Background:

The rapid pace of medical advances coupled with specialization and super-specialization, is eroding the traditional doctor–patient relationship.

Objective:

(a) To study the determinants of core dimensions, such as, concordance, trust, and enablement in a doctor–patient relationship; (b) to explore associations, if any, among these core dimensions.

Materials and Methods:

A cross–sectional study design with both quantitative and qualitative methods was employed. One hundred and ninety-eight outdoor patients were interviewed as part of the quantitative study. Three dimensions of the doctor–patient relationship, that is, physician patient concordance, trust in physician, and patient enablement were assessed using validated tools. Focus group interviews using an open-ended format among few physicians was carried out as part of the qualitative study.

Results:

In the quantitative analysis most of the sociocultural factors did not show any significant association with the doctor–patient relationship. However, gender was significantly and strongly associated with trust in the physician. Female patients showed a much lower trust in the physician (50%) as compared to male patients (75%) (OR = 0.33, 95% CI 0.17 – 0.64, Chi Sq = 12.86, P = 0.0003). A qualitative study revealed language and culture, alternative medicines, commercialization of medicine, and crowding at specialist and super-specialist clinics as barriers to a good doctor–patient relationship. Better concordance was associated with improved trust in the doctor (OR = 5.30, 95% CI 2.06 – 13.98, Chi Sq = 14.46, P = 0.0001), which in turn was associated with improved patient enablement (OR = 3.89, 95% CI = 1.60 - 9.64, Chi Sq = 10.15, P = 0.001).

Conclusion:

Good doctor–patient concordance (agreement) leads to better trust in the physician, which in turn leads to better patient enablement, irrespective of the sociocultural determinants.

Background:

There has been a growing concern among medical educators about the quality of medical graduates trained in various medical colleges in our country. Data based on the faculty and student perceptions of undergraduate curriculum indicate a need for laying more stress on practical skills during their training and assessment. The Objective Structured Clinical Examination (OSCE) is a reliable and an established and effective multistation test for the assessment of practical skills in an objective and a transparent manner. The aim of this article is to sensitize universities, examiners, organizers, faculty, and students across India to OSCE.

Materials and Methods:

We designed an assessment based on 22-station OSCE and administered it to 67 students during their final year, integrating all the domains of learning, that is higher order cognitive domain, psychomotor domain, and affective domain. Data analysis was done using SPSS version 15.

Results:

The OSCE was feasible to conduct and had high perceived construct validity. There was a significant correlation between the station score and total examination score for 19 stations. The reliability of this OSCE was 0.778. Both students and faculty members expressed a high degree of satisfaction with the format.

Conclusion:

Integrating a range of modalities into an OSCE in ophthalmology appears to represent a valid and reliable method of examination. The biggest limitation with this format was the direct expenditure of time and energy of those organizing an OSCE; therefore, sustaining the motivation of faculty might pose a challenge.

Background:

Indian society is in a stage of rapid social transition. As more women enter the workforce, stresses vis-à-vis the genders are to be expected in patriarchal society to which most of our population belongs. Earlier studies in Western societies have revealed gender differences in perception of what constitutes sexual harassment.

Aim:

Elicit gender differences, if any, in the workplace sexual harassment among future professionals.

Settings and Design:

A cross-sectional study among the students of professional colleges.

Materials and Methods:

A total of 200 students of both sexes were randomly selected from four professional colleges. Data collection was done on a structured questionnaire by interview.

Statistical Analysis:

Internal consistency of the questionnaire was tested by Crohnbach's α coefficient. Associations between gender and perceptions were explored with Chi-square, Odds Ratio with 95% confidence interval, where applicable.

Results:

The differences in perception on what constitutes sexual harassment among the genders were statistically significant on many measures (P<0.01).

Conclusions:

Men and women differ in their awareness as to what constitute sexual harassment. Men were more lacking in awareness regarding sexual harassment.

Background:

There is a growing concern that medical education does not prepare the future health professional to effectively deal with violence against women. Against this background, the present study was undertaken.

Aims:

To elicit perception of violence against women among medical and nursing students, and study the association of these perceptions with certain demographic and social variables.

Settings and Design:

The study was conducted among students of a Medical College and a Nursing College both located at Pune, India. A cross-sectional descriptive study design was used to elicit the perceptions of the study subjects toward violence against women.

Materials and Methods:

A random sample of 125 medical and 125 nursing students was selected. Both quantitative and qualitative methods of data collection were employed. Qualitative data collection was done by focus group discussions with key persons such as dean and faculty of medical and nursing colleges. The syllabi of medical and nursing colleges were also reviewed for any topic related to domestic violence.

Statistical analysis:

The WHO/CDC Statistical and Epidemiology Software Package was used for data entry and statistical analysis. Various associations were explored by nonparametric tests (Mann-Whitney) for ordinal data and by Chi-square and ODDS ratio (with 95% confidence intervals), for categorical data.

Results:

Overall 35.6% (95% CI 29.1%–42.6%) of the study participants had witnessed/were aware of violence against women among their family/acquaintances. This awareness was significantly more among female respondents (OR=2.65, 95% CI 1.37–5.16), Chi Sq=9.81, df=1, P=0.001. Other socioeconomic variables such as urban/rural background, education, and income were not associated with perception about family violence. Majority (>80%) agreed/strongly agreed that social agencies should do more to help battered women. Course content on violence against women was lacking in both medical and nursing syllabi.

Conclusions:

Female participants were generally more perceptive about the issue. Medical and nursing syllabi should incorporate strategies for dealing with violence against women.

Research studies are usually carried out on sample of subjects rather than whole populations. The most challenging aspect of fieldwork is drawing a random sample from the target population to which the results of the study would be generalized. In actual practice, the task is so difficult that some sampling bias occurs in almost all studies to a lesser or greater degree. In order to assess the degree of this bias, the informed reader of medical literature should have some understanding of the population from which the sample was drawn. The ultimate decision on whether the results of a particular study can be generalized to a larger population depends on this understanding. The subsequent deliberations dwell on sampling strategies for different types of research and also a brief description of different sampling methods.

Hypothesis testing is an important activity of empirical research and evidence-based medicine. A well worked up hypothesis is half the answer to the research question. For this, both knowledge of the subject derived from extensive review of the literature and working knowledge of basic statistical concepts are desirable. The present paper discusses the methods of working up a good hypothesis and statistical concepts of hypothesis testing.

Background:

Anxiety may not be recognized by physicians though they affect a large number of patients awaiting surgery as reported in some studies. Good doctor-patient communication may have an impact on preoperative anxiety.

Aim:

To find out the incidence of anxiety in patients awaiting surgery and its association with good doctor-patient communication.

Materials and Methods:

The study was undertaken in a medical college hospital situated in an industrial township, for the duration of two months. It was a cross-sectional study. The study included 79 patients admitted to various surgical wards of a teaching hospital. Data was collected on a pretested questionnaire, which included a set of questions on various aspects of doctor-patient communication. The level of anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS). Statistical analysis was carried out using the WHO/CDC package EPI INFO 2002. Though preoperative anxiety was collected on an ordinal scale, later during analysis, it was collapsed to give a categorical scale. Aspects of doctor-patient communication associated with preoperative anxiety were explored by Chi square tests.

Results:

Out of the total 79 patients, 26.5% reported definite anxiety levels. Good doctor-patient communication was found to be inversely associated with anxiety levels in the preoperative period.

Conclusions:

Preoperative anxiety is a common phenomenon among indoor surgical patients. A lot can be done to alleviate this anxiety by improving doctor-patient communication.

Objective:

Exposure to blood and body fluids is one of the hidden hazards faced by health care workers (HCWs). The objective of the present study was to estimate the incidence of such exposure in a teaching hospital.

Materials and Methods:

A cross-sectional study among a random sample of residents, interns, nurses and technicians (n = 830) was carried out in a teaching hospital to estimate the incidence of exposure to blood and body fluids in the preceding 12-month period. Self-reported occurrence and the circumstances of the same were recorded by face-to-face interviews using a semi-structured questionnaire.

Results:

The response rate to the study was 89.76%. Occupational exposure to blood and body fluids in the preceding 12 months was reported by 32.75% of the respondents. The self-reported incidence was the highest among the nurses. Needle-stick injury was the most common mode of such exposures (92.21% of total exposures). Index finger and thumb were the commonest sites of exposure. Only 50% of the affected individuals reported the occurrence to concerned hospital authorities. Less than a quarter of the exposed persons underwent post-exposure prophylaxis (PEP) against HIV, although the same was indicated in about 50% of the affected HCWs based on the HIV status of the source patient.

Conclusions:

Occupational exposure to blood and body fluids was a common occurrence in the study sample. There was gross under-reporting of such incidents leading to a lack of proper PEP against HIV in 50% of those in whom the same appeared to be indicated.