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Home > The Causes and Effects of Attrition from Post-Graduate Residency Programs at the Aga Khan University Hospital, Nairobi.

The Causes and Effects of Attrition from Post-Graduate Residency Programs at the Aga Khan University Hospital, Nairobi.

Thesis Info

Author

Wamalwa, Dennis

Department

General Surgery (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2018

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728068537

Similar


Background: Resident attrition is a global problem affecting most postgraduate residency training programs. It not only disrupts the educational and workload balance in the program but also results in loss of valuable time invested by the resident who has to leave before completion. AKUHN has similarly been affected with a worrying increase in resident attrition numbers over the last few years. There is however a lack of local studies on resident attrition which would inform measures to address modifiable risk factors for resident attrition and thus prevent future attrition. Objectives: To explore factors attributable to attrition amongst residents in Aga Khan University Hospital since inception and explore the effects it has had on the various programs over the years. We also seek to establish the reasons behind the recent upsurge in attrition numbers and the current fate of the residents who left. Methods: In-depth interviews, both face to face and telephone were carried out with the residents who left before completion of training and all current program directors. Different interview guides were used for each group. Data was collected using tape recording and later transcribed. Note-taking was also utilized during the interviews. Data collected was analyzed using the thematic framework fronted by Ritchie and Spencer for qualitative research. Results: Sixteen ex-residents and all eight current program directors were interviewed. The reasons mentioned for attrition in decreasing frequency included excessive workload, health problems, specialty/career change, financial strain, academic nonperformance, fellow resident harassment and foreign student challenges. Increased workload over the years and introduction of tuition fees were implicated as possible causes for the increased attrition rate. Others included generational differences, waning faculty support and recent institutional and administrative changes. The main effect of resident attrition was an increased workload to the remaining residents and finally most ex-residents seemed to have gone on to do well in new vocations including joining other residency programs and completing the training. Conclusion: Residents fail to complete training due to a varied number of reasons. The most commonly cited reason is excessive workload interfering with academic engagements. Establishing a balance between the workload assigned to residents and their academic engagements is paramount to ensure residents do not suffer burnout which would ensure more resident retention.
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ڈاکٹر ذاکر حسین

ڈاکٹر ذاکر حسین
افسوس ہے ڈاکٹر ذاکر حسین بھی ہم سے جدا ہوگئے۔وہ ہماری قومی تعلیم کے معمارِ اوّلین، اس ملک میں سیکولرزم کی آبرو اورجمہوریت کاوقار تھے۔ان کی وفات سے ہماری قومی زندگی میں جوخلا پیدا ہواہے اس کی تلافی عرصے تک نہ ہو سکے گی۔کم وبیش بہتّر(۷۲) سال کی عمر پائی۔ ۳؍مئی کی صبح کواچھے خاصے تندرست اُٹھے۔حسبِ معمول فجر کی نماز اداکی، اس سے فارغ ہوکر کچھ مطالعہ کیا، اخبارات پڑھے، پھر ہلکا پھلکا ناشتہ کیا۔یہ سب کرتے کراتے گیارہ بجے کاعمل ہوچکا تھا اوروہ روزانہ معمول کے مطابق طبّی امتحان کے لیے تیار ہورہے تھے کہ اچانک دل کا دورہ پڑا ۔ایک سے ایک قابل ڈاکٹر موجود تھے ہی فوراً اپنی جیسی ساری تدبیریں کرڈالیں لیکن وقتِ مدعو آپہنچا تھا۔اس کے سامنے کچھ پیش نہ چلی اور روح قفسِ عنصری سے پرواز کرگئی۔انا ﷲ واناالیہ راجعون۔
مرحوم کی قومی زندگی کے دو دَورہیں،ایک جامعہ کے ساتھ وابستگی سے لے کرتقسیم تک، اور دوسرا اس کے بعد سے وفات تک۔پہلے دورمیں جوایک ربع صدی پر پھیلا ہواہے مرحوم کاکردار ایک ہیرو،نہایت حوصلہ مند جرنیل اورعظیم الشان رہنما کاکردار رہاہے۔انھوں نے جرمنی سے معاشیات میں ڈاکٹریٹ کی ڈگری لی تھی۔اس کے علاوہ تعلیم بھی ان کاخاص مضمون رہاتھا۔انگریزی اوراُردو دونوں زبانوں میں تقریر وتحریر کاملکہ اورسلیقہ خداداد تھا۔ غرض کہ علمی اور فنی حیثیت سے ان کے پاس وہ سب کچھ تھا جس کے باعث وہ شہرت ، عشرت اورراحت کی زندگی بڑی آسانی سے بسر کرسکتے تھے، لیکن انھوں نے محنت ومشقت اورعسرت کی زندگی اختیار کی۔ابھی جرمنی میں تھے کہ انھیں معلوم ہواکہ مولانا محمدعلی مرحوم وغیرہ نے جوجامعہ ۱۹۲۰ء میں قائم کی تھی۔وہ مالی پریشانیوں کی صیدزبوں ہے اور اس کو بند کردینے کے منصوبے ہورہے ہیں۔ڈاکٹر صاحب اپنی تعلیم ختم کرچکے تھے، انھیں اس کا علم ہوا توفوراً کہلا بھیجا...

Return Migration to Pakistan during COVID19 Pandemic: Unmaking the Challenges

In order to contain the spread of corona virus (COVID-19) disease, strict border closure measures have been taken globally. Migrants and refugees are affected across the globe due to such measures. Amid the COVID-19 pandemic, the economic recession escalated across the globe which is expected to have serious implications for the migrant workers and laborers. Potohar region was selected to explore implications of return migration from abroad, but the fieldwork halted immediately due to the pandemic outbreak. Since the data on Pakistani migrants is dispersed and scant, it was nearly impossible to stick to the locale for returnees. Therefore, the data for this study was collected qualitatively using exploratory methodology. In-depth interviews were conducted using interview guide as a tool of research. The paper is based on analysis of the narratives based on the experiences of the returnees especially. It sheds light on the state of the stranded Pakistani migrants who have been returning or awaiting repatriation due to layoffs. It delves into long-run and short-run challenges due to return migration, in Pakistan which highly depends on remittances from abroad. Challenges created by sudden end to remittances, entrepreneurial setups and returnees’ reintegration in the society need immediate attention. It is recommended that the state should support and monitor the migrants living abroad, ease out issues in repatriation of the laid off workers, pave way for investment, offer insurance plans, reduce reliance on remittance flow and engage them in Public Private Partnerships for sustainable reintegration.

Chemical Composition and Biological Activities of Essential Oils from Selected Medicinal Plants of Soon Valley

Plants are recognized as the richest source of biologically active components called as plant secondary metabolites such as steroids, phytolipids, alkaloids, phenolics and antimicrobial agents. Many plant species are popular due to containing complex mixtures of volatile compounds, mainly composed of terpenoids, with specific essence and odour. The complex mixture of these components obtained from plants is regarded as essential oils. Recently, the essential oils are gaining valuable importance as a good source of antioxidants in nature and harmless bioactives with promising biological and pharmacological applications. During the recent few years, a lot of research is happening to appraise the composition and biological potential of plant EOs (essential oils). The present research work was mainly planned to appraise the variations in physicochemical parameters, composition as well as biological attributes of EOs isolated from four selected medicinal plants such as Euclayptus (Eucalyptus camaldulensis), Basil (Ocimum basilicum), Coriander (Coriandrum sativum) and Mentha (Mentha piperita) using two different techniques including hydro-distillation (HD) and super critical fluid extraction (SCFE). The selected plants were harvested from Soon Valley of Punjab, Pakistan which has specific agroclimatic conditions compared with the adjacent areas. The yields of essential oils from the areal parts of the selected medicinal plants by SCFE and HD revealed significant (P <0.05) variations between the extraction techniques. Overall, the yields of hydro-distilled plants essential oils were higher than the SCF extracted essential oils; hydro-distilled Eucalyptus essential oil gave the highest yield among others. Nevertheless, among the selected plants, the least essential oil yield was obtained from Eucalyptus using SCFE. The results regarding physicochemical parameters showed that the tested SCF extracted essential oils were somewhat denser and had higher refractive index than the essential oils obtained by HD. According to GC/GC-MS compositional analysis, the major chemical component identified in Eucalyptus essential oil, isolated using both the SCFE and HD techniques, was found to be eucalyptol; other important components detected were α-pinene, spathulenol, globulol etc. Linalool was the principal chemical component in Basil EO isolated by either of the techniques while estragole, piperitone oxide, and α- xix bergamotene were some of the other key chemical compounds detected in this oil. Mentha essential oil, produced by either of the techniques, was mainly composed of menthol and menthone. Meanwhile, SCF extracted and hydro-distilled Coriander essential oil contained linalool as a major component followed by α-pinene, phytol, camphor etc. Statistically notable variations were observed in quantitative chemical composition in the selected plant essential oils in relation to SCFE & HD that can be linked to the operational conditions and efficacy of the technique employed. The biological activities of the tested essential oils were evaluated by studying their antioxidant (TPC, TFC, DPPH free radical scavenging capacity and reducing power), antimicrobial (using bacteria and fungus), biofilm inhibition and hemolytic activities. The results showed that the maximum TPC, TFC and DPPH radical scavenging capacity were exhibited by SCF extracted essential oil of Coriander while the essential oil of Eucalyptus obtained by SCFE had superior reducing power among others. Overall, the plants essential oils isolated by SCFE had superior antioxidant capacity as compared to the essential oils obtained by HD. While from the data of antimicrobial activity it was noted that among the selected plants essential oils, isolated by either technique, Coriander essential oil acted as a better antibacterial and antifungal agent against the tested microorganisms. The essential oil of Eucalyptus obtained by SCFE exhibited superior biofilm inhibition potential while the hydro-distilled EO from Coriander gave the minimum hemolytic activity. Based upon the findings of this research project this can be inferred that the biological attributes and composition of the selected plant EOs not only varied within the plant species but also in relation to the two isolation techniques employed (P<0.05). Overall, the SCF extracted essential oils were found to be superior to the hydro-distilled essential oils in terms of antioxidant and biological attributes studied. It can be accepted that the essential oils from the selected medicinal plants of Soon Valley are good source of biologically active components and possessed appreciable antioxidant and other biological activities thus supporting their potential utilization as components for the functional food, pharmaceutical and nutraceutical applications. In this direction, further studies can be conducted in future towards evaluation of broader spectrum antioxidants using in-vivo trials.