful professional relationships. His words reminded us of the importance of building connections and learning from one another in a dynamic field like surgery.

As the Head of the Department of Surgery, it was an honour for me to deliver the farewell address. I took this opportunity to express my deep appreciation for both Professor Imran and Dr. Umair. The time spent with them had been enriching, and we had all gained much from their expertise and enthusiasm. Professor Imran, in particular, had been a source of inspiration, teaching us advanced surgical techniques, especially in the realm of general and laparoscopic surgery. His contributions to the department will be remembered fondly by all of us.

Looking back, this farewell event was a perfect blend of reflection and celebration. It allowed us to honour the accomplishments of our colleagues while also creating a sense of unity and collaboration. In a profession as demanding and fast-paced as surgery, moments like these are rare and invaluable. They remind us of the importance of human connection, support, and gratitude in shaping our careers and personal growth.

As we bid farewell to our colleagues, we also embrace the new opportunities that lie ahead for them. This event was a reminder that while life is constantly evolving, the bonds we form and the experiences we share will continue to shape us, both as individuals and as part of a larger professional community.

Professor Dr Muhammad Ateeq

       NSMC/ABSTH Gujrat

          13th March 2025

 ASSIGNMENT NO:  15 PGD HEALTH PROFESSIONALS’ EDUCATIONS HSA

Literature Review:   Perception of Final Year MBBS Students on Online Teaching during COVID19 Pandemic

Introduction:

The COVID-19 pandemic, which resulted in the closure of educational institutions worldwide, forced the educational institutions rapid transition to online learning. This transition resulted in unique challenges, particularly for final-year MBBS (Bachelor of Medicine, Bachelor of Surgery) students, who were nearing the completion of their medical education and were facing the complexities of clinical training. In this literature review, we will examine studies and qualitative research surveys on the perceptions of final-year MBBS students regarding online teaching during the COVID-19 pandemic.

1: The Shift to Online Education in Medical Colleges:

Prior to the pandemic, medical education was traditionally delivered through face-to-face teaching methods, which included lectures, clinical rotations in hospitals and practical exams.  However, the pandemic forced educational institutions to quickly transition to online platforms. The abrupt shift was seen across the globe, from well-established institutions in the West to developing nations in the East. As per Hassan et al. (2020), the transition to online learning was challenging for medical schools, particularly in terms of adapting practical training, clinical skills, and hands-on learning to virtual formats.

2: Impact on Clinical Skills & Training:

A key issue highlighted in several studies was the lack of practical, hands-on experience. For MBBS students, especially final-year students, clinical training is a vital component of their education, with exposure to real-life medical scenarios, patient interactions, and medical procedures. According to Dhar et al. (2021), while online teaching helped maintain theoretical education, it failed to replicate the critical aspect of clinical exposure. They also mentioned that the lack of physical presence in hospitals and clinics led to significant concerns regarding the readiness of students to undertake medical practice.

3: Challenges in Practical Assessment:

The assessment of final-year students traditionally includes clinical exams such as Objective Structured Clinical Examinations (OSCE), patient simulations, and direct observation during hospital rounds. The transition to online assessments was met with lack of practical experience and confusion. As noted by Smith et al. (2020), many students expressed dissatisfaction with the online assessment formats, especially in evaluating practical competencies. While theoretical knowledge was assessed via written exams and online quizzes, practical assessments were challenging to implement. This raised concerns about how accurately online assessments reflected the students’ true competencies in clinical practice.

4: Student engagement & Learning Experience:

Engagement is a critical factor for effective online learning. Singh et al. (2020) conducted a qualitative survey with final-year MBBS students and found that while online lectures were considered convenient, many students felt that the lack of face-to-face interaction with peers and faculty led to a passive learning experience. Medical students reported a preference for interactive learning, which is typically more prevalent in traditional classroom settings. Without the opportunity to participate in group discussions, physical demonstrations, or hands-on training, many students felt disconnected from the learning process.

In contrast, Zoya Karim et al (2022) observed that some students appreciated the flexibility of online learning, as it allowed them to revisit recorded lectures and study at their own pace. However, this did not completely compensate for the lack of face-to-face interactions and practical engagement.

5: Technological Barriers & Resources issues:

Technological issues were another major concern identified in the literature. In (Ahmad Asoufi 2021) it was reported that not all students had equal access to the technology needed for online learning, such as reliable internet access, personal computers, or even quiet spaces conducive to study. This disparity led to a sense of inequality among students, especially in low-resource settings. This issue of "digital divide" was particularly prevalent in rural or less-developed areas, where medical students were often disadvantaged due to poor connectivity and lack of technical resources.

6: Mental Health & Well Being:

The abrupt shift to online learning during a global health crisis also impacted the mental health and well-being of medical students. Viren Kaul (2021) highlighted that the lack of social interaction, isolation, and uncertainty surrounding the future of their education led to increased levels of stress, anxiety, and burnout among final-year MBBS students. The pressure to adapt to a new mode of learning while preparing for a critical phase in their education was a source of emotional distress.  Students expressed that they missed the physical aspect of their training and often felt overwhelmed by the lack of direct guidance

7: Advantages & Positive Perception:

Despite the challenges, several studies pointed out some positive aspects of online learning. According to Fareeha Farooq (2020), students valued the flexibility of online learning, which allowed them to structure their learning time more efficiently and manage their study schedules in a less rigid environment. Furthermore, online teaching facilitated access to a wider range of resources, such as pre-recorded lectures, digital textbooks, and online forums for discussion. Some students reported a sense of empowerment and independence in managing their learning experience.

8: Recommendations for future Medical Education:

Based on the literature, several recommendations were made for improving online medical education:

• Hybrid Learning Models: A blended approach that combines the benefits of online learning with essential in-person training, particularly in clinical skills, was widely recommended. Fareeha Farooq (2020) suggested that medical institutions could incorporate more virtual simulations and online case discussions to make up for the lack of direct patient interaction.

• Improved Technical Support and Infrastructure: Singh et al. (2020) emphasized the need for increased investment in technological infrastructure and support, ensuring that all students have equal access to the necessary tools for online education.

• Mental Health Support: Several authors, including Viren Kaul (2021), stressed the importance of providing mental health resources and counselling to help students cope with the emotional and psychological challenges posed by the pandemic

Conclusion:

In conclusion, the transition to online learning during the COVID-19 pandemic was a challenging experience for final-year MBBS students. While it provided some advantages in terms of flexibility and accessibility, the lack of hands-on learning, difficulties with assessments, and technological barriers significantly impacted students' perceptions. The literature suggests that while online education can supplement traditional methods, it cannot fully replace the hands-on, practical experiences that are integral to medical training. Moving forward, a hybrid model of education, which integrates the strengths of both online and in-person learning, could provide a more balanced and effective approach to medical education in the post-pandemic world.

References:

1: Smith et al: Exploring mental health and wellbeing among university faculty members: A Qualitative study: Journal of Psychological Nursing Vol 60, No 11,2022.

2: Adla Bakri  Hassan et al:  Adaptation of Clinical Teaching During the COVID 19 Pandemic : Perspectives of |Medical Students & Faculty Members. Advances in Medical Education & practice 2022:13 883-892

3: Poshmaal Dhar et al.  Augmented reality in medical education: Students experiences and leaning outcome. Med Educ Online. 2021 Dec.

4: Smith,J Doe, A. et al.  Impact of online Pedagogical Feedback on Academic Performance: A Comparative study. Journal of Educational Psychology, 15,123-136.

5: Singh et al. Medical Education Amid the COVID-19 Pandemic: Indian Pediatrics: Vol 57- 657 July 15,2020

6: Zoya Karim et al:  The effect of Covid on Medical Education. Pak J Med Sci. 2022 Jan-Feb;38(1):320-322.

7: Ahmad Alsafi et al: (2020) Impact of the COVID-19 pandemic on medical education: Medical Students Knowledge, attitude, and practices regarding electronic learning. PLoS One 15(11): e0242905. Doi: 10.1371/journal.pone.0242905.

8: Viren Koul et al:  Medical Education COVID-19 Pandemic.  CHEST 2021;159(5):1949-1960S

9: Fareeha Farooq et al. Challenges of Online Medical Education in Pakistan During COVID-19 Pandemic. J Coll Physicians Surg Pak.2020 Jun.

ASSIGNMENT NO 16:  REFLECTING WRITING - PGD HEALTH PROFESSIONALS EDUCATION

HEALTH SERVICES ACADEMY

Grand Health Employees Alliance:

 Convention & Protest Against Outsourcing / Privatization of Basic Health Units & Rural Health Centres in Punjab

Venue:  Aziz Bhatti Shaheed Teaching Hospital Gujrat

Health and education are two of the most essential components for the development of any civilized nation. Access to these basic necessities is a fundamental right for every citizen, and no individual or community should be deprived of these services. These services must be uniformly available to all members of society, regardless of location or socioeconomic status. Unfortunately, in Pakistan, these basic services are not consistently accessible, even in major cities. Advanced healthcare facilities are often unavailable to the common man in public sector hospitals, and the quality of education is similarly inconsistent.

Health and education departments are among the largest ministries in every province of the country. Basic Health Units (BHUs) and Rural Health Centres (RHCs) were established to provide primary healthcare to the rural population, focusing on preventive medicine, maternal and child health, immunization, and general community health. These units, staffed by qualified medical and paramedical professionals, serve as a vital resource for people living in rural areas. However, due to poor working conditions, inadequate logistical support, and lack of essential medicines, the objectives of these health centres have often remained unmet.

Despite these challenges, these health centers remain the only accessible source of healthcare for the rural poor.

Recently, the Punjab government decided to outsource the management of these health centers as part of their broader healthcare privatization program. This decision has caused significant unrest among healthcare workers—doctors, nurses, paramedics, and other staff—along with the public at large. Outsourcing and privatizing these health centers will inevitably lead to the loss of free healthcare services, replacing them with paid services that most rural residents cannot afford. Additionally, the job security and future career prospects of healthcare workers are now at risk.

In response to this, a Grand Health Employees Alliance was formed, consisting of doctors, nurses, paramedical staff, and class IV workers. A convention was held on March 16, 2025, at Aziz Bhatti Shaheed Teaching Hospital in Gujrat. Leaders from the Pakistan Medical Association, Young Doctors Association, and Young Nurses Association addressed the large gathering of health professionals and employees. They called for the immediate reversal of the government's decision and outlined their future plans for protest and agitation. The convention was followed by a walk along Bhimber Road, where participants chanted slogans and voiced their opposition to the outsourcing and privatization of basic health units and rural health centers. The participants made it clear that if the government does not withdraw this decision, they will escalate their protests and strikes at the provincial level.

In my opinion, the government’s decision to outsource rural health centers contradicts the very principles of a welfare state, where every citizen is entitled to basic services, including healthcare and education. The rural population in Pakistan is already marginalized and faces numerous challenges in accessing essential services. These people cannot afford to pay for healthcare, and privatizing health services will only widen the gap between the wealthy and the poor. The demands of the healthcare workers are based on undeniable facts: these health centers need urgent improvement in terms of working conditions, regular supply of essential medicines, and better governance, not outsourcing.

Rather than abandoning its responsibility to provide basic healthcare, the government should focus on strengthening these centers, addressing the root causes of inefficiency, and ensuring that the rural population continues to have access to free and quality healthcare services. The outsourcing of essential services like healthcare undermines the role of the state in protecting the welfare of its citizens, particularly the most vulnerable.

This protest and the ongoing efforts of the health workers highlight the urgency of revisiting the government’s decision and focusing on reforming and enhancing the public health system for the benefit of all.

       ASSIGNMENT NO:17 PGD HEALTH PROFESSIONALS EDUCATION HSA

 Reflective Writing: Final Professional MBBS Examination 2024 in General Surgery & Allied

The Final Professional MBBS 2024 Annual Clinical Examination in General Surgery & Allied was held on 26th and 27th March 2025 at the Aziz Bhatti Shaheed Teaching Hospital, Gujrat. This was an important academic event, marking a significant milestone for a new batch of young medical graduates about to enter the practical field of healthcare. As the internal examiner for this examination, I had the privilege of participating in an activity that not only tested the students’ knowledge and clinical skills but also provided valuable lessons for me as an educator.

The examination was conducted by the University of Health Sciences (UHS) and took place in accordance with its protocols. The clinical component of the examination was designed to assess the students in multiple domains: an Objective Structured Practical Examination (OSPE), short cases, and a long case. An external examiner and sensor from UHS were appointed to oversee the smooth conduct of the examination, which involved senior faculty members, postgraduate residents, and house surgeons actively contributing to the process. It was a two-day event with 116 students divided into four batches, two on each day. The OSPE was conducted in the department’s demonstration hall and consisted of 11 OSPE stations, short cases were assessed on real patients, the long case component was conducted at the bedside, where students were expected to demonstrate their ability to evaluate and manage a patient comprehensively.

I observed that there were several key takeaways from the experience that I feel compelled to share. One of the most prominent challenges I encountered was the difficulty of evaluating such a large number of students in a short span of time. With 58 students to examine in just 6-7 hours, it was quite a demanding task to assess each student adequately and fairly, in accordance with the Standard Operating Procedures (SOPs) and the designated components of the examination. While the structure of the examination was well-designed, the sheer number of students made it difficult to ensure that each candidate was evaluated to the best of their potential. I believe the examination would have benefitted from a more spaced-out schedule, limiting the number of students per day to no more than 20. This would allow the examiners to assess the students more thoroughly and provide each candidate with the attention and focus they deserve.

Another area that I found room for improvement was in the OSPE stations. While UHS provided the clinical scenarios for the OSPE, I noticed that many of these scenarios were repeated from previous examinations. In addition, the photographs used in the stations were sourced from a website rather than including local photographs of local patients. This is an aspect that could be further refined in future examinations. Using locally sourced images would better reflect the clinical realities that students are likely to encounter in their practice, ensuring that the examination is both relevant and practical.

Despite these challenges, it was an excellent opportunity for all the colleagues in the Department of General Surgery to collaborate and share their expertise. Throughout the event, the postgraduate residents and house surgeons provided tremendous support, assisting examiners in various aspects of the examination. Their enthusiasm, dedication, and responsibility were commendable, particularly since the examination was held during the holy month of Ramadan, when they were fasting.

In conclusion, the Final Professional MBBS Examination 2024 in General Surgery & Allied was a highly productive and educational activity. While there were challenges to overcome, they provided opportunities for growth and improvement, both for the students and for the medical educators involved. I am confident that the lessons learned from this examination will serve as a foundation for enhancing the quality of future examinations and contributing to the development of medical education at large.

                      ASSIGNMENT NO 17: HEALTH PROFESSIONAL MEDICAL EDUCATION HSA

CRITICAL REVIEW OF AN ASSESSMENT METHOD

Assessment methods in medical education are essential for evaluating students' knowledge, skills, and competencies, ensuring they are prepared for the responsibilities of healthcare professionals.

The Short Essay Question (SEQ) is one of the assessment methods used in the final professional MBBS General Surgery examination at the University of Health Sciences (UHS), Lahore. The purpose of SEQs is not only to test students' theoretical knowledge but also to assess their ability to critically think and apply that knowledge to clinical scenarios.

Strengths & weakness of SEQs as an assessment tool are as follow:

 Strengths of SEQs in General Surgery Assessments

1. Encouraging Critical Thinking SEQs are great at encouraging students to move beyond simple memorization & recall. Instead of asking for rote answers, these questions compel students to think critically and apply their knowledge in practical situations. In

2. Enhancing Communication Skills Surgeons need to be clear and concise when explaining complex information to patients and colleagues. SEQs test evaluate the ability of a student, how well he can express surgical concepts in writing. This makes the SEQ format especially valuable, as reflects communication demands students will face in their professional settings, whether it's explaining a diagnosis or documenting a patient's progress.

3.  Coverage of topics / syllabus:  SEQs offer the flexibility to cover a broad spectrum of topics within General Surgery. They allow examiners to test everything from basic procedures to more advanced concepts, including ethical considerations, decision-making, and managing surgical complications. This broad coverage ensures that students’ understanding isn’t limited to just a narrow portion of the curriculum.

4. Constructive Feedback One of the biggest advantages of SEQs is that they provide an opportunity for more personalized feedback. With SEQs, examiners can pinpoint areas where students excel and areas where they need improvement.

Weakness / Challenges in SEQs in General Surgery Assessment:

1. Grading Subjectivity: The biggest drawback of SEQs is the subjectivity in grading. The way one examiner interprets an answer can differ from another’s. This leads to inconsistencies in how answers are scored especially in complexed questions.  Even though rubrics don’t always fully eliminate the potential for bias or inconsistency in the grading process.

2. Time Pressures: Students often face pressure to provide detailed answers within a limited time frame. For example, 5 minutes are given for each SEQ in General surgery papers.  A students might feel rushed, which could lead to superficial responses that don’t fully express their understanding. On the other hand, examiners also face time constraints when grading, especially when they have to assess a large number of essays, which may affect the accuracy of their evaluations.

3. Risk of Rote Learning While SEQs are designed to test deeper understanding, there’s always a risk that students will memorize certain facts or case scenarios without truly understanding them.

4. Limited Practical Assessment:  Surgery is a hands-on field. While SEQs can evaluate theoretical knowledge and clinical reasoning, they can't assess practical skills. For example, a student might answer a question about surgical techniques correctly but may not demonstrate the fine motor skills required in the operating room. This highlights the need for a more comprehensive assessment that also includes practical evaluations.

5. Stress and Cognitive Load:  Final exams are stressful by nature, and SEQs, particularly in a complex subject like General Surgery, can be mentally taxing. The need to provide structured, in-depth answers can lead to cognitive overload, especially under the pressure of high-stakes exams. This stress can sometimes negatively affect a student’s performance, leading to anxiety and reduced clarity in their responses.

6. Real-World Application: Surgery is a fast-paced, dynamic environment that requires quick thinking and adaptability—skills that are hard to assess through SEQs alone. While SEQs are great at testing knowledge, they may not capture the real-world challenges surgeons face, such as rapid decision-making, teamwork, and managing unexpected complications in the operating room.

           CRITICAL ANALYSIS OF SEQs ASSESSMNET TOOL IN FINAL PROFESSIONAL MBBS SURGERY

 An Assessment tool should meet several criteria to effectively evaluate the knowledge, skills, and competencies of students. It must not only be reliable and valid but also reflect the complexity of medical practice and ensure that healthcare professionals are well-prepared for patient care. Here are the key criteria for an ideal assessment tool in medical education and SEQs tool being practiced by UHS in Final Professional MBBS examination is analyzed  below: 

Validity

Content Validity:  SEQs papers of final professional MBBS examination adequately covered the curriculum & matched with the learning outcomes.

Construct Validity:  In my opinion SEQs assessment being practiced by UHS is lack in content validity. Most of the clinical scenarios are not constructed in a way to assess the student’s ability to apply knowledge and critical thinking & reasoning.

Criterion-related Validity:  This assessment should be combined with some Hands on skills assessment tool align the students with encounter with  real case / practical situation.

Reliability

Inter-rater Reliability & Intra-rater Reliability: In my opinion this aspect needs to addressed. it has been observed that there is gross discrepancy in marking not among different examiners but also in same examiner while marking the same question of different students.

Fairness

Most of SEQs are clearly constructed in an easy understandable format but in some questions the information given is vague and creates confusion in interpreting the given data.   As a whole this can be considered meeting with the criteria of fairness.

Feasibility

Time / Resource-efficient & Logistical Feasibility:  This assessment tool meets this criteria to  some extent. Time per SEQ shall be increased to 10 minutes to give an optimum time to answer a question in comprehensive way. 

Educational Impact

SEQs, directs the student towards self-directed learning. Go through a topic completely to have better understanding at the same time cover the all the topics of curriculum. It also promotes formative feedback.

Comprehensiveness

 The assessment tool must cover knowledge, clinical reasoning, practical skills, communication, and professionalism while evaluating a student. I think  SEQs did not covers all these aspects due to constraint of time, 5 minutes are not enough to  follow all these components.

 Authenticity

The questions asked in SEQ are clinical oriented matches with real world cases, needs practical understanding that aspect is adequately covered.

Scorability / Objectivity

Few Seqs requires subjective evaluation, rubrics and clear guidelines to minimize subjectivity and enhance objectivity in scoring

Feedback Mechanism

SEQ assessment tool provides meaningful and constructive feedback to students, that help them understand what they did well and where they need to improve.

Acceptability

SEQs as a whole are accepted by both students & teachers

 Differentiation

SEQs assessment tool is good enough to differentiate between level of performance of different students

Alignment/with Professional Standards

This assessment tool is aligned with national or international standards of medical practice and training. Itcan assess the competencies needed for safe and effective patient care and ensure that students meet the expectations for their future roles as healthcare professionals

CONCLUSION:

The use of Short Essay Questions (SEQs) in the final MBBS General Surgery examination at UHS Lahore has its advantages and challenges. On the one hand, it allows students to demonstrate higher-order thinking, decision-making, and communication skills, all of which are essential for a future surgeon. On the other hand, issues such as grading subjectivity, time pressures, and the limitations of testing practical skills present significant drawbacks. Incorporating clear rubrics, combining SEQs with other practical assessments, and promoting a focus on critical thinking can help improve the effectiveness of this assessment method.

 ASSIGNMENT NO:18 REFLECTIVE WRITING PGD HEALTH PROFESSIONALS’ EDUCATION HSA

Awareness and Implementation of ESS (Employee Self-Service) App by Specialized Healthcare and Medical Education Department, Punjab

The Punjab Health Department recently introduced the ESS (Employee Self-Service) application, which aims to track attendance for Heads of Departments (HoDs) and Heads of Institutions (HoIs) at hospitals and medical colleges. This system was designed to ensure these key figures are physically present in their workplaces, thereby reinforcing the presence of faculty and clinical staff. As part of the rollout, an online workshop was conducted by the Punjab Information Technology Board (PITB), providing HoDs and HoIs with login IDs to check in and out during work hours.

Currently, only HoDs and HoIs are required to register on the system, while the rest of the staff and faculty remain unregistered. This raises an important question: Why is such monitoring necessary in healthcare and medical education?

Healthcare, particularly in public hospitals, operates 24/7. HoDs are in constant contact with their resident staff, actively monitoring patient care and overall clinical activities. They design duty rosters to ensure continuous medical care, even during holidays, with senior supervision available at all times. While occasional gaps may arise, there are no widespread issues of absence or neglect. Professors and senior staff work tirelessly, often during irregular hours, balancing clinical duties with academic responsibilities as internal and external educators.

However, imposing compulsory online attendance tracking at specific times could create unnecessary stress for medical professionals. Doctors, especially senior ones, are often engaged in critical tasks beyond the hospital, requiring mental focus even during off-hours. These professionals are mentally occupied with overseeing clinical activities, providing guidance to staff, and managing complex patient cases, sometimes well beyond regular duty hours.

The imposition of such a system may not improve work conditions; rather, it risks eroding trust and morale among healthcare professionals. Many HoDs and doctors view these measures as unnecessary, potentially questioning their integrity and professionalism.

Moreover, many doctors and HoDs contribute significantly to the healthcare system by using their personal resources to provide quality care, especially for underserved patients. The government has long struggled to provide adequate healthcare facilities to the population, which is a basic right for every citizen. This failure is often reflected in the outsourcing of medical services in the Punjab.

Instead of imposing such measures that question the integrity of healthcare professionals, the government should focus on improving governance and providing adequate funding. Public hospitals should be equipped with the necessary infrastructure, resources, and staff to deliver quality care to the public.

Suggestions for Improvement:

1. Inclusion of All Staff in ESS: While the ESS system currently only involves HoDs and HoIs, it would be beneficial to include all medical staff. This approach would create a more comprehensive attendance system. However, the system should remain flexible to accommodate the varied work hours and responsibilities in healthcare.

2. Shift from Time-Based Monitoring: Given the nature of healthcare work, attendance should not be tied to a specific time frame. Instead, a system could be developed to track overall work hours or key activities, allowing healthcare professionals more flexibility while ensuring accountability.

3. Focus on Resource Allocation: The government should prioritize improving the infrastructure, staffing, and supply chains in public hospitals. Proper resources would help healthcare workers focus on patient care rather than administrative duties.

In conclusion, while the ESS system may have good intentions, its implementation should be more thoughtfully designed to accommodate the unique demands of healthcare professionals. Instead of adding stress through rigid time-based systems, the focus should be on creating an environment where healthcare workers feel valued, supported, and equipped to deliver quality care. This will ultimately lead to better patient outcomes and improved healthcare delivery across the board.

 Assignment No 19: Reflection writing PGD Health Professionals Education HSA

Symposium: Recent Advances in the Management of Rectal Carcinoma
Department of Surgery, NSMC / Aziz Bhatti Shaheed Teaching Hospital, Gujrat

As Head of the Department of Surgery, medical teacher and mentor I’ve always believed in the power of academic collaboration for CME activities. On April 12th, 2025, I had the pleasure of chairing a very special academic event — a symposium on “Recent Advances in the Management of Rectal Carcinoma,” organized by our department as part of our CME program. This wasn’t just another scheduled lecture; it turned out to be a thought-provoking experience that brought together surgical minds across different levels of training.

We were fortunate to have Dr. Anwar Hussain, a distinguished colorectal consultant  surgeon from Manchester, UK, as our guest speaker. His expertise and excellent presentation skills made a strong impression on everyone. Dr. Abid Nazir, our Associate Professor, served as an excellent moderator and introduced Dr. Hussain to an attentive audience that included faculty members, postgraduate residents, house surgeons, and final-year MBBS students.

From the very beginning of his talk, Dr. Hussain had our full attention. His presentation was not only comprehensive but also crisp and easy to follow. He managed to cover all key aspects of rectal carcinoma — from early diagnosis to recent advances in treatment — in a way that well perceived by junior and senior participants. I particularly appreciated the clarity of his PowerPoint slides, which made it easier to grasp and retain complex concepts.

The most interesting & dynamic session for me was the interactive segment that followed the presentation. The Q&A session turned into a lively and intellectual discussion. I was proud to see our residents ask thoughtful, relevant questions and engage with Dr. Hussain in such a confident manner. It showed me how far they’ve come in their training and how eager they are for knowledge.

I also took the opportunity to share our local experience with colorectal cancer — specifically the challenges we face in early diagnosis due to limited resources in smaller districts like Gujrat. I highlighted the urgent need for a centralized tumor registry to better understand the epidemiology and geographical trends of this disease within Pakistan. I believe that collecting our own data is the first step toward developing realistic, resources-based treatment protocols. I was glad to see this point receive support from the participants.

Another idea I presented was the establishment of a dedicated clinic for patients presenting with bleeding per rectum. It’s a simple but potentially impactful step towards early detection. Dr. Hussain appreciated the concept, and I felt reassured that we’re thinking in the right direction.

A special moment during the session was when Dr. Hussain shared his journey of surgical training in the UK and spoke about opportunities available for our residents. His willingness to guide and facilitate those interested in pursuing careers abroad was really appreciable.

We concluded the session with a vote of thanks, followed by the distribution of participation certificates and refreshment tea. As I looked around, I felt a quiet sense of satisfaction as this was not just an academic event, but a meaningful exchange of knowledge, ideas, and future possibilities. Perhaps most importantly, this symposium has opened the door for long-term academic collaboration. I personally requested Dr. Hussain to stay connected with our department and join us for future CME sessions, including online ones. He kindly agreed.

In reflection, this activity reminded me why I chose to be in academic surgery?  for the chance to learn, to teach, and to connect. It reaffirmed the importance of external exposure for our students and the need to keep pushing the opportunities for knowledge & learning within our local limitations. This was truly a memorable and valuable experience for me as an educator, a surgeon, and a lifelong learner.

                ASSIGNMENT NO:20:  PGD HEALTH PROFESSIONALS MEDICAL EDUCATION HSA

Reflective writing:  AS Facilitator – MCQ Writing Workshop in the Department of Surgery

As a medical teacher and supervisor in postgraduation program, I arrange a workshop on Multiple Choice Question (MCQ) writing in the Department of Surgery for postgraduate residents of the department. I found it to be a highly productive and rewarding academic activity. This session, conducted under the umbrella of the Continuing Medical Education (CME) program, was attended by postgraduate residents of the department and focused on the construction of best-one-option MCQs, in accordance to the guidelines provided by the College of Physicians and Surgeons Pakistan (CPSP).

The session began with my detailed presentation, during which I introduced the theoretical framework and practical approach of MCQ writing. I emphasized the significance of structured question design in postgraduate assessment, highlighting essential components of a quality MCQ, such as theme, sub-theme, the lead-in stem, options, and the answer key. A practical example was used to illustrate the entire process, from the selection of a clinically relevant topic to the formulation of a well structured and valid MCQ. Referencing standard textbooks, ensuring alignment with learning objectives, and evaluating the difficulty index and the practical importance of the question in clinical settings were covered adequately.

Following the presentation, participants were divided into three groups and were asked to create a clinical scenario-based MCQ in General Surgery. This collaborative group activity not only promoted teamwork but also stimulated critical thinking and peer learning. Each group was given adequate time to brainstorm and formulate a question. Afterwards, we conducted a group-wise discussion where each MCQ was presented, critiqued, and refined collectively. This feedback session allowed for active engagement, correction of common mistakes, and reinforcement of best practices in MCQ development.

At the end of the workshop, all participants were assigned a follow-up task of submitting five problem-based MCQs by the next week. This assignment aims to consolidate their learning and provoke a habit of academic contribution and reflective practice.

As a facilitator, my personal reflection on this activity is highly positive. The level of enthusiasm, curiosity, and commitment shown by the participants was commendable. They not only engaged actively but also appreciated the structured methodology of question writing, which many found novel and enlightening. Several residents remarked that this was among the most unique and beneficial academic sessions they had attended during their training.

I strongly believe that such academic exercises are essential in shaping the academic mindset of future medical educators. MCQ writing is a critical skill that requires planning, understanding of pedagogical principles, and clinical relevance. Incorporating these sessions into postgraduate training will significantly enhance the quality of assessments and prepare our residents for their roles as future faculty members.

Inspired by the success of this initiative, I now plan to extend this workshop to a broader audience, involving young faculty members and postgraduate residents at the college level.

Assessment methods in medical education are constantly evolving to keep pace with the growing demands of quality assurance and competency-based learning. In this changing landscape, the development of a comprehensive and well-structured MCQ bank has become not just a necessity for degree-awarding institutions, but also a valuable resource at the departmental level within every medical college. Faculty members, along with residents, can play a vital role in its development—guided and supported by the medical education department. This collaborative approach ensures that the questions are relevant, well-aligned with learning objectives, and reflect real-world clinical scenarios.

In conclusion, this workshop was a great experience for me as a medical teacher. It reinforced my belief in the transformative potential of well-designed academic activities and reaffirmed the enthusiasm of our postgraduate trainees towards learning and academic development. 

ASSIGNMENT  NO 21: REFLECTIVE WRITING PGD HEALTH PROFESSIONALS EDUCATION HSA

MOCK CLINICAL EXAMINATION FOR POSTGRADUATE RESIDENTS DEPARTMNET OF SURGERY

As one of the founding CPSP-approved supervisors of the General Surgery postgraduate training program at Nawaz Sharif Medical College (NSMC), Gujrat, I have overseen the academic and professional growth of many trainees since 2013. Over the years, our department has grown under the Central Induction Policy of the Punjab Health Department, training candidates in both MS and FCPS tracks. From our very first FCPS-II postgraduate in General Surgery to the successful training of 7 FCPS Part-II and 28 IMM candidates in allied surgical disciplines, is a reflection of dedication and commitment of the department with continued medical education and progression towards excellence.

From 13th to 15th April 2025, our department conducted a Mock Clinical Examination for FCPS-II General Surgery trainees. Three candidates from Gujrat participated in this academic activity, structured in accordance with the College of Physicians and Surgeons Pakistan (CPSP) format, involving short and long clinical cases. My role as a facilitator, CPSP examiner, and mentor was to oversee the sessions, provide real-time feedback, and guide the candidates through clinical reasoning and communication challenges. The primary objective was to simulate the real exam environment and identify areas for improvement.

Personally, I felt a deep sense of fulfillment and responsibility while facilitating this examination. It was a moment of pride to see how far our department and training program have come. I also felt excitement and anticipation—both for the performance of the candidates and for my own role in shaping their progress. Observing their growth during the session was emotionally rewarding.

The mock examination yielded many positives. The structure closely resembled the actual FCPS examination format, and the candidates appreciated the realistic, high-pressure environment. They received tailored, constructive feedback from the faculty, which they reported as particularly valuable. The progression in their confidence and communication over the course of three days was a testament to the effectiveness of the simulation. However, time constraints posed a challenge—we could have benefited from longer case discussions or post-exam debriefing sessions. A few administrative aspects, such as time slot management and case preparation, could also be improved in future iterations.

This experience reaffirmed the value of experiential and reflective learning in postgraduate medical education. Traditional lectures and bedside rounds lay the groundwork, but mock exams bring theory to life. They test the ability to think critically, communicate effectively, and perform under pressure—all essential attributes of a competent surgeon. From an educational standpoint, the candidates’ visible transformation—from hesitant to confident—highlighted the impact of guided simulation. As a facilitator, I realized that my role extends beyond instruction—towards being a mentor, coach, and role model.

The mock clinical examination was a rich and meaningful learning experience for both the candidates and myself. It served as an effective assessment and developmental tool while also deepening my own engagement with medical education. More importantly, it aligned with our department’s mission to produce competent, compassionate, and confident surgeons ready to meet the complex healthcare needs of our communities.

Moving forward, I plan to organize regular mock exams as part of our formal training calendar. These will include a wider range of clinical scenarios and structured feedback mechanisms. I also aim to involve more faculty members in mentorship roles to create a supportive learning ecosystem. These actions will not only enhance our academic standards but also ensure sustained growth of our postgraduate training program. The  participation of whole faculty of the department and their keen interest in this academic activity was a satisfying and a source of encouragement for me as a team leader. 

 ASSIGNMENT NO:22 PGD HEALTH PROFESSIONALS MEDICAL EDUCATION HSA

Workplace dilemma:   Lack of   Professionalism & interdepartmental coordination ABSTH Gujrat

As clinicians and mentors, we carry the dual responsibility of providing the best possible care to our patients while also training and guiding the next generation of doctors. Both of these role of a medical teacher demands responsibility, professionalism, teamwork, and interdepartmental coordination. We the teachers / mentors are the role model for our trainees the future teachers, clinicians & role models for their era.  A student always reflects the personality of his mentor with his attitude, responsibility and professionalism.

The Dilemma: 

A recent incident at ABSTH Gujrat highlighted a growing concern in our clinical setting. A patient required an expert opinion from a different specialty. Despite a consultant’s request, it took nearly 24 hours to convince the postgraduate residents (PGRs) of the concerned department to respond appropriately. That was an emergency patient has severe upper GIT bleed but unfortunately it took 24 hours to convince postgraduate residents of medical department that this patient needs to shifted and manage in medical / Gastroenterology unit rather in Surgical ward where our surgical team remained involved in resuscitation of the patent.  Pathetically even after intervention of the hospital administration none of the physicians bother to examine and evaluate the patient physically.  In this delay, the welfare of the patient was compromised.

 Following are the few of the alarming observation which I observed during the whole proceedings of this incident:

• Postgraduate  residents (PGR) behaving as "super-consultants": Some residents are assuming authoritative roles beyond their current training level — reportedly under instructions from their seniors. Even they do not care of guidance / request of consultants of other specialties.

• Referrals handled inappropriately: Consultants requesting opinions are often met with dismissive responses from other departments. In many cases, the matter is delegated to PGRs or resolved through telephonic discharge instructions with vague outpatient follow-ups. This is specifically very hard & tough task in terms of logistics of indoor patients who are wheelchair / stretcher bound.

• Neglect of patient-centered care: Patients who are wheelchair- or stretcher-bound are being asked to follow up in the OPD unnecessarily, causing distress and increasing caregiver burden.

• Casual attitude of seniors / Head of departments: No one bother to coordinate, discuss with allied specialties for opinion regarding management of patient where inter departmental consultations / opinion are desired. 

• Insisting on formalities during dire emergency situation:  Unfortunately, most of the departments insists on written request for consultation rather responding on verbal request even in emergency situation.

This situation not only reflects poor interdepartmental communication but also sends the wrong message to trainees regarding clinical etiquette and professional accountability.

How it effects the patient care and professionalism: 

At ABSTH, we are fortunate to have all essential specialties under one roof. This proximity should streamline care — not complicate it. A lapse in interdepartmental professionalism can lead to:

• Delays in diagnosis and treatment,

• Poor patient satisfaction,

• Miscommunication,

• And compromised resident training.

All of the aforementioned factors adversely effect the patient outcome and grooming and inculcating professionalism in future physicians.

Feedback on this situation from colleagues:

I discussed this whole situation with my colleagues within the department and with serving in other clinical specialties. Moreover, I also have a detailed discussion with residents of my department during our routine intradepartmental meeting. I tried to dig up the reasons / factors responsible for this type of attitude and measures to improve it so that our future physicians groomed appropriately enable them to achieve highest standards of patient care, professionalism as a physician & mentor. 

Some of the narrations of the colleagues with their personal experiences are summarized as under: 

·       This issue resonates deeply. I've faced similar delays in getting urgent medical opinions. It’s frustrating when residents stall or try to make the call themselves. We need guidelines — yesterday."

·       "The assumption that a resident can decline a consultant’s request is troubling. The patient ends up waiting while departments protect 'turf'. Clear interdepartmental SOPs could prevent this."

·       "The culture of over-delegation is becoming normalized. We should mentor residents to collaborate, not to assert authority prematurely."

·       "A multidisciplinary approach is the future. Interdepartmental respect starts with consultant leadership and is mirrored by trainees."

How I reflect on this incident?

As clinicians and teachers of future clinicians, we bear multiple responsibilities — not only towards our patients but also towards our residents. Residents are a reflection of their supervisors and mentors; they emulate what they observe and learn during their training. Therefore, it is imperative that we consciously impart professionalism, teamwork, and interdepartmental coordination.

It must be emphasized: when a consultant from one specialty seeks an opinion from another department, they are requesting the opinion of a consultant, not a PGR. Every consultant has a foundational understanding of other specialties; they seek external input only when they recognize that the matter extends beyond their expertise. In such cases, it is an ethical, professional, moral, and legal obligation to honor and facilitate this request — in the best interest of the patient.

Alhamdulillah, ABSTH is privileged to have all essential specialties under one roof, enabling us to provide the required basic care within the hospital. We must leverage this strength by framing and implementing a clear, workable protocol for interdepartmental referrals and consultations.

Such a protocol would:

1.  Ease the burden on patients and their attendants,

2.  Foster mutual respect, teamwork, and collaboration among departments,

3.  Train residents to value and practice professional coordination,

What is required / expected:  

We must act collectively to:

• Develop and enforce clear protocols for interdepartmental referrals and consultations,

• Reinforce the role of residents as learners, not autonomous decision-makers in areas beyond their training,

• Encourage direct consultant-to-consultant communication when required,

• Prioritize patient welfare over departmental convenience.

I urge the administration and senior faculty to take this issue seriously and initiate immediate steps to draft and enforce referral and consultation guidelines. This change will not only serve humanity but will also uphold the professional standards we aspire to instill in our next generation of physicians, mentors.

Dr Muhammad Ateeq

Professor of Surgery

NSMC/ABSTH Gujrat

Dated: 29/04/2025

ASSIGNMENT NO 23: PGD HEALTH PROFESSIONALS EDUCATION HSA

REFLECTIVE WRITING ON WORKSHOP MEDICOLEGAL DOCUMENTATION FOR SURGICAL RESIDENTS

On April 30, 2025, I facilitated a workshop on medico-legal documentation for house surgeons and postgraduate students in the Department of Surgery. The session aimed to address a long-standing gap I have observed throughout my career — the inadequate training of clinicians in medico-legal documentation. Drawing from my extensive experience as a Medico-Legal Expert, District Surgeon, and member of the District Medico-Legal Appellate Board, I designed the session to be both practical and interactive. A key focus was the proper format and content of medical rest and leave certificates, especially for public servants, in line with the Punjab Government's Esta Code 2025.

Initially, I felt a strong sense of responsibility, aware that the knowledge I shared could directly impact how these young doctors practice in the future. As the session progressed, I became encouraged by the participants' engagement and genuine interest. Their openness to feedback and willingness to learn left me with a deep sense of satisfaction and fulfillment. I was also reminded of how valuable it is to guide the next generation through complex medico-legal challenges that they often fear or misunderstand.

The session was well-received, with active participation and thoughtful questions. The activity where participants drafted and presented their own certificates proved to be particularly effective. It revealed common issues like inconsistency, vague language, and missing details — flaws I have seen repeatedly in my legal work. The positive feedback from the participants, many of whom described the workshop as one of the most practically relevant sessions of their training, reinforced the importance and impact of the session.

This experience highlighted the critical need for medico-legal education in medical training. Many clinicians lack the confidence and knowledge to handle legal documentation, which can lead to unintentional errors with serious consequences. The session proved that when provided with appropriate tools and context, doctors are not only capable but eager to improve. More importantly, I realized that effective documentation is not just a technical skill — it's a professional and ethical responsibility. The training served as a bridge between clinical care and legal accountability, equipping doctors to navigate this intersection with more clarity and confidence.

This workshop reaffirmed the value of continuous mentorship and knowledge sharing. It reminded me that being a facilitator is not just about transferring information but about shaping attitudes and professional behaviour. I also learned that even experienced professionals like myself benefit from engaging with learners — their questions, perspectives, and reflections enriched my own understanding. I now view medico-legal teaching as a critical component of medical professionalism.

In future,  I plan to make such workshops a regular part of clinical training in collaboration with department heads and medical educators. I will develop standardized templates and case-based learning materials to make future sessions even more practical. I also intend to advocate for the inclusion of medico-legal documentation as a formal component of residency training curricula.  Next session will be on declaration of injuries in alleged medicolegal injured patients. The further medicolegal documentation & proceedings are based on the documentation / findings of operating surgeon. Finally, I will continue to reflect on my facilitation methods to ensure that each session is learner-centered, relevant, and transformative.

In conclusion, this workshop reminded me of the value of continuous learning, even for the teacher. It reinforced the need to keep sharing knowledge, to remain connected to the next generation of clinicians, and to ensure that medico-legal literacy becomes an integral part of medical training. I look forward to the next sessions and hope that this initiative continues to grow into something that transforms clinical practice in a positive and lasting way.

ASSIGNMENT NO:  23 PGD  HEALTH PROFESSIONALS EDUCATION HSA

CONTINUED PROFESSIONAL DEVELOPMENT  PROGRAM OF PROFESSOR DR MUHAMMAD ATEEQ FROM 2025- 2029

I have been working as a medical teacher , clinician for the last 35 years in public sector medical colleges of the Punjab.  Presently serving as Professor of Surgery  NSMC Gujrat. My superannuation of service in Health Department is going to complete in September 2029.  The plan of my continued Professional Development over the next 4 years is panned as under.  Few programs are ongoing where as time frame of future programs / activities is  planned  in a specific time frame.

DOMAIN

 1: Clinical Expertise

 Objectives:

1. Enhance clinical skills with current  advanced  operative techniques/ modalities  like  Advanced Laparoscopic  Surgery

2.  Stay  abreast of latest clinical practices  

3. Improve clinical Audit & Patient safety

Activities / Task:

1. Participate in hands on workshops on laparoscopic & Robotic Surgery

2. Participate in national Surgical conferences

Conduct Departmental & Hospital Surgical Audit & M&M Meetings

Time Line: 

1.Year I,II,III, IV

2.Year  I To Year IV

3.On Going

Expected Outcome:

Enhance surgical skills , will improve patient  outcomes.

Exposed to evidence based practices & recent advances

Improve patient Outcome

DOMAIN: 

2: Teaching competence:  

Objectives: 

Enhance the  teaching & Training skills in accordance with  modern concepts of medical education

Activities / Task: 

1.  To complete Post Graduate Diploma HPME

2. To complete Master in HPME

3. Participate in Workshops / Seminars etc on Medical Education for Health Professionals  

Timeline: 

1.  On Going

 2. Year II-III

 3. On Going

Outcome:

 Enhance teaching skills , better training of future health professionals

Domain: 

 3: Research & Publications 

 Objectives:

Strengthen  the research & Publications

Activities / Task: 

To supervise the  research  activities of the  postgraduate residents. Publish at least 4 prospective comparitive studies over 3 years

 Timeline: 

 On Going  

 2.Year I, II,III, IV

 Outcome: 

  Enhanced academic profile & institutional ranking / amputation

 Domain: 

4: Curriculm contribution 

Objectives:

Align Surgical Curriculum with  modern  standards  of Medical Education Modular System

Activities / Task: 

Participation in the ongoing transformation of traditional teaching methodology to integrated modular system as per UHS

Timeline: 

On Going process in NSMC

Completed over next 3 years

Outcome: 

 Curriculum alignment as desired by Pakistan Medical & Dental Council & UHS

Domain: 

4: Digital Competence

 Objectives: 

Learn  programme like Artifical intellegence   in Medical / Health Care

Activities / Task: 

Participate in Tele medicine Workshops on AI

To complete in PGD in AI  

 Timeline: 

1.On going

2.Year III

 Outcome:

Tech enhanced teaching and remote clinical consultations

Enhanced clinical & teaching skills

  Domain: 

5: Leader ship & Administration

Objectives: 

To enhance administrative skills

Activities/ Task: 

To  do  PGD in  Hospital Administration

Timeline:

Year IV

Outcome:

Enhanced Administrative & Hospital management  Skills

 Domain: 

6: Community Engagement

 Objectives:

Extend surgical care and awareness  to  rural community

Activites / Task: 

Awareness seminars on Breast diseases,  Foot care in Diabetics,  to be conducted in  rural areas in coordination with  Department of Community Medicine

 Timeline:

On Going

 Year I,II,III,IV

 Outcome:

Provision  of  health care facilities to underdeveloped  rural areas and provoking awareness of Primary prevention of  common diseases

ASSIGNMENT NO 24: PGD HEALTH PROFESSIONALS MEDICAL EDUCATION HSA

Reflective writing on my journey through CHPE  Program

With over 28  years of service as  a faculty of General Surgery & General Surgeon, teaching both undergraduate and postgraduate students, I have always appreciated the importance of good teaching. However, I recently recognized the need to systematically update and modernize my teaching approach to align with recent trends in medical education. To achieve  this goal, I enrolled in the Diploma Program in Health Professional Medical Education (HPME) offered by the Health Services Academy, Islamabad, in November 2024. This six-month course, forming the first part of the diploma, focused on the foundational principles of health professionals education. It involved regular, assignment-based assessments, most of which revolved around reflective writing and feedback—a practice that was initially unfamiliar to me but eventually proved very useful.

The first half of the HPME diploma course was delivered entirely online. Each week, we were tasked with completing one or two assignments. These focused mainly on developing our understanding of the basic principles of medical education. A significant proportion of assignments emphasized self-reflection, feedback mechanisms, and personal insights into educational practices. This was a new but enlightening experience for me.

Despite my clinical workload, I remained committed to the course. The flexibility of online learning and the clarity of the weekly assignments helped me stay consistent. I often found myself thinking deeply about how these theoretical concepts applied in my teaching settings.

At the outset, I was both excited and  motivated.  Being a senior faculty member who has spent years in conventional teaching systems, adapting to structured educational theories and reflective writing initially felt unnecessary or even redundant. I questioned whether this theoretical work would offer  significant benefits. However, as the weeks progressed, these assignments encouraged a deeper form of self-assessment than I had previously practiced. I found that putting my teaching experiences into words helped me identify gaps in my methods and habits I was previously unaware of. The process of regularly reflecting on my teaching & academic activities in the department and institution—not just the outcomes but the motivations and strategies—began to feel more natural and rewarding.

There were multiple positive aspects of this part of the program. The assignment-based structure ensured that learning was continuous and paced, rather than rushed. The requirement to complete reflective pieces on a regular basis helped me develop a habit of critical thinking. I began to evaluate not just what I was teaching, but how and why I was teaching it.

I particularly enjoyed the sections that offered concrete tools and models, like Gibbs model, program evaluation and review of  assessment methods. These made me realize how much of my teaching had been shaped by tradition and experience rather than evidence-based educational strategies.

 The topics that stood out were micro and macro teaching, the concept of "diseases of the curriculum", and the construction of a multiple-choice question (MCQ) bank. These areas were not only novel but immediately relevant to my day-to-day teaching responsibilities. Understanding these concepts gave me new perspectives on classroom dynamics, curriculum design, and assessment standards.

The topics of micro and macro teaching were particularly beneficial. They helped me distinguish between classroom-level interventions and broader, institutional curricular strategies. Understanding the "diseases of the curriculum"—such as overcrowding, content overload, and poor vertical integration—resonated strongly with what I have witnessed in our medical education system.

Learning about MCQ construction was another highlight. I realized how poorly constructed MCQs can mislead students and undermine fair assessment. Through this module, I learned the criteria for high-quality MCQs and practiced developing questions aligned with learning objectives and Bloom’s taxonomy.

On the other side of the picture,  the lack of live interaction and real-time feedback was a limitation. Being an entirely asynchronous course, the discussions were mostly limited to written exchanges. Occasionally, I missed the richness of verbal / interactive  discussions and peer learning that face-to-face or live online formats offer. Additionally, time management was a recurring challenge due to my busy clinical schedule.

This course has been eye-opening in helping me realize the extent to which formal training in education is essential even for experienced clinicians. While experience in teaching is invaluable, it does not automatically translate into effective teaching. The HPME program challenged my assumptions and taught me to question longstanding practices. For example, I had long relied  only on didactic lectures, believing them to be the most efficient way to deliver vast amounts of knowledge. Through this program, I learned about the effectiveness of learner-centered strategies, and the importance of  feedback & self reflection. 

Furthermore, reflecting on my teaching through assignments revealed some unconscious biases and teaching habits that may have unintentionally hindered student learning. I also understood the value of  self  reflection  and how feedback—both giving and receiving—is central to the learning process.  Describing my own experiences while self reflection of various academic  activities conducted in surgical unit , I learn the importance self analysis,  knowing short comings, gaps in delivering information and to plan strategy for improvement in future.  

This first part of the diploma program has equipped me with a solid foundation in medical education theory and practice. It has also helped me understand the critical role of reflective teaching and the importance of continual feedback. I now view education as a dynamic process that needs to evolve with evidence, feedback, and reflection—much like clinical practice.

During the first six months of the Health Professional Medical Education (HPME) diploma program, I took the initiative to apply my learning in a practical way by organizing small academic activities within my department. Drawing inspiration from the module on assessment and MCQ construction, I decided to involve my postgraduate residents in the process of developing MCQs. This was not only an academic exercise but also an attempt to foster deeper engagement with learning objectives and critical thinking.

These sessions were held in an informal, interactive format. We began with a short discussion on the principles of effective MCQ design, followed by small group exercises where residents attempted to write MCQs on specific topics. Each question was then peer-reviewed and critiqued in a guided discussion.

Initially, I had some hesitation about how this idea would be received. As someone with long-standing clinical and academic experience, I was stepping into a new role—that of a facilitator and collaborator, rather than just a lecturer or evaluator. I also wondered whether the residents would take the exercise seriously or view it as an added burden. However, to my surprise, the response was enthusiastic. The residents appreciated being included in the academic process and expressed genuine interest in learning how assessments are constructed. Personally, I found the experience very fulfilling. It felt refreshing to interact with students in a collaborative academic setting rather than the traditional top-down format. These sessions rejuvenated my own passion for medical education.

The exercise turned out to be a valuable learning opportunity for both the residents and myself. It gave them insights into the complexity of assessment design and helped them understand the importance of aligning questions with learning outcomes and cognitive levels. For me, it was a chance to see teaching from a new lens—one that emphasized mentor-ship, feedback, and co-creation.

The process of critiquing each other's questions created a healthy academic atmosphere. Residents began to recognize common errors in MCQ writing, such as ambiguity, implausible dis-tractors, or lack of clinical relevance. It was matter of immense satisfaction to see their rapid improvement from one session to the next.

This initiative helped me understand the power of active learning. By involving learners in the assessment process, we moved beyond rote memorization toward critical engagement. Residents started thinking more deeply about what makes a good question and, in the process, became more analytical about their own learning.

It also became clear that peer learning is an underused but highly effective tool in postgraduate education. The collaborative environment encouraged mutual feedback, fostered respect for differing perspectives, and cultivated a sense of ownership in the learning process.

On a personal level, these sessions reinforced for me that teaching is most impactful when it is shared and inclusive. The shift from being the sole source of knowledge to being a guide and facilitator was deeply rewarding.

What was once a series of obligatory assignments gradually became a journey of transformation. I have become more conscious of my teaching style, more systematic in my planning, and more empathetic toward learners' needs.

Participating in the academic course on medical education has been an enriching and interesting journey, especially in understanding the critical role of feedback in enhancing learning and teaching. Initially, I perceived feedback primarily as a means of evaluation; however, this course broadened my perspective, highlighting feedback as a powerful tool for formative development, reflective practice, and professional growth.

The course emphasized the importance of timely, specific, and constructive feedback in medical education. I learned that effective feedback is not a one-way transmission of information but a dialogical process that fosters trust, encourages self-assessment, and promotes continuous improvement. Engaging in role-plays, peer discussions, and feedback simulations allowed me to practice delivering feedback in a way that is respectful, goal-oriented, and tailored to individual learning needs.

One of the most impactful lessons was understanding the emotional and psychological aspects of receiving feedback. Creating a safe learning environment, where feedback is perceived as supportive rather than punitive, is essential for encouraging openness and reflection among learners.

As I move into the second half of the HPME diploma program, I intend to apply the following strategies:

1. Improve MCQ design and assessment literacy within my department by sharing what I have learned.

2. Continue reflective journaling, now a regular habit, to improve the quality of my teaching.

3. Integrate micro-teaching sessions for junior faculty in my department, especially those without formal training in education.

4. Experiment with flipped classroom models and student-led seminars to promote active learning.

5. Participate more actively in discussions during the second phase of the course, seeking peer feedback wherever possible.

This experience has significantly influenced my teaching philosophy. I now strive to integrate meaningful feedback into my interactions with students and colleagues, viewing it as a cornerstone of effective medical education and a catalyst for lifelong learning.

Overall, this six-month experience has redefined my understanding of what it means to be a good medical educator. It has reminded me that effective teaching is not just about delivering content but about creating an environment where learners are actively engaged, assessed fairly, and encouraged to think critically. I now look forward to the second part of the diploma with enthusiasm and the hope that it will continue to enrich my teaching journey. The only challenge was time management. Balancing clinical duties while organizing and moderating these sessions required additional effort. However, the outcomes far outweighed the logistical difficulties.

As I reach the conclusion of this enriching six-month Certificate Course in Medical Education for Health Professionals, I am filled with a deep sense of gratitude and accomplishment. This journey, facilitated by the Health Services Academy Islamabad, has been trans formative in reshaping my understanding of teaching, learning, and the broader responsibilities we carry as health professionals in education.

Throughout the course, I have gained valuable insights into  the basic concept of   medical education for teachers  and, most significantly, the role of feedback in fostering meaningful learning.  I would like to express my sincere appreciation to the esteemed faculty  course mentor Professor Junaid Sarfraz  and  course coordinator Miss Eman Fatima  for their dedication, guidance, and commitment to excellence. Their mentor ship has inspired me to reflect deeply on my teaching methods and to strive continuously for improvement.

Finally, I am committed to applying the knowledge and skills acquired here to enhance the quality of medical education in my institution. I believe this course has laid a strong foundation for ongoing professional development and has empowered me to contribute more effectively to the training of future healthcare professionals. Moreover, this is not the end this journey I will continue this further to enroll in  postgraduate diploma &  Masters in medical education  from Health Services Academy Islamabad.  Inn Sha Allah.