Introduction: Excessive use of internet can lead to "Internet Addiction". A sharp rise in the number of internet users among adolescents in Bhutan have been observed lately which could have potential side-effects on their health. The aim of this study was to find the prevalence of internet addiction and psychological co-morbidities among the secondary school-going adolescents. Methods: This is a descriptive cross-sectional quan-qual sequential mixed method design with a quantitative component and qualitative component. The study was conducted between 1st May and 30st November 2017 conducted in twelve schools across Bhutan after taking ethical clearance was from Research Ethics Board of Health of Bhutan. Data were doubleentered in EpiData Entry, validated and imported into STATA version 12.0 for analysis. Point estimate at 95% CI was calculated along with frequency and proportion for binary data. Results: Among 721 adolescents from twelve selected schools, prevalence of internet addiction was 248 (34.440%) at , 95% Confidence Interval (31-38%). Out of A total of 586 (81%) preferred smartphone for internet use with 388 (54%) actually using it. Depression and anxietywere the associated psychological co-morbidities seen along with internet addiction. Internet addiction was high among those using internet at home, using smartphone for internet access, social networking and night time internet use were associated with internet addiction. Boredom, stress/anxiety and peer pressure were triggers of internet use. Internet addiction also affected academic performance, social interactions and sleep. Conclusions: Prevalence of internet addiction among adolescents in Bhutan is high comparing to previous standard data which requires immediate attention.

BackgroundSoon after Bhutan’s first medical university was established in 2012, Faculty Development Programmes (FDPs) were adopted for efficient delivery of postgraduate medical curriculum. Medical education was an additional responsibility for the clinicians who already had multi-dimensional roles in the healthcare system where there is acute shortage of healthcare professionals. We studied the impact of FDPs on postgraduate medical education in Bhutan.MethodsThis was a mixed-methods study with a quantitative (cohort study – quasi-experimental with 18 participants) and concurrent explanatory qualitative component (focused group discussion (FGD) with 11 teaching faculty members). The 18 participants were given a structured FDP designed by the University. The FGD assessed teacher self-efficacy and competency using standard tools before and after the FDP. Thematic analysis of the FGD explored the impact of FDPs in the delivery of postgraduate residency programmes.ResultsThere were significant increase in the teacher self-efficacy (31 vs 34, p = 0.009) and competency scores (56 vs 64, p = 0.011). There were significant improvements in self-efficacy in the domain of the teaching relevant subject contents and developing creative ways to cope with system constraints. In teaching-learning assessments, there was a significant appreciation of the effectiveness of lectures and tutorials and the use of essay questions. The FGD demonstrated the acceptance of FDPs and its importance in quality improvement of postgraduate medical education, professional development of teachers and improvement of their communication skills. The teachers have now migrated from the conventional methods of teaching to workplace-based teaching and assessment. The FDPs also resulted in review and revision of postgraduate medical curriculum soon after the first batch graduated in 2018. Lack of adequate support from relevant stakeholders and lack of a medical education centre in the University were seen as major challenges.ConclusionsThe FDPs have brought tangible professionalization of postgraduate medical education at an early stage of the medical university. There is a need for continued efforts to strengthen, sustain and consolidate the gains made thus far.

Introduction: Ectopic pregnancy is an emergency and a life-threatening condition which is an important cause of major maternal morbidity and mortality. This study was designed to determine incidence, common identified risk factors, clinical presentations, management, morbidity and mortality due to ectopic pregnancy at the national referral hospital in Thimphu, Bhutan. Methods: This was a retrospective study of all cases of ectopic pregnancies for a period of two years from 1st January 2018 to 31st December 2019. Socio-demographic characteristics, risk factors, clinical presentations, investigations and mode of treatments were extracted. Simple descriptive statistics such as frequencies, percentages, mean and range were utilised. Results: There were 9603 pregnant women admitted for delivery, out of which 122 were ectopic pregnancies. The incidence of ectopic pregnancy was 12.7/1000 pregnancies. Majority of them were in the age group of 21-30 years and 32.69% of the affected were nulliparous. While Pelvic inflammatory disease was seen in 41.35%, 20.19% were unmarried. Abdominal pain, amenorrhea, and vaginal bleeding were the most common symptoms. Among the ectopic pregnancies, 99.5% were diagnosed with ultrasound. A total of 94.23% had undergone surgical intervention, of which only 1% had laparoscopic surgery. No maternal mortality had occurred. Conclusions: Women with past history of pelvic inflammatory disease, previous miscarriage, unmarried, and nulliparous presenting with history of amenorrhea, abdominal pain, vaginal bleeding should be a high index of suspicion for ectopic pregnancy. Timely diagnosis and intervention in the form of surgical or medical management will reduced the morbidity and mortality due to ectopic pregnancy.

Background:The Postgraduate Medical Education globally has transited from traditional cognitive based to more competency-based learning. Bhutan’s only medical university, Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB) introduced Competency Based curriculum (CBC) through implementation of workplace-based assessment (WPBA) in June 2018. The proposed competency-based curriculum (CBC) was aimed at developing appropriate competencies in the learners through workplace-based assessment. A programmatic evaluation of the trainees and trainer’s perception on implementation of workplace-based assessment for three years at KGUMSB was conducted in July-Sept 2021. Methods: The evaluation was conducted in July-Sept, 2021. The mixed methods design was utilized such as survey, review of student portfolios and focus group discussion. A total of 62 participants (46 residents in clinical training and 16 faculty members) participated in this evaluation. Results: After three years of implementation of WPBA, it was perceived as a good system of assessing learners with a high level of acceptability among both the students and faculty members. The practice of providing immediate feedback was well appreciated by students. Conclusions: These findings support that WPBA is a good assessment system in postgraduate education. However, it was also evident that issues such as perceived time constraints, overburdened students and lack of faculty capacity were possible obstacles to proper implementation of WPBA.

Introduction: Preconception care provided before conception or between subsequent pregnancies aims to identify and modify risks to women`s health or pregnancy through prevention and management. For successful implementation and uptake of preconception care services, adequate level of knowledge and positive attitude of women is important. Therefore this study was undertaken to assess the knowledge, attitude and level of practice of preconception care by our women.Methods: This was a hospital based cross sectional study done from July 2021 to December 2021. All pregnant women visiting the Mother and Child Hospital for booking visit were considered for the study. Stringent inclusion and exclusion criteria were utilized during recruitment. Data was collected using an interviewer administered questionnaire.Results: A total of 340 pregnant women consented for the study. The mean age of the participants was 28.3 (SD±4.5) years, 57.6% of the pregnant women had higher education and 54.4% were employed. The overall mean knowledge score on assessment of preconception care was 6.96±2.4 and 217(63.8%) had good knowledge. Of the 340 women, 98.2% had positive attitude towards the preconception care with a median score of 27 (Min-Max: 10-30) but 78.2% had poor practice. A significant association was found between good practice of preconception care with their knowledge level (p=0.012) but not with positive attitude (p=0.346).Conclusions: The study found that despite having good knowledge with positive attitude, the practice of preconception care among the study participants was poor. Therefore, we recommend further detailed study on factors associated with poor practice of preconception care among pregnant women.