Objective: To explore student’s perceptions regarding impact of kinesics (facial expressions, gestures, head movements and postures) on undergraduate medical education. Methods: A qualitative exploratory online survey was conducted from July-Sept 2020 among purposively chosen final year BDS students (n=150) of three dental colleges of Islamabad during COVID-19 lockdown phase. Semi-structured survey questions were validated and piloted before execution. Thematic analysis was performed, and consensus was built among all authors regarding findings, hence ensuring analytical triangulation. Results: Response rate was 46% (69/150). Twenty sub-themes emerged under three domains of kinesics. Participants told that ‘neutral expressions’ frequently used by teachers create ‘boring learning environment’ and ‘hesitation among students to ask questions.’ A smile of teacher imparts ‘new degree of interest in the subject’ and gives ‘freedom of expression’ to the students. On contrary, anger ‘demotivate’ students, instills ‘fear among them’, make them anxious therefore, they are ‘unable to understand lectures’ which ultimately leads to ‘loss interest in the subject’. Use of gestures by teachers creates ‘enjoyable teaching-learning process’ but movements such as clearing throat or shaky legs produce ‘constant split-second interruption’. Moreover, standing posture of teachers bring ‘interest and alertness among students’. Conclusion: Nonverbal communication can have positive or negative impact on undergraduate medical education. Therefore, teachers may start lecture with a smile and anger should be avoided to produce friendly and healthy learning environment. Faculty training is required for the effective use of nonverbal communication strategies to create an optimal learning environment for the students. doi: https://doi.org/10.12669/pjms.37.7.4180 How to cite this:Aziz A, Farhan F, Hassan F, Qaiser A. Words are just Noise, let your Actions Speak: Impact of Nonverbal Communication on Undergraduate Medical Education. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4180 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: To explore barriers and facilitators to write good quality items for undergraduate dental assessments. Methods: A qualitative case study was conducted from Feb–April 2021. Semi-structured interviews were conducted with a purposive sample of eighteen item writers from a public-sector dental institute of Rawalpindi, Pakistan. The data were transcribed verbatim and thematically analyzed to extract themes regarding barriers and facilitators to write good quality items. All quality assurance procedures of qualitative research were ensured during the research process. Results: Five themes related to barriers and three themes related to facilitators to write good quality items emerged from the data. The participants reported more barriers such as lack of frequent training and lack of peer review and feedback. Other barriers were demotivation due to lack of acknowledgement or monetary incentives, lack of content and construct expertise, clinical workload, and contextual barriers such as lack of internet facility, outdated library, and lack of place and time allocation for item construction. Facilitators were availability of peer review, feedback from post-hoc analysis, motivation due to the senior designation, clinical experience, and ample time for basic sciences faculty. Conclusion: Frequent item writing training, strong peer review process, pre-exam item vetting by the dental education department, and institutional improvements such as striving for content experts, time and place allocation for item construction, internet facility, updated library, and equal distribution of workload among faculty could enhance the quality of items. Moreover, ways to inculcate motivation among item writers such as appreciation or monetary incentives could be used to improve the quality of undergraduate assessments.

Young researchers and novice authors face lot of difficulties to document their research work and get it published due to lack of guidance and proper training in the art of scientific writing. This manuscript provides some important information and highlights some useful tips for novice authors which if followed in letter and spirit will minimize the trauma to their manuscripts with increased chances of publication in standard peer reviewed biomedical journals even those with Impact Factor. Other authors will also find it helpful to know the details related to the whole publishing process. doi: https://doi.org/10.12669/pjms.36.6.3135 How to cite this:Aziz A. How to get published in a standard peer-reviewed medical journal: Some useful tips for novice authors. Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.3135 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT: BACKGROUND & OBJECTIVE: Internet has swayed all aspects of human society and the exponential rise in global internet users indicates that internet & Social Networking sites (SNS) have become an essential part of the daily lives of people with potentially addictive effects of its overuse. This may lead to social isolation, depression & professional effects. This behavioral addictive pattern has also been observed in increasing trend among healthcare professionals worldwide. This study aims to assess prevalence of internet addiction and its behavioral patterns (BP) in Pakistani healthcare context, to determine the prevalence and intensity of Internet Addiction (IA) among Medical Doctors. METHODOLOGY: A Quantitative; Cross-sectional Survey was conducted at Shaikh Khalifa Bin Zayed/ Azad Kashmir Combined Military Hospital Rawalakot for 2 months.After calculating sample size with 95% Confidence Interval limit,100 medical and dental doctors were selected using convenience sampling. After IRB approval & informed consent data was collected using prevalidated “Young's Internet Addiction Scale”& “Behavioral Patterns scale”. The participants recorded their response on a 5-point Likert scale and dichotomous scale for each scale respectively. Data was summarized using descriptive statistics & inferential statistics in SPSS 23. Addiction was classified into 4 categories. The significant association between IA groups and BP groups was computed by Fisher's exact test with P-value <0.05 as significant.  RESULTS: The Response rate was 87% with 54% males and 56% females. The prevalence of internet addiction was 79%(n=69). Out of them 36% (n=31) had mild, 41% (n=36) had moderate addiction while 2% (n=2) had severe addiction. Pattern of internet addiction symptomatology shows that prevalence of IA is higher in excessive use (87.35%) & lack of control (77.01%) while least in anticipation (35.63%) category. Statistically significant difference was seen in behavioral patterns among addicted and nonaddicted medical and dental doctors. CONCLUSION: Internet Addiction is a recognizable disorder from the spectrum of Problematic Internet Use. This study reports the prevalence of internet addiction among health care professionals and burden of multiple behavioral patterns in association with IA, which is an emerging mental health concern.

Objective: To explore problems faced by struggling undergraduate medical students and their impact on student’s academics. Methods: A qualitative case study was carried out from March to August 2019. Semi-structured interviews were conducted with a purposive sample of sixteen struggling students. The interview questions were validated and then piloted to ensure clarity. All interviews were audio recorded and transcribed verbatim. Due to sensitive nature of the data, confidentiality and anonymity was ensured. Thematic analysis was employed to get meaning with in the data set. All authors ensured analytical triangulation by independently analyzing the data before developing consensus on the codes and themes. Results: Eleven sub-themes under four major themes emerged from the transcripts. Participants were found to be struggling with emotional, academics and family related problems. Psychological distress was caused by factors such as fight with friends, one-sided love, and hard financial times. Time management, lack of attention and commitments at home were few of the other problems. Problems had an impact on students as they were demotivated, lost focus in their studies, could not perform good and few participants even failed in examinations. Conclusions: Students were struggling more with emotional and family related problems and less with academics related problems. They were impacting student’s academics. The study site had a robust mentoring program however, struggling students need timely identification and more dedicated time to help them manage their problems. Stress relieving activities and counselling sessions may frequently be added, and academically underachieved students should also be given extra care, support, and guidance. doi: https://doi.org/10.12669/pjms.36.5.2267 How to cite this:Aziz A, Mahboob U, Sethi A. What problems make students struggle during their undergraduate medical education? A qualitative exploratory study. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.2267 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction: Reflective writing, a complex human activity is one of the innovative pedagogies to promote deep learning among medical students and doctors. Despite its potential to facilitate learning, there is limited literature on evaluation of various purposes of reflective writing in medical education. Hence, aim of this study is to develop an instrument and evaluate the perceptions of house officers about benefits of reflective writing. Methods: Mixed method study followed AMEE 87 guidelines for questionnaire development. The study was carried out from Oct 2018-Feb 2019 in a dental college in Islamabad. A 30-items questionnaire was developed by following these steps: (1) conduction of literature review, (2) item development, (3) conduction of cognitive interviews and (4) pilot testing. Coding and interpretation of transcribed data and notes taken during cognitive interviews was done to finalize three main themes (learning, self-regulation and alteration in clinical behavior) identified in literature review. In pilot testing, participants were asked to rate the purposes of reflective writing on a three-point Likert scale (Agree, do not know and disagree). Data was analyzed using SPSS version 22. Results: All of nineteen house officers (n= 3 for cognitive interviews, n= 16 for pilot testing) had previous experience of writing reflections using Gibb's reflective cycle. Thirteen (81%) out of sixteen house officers agreed that reflective writing improves learning, helps in self-regulation and alters clinical behavior, two (13%) did not know about the three themes that were finalized in cognitive interviews and one (6%) did not agree. Discussion and Conclusion: Reflective writing improves learning, helps in self-regulation and alters clinical behavior in the selected house officers. This study may inspire medical education experts to include reflective writing as a part of formal undergraduate medical and dental curriculum to enhance student's learning experience.

Objective: To explore the factors leading to patient non-compliance toward pre-prosthetic mouth preparation. Study Design: Qualitative exploratory study. Place and Duration of Study: Prosthodontic Department of Islamabad Dental Hospital, Bara khau Islamabad Pakistan, from May to Jul 2020. Methodology: Semi-structured interviews were conducted from purposively selected fifteen partially dentate patients who were advised but had refused to get pre-prosthetic mouth preparation. Five content experts validated interview questions. After thematic analysis, the authors developed a consensus regarding themes and subthemes of factors that cause noncompliance of patients toward pre-prosthetic mouth preparation. Results: Eight themes emerged. Patients were afraid of extraction and scaling and were concerned about cross-infection control, and they were short of time due to busy schedules and lengthy procedures. Few diabetic patients could not go for extraction of their teeth immediately. Patients also refused due to financial constraints and lack of awareness regarding treatment protocols. Some believe myths that removing the teeth results in other diseases such as cancer. Few quoted previous bad dental experiences and were not willing for any pre-prosthetic procedure. In addition, patients were not satisfied with the treatment plan and the associated treatment cost. Conclusion: Fear or anxiety related to extraction or scaling, time and financial constraints, fear of delayed wound healing, and improper guidance regarding treatment protocols were central factors in refusing pre-prosthetic procedures. Patient counselling must be done regardless of patient refusal, and patient concerns should be addressed.

BACKGROUND & OBJECTIVE: The integrated curriculum adopted by the university effects the learning process of dental students. They prefer selective study of specific objectives rather than developing a deeper understanding of anatomy. Thus, students’ perceptions would be helpful in improving curriculum delivery, at university level, for beneficial future clinical roles. METHODOLOGY: A qualitative exploratory study in a dental college affiliated with regional medical university spread over three months.   Second year BDS class (50 students) was purposively chosen excluding first year students. Fifteen item questionnaire was developed and distributed via Google form  followed by inductive analysis. RESULTS:  Forty-eight students (96%) responded. Seven themes and eighteen subthemes emerged. Three themes expressed students’ preference for group study, small group discussion and visual learning style. Content of anatomy was suggested to be divided in two years by few. In theme “Anatomy assessment weightage” majority consented on same number of multiple-choice questions of anatomy as other subjects as all found it difficult to prepare it in one day with other subjects. Most of them considered such anatomy assessment weightage to have a positive impact on their future practitioner role. CONCLUSION: Dental students are satisfied with the content of anatomy in each block. Main concern raised is misalignment between anatomy assessment weightage and its delivered content. This drives students to do selective anatomy study in each block. This concern should be considered by university in redesigning future curriculum to equip students with necessary knowledge of anatomy required by dentists in their future roles.