Postgraduates should not exaggerate problems as with positive approach a solution is always found-Prof.Gharib Nawaz


Introductory session for TMOs at Hayatabad Medical Complex
Postgraduates should not exaggerate problems
as with positive approach a solution is always
found-Prof. Gharib Nawaz
Discipline is part of your training, learn good clinical habits and
observe safety measures, for yourself, patients and your colleagues
Select exclusive topic for synopsis which must find solution to a
problem and also advance knowledge - Masood Jawaid

From our correspondent

PESHAWAR: Hayatabad Medical Complex organized an introductory session for the Training Medical Officers who have been recently inducted to welcome them at the newly built Auditorium on its Campus on August 25th 2021. Speaking at the occasion Prof. Gharib Nawaz highlighted the salient features of the training programme and what are their duties and responsibilities during training which will prove extremely helpful for them as they now know their academic roadmap.

He discussed in detail the Research Curriculum and the clinical skills which they are required to learn during their training. They were advised to take effective support from the institution as well as from their supervisors. They should discuss their progress with their supervisors on regular basis. Discipline, he further stated, was part of their training hence they must ensure punctuality and be mindful of their responsibilities. They were advised to learn good clinical habits, observe safety measures not only for themselves but patients as well as for their professional colleagues. Be careful of sharp prick needles, adopt and follow infection control measures. The postgraduates must use the institutional Hierarchy like Postgraduate Dean and scientific training committee for help and assistance.

Hayatabad Medical Complex organized an introductory session to welcome the newly inducted TMOs on
August 26th 2021. Photograph taken during the session shows Prof. Gharib Nawaz along with Prof. A. H. Amar
presenting mementos to Prof. M. Arif, Chief Executive Officer PGMI Prof. Zahid Aman, Principal Dean, KGMC
and Prof. Shahzad Akbar Medical Director.

Continuing Prof. Gharib Nawaz said that change of supervisors and institution is not allowed. As far as rotation in different units is concerned, they will be allowed rotation outside the institution at other centers only in those specialties which do not exist at the Hayatabad Medical Complex. Rotation will start on first day of the month. They must know the CPSP rules according to which five workshops are mandatory for all postgraduates including Research Methodology and BLS. They have to maintain eLog Book and make entries daily as their supervisors are also too busy so that they can check it. Feedback to the students is confidential and it is important. It is not meant for victimization. His advice to the postgraduates was that never try to exaggerate the problems. With positive approach all problems can be solved. Whenever they find some problem they must go to the Dean and find a solution, he added.

Another speaker from the administration discussed the mandatory requirements for starting the training. Registration with the CPSP is a must within a month of joining a training programme. Specialty once chosen cannot be changed. The postgraduates were advised to obtain the CPSP Prospectus which gives a roadmap for their training. CPSP rules and regulations are constantly being revised hence the postgraduates must keep themselves abreast of all these changes. Change of supervisor and institution is not allowed. They must keep their immunization record including vaccination against Covid19 which is mandatory for all the trainees. They were also advised to get their RFID Card immediately.

Prof. A.H. Amir Prof. of Medicine and a noted Diabetologist, endocrinologist in his brief address welcomed the guest speakers and the participants to the meeting. He further stated that it was fascinating to note that this was the first scientific meeting in this newly build auditorium where the topic of Research was being discussed.

Prof. Gharib Nawaz, Prof. A.H. Amar, Dr. Masood Jawaid Dr. Tehmeedullah Prof. of Plastic Surgery and another
senior official from the administration speaking at the introductory 
session organized to welcome the new
TMOs at Hayatabad Medical Complex on August 26, 2021.

Synopsis Writing

This was followed by a presentation on Synopsis Writing by Dr. Masood Jawaid, Associate Editor of Pakistan Journal of Medical Sciences who is also Director Medical Affairs and Innovations at PharmEvo Pharmaceuticals. Synopsis, he pointed out is a brief overview or summary of research protocol which has to be submitted to the RTMC of CPSP within six months after joining a training programme. Selection of a topic is the first and the most important thing in planning the research study. It should be brief of about one thousand words. It is written in future tense as compared to scientific paper which is written in past tense as by that time you have completed the study and now you are reporting the results.

Traditionally the postgraduates used to write Dissertations for FCPS but for the last many years now there is another option provided by the CPSP. The postgraduates can write two original scientific papers instead of Dissertation but the synopsis of both the papers must be approved by the RTMC. Now doctors prefer writing papers as it is economical besides offers more credit as one will require scientific publications during the professional career for promotion purposes. The topic selected must be exclusive and get it checked from the CPSP or look at the details of topics already covered. Your institution and the CPSP will also let you know if this topic is not being covered by another postgraduate. Consult your supervisor for selection of a topic, consult the statistician to determine sample size. Seek help and assistance from the supervisor and statistician while writing.

The important sections of synopsis include Title, Introduction, Objective, Operative definitions and Hypothesis, Material and Methods followed by References. Design proper proforma and submit the synopsis with a covering note to RTMC in CPSP. The topic selected must find a solution to some problem and at the same time it must advance knowledge. He was of the view that good or poor research is defined by the question being asked. Make sure that the question is well understood and the problem is also well defined. He cautioned the postgraduates not to rush while selecting a topic. It is always preferable to stick to common diseases and common procedures. Ensure that the follow up of patients in the study is not too long. Some of the useful sources for selection of a topic which he mentioned included scientific journals, conferences, supervisors, Dissertation Index which is available at the institution as well as with the CPSP Regional Centers. One can search for topic on the internet, discuss and seek guidance from colleagues while one can have one’s own observations as well.

Continuing Dr. Masood Jawaid said that while selecting a topic, keep in mind the resources required, your limitations. The topic selected for the study must be feasible, measurable, time bound besides taking care of the ethical issues. If the patients in the study need expensive investigations or medications, make sure that you will have enough resources for that or they are available free at your institution. If not, will the patients selected be able to afford all that? There are always some grey areas in research, there are some controversies as well. You can also look at new techniques, new protocols and new investigations. There could be different opinions on treatment, management of the patient and their follow up. One can select two drugs comparing their safety and efficacy. He then gave different examples from surgery and diabetes mellitus to emphasize that on can look at different aspects of a disease. For example while managing a patient of diabetes, one can look at efficacy of different drug combinations, risk factors, the effect of diet, obesity and family history, long term and short term complications. While using Insulin one can study different doses and different types. One can also study managing conditions like Diabetes Ketoacidosis etc. Most of the postgraduates usually fail to select a topic within six months and it takes them much longer period but they must remember that they have to complete the study and get is published in case of scientific papers to enable them to sit in the examination. Hence, it is important that one opts for meticulous planning to complete the study in time.

Research Grants by
PharmEvo Research Forum

In the later part of his presentation he introduced PharmEvo Research Forum which is a unique academic initiative by PharmEvo Pharmaceuticals. Apart from providing opportunities for professional capacity building of healthcare professionals through workshops, training courses, it also provides much needed funding for undertaking research. Residents in training and faculty members can apply for research grants up to three hundred thousand rupees. Details about the eligibility criteria, areas for undertaking research, criteria for selection for approval of grants are given on PharmEvo Research Forum website i.e. www. Research proposals can be submitted till October 30th 2021 and approval of grants will be announced in November 2021. The research must be completed within a period of eighteen months, he added.

Ethics in Research

Earlier Mr. Shaukat Ali Jawaid Chief Editor of Pakistan Journal of Medical Sciences who was also founder Member of National Bioethics Committee formed by Government of Pakistani 2003, talked about Ethics in human experimentation and scandals in medical research. He pointed out that most good or bad things have always started from United States and the same was true in ethics. United States which poses itself as Champion of safety against nuclear warfare was the only country which has so far used Atomic Bomb in Hiroshima and Nagasaki in Japan. He also gave details about the development of different Codes of Ethics and the importance of Informed Consent of the research subjects. These days it is said that informed consent means that the research subject has been explained in detail and they have well understood what it means. In the past prisoners and soldiers were used in experiments as they were more vulnerable.

Some surgeons Mr. Shaukat Ali Jawaid sated exaggerate the chances of their success which means either they are not operating or were just telling lies. Every surgeon has complications which are of course reduced with the experience. If the patient included in the research study are defiant, success is seldom possible. He then referred to Syphilis experiments in the 80s which then resulted in new rules for experiments in humans. Yellow Fever experiments were done on soldiers in Cuba. Similarly Italian physicians did experiments in Brazil and the US physicians were seen saving them from public anger. In the past even self-experiments by physicians were also quite common. He then talked about the Hypothermia experiments by military doctors on frozen bodies. Eventually it was the Nuremberg Trials which gave birth to Nuremberg Code in 1947. Americans were doing research on Malaria in Prisons and White House allowed it because the next year they had planned to invade Japan and Malaria was a big problem there. He also referred to injecting of three prisoners with Plutonium in November 1945 for which they selected seventeen cancer patients. United States Government also allowed Human Radiation experiments which was followed by formation of different Think Tanks. The famous Karen Case- Right to Die gave birth to Ethics Committees. A survey conducted among physicians in 1979 showed that 90% of them favoured telling patients that they suffer from Cancer. It was no more seen as a death sentence.

Now there is lot of mistrust in medical institutions due to various reasons and Physicians assisted death and Death Machines remained under discussion for quite some time. Dr. Shipman from UK who assisted many terminally ill patients to end their life became known as Dr. Death which was debated in the society at a greater length and all these incidents, scandals highlighted the importance of following ethics in research.

Speaking about the situation in Pakistan, he said, Government of Pakistan notified the National Bioethics Committee in 2003 of which I was one of the founder members. The NBC has so far helped formation of Provincial Ethics Committees, trained the ethics committee members about their duties and responsibilities. It has formulated Guidelines on Physicians Interaction with Pharma Trade and Industry, Stem Cells Research. Healthcare Committee of NBC headed by Prof. Farhat Moazam of which I was also one of the members has finalized the curriculum for teaching the subject of medical ethics to medical and dental graduates. It has prepared a very comprehensive resource book, what subjects has to be taught and how they will be taught. It consists of power point presentations, reading material, case scenarios, MCQs for assessment. The committee has recommended sixty hours for teaching bioethics but left it to the institutions in which year and in which subject they have to be taught so that it is flexible and every institution can plan it as per their schedule.

For publication, all the three Impact Factor Journals in Pakistan which includes Pakistan Journal of Medical Sciences, Journal of Pakistan Medical Association and Journal of College of Physicians and Surgeons of Pakistan now require Ethics Committee/IRB approval which is a must. Synopsis approval by the RTMC of CPSP he said was not enough because in case of any intervention, approval of the ethics committee is essential. Similarly, if the EC approval has been granted by one institution but the data for the study has been collected from different institutions, the authors must obtain permission from all the institutions to us their data, he concluded.

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