CONTEXT The subject of economic migration among health care professionals has received intense attention. However, the aetiology of this migration has not been rigorously evaluated in Pakistan. Such knowledge can potentially influence health care and academic policies. Our current study proposes to quantify the relative contributions of various personal, professional and economic variables among final-year medical students in Karachi.METHODS A self-administered structured questionnaire using a 10-point scale was developed and piloted among Karachi medical students. Additional openended questions were included to allow us to capture information not otherwise covered in the questionnaire. SPSS software was used for data entry and analysis.RESULTS Over 95% of Aga Khan University (AKU) and over 65% of Baqai University (BU) final-year medical students intend to proceed abroad for their postgraduate training. The 2 most important factors behind this intent as pointed out by the students are poor salary structure (AKU mean score 8.94 ± 1.73, BU mean score 7.14 ± 2.6) and poor quality of training in the home country (AKU mean score 9.20 ± 1.20, BU mean score 8.68 ± 2.03). Other interesting factors captured through the open-ended questions were the poor work environment and lack of rigor in teaching of residents in domestic university hospitals. Over 50% of final-year medical students cited these issues as major reasons behind their decision to migrate.

BackgroundSmoking rates among women are currently low, but they are the fastest growing segment of cigarette smoking population in developing countries. We aimed to assess the knowledge and perceptions towards smoking and to identify the factors related with level of knowledge and perceptions among adult women in urban slums.MethodsThis was a cross sectional study conducted on 250 adult (≥18 years of age) women attending primary care clinics in three slums of Karachi, Pakistan. A pre-tested and structured, interviewer administered questionnaire was used for data collection. Factors associated with level of understanding about smoking were analyzed with chi-square test.ResultsMost of the women knew that smoking has adverse effects on women and children's health but the knowledge of specific health effects was limited. About one third of the women knew that active smoking can cause lung disease, but only a small percentage (7%) knew that it could lead to heart disease. None of the women were aware that smoking contributes to infertility and osteoporosis. A small proportion of women were aware that smoking can lead to low birth weight (7%), congenital anomalies (5%) and less than 1% of women knew that it contributes to pregnancy loss, still birth and preterm delivery. The understanding of passive smoking affecting children's lung was low (20%) and a similar proportion voiced concern about the bad influence of maternal smoking on children. Educated women had better knowledge of health effects of smoking. Education was associated with having better knowledge about effects on women health in general (p = 0.02) and specific effects like lung (p = 0.03) and reproductive health effects (p < 0.001). Education was also associated with knowledge regarding effects on fetus (p < 0.001) and children (p < 0.005). Although most of the women disliked being around smokers, more than one third thought that smoking decreases boredom (39%), tension (38%) and also helps to relax (40%). A large proportion (48%) of women had the misconception that smoking helps to reduce weight.ConclusionsThis study reveals that women are aware of the general ill effects of smoking but fail to identify smoking to be associated with female maladies particularly those who were illiterate and had lower levels of education. Understanding and attitudes needs to be improved by increasing health awareness and education of women in these urban communities with special emphasis on the effects of smoking on women's health.

Background. Family Medicine Residency Program at the Aga Khan University has applicants for the residency position in excess of the positions offered resulting in formulation of certain selection criteria. The objective of this study was to compare MMI versus semistructured interviews for assessing noncognitive domains in the selection of residents. The secondary objectives were to determine perceptions of the interviewers and candidates for the acceptability and feasibility of MMI as a selection tool. Methods. The candidates underwent semistructured interviews along with MMI and identical attributes were tested in both. The attributes tested were safe doctor, communication skills, professionalism, problem solving, team approach, ethical issues, reasons for selecting family medicine, and commitment to the program. Descriptive statistics were calculated and comparison between ratings for MMI and interview was performed by Wilcoxon sign rank test. Results. Total number of candidates was 14. On comparison between interview and MMI, the scores were not statistically different for all attributes except ethics (mean interview scores: 3.04, mean MMI scores: 2.5, and P value 0.046). Conclusion. The study showed no difference between MMI and semistructured interviews. However, it needs to be replicated in order to determine the predictive validity and feasibility of MMI over time.

Introduction. Mentoring is a recognized form of teaching learning strategy in postgraduate medical education. This paper describes the effectiveness of a formal mentorship program from the residents' perspective after a year of implementation.Methods. The Aga Khan University Family Medicine Residency Program is the first program in Pakistan to our knowledge to implement formal mentorship for all four years of residency. A mentorship program was developed, implemented, and evaluated a year later using a rating scale. The 10-point Likert scale consisted of questions on academics, clinical work, research, administrative issues, and personal/social issues. Results. The response rate was 95% ( = 20). Eighty percent ( = 16) were women. Satisfaction level in seeking help was the highest for academics (75%). Residents scored mentorship as low in helping to tackle their personal problems (20%). Barriers reported in rapport building with mentor were time constraints and gender difference. The most useful attributes of the mentor which helped rapport building were accessibility, active listening, support for emotional needs, and trustworthiness. Conclusion. Mentoring has a role in trainees' personal and professional growth especially when their needs are addressed. The effectiveness of the mentorship program in residency can improve if the residents are allowed to choose their own mentors.

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