Ethical and Moral Issues in Undergraduate Medical Education: An Exploratory Study

Background: Ethical and moral values form the basis of the environment in any academic institution. Objectives: This study aimed to explore the ethical and moral issues faced by medical students during their undergraduate medical education in Pakistan. Methods: This qualitative exploratory study was conducted at ABWA Medical College, Faisalabad. It included thirteen semi-structured, one-to-one interviews of volunteering undergraduate medical students of Punjab, Pakistan, from September 2021 to February 2022. The interview invitation was sent electronically to social media groups. Member checking of transcribed interviews was done, and data were analyzed thematically using Atlas-ti software by two independent researchers. Results: Thematic data analysis led to the formation of 28 codes, 13 subthemes, and 3 main themes. Based on the social constructive approach, three main themes were categorized into ethical issues in (1) academic, (2) social, and (3) clinical contexts. Conclusions: The results showed that undergraduate medical students face a myriad of ethical and moral disruptions during their undergraduate study period at medical college. Much awareness about identifying and dealing with such issues is recommended to bring more quality to the program.

Diagnostic Utility of Who Defined Sepsis Syndromic Criteria With Procalcitonin in Identification of Sepsis in Children With Suspected Infections

Title: Diagnostic Utility of WHO Defined Sepsis syndromic Criteria with Procalcitonin in Identification of Sepsis in Children with Suspected Infections Background: Bacterial infections are a major cause of morbidity and mortality in children but accurate and timely diagnosis remains a challenge to the frontline clinicians. Cultures of sterile bodily specimens are considered the gold standard but are insensitive and results are delayed. Procalcitonin (PCT) has recently emerged as a biomarker with high sensitivity and specificity making it superior to culture based techniques performed in non-ideal circumstances which prevail in resource poor settings. This study investigated the diagnostic utility World Health Organization (WHO) defined criteria for sepsis in diagnosis of bacterial sepsis using procalcitonin (PCT) as the “gold standard”. Methods: This was a prospective survey conducted between July to October 2014 whose primary objective was to determine the sensitivity, specificity, and predictive values of WHO definitions of sepsis syndromes using procalcitonin as the ‘gold standard’ in children with suspected infections. Our secondary objective was to investigate association between PCT elevation and severity of disease and other markers of sepsis. The study was conducted at the paediatrics casualty of the Aga Khan University Hospital, Nairobi (AKUHN) and enrolled children aged >30 days and ≤15 years with suspected infection. This was defined as presence of systemic inflammatory response syndrome (SIRS) (abnormal temperature (>38.5°C or12hours. Children with obvious causes of SIRS such as mechanical/surgical trauma, severe burns, cancer, and without parental/guardian consent were excluded. A standard clinical proforma that allowed classification into various WHO clinical sepsis syndromes for enrolled patients was fulfilled by attending clinician. Blood sample of 0.5ml was collected and PCT test done. Sensitivity (Sp), specificity (Sn), negative and positive predictive values (NPV, PPV), and positive and negative likelihood ratios (LR+, LR-) were calculated for the WHO syndromic definitions. The gold standard for bacterial sepsis was defined as PCT level ≥0.5μg/l. Logistic regression was done and odds ratios calculated to test for association between procalcitonin and disease severity/clinical signs. Kaplan Meier survival analysis was done to compare duration of hospitalisation in various sub-groups. Results: A total of 231 children were enrolled and 22% (51 children) fulfilled criteria for WHO sepsis syndrome. WHO sepsis syndromes definitions had low Sn, 56.9% (95% CI; 50.5%, 63.3%) and Sp, 66.7% (95% CI; 60.6%, 72.8%) for diagnosis of sepsis. PPV was 32.6% (95% CI; 26.5%, 38.6%) and NPV was 84.5% (95% CI; 79.8% 89.2%). Presence of WHO