4Th Educational Research Day Abstract Book

Aga Khan University, Department for Educational Development 4th Educational Research Day

Department for Educational Development in collaboration with Department of Continuing Professional Education

4th Educational Research Day

Abstract Book

November 25 & 27, 2020

Aga Khan University, Department for Educational Development 4th Educational Research Day

Message from Dean

Message from the Dean, Medical College, Pakistan for Virtual Educational Research Day 2020 From its very inception, AKU’s Department for Educational Development has been instrumental in nurturing an environment in which Health Professions Education is valued as an integral and essential component of the academic mission of the University’s Faculty of Health Sciences. As the fourth in the series, the Department’s annual educational research day has proven to be an excellent platform for dissemination of research across the entire continuum of education in all AKU campuses, and national institutions with a special focus on Health Professions Education. My congratulations to the entire DED team, especially for the effort they have put into organising a wonderful, virtual programme during these unprecedented times.

Dr Adil H. Haider Professor & Dean, Medical College Aga Khan University

Message from the Interim Associate Dean, Education, FHS for Virtual Educational Research Day 2020 The Department for Educational Development (DED), Faculty of Health Sciences (FHS), serves as a resource for not only Aga Khan University (AKU) but other national and international institutions as well. It plays a vital role in assuring and enhancing the quality of education. It also conducts, encourages and disseminates research in HPE. Educational research is vital to identify strengths, weaknesses and way forward to overcome the existing challenges while improving practices in teaching, learning and assessment. Educational research helps to expand the existing body of knowledge by providing solutions to different problems. DED promotes Educational research by providing a platform for dissemination of educational research 2020 has been a challenging year, despite the restriction of COVID-19 we had overwhelming response for both E-Posters and Oral Presentations. This year organizing the Research Day virtually has enabled participation of our faculty members from all AKU campuses across the globe. I appreciate the departmental research committee for their diligence in successfully organizing this event.

Dr Muhammad Tariq Professor & Interim Associate Dean, Education, FHS Aga Khan University

Aga Khan University, Department for Educational Development 4th Educational Research Day

Organizing Committee

Dr Sonia Ijaz Haider Dr Rahila Ali

Chair, Educational Research Day Co-Chair, Educational Research Day Assistant Professor Senior Instructor Department for Educational Department for Educational Development Development Aga Khan University. Aga Khan University.

Dr Tabassum Zehra Dr Shazia Babar Assistant Professor Senior Instructor Department for Educational Department for Educational Development Development and Department of Aga Khan University. Obstetrics and Gynecology Aga Khan University

Dr Javeria Rehman Dr Muhammad Tariq Senior Instructor Professor & Interim Associate Dean, Department for Educational Education, Development and & Department of Department for Educational Pathology& Laboratory Medicine Development Aga Khan University Aga Khan University

Dr Lina Khan Mr Anil Khowaja Manager, Senior Assistant Department for Educational Department for Educational Development Development Aga Khan University Aga Khan University

Aga Khan University, Department for Educational Development 4th Educational Research Day

Abstract – E-Posters 10

Theme: Teaching and Learning

1. COVID-19 table top exercise for emergency department preparedness in a low resource, tertiary care setting 11

*Saima Salman, Syed Ghazanfar Saleem - The Indus Hospital

2. Concept Maps: An Effective Learning Strategy for Teaching Toxicology 12

*Marvi Masood Farooqui – Ziauddin University

3. Innovative ways of student engagement for active learning in science courses of nursing in the Four Baccalaureate program 13

*Shehla Khan, Shagufta Iqbal - Aga Khan University

4. Health literacy communications for people with hearing Impairment: Lessons from Covid-19 14

*Musa Saimon - Institute of Education Development (IED)

5. Management of Medically Compromised Patients in Dentistry as a Separate Domain, A Step Towards Medically Oriented Dental Training 15

*Saima Omar - Sir Syed College of Medical Sciences

6. Comparing reflection in leaning level of first and last clinical year medical students in a private sector medical college of Pakistan 16

*Musarrat ul Hasnain Shah, Sumera Ehsan - Rashid Latif Medical College

7. Impact of education intervention on Knowledge of infection control practices among healthcare providers during COVID -19 pandemic 17

*Iffat Khanum, Kiren Habib, Bilal Ahmed, Bushra Jamil - Aga Khan University

8. Training of Radiographers in Identifying Critical Radiological Findings: Making the Seconds Count 18

*Jehanzeb Shahid, Ismail Alvi - Aga Khan University

9. Medical students’ perception of live lectures compared to video lectures in basic sciences medical education 19

*Maria Khan, Ali Bin Abdul Jabbar, Daniyal Ali Khan, Muhammad Abdullah Javed, Muhammad Hassan Raza Raja, Kanza Muzaffar - Aga Khan University

10. Orientation to Operating Room- A Simulation Based Blended Learning Course for Undergraduate Medical Students (A Narrative) 20

*Soobia Rehman - Memon Medical Institute Hospital

11. Perceptions of students and faculty regarding the implementation of the baccalaureate nursing program in KPK 21

*Abdul Karim, Yasmin Noorali Amarsi, Yasmin Nadeem Parpio, Laila Akber Cassum, Munira Amirali - Aga Khan University

12. Association of Multiple Teaching Methodologies and Student Learning based on Test Scores 22

*Sara Shakil - Aga Khan University

13. Implementation of Skills-based Learning in Classrooms during COVID-19 Pandemic 23

*Farah Naz Ata, Raabia Hirani , Ali Bijani , Dr Shehzad Jeeva and Noshaba Hameed - Examination Board, Aga Khan University

Theme: E-Learning

14. Clinical Year Medical Students Acumen on the Shift to New Norms 24

*Shazia Durrani Fakhir, Ammara Hameed - Bahria University Medical and Dental College

15. SWOC analysis of e-learning educational services at Rawalpindi Medical University in the midst of COVID-19 25

*Khola Noreen, Muhammad Umar; Arshad Sabir - Rawalpindi Medical University

16. Self-perceived competency of Medical faculty for e-teaching in COVID 19 pandemic 26

*Shaur Sarfaraz - Jinnah Sindh Medical University

17. Transition to Online Teaching amid Covid-19 Pandemic: Perspective of Post Graduate Trainees of Medicine Department in a Tertiary Care Hospital 27

*Iffat Khanum, Zaibun Nisa, Azam Afzal - Aga Khan University

18. Effectiveness of E-learning on knowledge and attitude of health care professionals regarding Early Mobilization of Mechanically Ventilated patients 28

*Zahira Amir Ali Khalfan, Khairulnissa Ajani - Aga Khan University

19. New Norms In Medical Education: Faculty’s Perspective 29

*Shazia Durrani Fakhir - Bahria University Medical and Dental College

20. Observational study on e-learning during COVID pandemic 30

*Saara Khan, Asra Khan - Aga Khan University

21. Effectiveness of Virtual clinical education amid COVID-19 Pandemic: Medical and Nursing education revolution 31

Aga Khan University, Department for Educational Development 4th Educational Research Day

*Sumaira Warwani, Sumera Zulfiqar - Aga Khan University

22. Experiences of Undergraduate Medical Students Regarding Virtual Clinical Rotations During Covid-19 In Karachi 32

*Shazia Durrani Fakhir - Bahria University Medical and Dental College

23. Trials and tribulations in a journey from face-to-face to online education 33

*Hina Khalid, Syeda Kauser Ali, Shuar Sarfaraz, Syed Moyn Aly - Jinnah Sindh Medical University

24. Continuing Education Program via Virtual Learning & Education (VLE) for Technologists of Chemical Pathology 34

*Farhat Jahan, Hafsa Majid - Aga Khan University

25. Innovation in Continuing Professional Education for midwives: A new normal for service provision amid Covid-19 35

*Kiran Mubeen, Saima Sachwani, Farzana Yameen, Sadia Karimi, Marina Baig, Arusa Lakhani - Aga Khan University

Theme: Assessment

26. Development and validation of an instrument for assessment of professional behaviour during laboratory sessions 36

*Fatima Zehra, Sonia Ijaz Haider - Bahria University Medical and Dental College

27. Establishing the validity and reliability of Pain Clinical Evaluation Exercise (P-CEX) tool for postgraduate trainee in a teaching hospital 37

*Ali Sarfraz Siddiqui, Gauhar Afshan - Aga Khan University

28. Perception of junior faculty regarding Objective Structured Practical Examination (OSPE) 38

*Shizma Junejo, Talea Hoor - Bahria University Medical And Dental College

29. OSATS an Appropriate Assessment Tool to Evaluate Procedural / Technical Skills of Radiology Residents 39

*Nasreen Naz, Shaista Afzal, Rukhsana W Zuberi, Azam Afzal, Vaqar Bari - Dow University of Health Sciences - Dow University of Health Sciences

30. Mental health assessment of healthcare workers in the Emergency Department of a low middle-income country during COVID 19 pandemic 40

*Nirdosh Ashok, Shahan Waheed - Aga Khan University

31. Students’ Performance in English Academic versus Creative Writing at Secondary and Higher Secondary Examinations 41

*Tooba Farooqui, Raabia Hirani - Examination Board, Aga Khan University Theme: Evaluation

32. Evaluation of the Safe Circumcision Program- a critical decision 42

*Shazia Junejo, Lubna Samad - Indus Health Network

33. Evaluating the Effectiveness of Skills-Based Training Program for Teacher Trainers 43

*Ali Bijani, Munira Muhammad Rangwala, Naveed Yousuf - Examination Board, Aga Khan University

34. Monitoring and Evaluation for sustaining the Efficiency of Work while Working Remotely during Covid-19 Pandemic 44

*Malik Azam, Amjad Ali Shah - Examination Board, Aga Khan University

35. Monitoring and Evaluation of Capacity Development Programme on Students Assessment 45

*Sitara Jabeen - Examination Board, Aga Khan University

36. Evaluating the Effectiveness of Capacity Development Programme on Student Assessment 46

*Rabia Nisar, Muhammad Kashif, Muhammad Faheem, Naveed Yousuf - Examination Board, Aga Khan University

Theme: Curriculum Development

37. Factors underlying residents’ self-ratings in 360-degree evaluation 47

*Muhammad Tariq, Azam Afzal - Aga Khan University

38. Contribution of Microbiology In Nursing Theory and Practice 48

*Shagufta Iqbal, Shehla Khan – SONAM, Aga Khan University

39. An integrated model for developing research skills in an undergraduate medical curriculum: appraisal of an approach using Integrated Undergraduate Research Component and Student Research Components 49

*Khola Noreen, Arshad Sabir - Rawalpindi Medical University

40. Assessing insights and practices among graduates to signify the need for dental ergonomics within the dental curriculum. A cross-sectional survey 50

*Shaur Sarfaraz - Jinnah Sindh Medical University

41. Ensuring the Completion of Pain Fellowship Training through Innovation in Curriculum during COVID 19 Pandemic 51

Aga Khan University, Department for Educational Development 4th Educational Research Day

*Aliya Ahmed, Robyna Irshad Khan, Shemila Abbasi, Ali Sarfraz Siddiqui, Azhar Rehman, Ausaf Khan, Tanveer Baig, Gauhar Afshan - Aga Khan University

42. Mental Health in COVID Crises; integrating Synchronous Learning in Undergraduate Blended Curriculum 52

*Sana Asif Siddiqui, Aisha Sanober Chachar, Humera Saeed, Ayesha Irshad Mian - Aga Khan University

Theme: Social Media

43. Effectiveness of Multiple Reminders in an online research survey for Maximum Response 53

*Fatima Gauhar, Maria Khan, Nimra Iqbal, Mushahid Hussain Rizvi, Syeda Sadia Fatima - Aga Khan University

44. Social Media in Radiology Education 54

*Shaista Afzal Saeed - Aga Khan University

Theme: Well being

45. Prevalence and Factors Associated with Anxiety and Depressive Symptoms Among Undergraduate Nursing Students in KPK 55

*Muhammad Ilyas, Yasmeen Nadeem Parpio – SONAM, Aga Khan University

46. Impact on Mental Health of Undergraduates and the Ways to Cope Stress during Covid-19 Pandemic 56

*Kiran Fatiam Bana, Shaur Sarfaraz - Bahria University Medical and Dental College

Theme: Leadership

47. An analysis of the Role of principals as Transformative Leaders in Private Schools of Gilgit Baltistan 57

*Musrat Jahan

Theme: Interdisciplinary Approch

48. Efficacy of Transdisciplinary intervention Approach in Social skills group therapy for children with Autism Spectrum Disorder and Attention Deficit Disorder 58

*Hamamah Ansari, Noorulain Ghulam - Aga Khan University

49. A Multidisciplinary Model for Geriatric Care in Karachi, Pakistan 59

*Habiba Thawer, Saniya Sabzwari - Aga Khan University

Theme: Mentoring

50. Mentorship in Obstetrics and Gynecology Residency: Perspectives from both sides of the association 60

*Munazza Akhtar, Ayesha Malik - Aga Khan University

Theme: Learning Enviroment

51. Experiences and Reflection of Dental students facing Harassment during undergraduate education in Karachi 61

*Aliya Islam - Baqai Medical University

Theme: Miscellaneous

52. Academic Background as a Predicator of Performance/Success in Science Subjects amongst Undergraduate Nursing Students Enrolled at a Private University in Pakistan 62

*Naghma Rizvi, Shehla Khan – SONAM, Aga Khan University

53. Who are transgender and intersex individuals? Views of medical students and health care providers from Karachi 63

*Hira Tariq, Zaeema Ahmer, Sana Yasir - APPNA Institute of Public Health, Jinnah Sindh Medical University

54. Career Choice and Perception of Nursing Profession among Undergraduate Nursing Students in Peshawar (KPK), Pakistan 64

*Shakir Rahman, Naghma Rizvi – SONAM, Aga Khan University

Aga Khan University, Department for Educational Development 4th Educational Research Day

Abstract – Oral Presentations 65

Theme: Innovation in Teaching & Learning

55. An innovation in Flipped Class Room; a teaching model to facilitate synchronous and asynchronous learning during a pandemic 66

*Rehana Rehman, Syeda Sadia Fatima - Aga Khan University

56. Challenges and opportunities of Virtual Teaching 67

*Rubaba Azim, Munizha Nisar - Dow University of Health Sciences

57. Strengthening Skills for Developing a Flipped Classroom Undergraduate Medical and Nursing student and faculty perspectives 68

*Amber Sultan, Rahila Ali, Nida Zahid, Rozmeen Akber, Russell Martin, Muhammad Tariq, Khairulnissa Ajani - Aga Khan University

58. Status of Digital Learning Practices in Health Sciences Education in Pakistan 69

*Sanam Hanif, Hussain Maqbool Ahmed Khuwaja, Ali Maqbool, Komal Abdul Rahim, Sana Gul, Shabnoor Karim – SONAM, Aga Khan University

Theme: Faculty Development, Burnouts & Ethics in Health Profession Education

59. Development and Validation of a Multisource feedback tool to Assess the competencies of a Health Professional Educationist 70

*Rahat Naz, Azam Afzal - Jinnah Sindh Medical University

60. Knowledge Regarding the Importance of Medical Ethics: Cross-Sectional Study among Students of a Government and a Private Medical College of Karachi 71

*Zaeema Ahmer, Rameen Fatima, Roheen Sohaira, Maham Fatima - APPNA Institute of Public Health, Jinnah Sindh Medical University

61. The Prevalence and Association of Stress with Sleep Quality in Medical Students: A Cross-Sectional Study 72

*Mohummad Hassan Raza Raja, Muhammad Abdullah Javed, Maryam Pyar Ali Lakhdir, Ali Bin Abdul Jabbar, Maria Khan, Kanza Muzaffar - Aga Khan University

62. Faculty Development in Health Professions Education at Aga Khan University: The Needs Assessment 73

*Tabassum Zehra, Rahila Ali Mazhar, Sana Saeed, Amber Sultan, Sunder Khuwaja, Muhammad Tariq - Aga Khan University

Theme: Educational Assessment

63. Assessments in Medical Education: Challenges & Solutions during COVID Pandemic 74

*Sadia Fatima, Romana Idrees, Kausar Jabeen, Saniya Sabzwari, Sadaf Khan, - Aga Khan University

64. Conducting Formative Online Open-book Exam for First Year Medical Students - A Pilot Study 75

*Javeria Rehman, Rahila Ali, Azam Afzal, Sara Shakil, Amber Sultan, Romana Idress, Sadia Fatima - Aga Khan University

65. Developing and Validating Team Objective Structured Assessment of Technical Skills (Tosats) for Obstetrics Emergency Skills: Eclampsia Management 76

*Nida Najmi, Shazia Babar - Aga Khan University

66. Process-Oriented Quality’ Method for Assuring the Reliability of Large-Scale Assessment Scores at the National Level 77

*Amjad Ali Shah, Anila Ashique Ali - Examination Board, Aga Khan University

*Presenting Authors

Aga Khan University, Department for Educational Development 4th Educational Research Day

“4th Educational Research Day” Organized by

Department for Educational Development The Aga Khan University November 25 & 27, 2020

Programme Wednesday, November 25 from 10:00 am till Friday, November 27, 2020 06:00 pm Display of E-Poster: https://tiny.cc/ded-erd2020/ ______

Friday, November 27 02:00 to 05:30 pm

Online Registration

02:00 - 02:05 pm Tilawat e Quran

02:05 - 02:10 pm National Anthem

02:10 - 02:20 pm Welcome and Overview by Dr Muhammad Tariq Interim Associate Dean, Education, FHS, AKU

02:20 - 02:35 pm Address by Dr Adil H. Haider, Dean, Medical College, AKU

02:35 - 03:20 pm Oral presentation - Session I

Moderator: Dr Javeria Rehman

Theme: Innovation in Teaching & Learning An innovation in Flipped Class Room; a teaching model to Rehana Rehman, 02:35 – 02:42 facilitate synchronous and asynchronous learning during a Aga Khan University pandemic Rubaba Azim, Dow University of Health 02:43 – 02:50 Challenges and opportunities of Virtual Teaching Sciences Strengthening Skills for Developing a Flipped Classroom: Amber Sultan, 02:51 – 02:58 Undergraduate Medical and Nursing student and faculty Aga Khan University perspectives Status of Digital Learning Practices in Health Sciences Education Sanam Hanif, 02:59 – 03:07 in Pakistan Aga Khan University (15 min Question & Answers)

03:20 - 03:25 pm Break

Aga Khan University, Department for Educational Development 4th Educational Research Day 03:25 - 04:10 pm Oral presentation - Session II

Moderator: Dr Rahila Ali

Theme: Faculty Development, Burnouts & Ethics in Health Profession Education Rahat Naz, 03:25 – 03:32 Development and Validation of a Multisource feedback tool to Assess Jinnah Sindh Medical the competencies of a Health Professional Educationist University Zaeema Ahmer, Knowledge Regarding the Importance of Medical Ethics: Cross- Jinnah Sindh Medical 03:33 – 03:40 Sectional Study among Students of a Government and a Private University Medical College of Karachi The Prevalence and Association of Stress with Sleep Quality in Mohummad Hassan 03:41 – 03:48 Medical Students: A Cross-Sectional Study Raza Raja, Aga Khan University Tabassum Zehra, Faculty Development in Health Professions Education at Aga Khan 03:49 – 03:56 Aga Khan University University: The Needs Assessment (15 min Question & Answers)

04:10 - 04:19 pm 7 minutes for MHPE student’s video

04:20 - 05:05 pm Oral presentations - Session III

Moderator: Dr Tabassum Zehra

Theme: Educational Assessment Assessments in Medical Education: Challenges & Solutions during Sadia Fatima, 04:20 – 04:27 COVID Pandemic Aga Khan University 'Process-Oriented Quality’ Method for Assuring the Reliability of Amjad Ali Shah, 04:28 – 04:35 Large-Scale Assessment Scores at the National Level Aga Khan University Conducting Formative Online Open-book Exam for First Year Medical Javeria Rehman, 04:36 – 04:43 Students - A Pilot Study Aga Khan University Nida Najmi, Developing and Validating Team Objective Structured Assessment of Aga Khan University 04:44 – 04:51 Technical Skills (Tosats) for Obstetrics Emergency Skills Eclampsia Management (15 min Question & Answers)

05:05 - 05:20 pm Summary of best posters (Dr Rukhsana W Zuberi)

05:21 - 05:24 pm Announcement of Best Oral Presentation

05:25 - 05:30 pm Closing Remarks (Dr. Rozina Karmaliani)

05:30 - 05:35 pm Vote of thanks (Dr. Sonia Haider)

Aga Khan University, Department for Educational Development 4th Educational Research Day

Abstract – E-Poster

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Teaching and Learning

1. COVID-19 table top exercise for emergency department preparedness in a low resource, tertiary care setting *Saima Salman, Syed Ghazanfar Saleem - The Indus Hospital

Introduction: Table top exercises help in disaster preparedness through discussion based simulation to not only acquaint the participants with the existing mechanisms but also to identify gaps and assess the effectiveness of the emergency response. Our COVID-19 based table top exercise was aimed towards preparedness for this unique healthcare challenge and capacity building in a resource-limited setup. Method: A two day table top exercise was conducted with a pre-test/ post-test, followed by participant survey to assess the impact of the intervention. COVID-19 centered scenarios were run and concepts of planning, operations, communication and security in view of patient surge and resource management were discussed. Result: Twenty two participants including ED physicians and nurses underwent the training. There was a statistically significant difference between pre-test and post-test scores (p<0.0001) with post-test showing an improvement in the participant knowledge. A number of themes were identified through the exercise that established the foundation for improved patient management in COVID-19 pandemic. Conclusion: Table top exercises are a low cost, time sensitive means of capacity building and can be utilized effectively to increase the knowledge and awareness of ED personal in managing natural and manmade disasters, especially in low and middle income countries. Key words: COVID-19, Table top exercise, Emergency Department

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Teaching and Learning

2. Concept Maps: An Effective Learning Strategy for Teaching Toxicology *Marvi Masood Farooqui – Ziauddin University

Introduction: Toxicology has been taught in association with Forensic Medicine since the beginning of undergraduate medical education in Pakistan. Students have often performed poorly in tests and final exams and have reported difficulties in understanding reported difficulties in understanding and recalling mechanisms, effects and treatments of various poisonings and overdoses. The goal of this study is to assess whether concept mapping can effectively help students of toxicology understand their course content, synthesize past knowledge with new knowledge and recall their learnings better during testing or assessment. Objective: To compare toxicology test scores using concept maps in addition to lecture-based teaching/learning strategies with test scores using only traditional lecture-based teaching/learning techniques Methodology: Quasi-experimental study design will be employed, with non-probability purposive sampling. The sample population will be 3rd Year MBBS at Ziauddin Medical College. Sample size would be 280 students in total, with 145 students of the current (upcoming) year + 135 students of previous year (control). The current batch of MBBS students will undergo the traditional teaching strategies as well as concept mapping. The intervention will take 6 months (June 2020 to November 2020) according to the length of the semester. At the end, CAT test scores for all three CATs and final exam of previous batch and upcoming batch will be collected from the Examination Department and entered into Excel and SPSS for statistical analysis. Expected Outcomes: It is expected that this study will provide insight on the effect of concept mapping on the teaching/learning of toxicology concepts (and therefore scores) of the students of 3rd year MBBS at Ziauddin Medical College

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Teaching and Learning

3. Innovative ways of student engagement for active learning in science courses of nursing in the Four Baccalaureate program *Shehla Khan, Shagufta Iqbal - Aga Khan University

Introduction: Active learning strategies with innovative ways are now being used in the teaching and learning for the engagement of students in the classroom settings. A number of studies talks about the benefits the students have shown through their skills while using the active learning methods in their science courses that is Biochemistry, Anatomy and Physiology, Microbiology and Pathophysiology. It has been observed that active learning helps to retain material, motivate students and most of the time develops thinking skills. In the science courses of nurse education these are very much in use for developing the critical thinking qualities in their student nurses. Method: This review investigated the studies of last 10 – 15 years focusing on Active learning strategies. The review aims active learning in teaching sciences by using various innovative strategies which are creative and student centered. These strategies make students more engaged and at the same time promotes their clarity in concepts which they can apply in their nursing practice. Result: This paper results in focusing a variety of teaching learning strategies which helps the facilitator to engage their students in active learning. Conclusion and Discussion: To conclude we can say that Active learning is a student oriented process. The innovative active learning pedagogies played a vital role in engaging the students more independently through the learning process. It is recommended to provide such platform where we can train faculty to teach students by various innovative ways that can increase the student’s engagement and motivation in learning science courses in nursing

Keywords: Learning strategies, innovation, active learning, Student engagement, nursing education

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Teaching and Learning

4. Health literacy communications for people with hearing Impairment: Lessons from Covid-19 *Musa Saimon - Institute of Education Development (IED)

Lack of proficiency in using languages (except sign languages) among people with hearing impairment poses difficulties for them to comprehend health related information and thus, having low health literacy. To bridge this gap, health care providers adopt various communication practices to reach people with hearing impairment, some of which prove success while others prove failure. Consequently, reflection on health literacy communications becomes paramount for the sustainability of health education for people with hearing impairment. The present study reflects on communication practices during covid-19 pandemic control in Tanzania in relation to people with hearing impairment. The study adopted qualitative research approach in which the data were collected through interviews from five (5) people with hearing impairment and three (3) health care providers who were purposively sampled. Findings showed that adopted communication practices (the use oral communication without interpreters, failure of using sign languages among health care providers, and the use of written information) during covid-19 were less effective to people with hearing impairment. Therefore, this teaches us that health literacy education should always be given through sign language by using interpreters or by teaching sign language among health care providers as part of their preparatory or in-service courses. Keywords: Health Literacy; Health Literacy Communication; Hearing Impairment; Covid-19

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Teaching and Learning

5. Management of Medically Compromised Patients in Dentistry as a Separate Domain, A Step Towards Medically Oriented Dental Training *Saima Omar - Sir Syed College of Medical Sciences

Objective: Unaddressed oral health needs of medically compromised patients and inability to manage medical emergencies related to dental procedures due to lack of knowledge and expertise pertaining to discipline based training of dental residents. Introduction: Students are exposed to limited content for pre-assigned time and are being trained to give procedure focused segmented patient care to fulfill the numerical requirement in summative evaluation. However the requirement is interdisciplinary approach where a medically compromised patient should be treated holistically without precipitating the underlying medical condition. Linkages between dentistry and medicine are weaker than the nature of oral health problems that do not exist in isolation, as said ‘oral cavity is a mirror to general health’, systemic issues effect oral cavity and oral problems do have a significant impact on already deteriorated health. Therefore, it is inadvisable to isolate the dental component as the only requirement for dental professionals. Options to change the relationship between dentistry and medicine range from marginal change in dental education to complete integration and from discipline focused approach to multidisciplinary approach to produce lifelong competent professionals. Discussion: Most of the literature found is regarding the need of changes at undergraduate level, which practically is a difficult task as compared to change in post-grad curriculum which has not been documented although competency of specialists has been pointed out several times. However with like-minded people and with a view to produce better learners and practitioners we can change step by step. The start can be from anywhere, undergrad or postgrad. Method/Proposal: Introduction of new rotation for post-grad residents and extending this plan to all the institutes across the country. Arranging an interactive session between faculty, PG residents and medical education directors or chairpersons regarding management of medically compromised patients and record their reviews regarding pitfalls of present curriculum & training will facilitate the proposal. In addition, questionnaires will be designed and responses of PGs and unaddressed patients with medical complex history will be collected. Conclusion: Unfortunately the training of dentist at undergraduate and postgraduate level emphasizes only on clinical dental competence, neglecting the fact that a sound medical background knowledge of pharmacology and systemic conditions is mandatory along with communication skills to get patient compliance, in accepting risks associated with dental treatment to successfully handle patients with compromised health, that makes around more than 50% of total dental treatment seekers. Managing medically compromised patients demands not only clinical skills but also patience, time and resources. Screening of patients for any dental procedure also puts financial burden on patients. So only dentists and their training cannot be blamed for not treating patients requiring consecutive visits with compromised health status, a fact which has not been discussed in literature so far. We need a system where not only pitfalls of dental training should be addressed but the environment and introduction of general hospitals associated with oral health care should also be considered where dentistry cannot be blamed as an elite healthcare facility. Key Words: medically compromised, high risk, segmented patient care, summative evaluation, communication skills, comprehensive patient care

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Teaching and Learning

6. Comparing reflection in leaning level of first and last clinical year medical students in a private sector medical college of Pakistan *Musarrat ul Hasnain Shah, Sumera Ehsan - Rashid Latif Medical College

Introduction: Learning to graduate from a medical school is a complex process and gets influenced by multiple factors. Empirical research has been helpful in identifying these factors and reflection in learning has been given consistent weightage in the literature. The concept was defined with clarity by John Dewey describing relationship of learning and reflection. The work of Kolb and many other researchers have reaffirmed this relationship; however measurement of reflection in learning and its progress during studentship of clinical years has not been studied in various contexts. The objective of this study was to compare the level of reflection of third year (first clinical year) and fifth year (last clinical year) medical students in a private medical college. Summary of Work: Study Design: Observational (Analytical) Subjects included all students of third and fifth year in Rashid Latif Medical College, Lahore, Pakistan. After IRB approval a validated questionnaire “Reflection in Learning Scale” with 14 questions responded over 7 point scale was distributed in the respective classes and collected after filling by the students. Data were analyzed using SPSS version 20 and independent t test was used to compare both groups. Summary of Results: Age of the subjects ranged from 21 to 24 years. On average perception score of 3rd year MBBS was 62.67±15.74 and 5th year MBBS was 62.04±14.11. Perception score of 3rd year was higher than 5th year but the difference was not statically significant (p-value 0.824). Conclusion: There is observable decline in the level of reflection on comparing 3rd year with final year MBBS class. Therefore there is need for incorporation of teaching methods effective for inculcation of reflective learning practice in medical college.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Teaching and Learning

7. Impact of education intervention on Knowledge of infection control practices among healthcare providers during COVID -19 pandemic *Iffat Khanum, Kiren Habib, Bilal Ahmed, Bushra Jamil - Aga Khan University

Introduction: Healthcare workers (HCWs) are at an increased risk of exposure to SARS –CoV -2 infection. The objectives of the current study are to assess knowledge, attitude and practices among healthcare workers regarding infection prevention and control (IPC) practices related to COVID-19 and whether training session can be used as an effective educational tool to improve knowledge. Methodology: This cross sectional study was conducted among HCWs from Sindh .After assessment of baseline knowledge , attitude and practices via pretest a virtual session on COVID-19 IPC practices were conducted which is followed by posttest. Result: Among 240 participant, 141 ( 59%) were frontline workers dealing with patients with COVID -19 . Only 76 (31 %) had previous training on IPC before pandemic and even during pandemic, few (n = 95,40%) had attended any training workshop .Majority (70.4% ) of participants work in a facility with established IPC department . There was an overall statistically significant improvement in knowledge before and after education workshop ( p value < 0.01 ).The majority of HCWs believed that poor compliance of personal protective equipment ( PPE ) was due to hot climate , Interfere in daily work , increased work load and long working hours . The knowledge and reported compliance of hand hygiene were good among majority of participants ( > 90% ) . A large numbers of HCW ( 88%) carry hand sanitizer all the time and frequently clean their belongings during current pandemic . Although 75% of HCW believed that PPE can protect them from contracting infections but there was poor compliance of wearing PPE reported while dealing with patients with COVID - 19 . Conclusion: Frequent awareness sessions can help in improving knowledge relate to infection control and practices among HCW.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Teaching and Learning

8. Training of Radiographers in Identifying Critical Radiological Findings: Making the Seconds Count *Jehanzeb Shahid, Ismail Alvi - Aga Khan University

Introduction: Every radiological test is almost always screened through a radiographer first responsible for performing the procedure and later post-processing of the images is done. Therefore, if radiographers are adequately trained in identifying critical radiological findings by Continuous Medical Educational (CME) programs, then a window of communication of such findings to the primary teams can further be reduced and may have a significant impact on patient’s clinical outcome. Purpose: To access the effectiveness of training of radiographers in identifying critical radiological findings by means of CME programs. Method and Materials: This is a two phased Quasi-experimental study conducted at Radiology Department, Aga Khan University Hospital. First phase comprised pre- and post-training testing (using multiple choice questions and image-based test). Pre and post-test scores were evaluted after CME programs for all radiographers. In phase two, audit of already maintained critical findings log is done in three months before and after completion of CME programs. The study population included full time radiographers and those trainee radiographers who are in process of core training completion. Pre and post test scores were compared among the life-threatening diagnoses (like pneumothorax, intracranial hemorrhage, pulmonary embolism etc.) and paired sample T-test was employed to assess the statistical significance. Second phase of the study was conducted in the following 3 months period of intervention (CME programs). Results: A total of 37 radiographers and trainee radiographers took pre- and post-test. Mean age of participants was 32 ± 9.07 years. 27 % radiographers had an experience of > 7 years, 35.1 % had experience of < 7 years, 16.2 % of radiographers were in their second year of training and 21.6 % were in first years of training. Mean cumulative pre-test score was 14.5 ± 4.62, mean cumulative post-test score was 19.84 ± 4.13. Mean general radiography, CT, MRI pre-test scores were 4.72 ± 1.57, 4.69 ± 1.94 and 5.19 ± 1.73 respectively. Mean general radiography, CT, MRI post-test scores were 6.34 ± 1.48, 6.94 ± 1.50 and 6.59 ± 1.66 respectively. Significant difference in pre and post-test scores were noted by paired sample T-test with a p-value of < 0.001 among all categories. Pre-test accuracy of radiographers picking up a panic finding, when compared to radiologist was 63.24%, and that in post-test sample was 65.96 %. Conclusion: Significant improvement in radiographer's ability in identifying critical life-threatening diagnoses was observed after CME programs.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Teaching and Learning

9. Medical students’ perception of live lectures compared to video lectures in basic sciences medical education *Maria Khan, Ali Bin Abdul Jabbar, Daniyal Ali Khan, Muhammad Abdullah Javed, Muhammad Hassan Raza Raja, Kanza Muzaffar - Aga Khan University

Introduction: Live lectures are commonly used in medical education, yet many students prefer video lectures instead. As different learning modalities affect knowledge and examination scores, medical students’ perspectives about these learning modalities required exploration. Hence, this study aimed to explore and compare medical students’ perspectives regarding live lectures and video lectures. Methodology: This cross-sectional study used an online questionnaire. This was distributed to medical students, from 11 medical colleges across 7 cities in Pakistan, in their basic sciences years (years 1 to 3), via internet platforms after institutional approval. Data were analyzed using SPSS software (version 23, IBM, New York, NY, USA). Results: 585 participants were enrolled. 64·4% of the participants were females, while 34·0% were males. Day scholars comprised 43·5% of participants, and hostel-residents comprised 56·4%. First years were 32·7%, second years 29·2%, and third years 38·1% of the total participants. For each year of medical education, at least 28% of participants faced difficulty in maintaining an attendance of 75% or more. The commonest reason for not attending live lectures was ‘poor teaching quality’, while the commonest reason for attending was the ‘compulsory status’ (figure 1). 5.0% of students reported live lectures, and 51.8% found video lectures as ‘very helpful’ in concept clarification, and 85.1% found video lectures more useful for learning. Watching video lectures was the most popular way to prepare for examinations in all three years (figure 2). 50.6% of students wanted video lectures to be compulsory, compared with 28.5% for live lectures. Not using slides (PowerPoint) in live lectures was the most common improvement suggested by students (table 1). Discussion and conclusion: Medical students in Pakistan prefer video lectures over live lectures for learning and exam preparation. More students wanted video lectures to be compulsory in medical education. Several improvements have been suggested for live lectures.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Teaching and Learning

10. Orientation to Operating Room- A Simulation Based Blended Learning Course for Undergraduate Medical Students (A Narrative) *Soobia Rehman - Memon Medical Institute Hospital

The undergraduate medical students during their clinical rotation in Surgery attend the operating room sessions for elective and emergency surgeries. The operating room (OR) is a complex environment full of activity and momentum. It is a place where the surgical, nursing and anesthesia teams work together for patient care. The prime focus of this demanding environment is patient safety. The type and complexity of the surgical procedure determine the timing of all events taking place in the OR including teaching. Complicated procedures require intense concentration on the part of the surgical, anesthesia and nursing teams, sometimes over many hours. This heightened focus on efficiency and safety poses a challenge for the operating surgeon in a teaching hospital to accommodate the medical students and achieve the desired learning outcomes. On the other hand, for medical students, OR represents a totally new learning environment with new challenges. It presents an opportunity to observe real clinical problems and their surgical management and to gain insights into the work of multi professional teams. They do not know their roles in this busy and dynamic environment and find it intimidating at first as they are not familiar with the processes. They are fascinated and excited to see the surgical procedures and wish to participate but most of the time the operating teams restrict them to stand at a distance in order to maintain the sterilization of the operating field. This eventually results in loss of interest on part of students and absences from the OR sessions. In order to achieve the required learning from the OR rotation, medical students must successfully integrate themselves as a member of the OR team and familiarize themselves with culture and protocols of the OR environment. Students who are unprepared for the OR are more likely to harm themselves and others in the operating room and miss out on the learning potential in the OR. To overcome this problem, an orientation course is designed to help the students understand the operating room etiquettes and become familiar with the environment in a controlled simulated setting before they attend the operating room in real life. This course is a simulation based blended learning course using the flipped classroom strategy. Students will be provided with the course manual and videos online which they will study before attending the face-to-face practice session in a simulated environment. It will be mandatory for every student to attend this course before the beginning of their clinical rotation in Surgery.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Teaching and Learning

11. Perceptions of students and faculty regarding the implementation of the baccalaureate nursing program in KPK *Abdul Karim, Yasmin Noorali Amarsi, Yasmin Nadeem Parpio, Laila Akber Cassum, Munira Amirali - Aga Khan University

Background: The World Health Organization (WHO) declared the year 2020 as the "Year of the Nurses and Midwives" in honor of the 200th birth anniversary of Florence Nightingale. Similarly, the president of Pakistan declared 2019 as the year of nurses and midwives and phased out nursing diploma; thus, many nursing schools in the country have started the transition from a three-year diploma to the baccalaureate degree program. Therefore, it is essential to explore Baccalaureate Nursing (BScN) students and key informants' perceptions and experiences regarding the program implementation to improve nursing education. The study's purpose was to explore the perceptions and experiences of nursing students and faculty members regarding implementing the baccalaureate nursing program in a public university in Khyber-Pakhtunkhwa (KPK), Pakistan. Methodology: A qualitative, exploratory study design was used to explore the students' and faculty members' perceptions and experiences regarding the BScN program in KPK. Data was collected from 10 students and 05 faculty members through a semi-structured interview guide via purposive sampling. The analysis was carried out through Creswell's (2013) analysis approach from which categories and themes have emerged. Findings: Five themes that emerged from study participants' narratives include; overview of the program, nursing curriculum, challenges, infrastructure and learning resources, and recommendations. The participants have positive perceptions about the program's initiation, and they believed that BSN would improve the profession and quality of nursing care. However, participants also perceived some challenges regarding the nursing curriculum, teaching faculty, infrastructure, and learning resources. Conclusion: The study provided useful insight through the perspective of students and faculty members regarding the BScN program. The study suggested that a standard curriculum, qualified teaching faculty, appropriate learning resources, and proper infrastructure are necessary to successfully implement the program. ERC Number: 2020-3440-10141.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Teaching and Learning

12. Association of Multiple Teaching Methodologies and Student Learning based on Test Scores *Sara Shakil - Aga Khan University

Introduction: The concept of teaching and learning in undergraduate medial education has evolved drastically over the past few years with respect to small and large group learning methods. Hence this comparative study identifies the association of large and small group instructional methods on learning of students through analysis of mean scores obtained from formative quizzes. Objective: To determine association of multiple teaching methodologies on student learning by comparing formative test scores. Methodology: This observational comparative study was conducted in the Department of Biochemistry, Bahria University Medical and Dental College, Karachi from January 2017 till June 2018. The sample size of 90 was calculated by open epi sample size calculator version 3.01 using purposive sampling technique. Study participants included 2nd year MBBS students who attended all three teaching methods i.e. lecture, tutorial and PBL. Student learning was assessed by MCQ-based formative quizzes at the end of each instruction. Results: Data analysis was carried out using repeated measure ANOVA to compare the differences in written test scores among multiple groups. Students scored highest in post-tutorial quiz (mean score 7.37) as compared to post lecture (mean score 5.13) and post PBL (mean score 5.81). All p-values <0.05 are considered significant. Discussion and Conclusions: This study concludes that students learn better through tutorials in comparison to PBL and lecture. Training faculty for conducting PBL sessions and improvising large group teaching may result in better performance of medical students. Key Words: Teaching methods, student learning, small group learning, lectures, PBL. Reference # ERC 203/15

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Teaching and Learning

13. Implementation of Skills-based Learning in Classrooms during COVID-19 Pandemic *Farah Naz Ata, Raabia Hirani , Ali Bijani , Dr Shehzad Jeeva and Noshaba Hameed - Examination Board, Aga Khan University

Introduction: COVID-19 pandemic has changed the world as we knew it. Schools have only recently reopened, and that too with strict health guidelines. Education, especially for children, is as much about engagement and skill development, as it is about the learning content. AKU-EB’s innovative, low-cost Middle School Programme (MSP) integrated the two together using discussion, group work and experiential learning. Following the health guidelines, these activities may become difficult to implement in the low-resourced classrooms. AKU-EB conducted a survey of schools regarding their classroom practices during COVID19 pandemic. The results will help us to revise MSP activities while retaining its focus on active and experiential learning. Moreover, it will help to enable schools in its implementation.

Methods: A survey tool was developed consisting of 13 questions regarding the skills-based learning classroom practices during pandemic. A representative sample of 30 out of 135 schools were selected for the telephonic survey. Respondents were mostly principals, and coordinators of the schools. The responses have been quantitatively and qualitatively analyzed.

Results: • 83% schools could not implement online learning due to lack of internet facilities. • 53% schools continued skills-based learning in classrooms with health guidelines • 80% were using audiovisuals in the classrooms • Only 10% of the schools had classrooms big enough to follow complete health guidelines • Schools with additional classrooms, more teachers and/ or small number of students were at an advantage to follow the health guidelines

Conclusion: and Way Forward The findings helped to understand the dynamics of AKU-EB affiliated schools. The major challenges faced by schools are conducting online classes, managing large student strengths, small classroom sizes and lack of staff. The schools need guidance in overcoming these challenges. AKU-EB plans to revise the MSP activities while maintain its true spirit and develop guidelines for schools to offer contextual solutions during COVID-19 pandemic.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: E-Learning

14. Clinical Year Medical Students Acumen on the Shift to New Norms *Shazia Durrani Fakhir, Ammara Hameed - Bahria University Medical and Dental College

Background: Covid-19 pandemic disrupted traditional education worldwide which prompted transition of traditional to online teaching .It is important to determine the perception of students Objective: To determine the perception of clinical undergraduate MBBS students of online lectures in a medical university of Karachi, Pakistan Design: Descriptive PLACE AND DURATION OF STUDY: Bahria university medical and dental college started from May 2020 till July 2020. Methodology: This descriptive questionnaire based study conducted at Bahria University Medical & Dental College, four weeks after introduction of online lectures. Data was collected from clinical year students over two weeks using google forms and analysed using SPSS version 22. Faculty training workshop conducted through zoom 2 weeks after this sudden transition and post workshop google form survey done to see any change in student perception of faculty teaching. Result: Preworkshop result: Of 450 clinical year students, n=234 responded. Overall, 48.7% (n = 114) students were satisfied with the online lectures, 34.2 %( n= 80) were completely satisfied and 17.7 %( n=39) were unsatisfied. 53.4 %( n=125) felt lectures were serving the purpose whereas 37.2% (n=87) do not feel the same. The lack of interaction component in online lectures was felt by 45.7% (n=107) students. Regarding clinical teaching, 72.2% (n= 170) do not think it is possible online, 15.8 (n=35) feel it possible and 12.4% (n=29) were hopeful. Majority 61.1% (n=143) think it is impossible to complete medical studies online. Student ideas for improvement included availability of lecture recording for later viewing, integrated quizzes, increasing interactive component, training of faculty, small group sessions and case based teaching. Majorly students faced internet connectivity issues and timings of long lectures without break. Post faculty workshop survey showed that teaching improved In terms of interaction although more workshops needed. Conclusion: Online lectures improved teaching and students by faculty by workshops

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: E-Learning

15. SWOC analysis of e-learning educational services at Rawalpindi Medical University in the midst of COVID-19 *Khola Noreen, Muhammad Umar; Arshad Sabir - Rawalpindi Medical University

Background: The SWOC (strengths, weaknesses, opportunities and challenges) analysis of e-learning at Rawalpindi Medical during period of COVID-19 Pandemic was conducted. Methods: This cross sectional survey based study using mixed quantitative and qualitative approach was conducted at Rawalpindi Medical University in June 2020 through online survey. Data was collected electronically from 400 undergraduate medical students and faculty members using online Google forms. Study was carried out after obtaining ethical approval from Institutional Review board of Rawalpindi Medical University. Anonymity and confidentiality of data was maintained. Results: The salient features of e-learning at RMU was provision of prospect for remote learning in unprecedented circumstances, promotion of learner centered, self-directed lifelong learning while unavailability of internet and professional isolation was reported as potential weakness, opportunity provided by this platform was introduction blended learning programs and digital competence while potential challenges reported were conduction of valid ,reliable and feasible e-assessment and strategies for teaching ,learning and assessment strategies for psychomotor & soft skills. Conclusion: In-depth analysis of e-learning during midst of COVID-19 has made this evident that RMU is fully equipped and ready to cope up with any unforeseen event with regards to undergraduate medical education. There is startling need to develop infrastructure for long term sustainability and acceptability by availing opportunities, improving strength and overcoming potential weaknesses and challenges. Keywords: SWOC, e-learning, COVID-19 ERC number: 91/IREF/RMU/2020

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: E-Learning

16. Self-perceived competency of Medical faculty for e-teaching in COVID 19 pandemic *Shaur Sarfaraz - Jinnah Sindh Medical University

Introduction: The objectives were to evaluate the self-perceived competency (FSPC) of medical faculty regarding online teaching and the support received during COVID-19 pandemic. Method: An online validated structured questionnaire (likert scale) was used to collect responses from medical faculty. The questionnaire consisted of sections on student engagement, instructional strategy, technical communication and time management. Descriptive statistics and Independent paired t-test were used for analysis and comparison of quantitative and qualitative variables. A p-value of ≤ 0.05 was considered statistically significant. Results: 738 responses were included in the study. Nearly 54% (397) participants had < 5 years of teaching experience, 24.7% (182) had 6-10 years and 11.7% (86) had 11-15 years teaching expertise. Asynchronous mode was opt by 61% (450) and synchronous by 39% (288) of participants. Moreover, 22.4% (165) participants revealed that their online lectures were evaluated by a structured feedback from experts, while 38.3% were not evaluated. A significant difference (p<0.01) was found between FSPC scores and online teaching evaluation by experts. The mean score of FSPC scale was 5.62 ± 1.15. The mean score for student’s engagement, instructional strategies, technical communication and time management were of 5.18 ± 1.60, 5.67±1.61, 5.49±1.71 and 6.12±1.67 respectively. Majority of the faculty had taken support from web sources (33.5%) and asked help from peers (33.6%) and (20%) of the faculty didn’t take any support. Conclusion: Medical faculty had self-perceived to be somewhat competent in E-teaching in student engagement, instructional strategy, technical communication and time management skills. Faculty receiving feedback thought to have better skills then teaching without feedback and majority of the faculty had taken support from web sources and asked help from peers. Keywords: Teaching faculty; self-perceived competency; SARS-CoV 2; Online teaching.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: E-Learning

17. Transition to Online Teaching amid Covid-19 Pandemic: Perspective of Post Graduate Trainees of Medicine Department in a Tertiary Care Hospital *Iffat Khanum, Zaibun Nisa, Azam Afzal - Aga Khan University

Introduction: The COVID-19 pandemic has immense affect on medical education . Despite worldwide adoption of e-learning , it was not implemented by many institutions in Pakistan till current situation where , only e learning has given opportunity to continue teaching sessions . The purpose of current study is to assess perceptions of postgraduate trainees about online teaching , amid COVID-19 pandemic. Methods: This cross section survey was conducted between August 2020 to September 2020 at department of medicine ,Aga khan university hospital Karachi . The study participant were postgraduate graduate trainee of internal medicine and allied specialties. Results: Responses were obtained from 51 participants and majority were from department of internal medicine ( 74.5% ) followed by neurology , cardiology and pulmonology . Few postgraduate trainee has ever attended on line courses ( 61%) or workshops ( 35.3%) and did not received orientation before commencing e learning activities ( 35.5%) . Although resident believes that e learning sessions are interesting , knowledgeable ,relevant to their learning needs , feasible ( 82.4%) but only few ( 33.3% ) considered on line sessions as effective as face to face teaching sessions, provided adequate motivation & engagement in sessions ( 45.1%) , sufficient time for interaction with facilitators and had frequent technical issues ( 65%). The major hindrances as perceived by residents are technical issues ( 94% ) , lack of interaction with facilitators and peers ( 55% , )and computer literacy of trainee ( n = 28, 55% ) . Majority (90%) of residents opted to have hybrid model for teaching session in the future. Conclusion: The COVID -19 pandemic has given us opportunity to re structure our traditional class room based education system .However a strategic approach is required for successful implementation of e learning.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: E-Learning

18. Effectiveness of E-learning on knowledge and attitude of health care professionals regarding Early Mobilization of Mechanically Ventilated patients *Zahira Amir Ali Khalfan, Khairulnissa Ajani - Aga Khan University

Introduction: Patients at the Intensive Care Unit (ICU) who are Mechanically Ventilated (MV) develop complications due to bedrests. Early Mobilization (EM) is an evidence based practice that reduces patients’ hospital length of stay, decreases ventilator time period, enhances weaning, and reduces ICU-Acquired Weakness and ICU-Acquired Delirium. Although, EM of MV is practiced in many high income countries, it is not yet introduced as a standard care approach in the ICU of Pakistan. Moreover, there is no evidence in literature identifying the use of E-Learning on EM to analyse healthcare professional’s knowledge and attitude. The aim of this study was to assess the knowledge and attitude of health care professionals regarding EM of MV patients through E-Learning at the ICU of a tertiary care hospital in Karachi, Pakistan?

Method: Quantitative pre-test and post-test design was used on a sample of 57 healthcare professionals (doctors, nurses, physiotherapists and respiratory therapists) using total population sampling. The study questionnaire was based on knowledge and attitude assessment using trichotomous responses and 5 point Likert scale respectively. The tool was adapted from Qutub, Matani & Farooqi's (2018) and Jolley, Regan- Baggs, Dickson & Hough, (2014) studies and was contextually modified after expert review and pilot testing. Self-developed E-Learning module was utilized as an intervention. Data collection was performed from 1st June to 31st August 2020.

Results: All responses were scored and results were analysed through paired t test. Results revealed that change in knowledge was statistically significant (p<0.01), however, change in attitude was statistically insignificant (p=0.096). Hence, E-Learning was effective to enhance knowledge but didn’t had an effect on attitude change.

Discussion and Conclusion: E-Learning can be effective to acquire knowledge regarding EM of MV patients. Simulation Based Education could be used to bring positive attitude and behaviour through experiential learning. Moreover, study could be expanded to other tertiary care hospitals of Pakistan to attain results at a large scale. Implementation of EM in MV patients will improve patient outcomes. Advance Practice Nurses can work as EM champions for healthcare professionals training, institutional protocol and policy development and practice auditors to initiate and sustain EM interventions as part of ICU routine care.

ERC Number: 2020-2244-10543

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: E-Learning

19. New Norms In Medical Education: Faculty’s Perspective *Shazia Durrani Fakhir, Ammara Hameed - Bahria University Medical and Dental College

Background: Majority of Medical faculty had been used to teaching in the traditional way but had to change strategy from face to face to online lectures all so sudden in uncertain conditions. In order to adapt to the new normal, it was important to understand the issues faced by the medical educators to adapt a strategy for improvised teaching and learning strategies for post covid era. Methodology: A descriptive study was conducted at Bahria University Medical And Dental College, Karachi from 8 September 2020 to over a period of 6 weeks after approval from ERC department. The study was conducted by using an online questionnaire. Consent was taken online. Convenience sampling technique was employed. The questionnaire was designed using the online google forms and comprised of 3 sections including consent, personal information and questions related to the experience regarding online teaching. The last section included 11 closed ended questions and 1 open ended question regarding improvement. Result: 68 responses were recorded.42% feel training given by their institutes was satisfactory. 67% said was user friendly system. 61% changed teaching strategy although 49% were not prepared. 67% felt student feedback was essential and 59% felt interaction was vital. 37% said clinical teaching was compromised. When asked about other issues, student behavioral issues were identified by 32.3% of the faculty members. Problem with technology was faced by 48.5% Conclusion: Online teaching and learning will continue in this new normal post covid era. Transition was difficult but faculty training programs promise improvement to continue this strategy in the future.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: E-Learning

20. Observational study on e-learning during COVID pandemic *Saara Khan, Asra Khan - Aga Khan University

Introduction: In March 2020, educational institutions in Pakistan deferred all activities at the site due to the COVID-19 pandemic. As a result, all institutions faced problems on how to convert face-to-face learning (F2F) into distance learning and the focus of the original course with completion of the academic hours were exposed to the students. Methodology: All these efforts were made for preservation of functional and psychological similarity to the on-site learning, involving maximum student engagement, and discussion of topics during briefings (reflecting EO). Hence, within the concept of physical similarity, visual and auditory perceptions were made achievable through e-learning. However, in many educational institutions, it was observed that students were not able to provide timely feedback as creation of such forms required IT skills and posed a challenge to students and faculty members. These barriers were actively overcame with proper teachers and students training, enabling them to learn e-learning tools. The most profoundly and seamleesly used channels were Zoom ad Microsoft teams, however, skype, whatsapp and ilmo were also used for small group learning. It is worth mentioning that at times unexpected technical problems also arose that were mainly contingent to internet connectivity, browser issues and power outages. Results: It is recognized that the transition for F2F learning to e-learning was difficult but not impossible and many educational institutions were able to apply eLearning quite quickly with AKU shifted its undergraduate learning to eLearning within three days post COVID lockdown to facilitate medical education. Conclusion: From our experience, the presented approach provided an acceptable alternative to on-the- spot simulation-based teaching during the COVID-19 pandemic. Although not suitable for psychomotor skills scenarios, it appeared to maintain a sufficient similarity that allows learners to get ample training in critical thinking, multiple work, prioritization, decision making, job selection, resource utilization and more.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: E-Learning

21. Effectiveness of Virtual clinical education amid COVID-19 Pandemic: Medical and Nursing education revolution *Sumaira Warwani, Sumera Zulfiqar - Aga Khan University

Introduction: Fast and a furious life came to a pause when suddenly COVID-19 was declared as a pandemic. Similarly, in other walks of life, it caused a major disruption on clinical education as well. This imposed a great responsibility on medical and nursing educationist to take care of students as well as community health during the unprecedented time. Simultaneously, educationist ought to find best possible alternative for continuation of medical education without compromising on quality teaching learning. Methodology: A comprehensive electronic search was carried out via electronic data basis; Pub Med, CINAHL, Science Direct and Google scholar. These data bases were combed by using key terms virtual clinical, Medical and Nursing, clinical education amid COVID. A total of 30 articles were retrieved. Primarily title of the studies were scanned then if found germane then full abstracts were reviewed and based on that decision was made to include those studies for analysis. A total of 10 articles were identified relevant and were analyzed. Results: The commentary explored COVID-19 challenges on medical and nursing education and viewing alternative approaches as a ray of hope to meet the learning needs and objectives of undergraduate and graduate students in Pandemic situation. Furthermore, the literature review findings suggested that virtual clinical education has provoked a conscious thought on future challenges that lie ahead following pandemic when increased clinical demand will follow the imbalance in supply verses demand of professional health care personnel. Discussion/Conclusion: In conclusion, the rapid adaptation of innovative alternatives in teaching learning will have long term benefits in medical and nursing virtual clinical education. Adhering to social distancing has provoked medical educationist to give a mindful thought to effectually utilize the already existing technologies in medical and nursing education without compromising quality education; by making action plans and adopting available technologies to educate health science students to prepare them for upcoming challenging time. Keywords: Clinical education, COVID-19, Medical and Nursing education, virtual learning

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: E-Learning

22. Experiences of Undergraduate Medical Students Regarding Virtual Clinical Rotations During Covid-19 In Karachi *Shazia Durrani Fakhir, Ammara Hameed - Bahria University Medical and Dental College

Background: The post covid Era requires new strategies. Innovations in medical education have already replaced face to face learning by virtual to reduce exposure. Low socioeconomic countries cannot afford expensive gadgets, high fidelity simulations and holographic cameras and other latest technologies for their students so it was a concern to continue virtual medical education in our country in the best way possible . Student experiences led us to know whether learning was actually taking place in these circumstances and what steps should be taken to ensure this. Objective: To explore the lived experiences and feelings of clinical year undergraduate MBBS students regarding virtual clinical rotations . Methodology: Setting: private and public University in Karachi Duration: 6 months Study type: Descriptive study. In-depth interviews of at least 7 to 10 students taken from clinical year undergraduate medical students regarding their lived experiences and feelings Views recorded through video clips and conference calls. Atleast 2 live focus group discussions conducted and recorded .After transcription, codes and themes made and data interpreted and recorded. Result: A thematic content analysis yielded four core themes: (1), not the true feel (2), history taking of simulated patients (3) no hands on learning,and (4) weak internet. The online clinics were not as effective. Skills and examinations not learnt. Interaction less due to internet connection failure. Most students preferred face to face for clinical rotations due to lack of technical resources. Conclusion: Online clinical rotations cannot replace actual campus and clinic face to face teaching in low socioeconomic countries

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: E-Learning

23. Trials and tribulations in a journey from face-to-face to online education *Hina Khalid, Syeda Kauser Ali, Shuar Sarfaraz, Syed Moyn Aly - Jinnah Sindh Medical University

Introduction: The year 2021 has witnessed a massive/global shift in the teaching learning strategies across the entire continuum of education; from preschool to continuing education. This change was mostly unplanned and happened as an emergency response to Covid-19 and has been named as emergency remote teaching versus online education. One important element in this context is the readiness of teaching faculty, institutions, accrediting and regulatory bodies and students to embark on the new learning milieu. Jinnah Sindh Medical University wholeheartedly embraced the situation very early on and started to offer online teaching sessions for its undergraduate and postgraduate students, focusing on both asynchronous and synchronous sessions.

Methodology: It is a mixed method cross-sectional study. Readiness for online education survey form will be administered using google forms sent through email to all stakeholders. In depth interview with institutional heads, in charge IT (~6) and Focus group discussions with heads of departments of different institutions (~ 4) will be conducted.

Result: This study focuses on identifying the struggles faced by all those involved in teaching and learning while shifting from a traditional face-to-face teaching mode to a fully online mode and their readiness for such a change. This includes institutional leadership, heads of departments, faculty, IT department and students. It will also identify the steps taken by them in the resolution of the problems and facilitating this shift. It is expected that this study will identify faculty development needs for offering good quality online education and resources and policies that need to be looked into at the institutional and maybe national level. It is hoped that this study will provide some guidance to other institutions struggling with similar issues

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: E-Learning

24. Continuing Education Program via Virtual Learning & Education (VLE) for Technologists of Chemical Pathology *Farhat Jahan, Hafsa Majid - Aga Khan University

Introduction: The laboratory technologists are responsible for the performance of the clinical laboratory tests that aid clinicians in the diagnosis and monitoring of disease. Their learning and education is an ongoing process. During the surge of the COVID-19 pandemic in Pakistan, all educational sessions were discontinued.

Objectives: To develop a Continuing Education (CE) program on VLE, for technologists and assess the perception of technologists regarding the new CE program.

Methods: Plan-do-check-act cycle. Plan: Team was developed, the shell was created in Moodle. Technologists trained on the VLE, develop educational content and assessment, orient technologists to attend CE programs via VLE. The perception of technologists about the CE program was carried through an e-questionnaire. Do: Responsibilities of the team were defined, content developed, uploaded to Moodle, piloted by two technologists. The enrollment method for students was created in a certificate-based Basic QC module. This module was designed to focus on scientific knowledge (SK) and critical thinking (CT). The module was implemented on July 15th, 2020. An e-questionnaire was constructed to which respondents selected a point on a Likert scale. Check: Data was analyzed. Act: Detailed report was generated.

Results: 36 questionnaires were completed. 32 (88.8%) agreed that teaching methods were effective. 31 (86.1%) agreed that the course level was appropriate. Seventeen (47.2%) technologist strongly agreed that the aims and objectives of the course were clear. Thirty-one (86.1%) technologist agreed that the course improved their scientific knowledge. 33 (91.6%) rated their overall experience as very good. 24 (66.6%) suggested adding more modules.

Conclusion: Use of VLE encourages independent learning and positive impacts, promote reflection, increase enthusiasm and confidence and more modules should be developed for continuing education.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: E-Learning

25. Innovation in Continuing Professional Education for midwives: A new normal for service provision amid Covid-19 *Kiran Mubeen, Saima Sachwani, Farzana Yameen, Sadia Karimi, Marina Baig, Arusa Lakhani - Aga Khan University

Introduction: Pakistan being a Low and Middle Income Country has been seriously affected with the pandemic especially maternal and child health providers working in remote destinations of Gilgit Baltistan and Chitral (GBC). One of the largest and key community-based service provider in Gilgit Baltistan and Chitral (GBC) requested AKUSONAM faculty to facilitate training and development of contextually relevant e-learning resources for midwives and LHVs of GBC with due focus on sexual and reproductive health service provision during the pandemic.

Methods: An E-learning module was designed based on the need assessment shared by the relevant stakeholders. The module comprised of case study-based videos and Voice over PowerPoints. The module content was developed based on a thorough review of literature and Information, Education and Communication (IEC) material available from key stakeholders including WHO, UNFPA, CDC, RCOG, Ministry of Health, AKU and AKHS, P.

Results: A total of 52 participants were enrolled from Gilgit Baltistan and Chitral (GBC) in the virtual training program. The preliminary analysis of training evaluation form shows that the participants found training content, video based case studies and interactive discussions highly effective. They also shared that the training was helpful in improving their confidence in providing services in COVID situation. Online teaching resources were helpful in clarifying their myths and misconceptions related to Standard Operating Procedures for their own and community safety. Furthermore, the mode of training was also appreciated however few participants mentioned that the training should have been face to face.

Discussion and Conclusion: This was first of its kind training session that was conducted in a remote setting of Pakistan, using complete online modality using the principles of effective teaching and learning. There have been several myths around the nature of the Covid infection. In this situation, the healthcare provider lacked the evidenced based information to deal with days to day practice scenarios. The participants’ feedback was highly encouraging to continue periodic virtual trainings. • Center of Disease Control (2020). Considerations for Inpatient Obstetric Healthcare Settings. [online] Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html [Accessed October 16, 2020] • Royal College of Obstetricians & Gynecologists (2020). Coronavirus (COVID-19) infection and pregnancy. [online] Available at: https://www.rcog.org.uk/coronavirus-pregnancy [Accessed October 16, 2020]. • UNFPA - United Nations Population Fund. (April, 2020). Retrieved from: https://www.unfpa.org/sites/default/files/resource-pdf/COVID-19_MNH_guidance_04.pdf [Accessed October 16, 2020] • World Health Organization (2020). Q&A On COVID-19, Pregnancy, Childbirth and Breastfeeding. [online] Available at: https://www.who.int/news-room/q-a-detail/q-a-on-covid-19-pregna

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Assessment

26. Development and validation of an instrument for assessment of professional behaviour during laboratory sessions *Fatima Zehra, Sonia Ijaz Haider - Bahria University Medical and Dental College

Objective: To develop an instrument to assess professional behaviour among medical students, and to determine its validity, reliability, feasibility and acceptability. Method: This cross-sectional study was conducted at Bahria University Medical and Dental College, Karachi, from July to September 2017, and comprised of medical students in years 1 and 2 of their academic programme. The instrument was developed for the Physiology laboratory sessions using nominal group technique and was tested for validity, reliability, feasibility and acceptability by two assessors through validity and reliability statistics. Data was analysed using SPSS 23. Results: Of the 250 students enrolled, 232(92.8%) had their assessment completed. Applicability of the scale was indicated by exploratory factor analysis. Two factors were isolated which explained 57.65% of the variation. The first factor, comprising of 7 sub-factors, was labelled as 'practical performance', and the second factor, consisting of 5 sub-factors, as 'personal interactions'. A final 12-item instrument was retained. Cronbach's alpha was determined to be high at 0.863. Intra-class correlation was 0.863 for both years 1 and 2 combined. Conclusion: It was possible to develop an instrument for professional behaviour assessment in Physiology laboratory skills session which could indicate valid, reliable, feasible and acceptable results. Keywords: Professionalism, Professional behaviour, Unprofessional behaviour, Instrument, Physiology laboratory, Existing tools for professionalism. (JPMA 70: 1398; 2020). https://doi.org/10.5455/JPMA.37124

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Assessment

27. Establishing the validity and reliability of Pain Clinical Evaluation Exercise (P- CEX) tool for postgraduate trainee in a teaching hospital *Ali Sarfraz Siddiqui, Gauhar Afshan - Aga Khan University

Introduction: Assessment methods in anaesthesia training programs are evolving from exclusively knowledge-based examinations to continuous performance-based assessment at trainee workplace. These assessments determine the progression through training and ultimately to specialist practice. In order to improve work place based assessment and adding to objectivity in continuous assessment of anaesthesia and pain trainee rotating in pain management clinic, P-CEX tool was developed and introduced in the Department of Anaesthesiology. As this is newly developed assessment tool so this study is designed to estimate its validity and reliability of this tool. Methods: PG trainee of anaesthesiology and pain fellow rotating in the out-patient pain management clinic at Aga Khan University will be included in this study. This study will be conducted in two steps; Step # 01: The content validity of the instrument (P-CEX) will be calculated from the viewpoints of a panel of experts using a special assessment response form. The rating of panel members will be used to calculate content validity ratio (CVR), content validity index (CVI), and instrument comprehensiveness. Step # 02: The reliability of the P-CEX tool will be calculated after the implementation of the tool. Inter-rater and intra-rater reliability of the P-CEX assessment tool will be calculated. Those trainees who do not want to participate in this study and did not give consent will be excluded from this study. Results / Expected outcome: Content validity ratio (CVR), content validity index (CVI), and instrument comprehensiveness will be calculated by the rating of panel members. Internal consistency of the different items in the P-CEX form will be determined by Cronbach's alpha. Inter-rater reliability will be measured by Pearson correlation if data is normally distributed but if data is not normally distributed then Spearman test will be used. ERC number 2020-5394-14335

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Assessment

28. Perception of junior faculty regarding Objective Structured Practical Examination (OSPE) *Shizma Junejo, Talea Hoor - Bahria University Medical And Dental College

Introduction: Objective Structured Practical Examination (OSPE) , which is a highly significant competency assessment tool . Objective Structured Practical Examination (OSPE) is a credible way of assessing undergraduate medical students. OSPE provides assessment all three domains including knowledge, skill and attitude. OSPE has proved beneficial over the traditional assessment method. The appropriate perception of teaching faculty regarding Objective Structured Practical Examination (OSPE) is highly imperative. This research design will unfold perception of junior teaching faculty regarding Objective Structured Practical Examination (OSPE). The study will reveal awareness among junior faculty regarding significance of OSPE as an assessment tool. Methods: This study is based on quantitative research. The participants for this study include individuals who have been into teaching in Medical & Dental colleges for less than 2 years only. The study includes only junior faculty members. The study setting includes various medical colleges in Karachi. The study includes a sample size of 100 participants. The sampling technique is non-probability convenience sampling. As part of this study participants are required to fill a questionnaire, after voluntary consent. Only the participants fulfilling inclusion criteria have been requested for participation in this study. Participants have been inquired regarding their basic knowledge about Objective Structured Practical Examination (OSPE) including the significance of OSPE for assessment of knowledge of undergraduate students in terms of practical skills, purpose of OSPE being subjective or objective and domains tested by OSPE. Results: The study will reveal awareness among junior faculty regarding significance of OSPE as assessment tool. Conclusion: This research design aims to unfold perception of junior teaching faculty regarding Objective Structured Practical Examination (OSPE). The inclination amongst young fresh graduates to take medical teaching as profession calls for study like this for assessing the potential of young faculty members in terms of adaptability to learn and apply latest teaching and assessment strategies.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Assessment

29. OSATS an Appropriate Assessment Tool to Evaluate Procedural / Technical Skills of Radiology Residents *Nasreen Naz, Shaista Afzal, Rukhsana W Zuberi, Azam Afzal, Vaqar Bari - Dow University of Health Sciences

Introduction and Background: The procedural and technical skills are the mandatory component of radiology training along with comprehensive and meaningful Image reporting. Interventional radiology is an important segment of radiology residency training programme that includes performance of interventional procedures under ultrasound, CT and fluoroscopic guidance. Assessment of Radiology Residents’ technical skill is essential but though difficult part of radiology training. It has been observed that residents are experiencing less technical skill training due to reduced working hours, decreased case- load and increase in number of residents. This hampers performance not only during residency as well as in the post residency period. Abstract: The purpose of this paper is to describe the feasibility, validity, reliability and practicality of Objective Structured Assessment of Technical skills (OSATS) to provide feedback on learners’ competencies and to provide constructive guide that helps residents to improve their procedural / technical skills. Methodology: There is proposal of at least 4 OSATs mandatory per year to promote to next level. Before conducting the procedure on a real patient, Mannequin and the Virtual reality (VR) simulator models use to train and assess the core skills and after that trainees will allow to perform procedures on real patient with assistance and independently according to their level of residency. Results: This assessment tool to be undertaken by residents according to the curriculum devised by the department and licensing authority e.g. CPSP. More than one assessor should assess and provide feedback at the end of the procedure with mutual agreement on strengths and areas for future development. Residents / trainees complete OSATS throughout their training until they are considered competent to practice independently. Conclusion: The blueprint introduced in this paper would help medical educators especially for those institutions which intend to introduce OSATS. It is a validated work place based assessment tool that assesses the technical competency of resident in a particular procedure / technique. OSATS can be used to evaluate residents' performance, provide feedback, and identify areas for improving performance and filling the identified gaps. Key Words: Assessment, Objective Structured Assessment Tool, Technical skills

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Assessment

30. Mental health assessment of healthcare workers in the Emergency Department of a low middle-income country during COVID 19 pandemic *Nirdosh Ashok, Shahan Waheed - Aga Khan University

Introduction: Emergency department healthcare workers of Pakistan during COVID 19 pandemic are facing an acute rise of mental illnesses. In the present study, the authors aim to assess the frequency of anxiety and depression among healthcare workers in the emergency department. Methods: A cross-sectional online survey was conducted in the emergency department between July to August 2020 at Aga Khan University Hospital Karachi, Pakistan. The Hospital Anxiety and Depression (HAD) scale was used for mental illness assessment among emergency physicians and nurses. Descriptive analysis of grading as per Likert scale is done through frequencies, means and standard deviations. Categorical variables were expressed as frequency (%). Mann-Whitney U test was used to compare scores of various groups and sub-groups and Chi-square test was used to assess the association of depression and anxiety categories among the groups. Results: In the emergency department, 127 healthcare professionals (physicians and nurses) were included in this survey. Median depression score was 8 (IQR 6-10) with 21% (27) fall under depression and 39% (50) to borderline depression. Median anxiety score was 9 (IQR 7-12) with 33% (42) had abnormal, 38% (48) had borderline anxiety. Healthcare workers working for >45 hours per week have odds of 3.62 [1.374 - 9.549] of developing depression compared to anxiety with a p-value of 0.009. Similarly, nurses and medical officers develop depression with odds of 2.18 [1.016 - 4.686] p-value 0.045 and 5.18 [0.197 - 1.02] p-value 0.002 respectively. Conclusion: In our study, we determined that healthcare workers working in the Emergency Department during COVID-19 pandemic suffered high levels of anxiety and depression, which is a matter of concern. Therefore, comprehensive support should be instituted to safeguard the wellbeing of healthcare professionals both by Government and health care agencies. Training of emergency department healthcare providers is paramount to promote physical and mental wellbeing during COVID 19 pandemic specifically through adequate provision and training on the use of personal protective equipment, strict infection control practices, shorter shift length, and provision of mental health and support services.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Assessment

31. Students’ Performance in English Academic versus Creative Writing at Secondary and Higher Secondary Examinations *Tooba Farooqui, Raabia Hirani - Examination Board, Aga Khan University

Introduction: The Aga Khan University Examination Board (AKU-EB) assesses academic (letters, reports) and creative (descriptive, narrative, argumentative) writing in Secondary and Higher Secondary (SSC and HSSC) English Compulsory Examinations. These two kinds of writing are different in their inherent nature with regards to complexity, length, and focus. Students performance on these forms of writing will inform the teacher development activities.

The purpose of this research is to investigate if there is a difference in students’ scores in academic versus creative writing in AKU-EB English Compulsory examinations. Moreover, to find if there is a correlation between scores on the two forms of writing.

Methods: Students’ academic and creative writing scores on AKU-EB’s SSC and HSSC English Compulsory Examinations for the years 2014 to 2019 from across the country are used. Descripting statistics (mean, median, minimum, maximum and standard deviation) are calculated. Paired T-test is performed to find out the difference between academic and creative writings at 95% confidence level. Pearson’s correlation is used for the correlation between the two scores.

Results: The mean scores in SSC for academic writing and creative writing are 67.4% and 63.6% while in HSSC are 70.8% and 67.3%, respectively. There is a statistically significant difference between the scores on academic and creative writing. However, the correlation of scores between the two kinds of writing is 0.76 and 0.69 in SSC and HSSC, respectively.

Discussion: There could be a variety of reasons for this variation including (a) there is a standard pattern for academic writing but no such pattern exists for creative writing (b) the standard pattern for letter/ report can be rote-learnt whereas creative writing requires skills (c) guidance in creative writing is often not provided in schools, leading to lower performance. However, more research can be done on it to further analyse the causes

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Evaluation

32. Evaluation of the Safe Circumcision Program- a critical decision *Shazia Junejo, Lubna Samad - Indus Health Network

Introduction: Safe Circumcision Program (SCP) program has been functional at the Indus Hospital Karachi since 4 years but an evaluation has never been conducted. Program outcomes appear encouraging; trained providers, which include OR technicians, midwives and health workers, have been performing circumcisions with low complication rates that are comparable globally, indicating that task sharing is a viable and safe approach (1-4). A formal evaluation of the program will allow objective evidence to be generated, and provide data that will facilitate policy makers to debate the value of task sharing in general, and specifically its role in providing safe circumcisions to the Pakistani population. Methods: To fulfil the purpose of the evaluation, the ‘Decision-Oriented Approach (The CIPP Model)’ has been finalised with two modifications- increased input by stakeholders and addition of a content expert ‘external’ evaluator (Paediatric Surgeon), incorporating the essence of a ‘Connoisseur-based approach’ (5- 7). Study design would be cross-sectional to examine the program and a quasi-experimental interrupted time series design for evaluating the training of the health providers. Triangulation of methods will be employed to increase the credibility and validity of research findings (8). Quantitative methods will include surveys, quasi-experiment and significance tests, whereas qualitative methods will comprise document and narrative analysis, in-depth interviews, focus group discussions (FGDs), flow-charts and performance assessments. Prior IRB approval will be taken. Results: Depending on the evaluation results, the government and policy makers will be approached to allow early infant circumcisions of babies meeting defined inclusion criteria, to be conducted by trained health workers in closely monitored settings. Conclusion: Mobilizing and training community health workers to perform safe circumcisions may be a valid and feasible approach towards ensuring that this procedure is performed safely with efficient utilization of resources in settings where large volumes of male children require circumcision (9). Program evaluation is an essential monitoring and evaluation tool that could help judge the merit for continued and expanded implementation of this intervention.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Evaluation

33. Evaluating the Effectiveness of Skills-Based Training Program for Teacher Trainers *Ali Bijani, Munira Muhammad Rangwala, Naveed Yousuf - Examination Board, Aga Khan University

Introduction: Traditional didactic teaching is evolving into student-centered active learning. Skills-based facilitation expertise is a pre-requisite to successfully implement the latter. On the contrary, teacher and teacher trainer recruitment process is based on discipline-based qualification or expertise overlooking the facilitation skills. Moreover, a structured pre-service and in-service capacity development of teachers is either missing or not effective due to lack of skills-based capacity development and assessment. The purpose of the present study is to evaluate the effectiveness of a skills-based capacity development programme for teacher trainers using a validated assessment tool. Method: A six-day skills-based capacity development programme for training of trainers was designed including reading materials, hands-on experiences, role plays, skills-based assessments and individualised feedback for improvement. A 21-item seven-point rubric was used to assess the facilitation skills of teacher trainers before and at the end of the programme (pre- and post- test). This rubric has been developed by experienced teacher trainers, reviewed by a group of educational experts and pilot tested on a similar cohort earlier for validation. The pre and post assessment was done by the ten participants themselves (self- assessment), two expert assessors, and peers. Descriptive statistics of the scores are used to assess the effectiveness of the programme. Results: • The participants’ median-score assessed by experts increased from 2.95 to 5.10 • Participants’ self-assessment median-score increased from 3.75 to 4.25 • Peer-assessment median-score increased from 3.5 to 4.45 • On pre-assessment, the median-scores by experts were the lowest, followed by peers and self. On the contrary, the post-assessment median-scores from lowest to highest were of the self, peer and expert. Conclusion: The result shows effectiveness of the skills-based capacity development programme as the skills-based assessment scores increased from pre- to post-assessment. The self-assessment and expert assessment scores became relatively similar on post-assessment as compared to pre-assessment.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Evaluation

34. Monitoring and Evaluation for sustaining the Efficiency of Work while Working Remotely during Covid-19 Pandemic *Malik Azam, Amjad Ali Shah - Examination Board, Aga Khan University

Introduction: The COVID-19 pandemic had a disastrous social and economic effect on the masses worldwide and bound many employees to work remotely to avoid infection and spread of the virus. Following the government instructions, the Aga Khan University Examination Board (AKU-EB) also took critical decisions and shifted towards remote work. To overcome the new challenges, AKU-EB’s management and the Quality Assurance department developed a plan with the mutual consensus of all the departments. The strategy was to ensure the productivity and efficiency of staff while working remotely. It includes the range of activities from the development of examination papers to operational matters.

Method: The daily tasks plan mainly consists of monitoring frameworks, which provide information regarding departmental weekly deliverables. Every week, the departments were required to submit their weekly planners to the Quality Assurance department with the targets mention in it. Also, two separate meetings were held within the department and across departments in the presence of leadership to share their daily activities and challenges faced during remote work. By the end of the week, departments submitted their weekly status, which contains information about the achieved/ variance of targeted activities. After every four weeks, performance reports were shared with departmental Managers and Directors.

Results: Despite certain challenges at home, the employees performed their tasks efficiently and happily. The departments achieved most of their planned targets and worked together and supported each other in different tasks and assignments. This also harmonized the excellent relationship between the departments and enabled them to understand each other’s challenges. The results from the performance reports depicted that departments have been working hard in achieving their daily targets, also the staff become more accountable about their daily activities. However, few departments faced challenges initially in the remote work because of the multiple responsibilities they encounter.

Discussion and Conclusion: The notion of remote work was a new and challenging concept, particularly in a developing country like Pakistan. However, the continuous guidance, motivation, and support from AKU-EB senior leadership enabled all the departments to overcome those challenges and start a new normal.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Evaluation

35. Monitoring and Evaluation of Capacity Development Programme on Students Assessment *Sitara Jabeen - Examination Board, Aga Khan University

Introduction: AKU-EB with UNICEF and Government of Balochistan (GoB) signed a collaborative project ‘Capacity Development Programme on Students’ Assessment’ with an aim to improve the students’ assessment criteria in the province of Balochistan. To strengthen the quality of the programme AKU-EB initiated the M&E process for all the modules. Two independent monitoring and evaluation frameworks (Academic and Non-Academic) were developed to ensure the quality for each session; to achieve set targets; and to provide daily feedback. This paper discusses the outcomes of implementing the M&E frameworks for improving the overall quality of the project. Method: The quality of the programme was monitored through following the M&E frameworks. Also, qualitative, and quantitative data was collected through daily session evaluation forms, course evaluation and participants’ daily attendance sheets. Data from these set of activities were analyzed. Based on the analysis, daily M&E report was developed and shared on the same day to the project team. Also, daily M&E meeting was held with the team to discuss the training feedback and to address the concerns and challenges when and where required. Results: The data shows that M&E frameworks led the participants towards more effective and interactive ways of learning. It facilitated in identifying new ways of learning and improvements for both facilitators and participants through formative feedback during programme. Further, it also helped in identifying the challenges encountered by both facilitators and participants. Conclusion: The study recommends that the participation of the program facilitators in M&E meetings is significant for the continuous quality improvement of the overall program. M&E is therefore a valuable tool in ensuring the on-going effectiveness of any programme through action taking and decision making for further improvement through involving the voice of all stakeholders, which helps in achieving the set goals.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Evaluation

36. Evaluating the Effectiveness of Capacity Development Programme on Student Assessment *Rabia Nisar, Muhammad Kashif, Muhammad Faheem, Naveed Yousuf - Examination Board, Aga Khan University

Introduction: A student assessment body requires expertise in the complete examination cycle (i.e. from syllabi and examination development to data analysis and feedback) to perform effectively. Needs assessment of the government education departments in Balochistan revealed gaps in knowledge and skills regarding assessments. A structured, holistic and sequential capacity development programme on student assessment was developed for these departments. The purpose of this study is to evaluate its effectiveness. Method: A thirty-five-day face to face capacity development programme was designed over four modules for thirty participants. These modules were interlinked with one-hundred-thirty-days of distance learning with one major distance learning assignment after each module. The pedagogy consisted of participant- centered facilitation, reading assignments, group exercises, individual assignments and in-situ experiential learning. The first three levels of Kirkpatrick’s model were used to evaluate the programme’s effectiveness which are as follows: Level 1: Participant perception and satisfaction using 13-item module evaluation form Level 2: Learning using 65-item pre- and post- test Level 3: On-the-job attitude and practice using survey (pre- and post- programme) Data was analysed using SPSS version 20. Descriptive statistics were estimated. For levels 2 and 3, paired t-test was used to investigate any statistically significant difference at 95% confidence level. Results: Level 1: The average satisfaction level of the participants was 86%. Level 2: There is a statistically significant difference in the participants pre-test (Mean 40%) versus post-test (Mean 64%) scores. Level 3: There was an increase of 121% in interdepartmental coordination for implementing quality assessment and an increase of 73% in willingness to seek assistance amongst colleagues within and outside department. Conclusion: The result shows effectiveness of the capacity development programme as the pre- and post- test scores show an increase in learning. Participants were satisfied with the course and coordination and collaboration amongst departments increased after the course.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Curriculum Development

37. Factors underlying residents’ self-ratings in 360-degree evaluation *Muhammad Tariq, Azam Afzal - Aga Khan University

Background: Effective communication, interpersonal skills and professionalism are key components for the optimal performance of any health care professional. Residency programs are adopting various methods to assess how well their trainees can interact with patients and coworkers and 360-degree evaluation is one of them. It requires the collection of ratings of training or job related competencies from raters occupying multiple sources (Hoffman, Lance, Bynum, & Gentry, 2010). One of the very important rater source in 360-degree evaluation is the ratee himself/herself, whose evaluation about one’s own performance allow for a ‘‘gap analysis’’ between how individuals perceive themselves and how others perceive them (Rodgers & Manifold, 2002). It is important to investigate what underlies self-ratings, since self-ratings are assumed to be main drivers for reflection on and use of feedback, which may lead to performance improvement. The purpose of this study is to gain better understanding of self-ratings. More specifically, we want to investigate factors underlying residents’ self-ratings in 360-degree evaluation

Methods: The study was conducted at the Aga Khan University in the Department of Medicine. Quantitatively 103 self-ratings of residents were analyzed, using SPSS version 20. For each of the items in the questionnaire we calculated mean score and standard deviation. In order to identify underlying dimensions and to estimate construct validity of the instrument of self- ratings in 360-degree feedback, we conducted exploratory factor analysis. The extraction method used was Principal Component Analysis. Display was with unrotated factor solution and scree plot. Extraction was done based on the Eigenvalues greater than one with the maximum of 25 iterations for convergence. Oblique rotation (oblimin) was used to allow for factors that are correlated with each other. Coefficient display format was sorted by size. Internal consistency (Cronbach’s alpha) of the scales was derived from reliability statistics and inter-item correlation was measured.

Results: The data was screened for missing and/or invalid values. The sampling adequacy was measured by Kaiser-Meyer-Olkin measure of sampling adequacy (KMO). There was sufficient inter item correlation; KMO = .905, indicating that the patterns of correlation are relatively compact. The correlation matrix was significantly different from the identity matrix (Bartlett’s χ2(28), = 485, p<.001).. Therefore these distributional properties of the data allowed principal component analysis to yield distinct and reliable factors. Since our MSF form is an 8-item questionnaire/ instrument, our sample size of 103 meets requirements for factor analysis. The reliability for the full set of items1-8 (Cronbach’s α) was .915. Principal component analysis was conducted on the 8-item-self-rating questionnaire with oblique rotation (direct oblimin). Only one factor had Eigenvalue over 1and explained 63% of variance.

Conclusion: Factor analysis reveals that all the performance dimensions in the self-rating instrument are highly correlated with a single factor, which seems to encompass aspects of professional behavior. Further exploratory studies are needed to identify more items to be incorporated in the questionnaires to augment its construct validity

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Curriculum Development

38. Contribution of Microbiology In Nursing Theory and Practice *Shagufta Iqbal, Shehla Khan – SONAM, Aga Khan University

Abstract: The accomplishment of a basic microbiology course is a solid indicator of how students will perform in further nursing courses and clinical area. The students should give special attention to a microbiology course in nursing school. A good nurse must have a sound knowledge of basic microbiology to integrate this knowledge in clinical practice. Nurses who are working in the hospital settings mostly use their knowledge for infection control, hospital-acquired infection, disease transmission and control of microorganism. Those who are mostly working in the community settings utilize microbiology knowledge in the collection and handling of specimens, understanding the medically important microorganisms, and combating infection in the immune-compromised host. In the case of the clinical setting nursing, students lack the knowledge about the infection control which may lead them to exposure with infectious organisms. Therefore, there should be some educational strategies to enrich their ability to control this exposure effectively. Methods: This review synthesized all the studies of last 10 years focusing on Contribution of Bioscience courses in nursing Education. It is significant to discuss and highlight the main contribution of microbiology in the field of nursing practice. Conclusion: The findings in this literature review contributes to the understanding that bioscience in nursing has a beneficial effect on students’ learning experience by enhancing their learning motivation and learning capacity. These results also suggest that the academic nurse is the ideal educator to bridge the gap between the biosciences and nursing practice, therefore the academic nurse needs to have a thorough knowledge of biosciences as well. Keywords: Microbiology, Nursing, Clinical Practice, Nursing Education

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Curriculum Development

Introduction and back ground: To build research capacity among graduating medical students, the teaching of research and critical analysis was integrated into the new integrated undergraduate medical curriculum of Rawalpindi Medical University (RMU) to align medical education with global concept. This paper aims to present a guideline for development and implementation of Integrated Undergraduate research curriculum (IUGRC) at RMU. Methods: Integrated Undergraduate research curriculum (IUGRC) has two components, a theoretical component (IUGRC1-V) and Practical Research Component (Student Research component SRC 1-V) incorporated into different modules across five years of undergraduate medical teachings. Each module is based on philosophical perspective underpinning the adult learning principles and theories of learning. Results: Teachings of research, critical thinking and evidence based medicine, embodied in various modules spanning across 1st year to final year MBBS, in specific way that they have horizontal as well as vertical integration. The integrated undergraduate research curriculum provides an integrated and sequential development and assessment of research skill learning outcomes in alignment with teaching learning strategies. Conclusion: The blueprint introduced in this paper would help medical educators to draft integrated research curricula for those institutions which intend to introduce component of research as a longitudinal theme into undergraduate curriculum. Keywords: Education, Medical, Undergraduate; Schools, Medical; Curriculum; Research teachings, Integration, Module,

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Curriculum Development

40. Assessing insights and practices among graduates to signify the need for dental ergonomics within the dental curriculum. A cross-sectional survey *Shaur Sarfaraz - Jinnah Sindh Medical University

Objective: To assess the knowledge, attitude and practices of ergonomics among dental graduates in Karachi. Material and Method: A descriptive cross-sectional study was conducted at Altamash Institute of Dental Medicine from February to June 2020. The study was carried out among 174 dental graduates (house officers) in Karachi, using a validated, closed-ended questionnaire. Results: Out of 200 dental graduates, 174 responded and data was analyzed in SPSS version 21. Females (78.2%) were more in number than males (21.8%), most of them aged >23 years (59.1%). Of the study population, (78.7%) graduates worked 4-6 hours per day, and more than half of the graduates (58%) did not do physical exercise outside the work. Further, we found that majority have a fair knowledge of ergonomics principles and a total of 134 (77%) dental graduates had a positive attitude towards its implementation, but this is not reflected in their practices as 128(73.6%) had bad practices of ergonomics. It was also found that knowledge and practices of ergonomics had a weak but significant correlation (r=0.263, p=0.001). Moreover, males were more positive about implementing and practicing ergonomics then females with a significant association (p=0.001). Conclusions: A majority of the dental graduates (house officers) in this study had a reasonable knowledge of ergonomics and its principles, also showed positivity but small number of them were practicing dental ergonomics. This study recommends the need for including dental ergonomics in the academic curriculum of clinical years of both dental undergraduate and postgraduate studies and also conduct workshops to develop faculty to reinforce its importance.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Curriculum Development

41. Ensuring the Completion of Pain Fellowship Training through Innovation in Curriculum during COVID 19 Pandemic *Aliya Ahmed, Robyna Irshad Khan, Shemila Abbasi, Ali Sarfraz Siddiqui, Azhar Rehman, Ausaf Khan, Tanveer Baig, Gauhar Afshan - Aga Khan University

Introduction: COVID-19 pandemic has caught the entire world blindsided, causing dramatic changes to professional and personal lives. Graduate and postgraduate medical education has been significantly affected. The implementation of lockdown has hugely affected teaching and learning. Pain fellowship at the authors’ institution is a one-year structured training program. The fellow presently enrolled is on training leave from a public health institution. Completion of training within the stipulated time is therefore highly important. The authors faced the challenge of developing innovative solutions to ensure effective teaching, learning, and assessment with an overarching goal of timely completion of training. Methods & Results: The challenge was addressed by creative innovations using virtual solutions. Pain grand rounds that were being held in conventional class room were modified to virtual class room. Simulation based workshops were conducted for procedural skills. Given the low patient volumes during initial lockdown, a roster was worked out to provide ample opportunity to the fellow to work with all pain faculty members to be able to observe and practice various interventional procedures and pain management strategies. Guest lectures were also resumed as web-based lectures. Tele-clinics were resumed early after the implementation of lockdown and slowly in-person clinics were re-started. Discussion & Conclusion: The fellow and faculty had no prior experience of virtual teaching and learning and were apprehensive about the availability of adequate resources. With support and training by institution’s information and technology department, the transition was frictionless. Even the most traditional of teachers are now using innovative web-based technology and plan to continue it in future. The ready acceptance of advanced technology in a traditional teaching program of a developing country has made the authors wonder: is COVID-19 a blessing in disguise for postgraduate medical education in developing countries?

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Curriculum Development

42. Mental Health in COVID Crises; integrating Synchronous Learning in Undergraduate Blended Curriculum *Sana Asif Siddiqui, Aisha Sanober Chachar, Humera Saeed, Ayesha Irshad Mian - Aga Khan University

Introduction: Medical Students at the Aga Khan University (AKU) rotate through Psychiatry in their 4th year of a five-year undergraduate medical education (UGME) program. In March 2020, a province-wide lockdown was mandated by the government, thereby leading to a suspension of all onsite clinical teaching in the middle of an academic year. The institution called to move all teaching and learning (T&L) online. All 4th year clinical clerkship directors were given a week to develop an online specialty-based curriculum . Before the suspension of onsite teaching, half the 100-student 4th year cohort had already undergone their core rotation. The curriculum therefore had to be applicable and engaging for two cohorts, one that had already undergone the core psychiatry rotation, and the other that had no exposure to psychiatry yet. Methods: A 10-hour 100% online course was developed to be delivered through a blend of synchronous meetings on Microsoft Teams and asynchronous discussions on Moodle- a Virtual Learning Environment (VLE). This ensured both real-time and time-delayed learning to enhance optimal student engagement. Divided into 5 modules, the content followed an informal needs assessment by faculty and students and focused on the mental health dimensions of a global public health crisis. Each 2-hr module included self- directed pre-readings, interactive online sessions, and a webinar by internationally renowned psychiatrists. Formative assessments were based on participation in student discussion forums, attendance in online sessions and scoring in online activities. Student reflections (formative assessment) and session ratings were the primary data source for feedback. Results: Given the time constraints though, developing a comprehensive competency-based curriculum from start to finish, proved a formidable task. The team also found it hard to master the newly mandated use of Microsoft Teams. Majority of the students found the curriculum ‘interesting’, ‘novel’ ‘according to the needs’ and ‘of just right length of time’. They found the synchronous online learning more engaging than asynchronous learning; in particular case based studies were seen as a favored teaching strategy. Conclusion: Overall, integrating Synchronize Online learning into Blended Learning was an enlightening experience in creating a course on Mental Health and Public Crises. This comprehensive online curriculum would be applicable and easily extended as an enduring educational material that is short, readily available, contextualized to any setting, and easy to use.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Social Media

43. Effectiveness of Multiple Reminders in an online research survey for Maximum Response *Fatima Gauhar, Maria Khan, Nimra Iqbal, Mushahid Hussain Rizvi, Syeda Sadia Fatima - Aga Khan University

Introduction: Medical graduates from Pakistan either practice medicine in their home town or abroad, especially in the United States of America (USA). They adopt a multi-factorial approach from the beginning of medical school to increase their likelihood of practicing medicine in USA. Therefore, we planned to conduct an online survey based study to evaluate the key factors affecting pursuing residency in America. This short communication focuses on our strategies to maximize the response rate using a web-based survey. Method: This cross-sectional study was conducted via social media platforms. A population of 1300 AKU alumni across the globe from the class of 2006-2018 were approached. A message with a link to a Google Form was sent to the participants via Facebook, anticipating a response of at least over 15.4% (> 200 participants). However, we were unable to achieve the desired target with this approach. One of the main causes of the low response rate was that our message went unnoticed by majority of participants. Thus, we strategized to send reminders. From Mid-March to Mid-May 2020 messages and emails were sent out to the AKU Alumni four times at pre-decided intervals. Records were kept of the platform used, number of times, time of the day and the response rate of filled survey forms. Results: Before the intervention, the response rate was 2.8% (36 participants filled out the form out of 1300). After sending repeated reminders, the response rate increased to 13.7% (173 participants filled out the form out of 1264) which is 4.9 time higher than before the intervention (p<0.001). Hence, we were able to reach our target responses for our study. Conclusion: Our study suggests to sending three spaced-out reminders to collect a satisfactory number of responses for an online a cross-sectional study. (ERC # 2019-1924-5025)

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Social Media

44. Social Media in Radiology Education *Shaista Afzal Saeed - Aga Khan University

Narrative writing: Social media has become integrated into the lives of a large part of society and is now being evaluated as a potential teaching and learning resource. A number of studies suggest that the present students learn better with the use of collaborative platforms resulting in higher level of satisfaction, however the degree of knowledge transfer and retention is not well documented. The barriers to the implementation of a social media based curriculum have been reported but the educators in the present era are expected to overcome these and find creative ways to utilize this powerful media for fulfilling the educational requirements of the digital native generation in the era of web 2.0

In this narrative writing, my experience of using a social media tool i.e. blogger for conducting an educational activity for the women imaging group and for year III radiology rotation will be discussed.

In my reflection, the process of setting up, utilization and experience of the social media tool will be elaborated. In addition the lessons learned from the use of social media for educational purpose will also be shared

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Well Being

45. Prevalence and Factors Associated with Anxiety and Depressive Symptoms Among Undergraduate Nursing Students in KPK *Muhammad Ilyas, Yasmeen Nadeem Parpio – SONAM, Aga Khan University

Introduction: Anxiety and depressive symptoms among adults are a public health concern. The university level is the transition stage for adult-learners in which they start to become accountable for their life-choices and their health-related activities. Therefore, challenges related to university study and lifestyle may cause anxiety and depressive symptoms among undergraduate students. The current study focused on the proportion and factors associated with anxiety and depressive symptoms among nursing students. The study aimed to determine the prevalence and factors associated with anxiety and depressive symptoms among nursing students of public and private nursing colleges in Khyber Pakhtunkhwa, Pakistan. Methodology: An analytical cross-sectional research design was employed for the study. The data was collected from both public and private nursing institutes by implying consecutive sampling. The Open Epi v.6 was used to calculate the sample size for prevalence and associated factors which were 400. “The Aga Khan University Anxiety Depression Scale” too was used with a cut-off of ≥19 for individuals said screen positive. Descriptive and inferential statistics were used by using SPSS v.21 for data analysis. Results: The response rate of the study was 82.5%, around 72.1% female and 27.9%, male participants reported 60.3% prevalence of anxiety and depressive symptoms. In Univariate logistic regression analysis, a statistically significant association was found among age, marital status (p-value˂0.001), satisfaction from the study (p-value˂0.001), living arrangements (p-value=0.002), family history of psychiatric illness (p-value˂0.001). Finally, the multivariate model revealed that the married participants were 3.8 times at of anxiety and depressive symptoms as compared to singles (95% CI: 1.597-9.455). Similarly, with one unit increase in the year of the study the risk was found significantly high (OR=6.843, 95% CI: 2.253–20.781). Conclusion: The alarming rates of anxiety and depressive symptoms indicates the implications for health promotion and mental health issues prevention among undergraduate nursing students. It is essential to enhance the mental health status of the undergraduate nursing students with the help of appropriate interventions and developed strategies by contemplating the relevant associated factors to overcome the mental health problems.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Well Being

46. Impact on Mental Health of Undergraduates and the Ways to Cope Stress during Covid-19 Pandemic *Kiran Fatiam Bana, Shaur Sarfaraz - Bahria University Medical and Dental College

Introduction: The COVID-19 pandemic has dreadful consequences on every aspect of human life. People around the world are facing various mental disorders such as anxiety, post-traumatic disorder during self- isolation, and quarantine. This study was aimed to evaluate the mental health status of undergraduate students of three different programs. Secondary objectives were to correlate the related factors influencing GAD-7 score and to assess the coping methods practiced by undergraduates. Methods: Cross-sectional survey was conducted from 10th to 30th May -2020 during the COVID-19 lockdown period. Medical, dental and engineering undergraduates of private sector universities of Karachi were the target population. The GADS-7 (Generalized anxiety disorder scale 7-items) validated tool was used along with the demographic variables, related stress factors, and the coping skills practiced during last two weeks. A total of 571 questionnaires were completed in all sections. Results: From the total students (n=132-23.1%) experienced mild, (n=343-60.1%) moderate and (n=78- 13.7%) had severe anxiety level on GADS-7 scale. All related stressors were significantly associated with the GAD-7 scale at a p-value of < 0.01. Moreover, the results depicted that there was a moderate positive correlation found (0.489, 0.342, 0.310, and 0.328) for all related stressors. Taking breaks from watching, reading news about the outbreak of COVID-19, meditation, and engaging in some other activities were the most frequently used coping strategies among undergraduates’. Discussion and Conclusion: Mental health of college students were assessed in China; in which 24.9% of college students were experiencing anxiety during the COVID-19 crisis and this study revealed 96.9% level of anxiety in undergraduates. There was significant difference found in mental health of all three cohorts. There was a moderate positive correlation found for all related stressors. Taking breaks from watching, reading news about the outbreak of COVID-19 was the most frequent coping behavior practiced by all students.

ERC Number: BUMDC 50-2020.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Leadership

47. An analysis of the Role of principals as Transformative Leaders in Private Schools of Gilgit Baltistan *Musrat Jahan

The study was done to analysis the role of principals as transformative leaders in private schools of Gilgit. Objectives of the study were to determine teacher’s professional development in context of transformative leadership in schools, to identify participation of principals as a transformative leader for teachers’ professional development in schools. Explore challenges faced by principals as a transformative leader during service in schools. It was survey study. Questionnaires were used as a data collection tool. Validity & reliability of both questionnaires were tested. Pilot test was administered before the final use of tool. The data were analyzed through SPSS (frequency, Percentage and mean) were calculated. Result of principals’ and teachers’ questionnaire in context of the four components of transformative leadership (Idealized influence, Inspirational motivation, Individualized consideration, and Intellectual stimulation were considered by principals in schools shows that principals’ play transformative leader role in school. Result shows that principals play vital role in professional development of teacher’s in schools. Findings were that evaluation of teacher’s effectiveness is challenging for principals’ in schools and principals also face problem to provide guidance and opportunities’ for teachers to build their competence and skills. Performance of teachers creating problems in schools and teacher’s absenteeism is big hindrance for principals. So that transforming a school’s culture is the principal’s greatest challenge. Majority teachers were agreed about the challenges faced by principals in schools. Suggestions were on the basis of findings of the study that; Seminars for principals in school can strengthen the knowledge and skills of principals to overcome challenges faced by principals in schools. Evaluation may be on clear criteria, and collaboration of both teachers and principals in schools. Principals’ may follow leave policies to overcome teachers’ absenteeism in schools

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Interdisciplinary Approach

48. Efficacy of Transdisciplinary intervention Approach in Social skills group therapy for children with Autism Spectrum Disorder and Attention Deficit Disorder *Hamamah Ansari, Noorulain Ghulam - Aga Khan University

Introduction: This is a case study which was conducted to study the efficacy of transdisciplinary intervention approach in social skills group therapy for children with Autism Spectrum Disorder (ASD) and Attention Deficit Disorder (ADD). ASD and ADD is a neurological developmental disorder both disorders have common signs of attending instructions i.e. following the verbal commands, deficits in social communication and interaction.

Method: In this study 3 male children ages from 5 to 8 years were enrolled in social skills group therapy program according to their screening results of their cognitive skills and language skills, for 12 sessions with the time duration of 30 to 40 minutes once a week. These children were attending mainstream school and individual speech therapy and occupational therapy program. This social skills group was facilitated by two professionals, a speech language therapist and an occupational therapist at Child Learning Behavioral Services (CLBS), Psychiatry Department; Aga Khan University Hospital (AKUH) to focus on social communicative skills. The efficacy of the social skills group was assessed by Pragmatic Language Developmental Scale, The Pragmatic Profile and Sensory Profile-Pearson assessment.

Result: Post therapeutically significant improvement in social communicative skills. The children became more focus attending towards the command following, initiating communication and social interaction with peers.

Discussion and Conclusion: This transdisciplinary approach; incorporating Speech and Language therapist and Occupational therapist played significant providing opportunity for the children with ASD and ADD to be introduced with different professionals with diverse intervention approaches and, also helps to alleviate their self –esteem and enhancing their social skills.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Interdisciplinary Approach

49. A Multidisciplinary Model for Geriatric Care in Karachi, Pakistan *Habiba Thawer, Saniya Sabzwari - Aga Khan University

Introduction: Pakistan is a developing country with an increasing elderly population. Currently at 6%, it is predicted to double by 2050. The lack of governmental and public support for said group makes medical management challenging. Growing co-morbid illnesses, depression, cognitive decline and mobility impairments further compound this problem. The role of physiotherapy for such conditions is well documented however utilization is limited due to lack of resources and awareness. We decided to develop a combined geriatric assessment and physiotherapy program at our institution to provide an accessible and affordable service to our elderly population. Methods: The cornerstone of the Geriatric Reactivation Program (GRP) is a combined assessment and intervention by geriatricians and physiotherapists with the goal of optimizing overall health, mobility, functionality and independence of the elderly. The GRP’s Outreach Team allows provision of ancillary services at home, with interventions to optimize home safety, regular exercise and safe medication practices. Results: The GRP will be evaluated annually to determine its effects on the functional status of the elderly. Discussion and Conclusion: Developing interdisciplinary liaison services to improve healthcare of elderly in resource constrained settings is a necessary. ERC: Not applicable at this stage.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Mentoring

50. Mentorship in Obstetrics and Gynecology Residency: Perspectives from both sides of the association *Munazza Akhtar, Ayesha Malik - Aga Khan University

Introduction: Mentoring is an age-old developmental tool whose practice extends as far back as 800 (1). It is the process of one person supporting, teaching, leading, and serving as a model for another person (2) Previous studies of mentoring in academic medicine suggest that the mentoring programs influence academic productivity, personal development, and career guidance of mentees. (3) Mentoring is a beneficial resource to decrease negative outcomes like academic failure and emotional distress and increasing preparedness for career beyond residency. (4,5) A formal mentoring program for residents was introduced at Department of Obstetrics and Gynecology – AKUH in 2016. There is paucity of research investigating factors that promote or hinder effective mentoring relationships as perceived by both faculty and residents. (6) Thus, we have planned to explore the perspective of both sides. The objectives of this study would be 1. To explore the experience of mentors/mentees participating in Obstetrics and Gynecology Residency mentoring program at Aga Khan University Hospital and secondarily 2. To recommend suggestions for improvement of mentoring program Methodology: Setting: Obstetrics and Gynecology Department at AKUH Duration: 06 months Sampling: Purposive till saturation reached Study Design: Interpretive (Hermeneutic) Phenomenology Data collection methods: audio recorded, semi structured, in depth interviews of residents (mentees) and faculty(mentors) using interview guide. Data analysis Interviews will be audiotaped and transcribed verbatim. Analysis of data will be done by coding and content analysis. Coding of the individual interviews will be used to create a list of categories and themes leading to analysis. Results: The key factors will be inferred from both mentor and mentee perspectives for a successful mentorship program. Themes will be compared between mentors and mentees, to see the differences in their perception of this association. Discussion & Conclusion: The key factors will be identified that facilitate or hinder mentorship relationships. We are hoping to propose solutions for effective mentorship in residency training programs after this study.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Learning Environment

51. Experiences and Reflection of Dental students facing Harassment during undergraduate education in Karachi *Aliya Islam - Baqai Medical University

Objective To explore the experiences of dental students regarding the harassment they face in their institutions Introduction Harassment: covers a wide range of behaviors of an offensive nature. It is commonly understood as behavior that demeans, humiliates or embarrasses a person, and it is characteristically identified by its unlikelihood in terms of social and moral reasonableness. They are different types of harassment. (contributors)

Problem Statement: Harassment is a major issue that gives rise to concern and despite counter-efforts, continues to demands attention. Harassment at work or school can be uncomfortable, since these environments are part of people’s everyday lives. Medicine is a very hierarchical profession and medical students are at the bottom of that hierarchy. Several researches in different countries have shown that bullying, harassment, abuse or belittlement are a regular phenomenon faced by medical students, also junior doctors, doctors undertaking research and other healthcare professionals. While research has been carried out on bullying experienced by psychiatrists and psychiatry trainees in Pakistan no such research has been conducted on medical students in this country.(Ahmer et al., 2008) Colleges have been condemned for not addressing harassment adequately, but the problem nevertheless continues. Some incidents go unreported, and others may be minimized as administrations get nervous at the prospect of scandals .Although over one year since higher education commission (HEC) issued instructions to establish sexual harassment committees in educational institutions ,98 out of 138 universities and degree awarding institutes (DAI) were yet to comply. Bullying and harassment clearly being an issue affecting healthcare organizations across the UK—as exemplified by the NHS Bullying Survey25 and a 2013 report funded by the National Institute for Health Research(Timm, 2014). Bullying or harassment is faced by quite a large proportion of medical students in Pakistan. The most frequent perpetrators of this bullying are consultants. Adoption of a policy against bullying and harassment by medical colleges, and providing avenues of support for students who have been bullied may help reduce this phenomenon, as the presence of these two was associated with decreased likelihood of students reporting having being bullied.(Ahmer et al., 2008)

Methods: A qualitative design involving focus group discussions (FGDs) and key informant interviews will be used.

Study Design: Phenomenological Design

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Miscellaneous

52. Academic Background as a Predicator of Performance/Success in Science Subjects amongst Undergraduate Nursing Students Enrolled at a Private University in Pakistan *Naghma Rizvi, Shehla Khan – SONAM, Aga Khan University

Introduction: In professional education, students’ academic performance has been of concern for relevant stakeholders. Research concerning nursing students' academic outcomes has been continuing for over half a century. Generally, the entry criteria for nurses into four-year Baccalaureate of Science in Nursing is after the completion of twelfth grade with major in science. In the existing literature that there are no consistent variables which predict nursing student success across programs. Hence, it is important to examine the effect of academic background on success in the local context in the Post RN BScN program. Objectives: To assess the proportion of students enrolled in Post RN BScN with science and non-science background in ten (10) years (2001-2010). Moreover, to understand if there is a difference in the performance of Post RN BScN students with science and non-science background, with respect to science subjects. Method: A quantitative descriptive design was used. Therefore, a retrospective cross-sectional study design was used. Data of the last ten years of Post RN graduates was collected through Aga Khan University registrar office. Result: This study found that students entering post RN BScN program with non-science background had statistically significantly lower scores in a science subject (2.93 ± 0.60) as compared to students with science background (3.12 ± 0.68), t (346) = 2.48, p =0.0136. Conclusion: In order to increase the workforce of nurses in the country and improve health care facilities, we need to rethink and rewrite our present policies that restrict diploma prepared nurses to upgrade their academic qualification and increase their chances of climbing the available career ladder. Keywords: Science Subject, Nursing Education

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Miscellaneous

53. Who are transgender and intersex individuals? Views of medical students and health care providers from Karachi *Hira Tariq, Zaeema Ahmer, Sana Yasir - APPNA Institute of Public Health, Jinnah Sindh Medical University

Background: Transgender and intersex individuals face numerous hurdles in accessing health facilities. Furthermore there is no formal training for provision of care of such vulnerable population. This study explores the knowledge and attitude of medical students and Healthcare Providers (HCPs) about transgender and intersex individuals in Karachi.

Methods: The cross-sectional study was conducted among medical students of a government medical college and HCPs, from August to September 2019. A structured questionnaire was used to assess the knowledge and attitude of study participants, towards intersex and transgender individuals. Data was analyzed using SPSS 20.

Results: Of the 200 participants, 171 returned the complete questionnaire with a response rate of 85.5%. There were 100(58.5%) females and 71(41.5%) males, with 93(54.4%) medical students and 78(45.6%) HCPs. All study participants were familiar with the term transgender, whereas 138(80.7%) reported to have heard the term intersex whereas 35(20.5%) regarded the conditions as a mental illness. Significant association was observed between HCPs, 32(36.9%) and medical students 13(46.8%) knowledge regarding awareness of PMDC code of Ethics (p<0.001). Medical students 33.3% were more in favor of corrective surgery to be performed as compared to the HCPs 19.9% (p=0.02).

Conclusion: Medical students and HCPs had heard the term transgender and intersex however they did not have sufficient knowledge regarding the said conditions. It is recommended that sexuality information is incorporated in basic medical curriculum.

Keywords: Intersex, Transgender, Knowledge & Attitude study

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Miscellaneous

54. Career Choice and Perception of Nursing Profession among Undergraduate Nursing Students in Peshawar (KPK), Pakistan *Shakir Rahman, Naghma Rizvi – SONAM, Aga Khan University

Introduction: Nursing is selected as a profession for multiple reasons, among which help and caring for people is a dominant factor. Students are reluctant to choose nursing because it is negatively perceived in the Pakistani context. Literature has revealed that students who join the nursing with a clear image in their minds about the profession are reluctant to change the field of study in future, and retained in the profession. Therefore, an in-depth understanding is required to explore career choice and perceptions of undergraduate students’ about the nursing profession in KPK as well as in Pakistan. The study aimed to understand and explore the reasons for choosing nursing as a career by undergraduate nursing students and their perceptions of the profession. Methods: A qualitative exploratory study design was used. Data were collected from 14 final years BScN nursing students through semi-structured interviews. The participants were recruited from both public and private nursing institutions in Peshawar, (KPK) Pakistan using purposive sampling. Data were analyzed using the Creswell (2013) analysis approach. Findings: After the in-depth analysis of the data, three broad themes have emerged; reasons for choosing nursing, perceptions, and way forward for the profession. Participants acknowledged the family influence, interest in the medical field, and personal reasons as influential factors for joining nursing. The participants perceived that the stereotypes and lack of updated nursing knowledge negatively influence the profession in society; however, the participants regard nursing as a multi-dimensional profession. Besides, participants also believed that prior information about nursing and educating senior nurses might contribute to enhance the current status of the profession in society. Conclusion: The study findings suggest the need for seminars, workshops, and career counselling sessions at the institutes before admissions. Media must avoid propagating stereotypical images of the profession. In addition, the major stakeholders should focus on the development of a uniform scope of practice for nursing across the country.

Aga Khan University, Department for Educational Development 4th Educational Research Day

Abstract – Oral Presentations

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Innovation in Teaching & Learning

55. An innovation in Flipped Class Room; a teaching model to facilitate synchronous and asynchronous learning during a pandemic *Rehana Rehman, Syeda Sadia Fatima - Aga Khan University

Introduction: The COVID-19 pandemic has refocused the world to an era of online learning through use of digital technology and a number of virtual learning platforms. Our objective was to conduct an on line Flipped Class Room (FCR) to facilitate synchronous (in class activity) and asynchronous learning [Virtual Learning Environment (VLE)] and acquire feedback of the learning experience from medical students at Aga Khan University.

Methods: This interventional study was conducted with year II students undergoing Endocrine Reproduction Module at the Aga Khan University during April 13 to May 22, 2020. Pre reading material and pretest was shared with the students via Virtual Learning Environment (VLE) one week before the class. Microsoft Teams was used to conduct online session by two facilitators, where student discussion on case studies was encouraged. A WhatsApp group was created with the facilitators to respond to any student queries. The session was recorded and later uploaded on VLE. Posttest and a student satisfaction survey was conducted at the end of the session.

Results: The average score for the pretest and posttest was 19.67 ± 1.37 and 24.60 ± 1.34 respectively (p value <0.05). The learner curve showed an increase in the knowledge learned by 4.93 points (p value <0.05). Fifty-five percent students felt that placement of session was appropriate and were satisfied with the instructions and expected outcomes, received constructive feedback for improvement and generated positive attitude towards learning.

Discussion & Conclusions: The innovative model of FCR through facilitation of synchronous and asynchronous learning empowered student’s engagement and interactive learning. Students perceived as a great learning experience which they enjoyed with positive reinforcement from feedback given by the facilitators. They suggested continuation of this model for further learning sessions in other modules of undergraduate medical education at Aga Khan University.

Keywords: Online learning, Flipped class room, learning experience, in class activity, Student engagement, Virtual learning environment, Synchronous and asynchronous learning. ERC# 2019-2048-5368)

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Innovation in Teaching & Learning 56. Challenges and opportunities of Virtual Teaching *Rubaba Azim, Munizha Nisar - Dow University of Health Sciences

The current pandemic forced the world to change in many ways, medical education is not the exception (1). Teachers are left with the only choice of online delivery of content at a very short notice. The traditional, campus-based institute has moved their classes online. The faculty members, who have little or no experience of virtual teaching, deliver their lectures through an online learning platform (2). The sudden transition from on-campus learning to exclusively distance learning during the pandemic of coronavirus (COVID-19) poses a challenge for teaching faculty and medical educators. Teachers are expected to face various challenges, yet many new opportunities fall in their way while experimenting with relatively new mode of teaching (3). The purpose of this study is to explore the various challenges and issues related to the virtual teaching. The results of the study will be used to enhance the quality of online course development and the need assessment for the faculty development. Objective: The main objective of this study is to explore the challenges and opportunities of virtual teaching in medical institutes of Pakistan. Methodology: This was a cross-sectional study which used quantitative methodology for data collection. A detailed Google survey questionnaire was designed and reviewed by our research team. This study was conducted at the Medical Institutes of Karachi who are using online methods to deliver their course. All undergraduate BDS and MBBS clinical and basic sciences teaching faculties of Pakistan who are involved in online teaching were included. Faculty who are not involved in virtual teaching and Faculty of medical allied were not included. Data was kept confidential in software protected by a passcode. Information provided by the participants was kept strictly confidential. Results: Out of 385, 40.78% were from basic science faculty and 59.2% were clinical teaching faculty (Figure 1). Results showed that majority were from government institutes that are 53 % whereas 47% were private institutes. It was also found that 80% belonged to MBBS field (80%) and mostly had 3-5 years of teaching experience (37%). Results showed that there was a significant relation between successful in controlling and engage students with online teaching. It showed that faculty had training of online delivery were more successful in controlled and engaged students as compare to others. Similarly, who had experience in online teaching and had enough computer literacy were more successful in controlled and engaged students as compared to those whose less literacy and no online teaching experience. P value >0.05 is scientifically significant. Conclusion: E-learning will undoubtedly have a significant impact on the environment in which future medical students learn and faculty development is crucial for the effectiveness of virtual teaching.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Innovation in Teaching & Learning 57. Strengthening Skills for Developing a Flipped Classroom Undergraduate Medical and Nursing student and faculty perspectives *Amber Sultan, Rahila Ali , Nida Zahid, Rozmeen Akber, Russell Martin, Muhammad Tariq, Khairulnissa Ajani - Aga Khan University

The idea of “Flipped classroom” (FCR) is a growing concept in education which is gaining popularity.1 In several studies, blended learning approaches, like the flipped classroom; which utilizes online technology along with instructor-led active learning strategies has shown favorable results. This model of classroom instruction rely primarily on student preparation outside of class in order to use in-class time for specific kinds of active learning activities, such as problem-based learning (PBL) or team-based learning (TBL).2 Use of different technological tools provides opportunity for educators to develop sessions that improve student’s willingness, desire and compulsion to participate in, and be successful in the learning process.3 Technology not only enhances student’s engagement in the learning process, but it also improves student satisfaction.4 The aim of this study was to strengthen the skills of faculty in developing flipped classroom and to enhance student’s learning & engagement through flipped classroom.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Innovation in Teaching & Learning 58. Status of Digital Learning Practices in Health Sciences Education in Pakistan *Sanam Hanif, Hussain Maqbool Ahmed Khuwaja, Ali Maqbool, Komal Abdul Rahim, Sana Gul, Shabnoor Karim – SONAM, Aga Khan University

Introduction: The Higher Education Commission (HEC), Pakistan Medical and Dental Council (PMDC), and Pakistan Nursing Council (PNC) look after undergraduate and postgraduate medical and nursing education programs in Pakistan. Recently, due to curtailing the spread of COVID19, an academic halt foisted many health sciences universities to digitalize the learning environment in the absence of a traditional classroom setup. Therefore, this research aims to assess the digital learning practices in health sciences education institutes of Pakistan and to discuss different modes of digital learning strategies available for Higher Education Institutes across Pakistan.

Methodology: In this descriptive cross-sectional study, all medical, dental, and nursing education institutes registered with PMDC and PNC were approached between 1st April and 15th April 2020. Data was collected on the use of online classes during the routine academic year as well as during the COVID19 Pandemic. [ERC No. BDMC/R&D/ERC/2020-05].

Result: There were 111 medical colleges, 52 dental colleges, and 62 nursing education institutes found in the latest lists available on PMDC and PNC websites. The majority of health sciences education institutions were found in Punjab and Sindh, indicating sheer discrimination with other provinces of Pakistan. The use of online classes was found very low in the routine academic year in all three disciplines of health sciences education explored in this study. Discussion The most common digital modalities across Pakistan’s health sciences universities include MOODLE, Google Classroom, Microsoft Team, etc. However, biomedical communities are left in uncharted water to cross over the barriers such as unavailability of gadgets and internet, Inadequate funds to develop digital infrastructure, lack of technical expertise, computer illiteracy, and spacious setup.

Conclusion: HEC, PMDC, and PNC must realize the scope of digital learning, and invest in infrastructure and capacity building for digital learning in health sciences education in Pakistan.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Faculty Development, Burnouts & Ethics in Health Profession Education

59. Development and Validation of a Multisource feedback tool to Assess the competencies of a Health Professional Educationist *Rahat Naz, Azam Afzal - Jinnah Sindh Medical University

Development and Validation of a Multisource feedback tool to Assess the competencies of a Health Professional Educationist Introduction The Pakistan Medical and Dental Council makes it mandatory for every medical college to have a department of medical education to enhance the quality of education by devising programmes for faculty development. There are a number of programmes for faculty development but there is almost no standard tool available to assess the performance of the Health professions educationist. The purpose of this study is to develop a validated tool to assess the competencies of Health professions educationist. Subject and Methods After a detailed literature search the competencies were selected for evaluation of medical educationist and a cross sectional study was conducted at Jinnah Sindh medical university, with a sample size of 40. The data collection was done at the work place. The Messik framework was used for validity. Result: The descriptive statistic reveals female preponderance and mean experience of 3.6 years. The item content validity index (I-CVI) was above 0.78 which shows a good content validity. The inter-rater reliability analysis showed fair agreement. The significant moderate to strong correlation was found between all the sections. The Cronbach's alpha was estimated as 0.9, which shows a high level of internal consistency of the tool for seven sections. Discussion Most of the faculty lacks in academic qualification in Medical Education and their designations were not according to their academic credentials. Among the competencies, the mean highest score was for leadership. On the basis of reliability and validity evidence against the null hypothesis, we reject the null hypothesis and accept the Alternative. Conclusion: This multisource feedback will help in developing the standards in medical education by providing the feedback to the medical educationist and providing guideline for training needs of all those working in this area. We conclude that MSF is a reliable and valid tool to assess the competencies of a health professions educationist. ERC No:2019-2218-7103.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Faculty Development, Burnouts & Ethics in Health Profession Education

60. Knowledge Regarding the Importance of Medical Ethics: Cross-Sectional Study among Students of a Government and a Private Medical College of Karachi *Zaeema Ahmer, Rameen Fatima, Roheen Sohaira, Maham Fatima - APPNA Institute of Public Health, Jinnah Sindh Medical University

Introduction: Healthcare ethics is of prime importance and medical students should learn to incorporate it in their everyday practices. Our study aims to assess and compare the knowledge of medical ethics among students enrolled in a government and a private medical college of Karachi, Pakistan. Methods: A cross-sectional study was conducted from November-December 2019 among 380 medical students who were recruited via convenience sampling after getting their informed consent. A pre-tested, self-administered structured questionnaire was used to assess knowledge. Data was analyzed by Statistical Package of Social Sciences version 22. Results: Majority, 323 (85%) regarded medical ethics as important while 138 (36.3%) had acquired their knowledge from different workshops. Almost half, 187 (49.2%) had knowledge regarding Hippocratic Oath. When asked regarding ethical scenarios, 69 (18.2%) students in government medical college were of the opinion that a doctor can refuse to perform abortion even if law allows it as compared to 57 (15.0%) in private medical college (p=0.019). Moreover, 80 (21.1%) students in government medical college strongly disagreed that a patient who wishes to die should be assisted in doing so, as compared to 45 (11.8%) in private medical college (p< 0.001). Conclusion: Students had knowledge and were aware of the importance of ethics in their profession. The ones belonging to government medical college held stronger views regarding ethical scenarios as compared to the ones in private medical college.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Faculty Development, Burnouts & Ethics in Health Profession Education

61. The Prevalence and Association of Stress with Sleep Quality in Medical Students: A Cross-Sectional Study *Mohummad Hassan Raza Raja, Muhammad Abdullah Javed, Maryam Pyar Ali Lakhdir, Ali Bin Abdul Jabbar, Maria Khan, Kanza Muzaffar - Aga Khan University

Introduction: As yet no study has been conducted assessing the association of stress and sleep quality in a medical college employing a Problem Based Learning (PBL) based integrated curriculum in Pakistan. Thus this study aims to find the prevalence of stress and investigate the correlation between stress and sleep quality among medical students of Karachi, enrolled at a private medical institute employing a PBL teaching methodology. Methods: 240 medical students participated in a cross sectional study administered at the Aga Khan University Karachi between July and October 2019. Participants’ perceived stress was recorded using the Perceived Stress Scale-14 (PSS-14), and sleep quality was recorded using the Pittsburgh Sleep Quality Index (PSQI). Results: The mean PSS-14 score was 27.38 ± 6.66. Males had a mean PSS-14 value of 26.50, whereas females had a statistically lower mean score of 28.33 (p<0.05). The mean PSQI score was 6.31 ± 2.78. The prevalence of high stress levels and poor sleep quality were 41.7% and 54.2% respectively. Students with “Low Stress” had significantly better sleep quality as compared to students with “High Stress” (Low Stress PSQI= 5.29 ± 2.29 vs. High Stress PSQI= 7.75 ± 2.77, p<0.01 (t-test)). A significant association (via Pearson’s chi square test) was found between sleep quality and napping habits as well as sleep quality and self-reported sleep cycle (p=0.001, Odds Ratio=2.92 and p=0.048, Odds Ratio= 1.81 respectively). Conclusion: This study demonstrates there is a significant association between stress and sleep quality, with students with high stress levels more likely to suffer from poorer sleep quality. Females were more likely to be stressed than males. Irregular sleep cycles and napping were found to be associated with poorer sleep quality.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Faculty Development, Burnouts & Ethics in Health Profession Education

62. Faculty Development in Health Professions Education at Aga Khan University: The Needs Assessment *Tabassum Zehra, Rahila Ali Mazhar, Sana Saeed, Amber Sultan, Sunder Khuwaja, Muhammad Tariq - Aga Khan University

Capacity building of faculty requires faculty development for them to develop as professional and competent teachers, educators, researchers and leaders who are ready and efficient to fulfill their new roles and responsibilities (McLean, Cilliers, & Van Wyk, 2008). Workshops are an effective and convenient forum to develop the diverse needs of many faculty members. They can enable change in participant’s teaching, research, and administrative abilities. While the method is popular with participants, organizing and conducting such workshops presents a challenge to the person responsible for its success (Wu & Chang, 2014). Lack of scheduled educational activities and protected time, often prevents faculty from attending capacity development programs. In the year 2003, the Higher Education Commission (HEC) of Pakistan recognized the role of faculty development in order to come at par with international standards of education. The achievement of this goal was possible only through faculty development activities. There is a dearth of local literature in this area. There is no published data available on faculty development initiatives started by the medical colleges of Pakistan (Mukhtar & Chaudhry, 2010). As part of the larger project, this study was conducted to assess the perceived needs of the faculty at the Aga Khan University in order to identify the essential educational skills needed within different faculty tracks to fulfill their faculty roles effectively.

Methodology: Observational study design with cross section survey was conducted. A survey questionnaire was developed by a group of clinical and educational experts based on the workshops and courses of faculty development in health professions education offered by the Department for Educational Development, AKU. The survey questionnaire was piloted on a group of 4-5 faculty members. With ethical approval, the survey questionnaire was sent to the departmental chairs of clinical and basic sciences disciplines, programme directors and clinical coordinators of undergraduate programme, various postgraduate programmes offered by the Postgraduate Medical Education (PGME) at AKU and the graduate programmes. This study was also extended to FMIC, Afghanistan to assess the needs of faculty at FMIC through the same survey questionnaire.

Results: Response rate was 50%. Nine (09) essential workshops in health professions education were perceived by the faculty as mandatory for the faculty in Educator Track. Faculty with 80-70% clinical and 20-30% Education in Clinician Educator track was perceived to complete Advance Level Course (ALC) on Teaching & Learning and ALC Assessment. Faculty with 50-40% clinical and 50-60% Education in Clinician Educator track was perceived to complete all five Advanced Level Courses. Postgraduate Medical Education and Graduate Programme Director was perceived to complete at least ALC Teaching & Learning, ALC Assessment and ALC Curriculum Development.

Conclusion: Faculty development in Health Professions Education is gaining attention nationally and internationally. The implementation of the identified areas of capacity building, through the continuous faculty development programme at AKU will help faculty within different tracks to enhance competence and performance in their roles as a teacher, thereby better health care delivery and enhanced patient outcomes.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Educational Assessment

63. Assessments in Medical Education: Challenges & Solutions during COVID Pandemic *Sadia Fatima, Romana Idrees, Kausar Jabeen, Saniya Sabzwari, Sadaf Khan, - Aga Khan University

Background: The Covid19 pandemic has caused large-scale disruption in almost all educational programs across the world. Planning and rapid implementation of assessment through an online format presents the next set of novel challenges that must be addressed by academic administrations across the globe. Methods: We describe the planning, processes, and outcomes of online assessments using video communication platforms conducted at a private university in Pakistan. Standardized protocols were written and piloted, extensive training of student, proctors and staff for preparation and conduct of online assessments were developed. Feedback was recorded after each session and suggestions were incorporated in subsequent high-stakes assessments. Results: A total of three pilot assessments were conducted to identify issues and process refinement. Commercially available lockdown browser and ZOOM were used in the first pilot; 80% of the class was unable to launch lockdown browser and laptops required repeated reload/reboot. For the second pilot assessment, University’s VLE page & MS Teams was trailed. Issues with internet connectivity, VLE page slowdown, and suboptimal recording feature in MS Teams were identified. For the final pilot assessment, phased launching of VLE page with single test item per page was implemented with success. Visual proctoring was successfully conducted through Zoom, with reliable recording of the proceedings. Conclusion: In order to device an effective protocol for e-assessments conducting multiple trial runs, and incorporating feedback from all stakeholders is a necessity. Active visual monitoring during the examination, and review of recordings after the exam will ensure exam integrity.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Educational Assessment

64. Conducting Formative Online Open-book Exam for First Year Medical Students - A Pilot Study *Javeria Rehman, Rahila Ali, Azam Afzal, Sara Shakil, Amber Sultan, Romana Idress, Sadia Fatima - Aga Khan University

Introduction: The spread of COVID-19 pandemic in early 2020 compelled all the educational activities, including medical education to be shifted from face-to-face interaction to virtual platform. This shift provided the opportunities of exploring online assessment modalities. One such assessment method is an online open book exam which is relatively a new concept in medical education of Pakistan. Limited information is available in literature regarding open book exam for the basic science subjects. Hence, the objective of the study was to determine the quality of the open book exam administered as a pilot project to the first year medical students.

Method: It was a cross-sectional analytical study that included 99 students of first year MBBS. The students were administered an online unrestricted type of open book exam as a formative assessment in Renal module. All the questions were reviewed by the team of content specialist and medical educationists and a pre-hoc analysis was done before the administration of assessment. The exam consisted of 30 open- ended, short answer type questions. The duration of exam was 70 minutes. All questions selected were assessing Blooms cognitive levels of understanding and application. The scores of the exam were analyzed for quality and post-hoc of assessment using MS Office Excel.

Results: A total of 99 students appeared in the exam. The students’ scores for 30 questions were analyzed. The mean score was 47.24 ±15.30 SD %. The reliability of exam was 0.79. 07 (23.3%) questions were identified as very difficult while 03 (10%) questions were very easy.20 (66.6%) questions were found to be moderately difficult with their difficulty index ranging from 31-80%. 26 (86.6 %) questions were in the range of moderate to high discrimination index. There were no questions with negative discrimination.

Conclusion: The exam was found to be reliable and can be implemented with training of faculty and students. Online open book exam provides a good format for remote and formative assessment of students with minimum proctoring during times of constraints such as COVID 19 pandemic.

Recommendation: Faculty training is required to create an open book exam assessing application of knowledge in basic science subjects. Furthermore, students should be trained to utilize all resources effectively while preparing for and avoid plagiarism while attempting open book exam.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Educational Assessment

65. Developing and Validating Team Objective Structured Assessment of Technical Skills (Tosats) for Obstetrics Emergency Skills: Eclampsia Management *Nida Najmi, Shazia Babar - Aga Khan University

Background: There is a paucity of validated tools available in the literature which through which technical and non technical skills of a team performance in an emergency obstetrics drills can be assessed.

Objectives: To develop Team-OSATS (TOSATS) tool for Emergency Obstetric Skills of eclampsia management and investigate the validity and reliability of the tool.

Methodology: The tool was developed by reviewing the available literature for item identification. A seven point Likert scale was used to measure the ease or difficulty of performance of each task. The tool was reviewed by team of experts to investigate the content and face validity. Reliability of the tool was assessed by using it on 6 teams of physicians and nurses who performed emergency obstetric drill of eclampsia in simulated environment. Three assessors observed and recorded these performances on the TOSATS tool.

Result: TOSATS tool was found to be a reliable and valid tool for measuring eclampsia drill. The Cronbach’s alpha of .804 was caluculated suggesting good reliability. Assessor 1 had significantly different assessment of the teams as compared to assessors 2 & 3 (p-0.028) while there was no difference in the assessment of assessors 2 & 3.

Conclusion: TOSATS is a reliable and valid tool to measure teams performances in eclampsia drills.

Aga Khan University, Department for Educational Development 4th Educational Research Day Theme: Educational Assessment

66. Process-Oriented Quality’ Method for Assuring the Reliability of Large-Scale Assessment Scores at the National Level *Amjad Ali Shah, Anila Ashique Ali - Examination Board, Aga Khan University

Introduction: Since 19th century, the standardized written examination has become an essential component in schools, colleges and universities for assessing the students’ performance (Congress, 1992). Educational assessment has various modes depending on the purpose. The most prevalent modes are large- scale testing (summative) and classroom assessment (formative). Large-scale testing is a commonly used method for assessing students at state/national level (Abu-Alhija, 2007). However, the administration of large-scale assessment has remained a significant challenge over the years to ensure the exam scores' reliability. Poor management during exams could increase the chances of malpractice. Malpractice has many forms such as copying, impersonation, mass cheating, leakage of exam papers and other irregularities. Factors contributing to increase the exam malpractice include poor implementation of exam rules, inadequate preparation, poor invigilation etc (Kobiowu, 2005). It usually happens due to lack of proper documentation of key processes in the form of Standard Operating Procedures (SOPs) and continuous supervision. Methods: Examination malpractice issues can be eliminated/reduced by using the effective management strategies during the conduct of large-scale assessment, as did by AKU-EB in the recent years. This paper highlights the outcomes of piloted micro-management model, named ‘Process-Oriented Quality’ (POQ), pursued by AKU-EB to ensure the quality of large-scale assessment through systemic monitoring of operational activities. Results The outcomes of inculcating POQ model has proven to be successful in reducing the malpractice and operational issues during exams, as the number of observations reported from the exam centres have been decreased over the period. In the first fifteen days, there were 287 observations which went down to a total of 144 observations till the end of the examination (15 days) which shows a 50% reduction. Furthermore, no malpractice case was reported due to strict compliance with the developed SOPs. Conclusion: The ultimate objective of using the POQ method is to institutionalize the Exam Board by embedding international best practices which would help to get the international accreditation. Moreover, this paper recommends other exam regulatory bodies, in Pakistan, to pursue POQ model in their respective institutions for increasing the exam scores reliability by reducing malpractice and operational issues.