Burn injuries are a leading cause of morbidity and disability worldwide, with significant socioeconomic implications. The World Health Organization (WHO) estimates that over 180,000 deaths occur annually due to burns, with the majority in low- and middle-income countries [1,2]. Effective management requires interdisciplinary collaboration across various medical specialties, including General Surgery, Anesthesiology, Emergency Medicine, General Medicine, and Pediatrics. 

Postgraduate trainees are often the first responders in hospital settings, making their competency in burn management critical. Studies have highlighted knowledge gaps among healthcare professionals, particularly in fluid resuscitation, infection control, and surgical intervention strategies [3-5]. This study assesses postgraduate trainees' knowledge, attitudes, and practices concerning burn treatment, identifying areas for improvement in training programs.

A cross-sectional observational study was conducted among postgraduate medical trainees from five specialties—General Surgery, Anesthesiology, Emergency Medicine, General Medicine, and Pediatrics.

Sample Size and Selection

A total of 150 postgraduate students were included in the study, selected through stratified random sampling from tertiary care hospitals. The distribution was as follows:

• General Surgery (n=30)
• Anesthesiology (n=30)
• Emergency Medicine (n=30)
• General Medicine (n=30)
• Pediatrics (n=30)

Data Collection Tool

A structured, validated questionnaire assessed:

1. Knowledge – covering pathophysiology, assessment, and management.
2. Attitude – perception towards burn treatment and willingness to engage in specialized training.
3. Practice – adherence to evidence-based guidelines in clinical settings.

Data Analysis

Responses were analyzed using SPSS version 26. Descriptive statistics, chi-square tests, and ANOVA were applied to assess differences among specialties. Statistical significance was set at p < 0.05.

A total of 150 postgraduate medical trainees from General Surgery, Anesthesiology, Emergency Medicine, General Medicine, and Pediatrics participated in this study. The mean age of participants was 29.2 years, with a male-to-female ratio of approximately 55:45. The highest number of male participants was observed in Emergency Medicine, while Pediatrics had a higher proportion of female trainees. The demographic distribution was relatively uniform across all specialties, ensuring comparability in knowledge, attitude, and practice assessments (Table 1).

Table 1: Demographic Characteristics of Participants

Overall, knowledge of burn management varied significantly across specialties. Emergency Medicine trainees demonstrated the highest proficiency, particularly in fluid resuscitation and inhalational injury management, scoring 80% and 90%, respectively. General Surgery residents also performed well, with 75% and 78% accuracy in these domains. In contrast, Pediatrics residents exhibited the lowest knowledge scores, with only 50% proficiency in fluid resuscitation and 60% in inhalational injury assessment. Anesthesiology trainees showed moderate knowledge levels, particularly excelling in airway management and pain control. General Medicine trainees displayed lower knowledge levels than their surgical and emergency medicine counterparts, particularly in wound management (Table 2).

Table 2: Knowledge Scores by Specialty

The majority of postgraduate trainees (85%) acknowledged the need for additional training in burn management, with the highest agreement observed among Pediatric and General Medicine residents. Despite this, only 60% of the trainees expressed interest in specializing in burn care. Confidence in their existing knowledge was relatively low, with only 45% of participants feeling adequately trained to manage burn cases independently. Emergency Medicine and General Surgery trainees reported the highest confidence levels, while Pediatric trainees had the lowest self-reported confidence (Table 3).

Table 3: Attitude Towards Burn Management Training

Regarding adherence to evidence-based burn treatment protocols, notable gaps were identified. While 70% of trainees correctly applied the Parkland Formula for fluid resuscitation, compliance was highest among Emergency Medicine and General Surgery trainees. Early debridement practices were followed by 65% of participants, with General Surgery residents showing the highest adherence. Pain management protocols were applied consistently by 75% of trainees, with Anesthesiology trainees exhibiting the highest compliance. However, gaps remained, particularly in Pediatric and General Medicine trainees, who demonstrated lower adherence to standard treatment protocols (Table 4).

Table 4: Adherence to Burn Treatment Guidelines

Discussion

Gall stone diseases are the major cause of morbidity and mortality throughout the world. The prevalence of the disease varies with age, sex, geographic area and the ethnic groups. The trend of the disease has changed in thelast couple of decades due to the change in the dietary habits, migration of people and environmental insults. [15] In our study, the mean age of the patients was 44 years. We observed maximum (50.9%) number of patients in 31-50 years age group, equally distributed in each decade. This was in concordance with the studies of Kaur et al in a total of 384 patients in which 196 (52%) were of age group between 31-50 years. [15] However in study by Thamilselvi et al maximum number of patients were in 51 to 60 years of age which is higher in comparison to our study. In this study, we observed female predominance i.e. male: female was 1:8.3 that is similar with the previous studies. [16]

Inter play of female sex hormones (progesterone and estrogens) and its metabolic effects along with the sedentary lifestyle is said to be responsible for the high incidence of gall stones in females. [17] Gall stones are generally responsible for various forms of cholecystitis and associated lesions i.e. hyperplasia, metaplasia, dysplasia and carcinoma of the gallblader. [18] However, in 5 % to 10% of the cases, cholecystitis occurs without calculus. [19] In India, the incidence of calculus disease and its relationship with chronic cholecystitis varies from North to South India.

We observed nearly similar frequency of chronic calculus cholecystitis as seen in other North Indian studies by Mohan et al and Goyal et al. [20] Depending upon the colour, shape and size, the gall stones are classified into mixed (brownish yellow), cholesterol (yellow and white) and pigmented stones (dark brown and black). [21] In the present study, mixed stones were the most common type. This was correlated with the previous studies by Mohan et al, Mathur et al and Gopal Krishnan et al. The various lesions noted with gall stones include acute cholecystitis, chronic cholecystitis with associated epithelial and stromal alterations, chronic activecholecystitis, dysplasia and carcinoma. [22]

In present study, 1.8% of gall bladder lesions were due to acute cholecystitis which is quite close to the figures in the study by Thamilselviet al. Chronic cholecystitisis is associated with cholelithiasis in more than 90 % of the cases. In the present study, we observed chronic cholecystitis in 94.2% cases which is concordant with the observations made by Stanchu et al. [23] In this study in majority of specimens, cholesterolosis was found to be associated with cholesterol stones followed by mixed stones.

The incidence of chronic calculus cholecystitis was found to be 57.76% with female preponderance and mostly in third decade. Our study strongly recommends routine histopathological examination of all cholecystectomy specimens for the detection of various variants of chronic cholecystitis and also of incidental carcinoma of gall bladder which helps in their treatment and prognosis The histopathological spectrum of gallbladder lesions in gallstone disease included chronic cholecystitis and associated variety of mucosal alterations and lesions like cholesterosis, metaplasia, dysplasia and carcinoma. Commonest stones were mixed type and were more frequently associated with premalignant lesions. Frequency of Incidental gallbladder carcinoma detection was 0.6% and these were more commonly associated with pigment type of stones. Carefully planned studies to learn the etiopathogenesis of cholelithiasis will go a long way in preventing

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