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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Awareness of Medicolegal Issues among Interns and Resident Doctors at a Tertiary Care Hospital in Kolar, Karnataka, India: A Cross-sectional Study
Correspondence Address :
Dr. P Srinivasa Reddy,
Professor and Head, Department of Forensic Medicine, Sri Devaraj Urs Academy of Higher Education and Research, Kolar-563103, Karnataka, India.
E-mail: drsrinivasareddyp@gmail.com
Introduction: Medicolegal issues are handled by every doctor in their day-to-day medical practice. However, if they are not well versed in the rules of managing such cases and the law behind them, they often land into criticism and distress in court while dealing with evidence in Medicolegal Cases (MLCs).
Aim: To assess the awareness of interns and resident doctors, who are working at RL Jalappa Hospital and Research Centre, regarding the management of MLCs in their day-to-day practices.
Materials and Methods: A cross-sectional questionnaire-based study was conducted to determine the awareness of medicolegal issues among 107 participants, including interns and resident doctors in the Department of Forensic Medicine and Toxicology at a tertiary care hospital, Sri Devaraj Urs Medical College, Tamaka Kolar, Karnataka, India, from January 2022 to October 2022. A prevalidated list of 21 questionnaires, obtained through a pilot study with Cronbach’s alpha=0.78, was used. Numerical data were summarised using mean and standard deviation, while categorical data were expressed using percentages.
Results: The mean age of the study participants was 28.6 years. Most of the participants were from Surgery and allied fields (61%), and the majority of the participants (51.4%) had one to two years of experience in the medical field. Among the findings, it was observed that 67.28% of participants had insufficient knowledge about the minimum age requirement for informed consent, 60% of residents had insufficient knowledge of maintaining meticulous medical records, 57% of the participants responded incorrectly regarding the desired way of handling brought dead cases in hospitals, and 63.8% of the participants had poor knowledge of the Karnataka Private Medical Establishment (KPME) act and organ transplantation act.
Conclusion: The study concluded that while interns and postgraduates showed some level of awareness regarding certain aspects of medicolegal issues, like need for consent, they still lack comprehensive knowledge on subjects like legal requirements of consent, medical records, the KPME act, and organ transplantation act. Therefore, it is necessary to modify the curriculum for students and provide orientation programs, continued medical education, and guest lectures to interns and residents to build fiduciary character in Indian medical graduates.
Karnataka private medical establishment act, Medicolegal cases, Medical records, Organ transplantation
India has evolved massively over the time with respect to healthcare infrastructure. Today, as the literacy rate in India exceeding 74% (1), patients are well-informed about diseases, treatments, available alternatives, and the legal guidelines associated with them. Medicolegal matters pertain to the legal challenges that medical professionals may encounter while treating patients. In the past five years, complaints of medical negligence and medicolegal issues have increased by 30 to 40% (2). Medical professionals are not only responsible for providing the best possible treatment to their patients but also for ensuring that their actions comply with the law. This dual obligation necessitates the inclusion of training in MLC (Medicolegal Cases) in medical education, typically taught in the second and third years of medical school (3).
According to the Crime Record Bureau of India, the crime rate stands at 445.9 per 100,000 population (4). Consequently, the Emergency Medicine department of hospitals receives numerous cases that not only require medical care but also medicolegal attention. Providing medicolegal care to patients involves being confident in conducting medicolegal examinations, writing reports, following standard operating procedures, and testifying as expert witnesses in court proceedings. By staying informed and prepared, medical professionals can provide the necessary care and support to patients involved in MLC (5).
During their internship and residency, doctors encounter real-life case scenarios in casualty departments where they may have overlooked the provision of medicolegal care during their undergraduate curriculum. It is crucial for doctors to possess a thorough understanding of the ethical aspects of MLC in order to handle them effectively (6).
Research in this area can help identify strengths and weaknesses in medical education and training, informing the development of more effective approaches to prepare future medical professionals for handling MLC. The purpose of the present research is to assess the level of awareness of medicolegal issues among interns and resident doctors who are responsible for handling such cases in the hospital. The findings of the present study will contribute to the development of refresher courses for all interns and resident doctors, reinforcing their understanding of these matters and emphasising their importance.
This cross-sectional study was conducted among participants, including interns and resident doctors in the Department of Forensic Medicine and Toxicology at a tertiary care hospital, Sri Devaraj Urs Medical College, Tamaka Kolar, Karnataka, India, from January 2022 to October 2022. The study received approval from the Institutional Ethics Committee before data collection (No. SDUMC/KLR/IEC/203/2021-22, Dated: 31/12/2021).
Inclusion criteria: The study included interns, postgraduates, and senior residents of any age and gender who were working at the selected hospital during the study period.
Exclusion criteria: The study excluded interns, postgraduates, and senior residents who were unwilling to participate, as well as postgraduates who were assigned to external postings during the study period.
Sample size calculation: A total of 107 participants were included in the study. The sample size was calculated using Epi 7™ info program, based on a 95% confidence interval and a 5% margin of error. Previous literature (Jambure M and Jambure A, 2017) was taken into account (7). The estimated sample size was 130 individuals, with the total number reduced after excluding eight non-responders and 15 postgraduates who were on external postings.
Study Procedure
Questionnaire: The authors developed a predesigned, self-administered questionnaire by referring to textbooks (8),(9), gazette documents [10,11], and government of India office memorandum (12). The questionnaire was formulated and carefully revised based on the minimal knowledge requirements for interns, postgraduates, and senior residents to handle MLC. A pilot study was conducted among five postgraduates and five interns to assess the validity and repeatability of the questionnaire, resulting in a Cronbach’s alpha of 0.78. Data was collected by administering the pre-tested questionnaire, which consisted of two parts. The first part recorded demographic information parameters like age, gender, duration of work experience, and designation. The second part consisted of 21 questions, covering different aspects of medicolegal issues faced in day-to-day practice. The questions were classified into five groups, including consent (04), MLC (09), maintenance of medicolegal records (03), human organ transplantation act (01), and KPME act (04) [Annexure-1].
Statistical Analysis
The data obtained was entered into MS Excel 2018 and analysed. Numerical data were summarised using the mean and standard deviation, while categorical data were expressed as percentages.
The study involved 107 interns and resident doctors working in a tertiary care hospital. (Table/Fig 1) presents the demographic characteristics of the participants. Out of the total respondents, 45 were males and 62 were females. In terms of departmental distribution, 61 participants (57%) belonged to the Department of Surgery and allied subjects, while 46 participants (42.99%) belonged to the Department of Medicine and allied subjects. The mean age of the participants was 28.6 years. There were 28.03% senior residents, 42.05% junior residents (postgraduate students), and 29.90% interns. The frequency distribution of years of experience in the medical field showed that 55 participants (51.4%) had one to two years of experience, while 52 participants (48.6%) had three to five years of experience (Table/Fig 2).
In the present study, 67.28% and 32.72% of participants had poor knowledge about the minimum age of a patient to give consent for physical examination and surgical procedures, respectively. 78.5% and 51.40% of participants were aware of the requirement of informed written consent prior to surgery and publishing patient pictures, respectively (Table/Fig 2). As shown in (Table/Fig 3), with respect to informing the police, 67.28% (in the case of poisoning), 43% (handling brought dead cases), and 46.73% (incidental information about a homosexual major individual), and 33.64% (handling an agitated mob at the hospital) of participants had proper awareness and knew the appropriate measures to be adopted.
In the assessment of knowledge about handling dead bodies at the hospital, it was observed that 57% of the participants responded incorrectly. This is concerning as proper handling of such cases is critical for ensuring the smooth functioning of hospitals and preventing legal issues. Likewise, the fact that 86% of participants responded incorrectly about the management of Human Immunodeficiency Virus (HIV)-infected patients suggests a lack of knowledge about infectious diseases and their management.
This is particularly worrying as HIV is a serious and potentially life-threatening condition, and there are many rights and guidelines laid down by the government for people living with HIV infection.
As shown in (Table/Fig 4), 46.73% of the participants had poor knowledge of the organ transplantation act with respect to the concept of ideal donors. In total, 62.85% of the responders had wrong information about the provisions and guidelines of KPME Amendment Act 2018, which is an act that all registered medical practitioners in Karnataka are expected to be familiar with. This table displays the level of awareness among participants about the maintenance of medicolegal records. The findings indicate that 41.12% of the participants had limited awareness about the proper storage of outpatient medical records, 62.61% lacked knowledge about the appropriate storage of inpatient medical records, and 67.28% of the participants were unaware of the proper retention policy regarding MLC records (Table/Fig 5).
The competency and effectiveness of the healthcare system rely highly on the proficiency and disposition of medical practitioners who possess the necessary knowledge, skills, and attitudes toward patient rights (13). The present study aimed to assess the knowledge of interns and postgraduates towards medicolegal issues and revealed that while a significant portion of participants were well-informed about the necessity of obtaining written informed consent before conducting any medical procedure, 67.28% of participants had insufficient knowledge about the minimum age requirement for physical examination. In a similar study by Yashwanth R and Channabasappa SR in Chennai, it was observed that 56% of participants had insufficient knowledge about this (14). This finding highlights the need for continued education and training to improve the knowledge of medical practitioners in this aspect.
The findings of the present study are consistent with previous research by Jasuma J et al., conducted in a medical college in Vadodara, India, which revealed limited awareness of medicolegal issues among residents, particularly regarding medical ethics and informed consent (15). This study also showed that more than 60% of residents had insufficient knowledge of maintaining meticulous medical records, including medical history, chart notes, radiographs, and photographs. These results are similar to those of a previous study conducted by Thomas TE and Magendran J, which highlighted a significant level of unfamiliarity with medicolegal issues among medical students (16).
In another study by Radhika T et al., conducted among dentists in a tertiary care hospital in Chennai, Tamil Nadu, it was found that 56.5% of participants had correct knowledge about consent in medical practice, and 59.3% had sufficient knowledge about maintaining medical records (17). Compared to the present study, a total of 57.33% of participants had correct knowledge about consent in medical practice, and 32.24% had sufficient knowledge regarding maintaining medical records. As the participants of the study in Chennai included practicing professionals as well, they slightly had better knowledge in these areas (17). The study also recommended the inclusion of medicolegal education in the undergraduate medical curriculum to improve the knowledge, attitude, and practice of medical interns.
Similarly, a study conducted by Jambure M and Jambure A at a Medical College in Maharashtra revealed that medical residents had limited knowledge about consent (62% correct response), preservation of medical records (46% correct response), management of poisoning cases (24% correct response), and the organ transplantation act (12% correct response) (7). The study recommended the inclusion of legal education in the medical curriculum to enhance awareness of medicolegal issues among medical residents. The participants in the present study had slightly better knowledge about these aspects as there were a few senior residents in the present study population.
In a study by Hariharan S et al., at Queen Elizabeth Hospital in Barbados (a tertiary care teaching hospital), it was observed that 98% of participants had awareness about confidentiality with patient information, and 92.3% had sufficient knowledge about informed consent (18). The study attributed the high level of awareness to the presence of medicolegal education in the medical curriculum. The present study found limited knowledge among participants regarding maintaining meticulous medical records and the KPME Amendment Act. It emphasises the importance of maintaining accurate medical records as physicians’ written records carry more weight than patients’ recollections.
Taken together, these studies suggest that the level of awareness of medicolegal issues among medical interns and postgraduate residents varies depending on the presence or absence of medicolegal education in their medical curriculum (7),(17),(18). To enhance their knowledge, attitude, and practice regarding medicolegal issues, it is necessary to include medicolegal education in the medical curriculum and develop interventions to address the gaps in their understanding of legal and ethical issues related to medical practice.
Limitation(s)
The study was conducted in a single medical college, which may not be representative of the entire population of young doctors in India. Therefore, the findings of the present study may not be generalisable to other settings. Secondly, the study relied on self-reported data, which may be subject to recall bias or social desirability bias. Also, the sample size of the study was relatively small, which may limit the statistical power and precision of the findings and the study did not assess the impact of demographic factors such as age, gender, and educational level on the knowledge, attitude, and practices (KAP) of medicolegal issues. Finally, the study did not investigate the reasons for the lack of knowledge and awareness among interns and postgraduates, which could be explored in future studies.
In conclusion, the present KAP study indicates that while interns and postgraduates showed some level of awareness of certain aspects of medicolegal issues, they still lack comprehensive knowledge on the subject. Although they understood the importance of obtaining informed consent, they demonstrated limited knowledge of medicolegal issues, medical records, organ transplantation, and the KPME act. Therefore, it is necessary to provide continuing medical education, guest lectures, and orientation programs for young doctors to improve their knowledge and awareness of these crucial aspects. Additionally, it is suggested that the curriculum for students be modified to include more detailed information on medicolegal aspects. Such efforts can lead to a better understanding of the medicolegal process and the associated ramifications, thereby enabling young doctors to provide better quality healthcare services to their patients.
DOI: 10.7860/JCDR/2023/62807.18336
Date of Submission: Jan 11, 2023
Date of Peer Review: Apr 11, 2023
Date of Acceptance: May 23, 2023
Date of Publishing: Aug 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 19, 2023
• Manual Googling: Apr 27, 2023
• iThenticate Software: May 18, 2023 (7%)
ETYMOLOGY: Author Origin
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