Displaying publications 1 - 20 of 68 in total

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  1. Chanakit T, Low BY, Wongpoowarak P, Moolasarn S, Anderson C
    BMC Med Educ, 2015 Nov 19;15:205.
    PMID: 26585968 DOI: 10.1186/s12909-015-0473-4
    BACKGROUND: Pharmacy education and pharmacy practice are facing remarkable changes following new scientific discoveries, evolving patient needs and the requirements of advanced pharmacy competency for practices. Many countries are introducing or undertaking major transformations in pharmacy education. The Thai pharmacy curriculum has been changed from a 5-year BPharm and a 6-year PharmD to only a 6-year PharmD programme. Curriculum change processes usually involve stakeholders, including both internal and external educational institutions, at all levels. This study aims to understand the experiences and perceptions of stakeholders regarding the transition to an all-PharmD programme in Thailand.

    METHODS: Semi-structured interviews were conducted in Thailand with 130 stakeholders (e.g., policy makers, pharmacy experts, educators, health care providers, patients, students and parents) from August-October 2013. The interviews were audio recorded, transcribed verbatim and analysed using an inductive thematic analysis.

    RESULTS: Three main themes were derived from the findings: 1. influences on curriculum change (e.g., the needs of pharmacists to provide better patient care, the US-Thai consortium for the development of pharmacy education); 2. perceived benefits (e.g., improve pharmacy competencies from generalists to specialists, ready to work after graduation, providing a high quality of patient care); and 3. concerns (e.g., the higher costs of study for a longer period of time, the mismatch between the pharmacy graduates' competency and the job market's needs, insufficient preceptors and training sites, lack of practical experience of the faculty members and issues related to the separate licenses that are necessary due to the difference in the graduates' specialties).

    CONCLUSIONS: This is the first study to highlight the issues surrounding the transition to the 6-year PharmD programme in Thailand, which was initiated due to the need for higher levels of competency among the nation's pharmacists. The transition was influenced by many factors. Many participants perceived benefits from the new pharmacy curriculum. However, some participants were concerned about this transition. Although most of the respondents accepted the need to go forward to the 6-year PharmD programme, designing an effective curriculum, providing a sufficient number of qualified PharmD preceptors, determining certain competencies of pharmacists in different practices and monitoring the quality of pharmacy education still need to be addressed during this transitional stage of pharmacy education in Thailand.

  2. Singh S, Pai DR, Sinha NK, Kaur A, Soe HH, Barua A
    BMC Med Educ, 2013;13:128.
    PMID: 24044727 DOI: 10.1186/1472-6920-13-128
    Effective teaching in medicine is essential to produce good quality doctors. A number of studies have attempted to identify the characteristics of an effective teacher. However, most of literature regarding an effective medical teacher includes student ratings or expert opinions. Furthermore, interdisciplinary studies for the same are even fewer. We did a cross-sectional study of the characteristics of effective teachers from their own perspective across medicine and dentistry disciplines.
  3. Chew BH, Zain AM, Hassan F
    BMC Med Educ, 2013;13:44.
    PMID: 23537129 DOI: 10.1186/1472-6920-13-44
    BACKGROUND: Research on emotional intelligence (EI) suggests that it is associated with more pro-social behavior, better academic performance and improved empathy towards patients. In medical education and clinical practice, EI has been related to higher academic achievement and improved doctor-patient relationships. This study examined the effect of EI on academic performance in first- and final-year medical students in Malaysia.
    METHODS: This was a cross-sectional study using an objectively-scored measure of EI, the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). Academic performance of medical school students was measured using continuous assessment (CA) and final examination (FE) results. The first- and final-year students were invited to participate during their second semester. Students answered a paper-based demographic questionnaire and completed the online MSCEIT on their own. Relationships between the total MSCEIT score to academic performance were examined using multivariate analyses.
    RESULTS: A total of 163 (84 year one and 79 year five) medical students participated (response rate of 66.0%). The gender and ethnic distribution were representative of the student population. The total EI score was a predictor of good overall CA (OR 1.01), a negative predictor of poor result in overall CA (OR 0.97), a predictor of the good overall FE result (OR 1.07) and was significantly related to the final-year FE marks (adjusted R(2) = 0.43).
    CONCLUSIONS: Medical students who were more emotionally intelligent performed better in both the continuous assessments and the final professional examination. Therefore, it is possible that emotional skill development may enhance medical students' academic performance.
  4. Lim WK
    BMC Med Educ, 2012;12:89.
    PMID: 23009729 DOI: 10.1186/1472-6920-12-89
    Problem-based learning (PBL) has become the most significant innovation in medical education of the past 40 years. In contrast to exam-centered, lecture-based conventional curricula, PBL is a comprehensive curricular strategy that fosters student-centred learning and the skills desired in physicians. The rapid spread of PBL has produced many variants. One of the most common is 'hybrid PBL' where conventional teaching methods are implemented alongside PBL. This paper contends that the mixing of these two opposing educational philosophies can undermine PBL and nullify its positive benefits. Schools using hybrid PBL and lacking medical education expertise may end up with a dysfunctional curriculum worse off than the traditional approach.
  5. Lai NM, Teng CL
    BMC Med Educ, 2011;11:25.
    PMID: 21619672 DOI: 10.1186/1472-6920-11-25
    BACKGROUND: Previous studies report various degrees of agreement between self-perceived competence and objectively measured competence in medical students. There is still a paucity of evidence on how the two correlate in the field of Evidence Based Medicine (EBM). We undertook a cross-sectional study to evaluate the self-perceived competence in EBM of senior medical students in Malaysia, and assessed its correlation to their objectively measured competence in EBM.
    METHODS: We recruited a group of medical students in their final six months of training between March and August 2006. The students were receiving a clinically-integrated EBM training program within their curriculum. We evaluated the students' self-perceived competence in two EBM domains ("searching for evidence" and "appraising the evidence") by piloting a questionnaire containing 16 relevant items, and objectively assessed their competence in EBM using an adapted version of the Fresno test, a validated tool. We correlated the matching components between our questionnaire and the Fresno test using Pearson's product-moment correlation.
    RESULTS: Forty-five out of 72 students in the cohort (62.5%) participated by completing the questionnaire and the adapted Fresno test concurrently. In general, our students perceived themselves as moderately competent in most items of the questionnaire. They rated themselves on average 6.34 out of 10 (63.4%) in "searching" and 44.41 out of 57 (77.9%) in "appraising". They scored on average 26.15 out of 60 (43.6%) in the "searching" domain and 57.02 out of 116 (49.2%) in the "appraising" domain in the Fresno test. The correlations between the students' self-rating and their performance in the Fresno test were poor in both the "searching" domain (r = 0.13, p = 0.4) and the "appraising" domain (r = 0.24, p = 0.1).
    CONCLUSIONS: This study provides supporting evidence that at the undergraduate level, self-perceived competence in EBM, as measured using our questionnaire, does not correlate well with objectively assessed EBM competence measured using the adapted Fresno test.
    STUDY REGISTRATION: International Medical University, Malaysia, research ID: IMU 110/06.
  6. Short J, McDonald S, Turner T, Martis R, SEA-ORCHID Study Group
    BMC Med Educ, 2010;10:37.
    PMID: 20492706 DOI: 10.1186/1472-6920-10-37
    Fellowships are a component of many professional education programs. They provide opportunities to develop skills and competencies in an environment where time is protected and resources and technical support are more readily available. The SEA-ORCHID fellowships program aimed to increase capacity for evidence-based practice and research synthesis, and to encourage fellows to become leaders in these areas.
  7. Perera J, Perera J, Abdullah J, Lee N
    BMC Med Educ, 2009;9:37.
    PMID: 19563621 DOI: 10.1186/1472-6920-9-37
    BACKGROUND: Most medical schools use simulated patients (SPs) for teaching. In this context the authenticity of role play and quality of feedback provided by SPs is of paramount importance. The available literature on SP training mostly addresses instructor led training where the SPs are given direction on their roles. This study focuses on the use of peer and self evaluation as a tool to train SPs.
    METHODS: SPs at the medical school participated in a staff development and training programme which included a) self-assessment of their performance while observing video-tapes of their role play using a structured guide and b) peer group assessment of their performance under tutor guidance. The pre and post training performance in relation to authenticity of role play and quality of feedback was blindly assessed by students and tutors using a validated instrument and the scores were compared. A focus group discussion and a questionnaire assessed acceptability of the training programme by the SPs.
    RESULTS: The post-training performance assessment scores were significantly higher (p < 0.05) than the pre-training scores. The degree of improvement in the quality of feedback provided to students was more when compared to the improvement of role play. The acceptability of the training by the SPs was very satisfactory scoring an average of 7.6 out of 10. The majority of the SPs requested the new method of training to be included in their current training programme as a regular feature.
    CONCLUSION: Use of structured self-reflective and peer-interactive, practice based methods of SP training is recommended to improve SP performance. More studies on these methods of training may further refine SP training and lead to improvement of SP performance which in turn may positively impact medical education.
  8. Chanakit T, Low BY, Wongpoowarak P, Moolasarn S, Anderson C
    BMC Med Educ, 2015;15:181.
    PMID: 26498661 DOI: 10.1186/s12909-015-0471-6
    Thai pharmacy education has moved to an all Doctor of Pharmacy (PharmD) programme. However, there has been no previous research about the perceptions regarding the suitability of PharmD graduates employed in hospital settings, which is the major pharmacy workforce in Thailand.
  9. Lai PS, Sim SM, Chua SS, Tan CH, Ng CJ, Achike FI, et al.
    BMC Med Educ, 2015;15:153.
    PMID: 26391883 DOI: 10.1186/s12909-015-0433-z
    BACKGROUND: Prescribing incompetence is an important factor that contributes to prescribing error, and this is often due to inadequate training during medical schools. We therefore aimed to develop and validate an instrument to assess the prescribing readiness of medical students (PROMS) in Malaysia.
    METHODS: The PROMS comprised of 26 items with four domains: undergraduate learning opportunities; hands-on clinical skills practice; information gathering behaviour; and factors affecting the learning of prescribing skills. The first three domains were adapted from an existing questionnaire, while items from the last domain were formulated based on findings from a nominal group discussion. Face and content validity was determined by an expert panel, pilot tested in a class of final year (Year 5) medical students, and assessed using the Flesch reading ease. To assess the reliability of the PROMS, the internal consistency and test-retest (at baseline and 2 weeks later) were assessed using the Wilcoxon Signed Ranks test and Spearman's rho. The discriminative validity of the PROMS was assessed using the Mann-Whitney U-test (to assess if the PROMS could discriminate between final year medical students from a public and a private university).
    RESULTS: A total of 119 medical students were recruited. Flesch reading ease was 46.9, indicating that the instrument was suitable for use in participants undergoing tertiary education. The overall Cronbach alpha value of the PROMS was 0.695, which was satisfactory. Test-retest showed no difference for 25/26 items, indicating that our instrument was reliable. Responses from the public and private university final year medical students were significantly different in 10/26 items, indicating that the PROMS was able to discriminate between these two groups. Medical students from the private university reported fewer learning opportunities and hands-on practice compared to those from the public university. On the other hand, medical students from the private university reported more frequent use of both web based and non-web-based resources compared to their public university counterparts.
    CONCLUSIONS: The PROMS instrument was found to be a reliable and valid tool for assessing medical students' readiness to prescribe in Malaysia. It may also inform on the adequacy of medical programmes in training prescribing skills.
  10. Ahmadi K, Reidpath DD, Allotey P, Hassali MAA
    BMC Med Educ, 2016 May 30;16:155.
    PMID: 27240562 DOI: 10.1186/s12909-016-0676-3
    BACKGROUND: The attitudes of healthcare professionals towards HIV positive patients and high risk groups are central to the quality of care and therefore to the management of HIV/AIDS related stigma in health settings. Extant HIV/AIDS stigma scales that measure stigmatising attitudes towards people living with HIV/AIDS have been developed using scaling techniques such as principal component analysis. This approach has resulted in instruments that are often long. Mokken scale analysis is a nonparametric hierarchical scaling technique that can be used to develop unidimensional cumulative scales. This technique is advantageous over the other approaches; as the scales are usually shorter, while retaining acceptable psychometric properties. Moreover, Mokken scales also make no distributional assumptions about the underlying data, other than that the data are capable of being ordered by item and by person. In this study we aimed at developing a precise and concise measure of HIV/AIDS related stigma among health care professionals, using Mokken scale analysis.
    METHODS: We carried out a cross sectional survey of healthcare students at the Monash University campuses in Malaysia and Australia. The survey consisted of demographic questions and an initial item pool of twenty five potential questions for inclusion in an HIV stigma scale.
    RESULTS: We analysed the data using the mokken package in the R statistical environment providing a 9-item scale with high reliability, validity and acceptable psychometric properties, measuring and ranking the HIV/AIDS related stigmatising attitudes.
    CONCLUSION: Mokken scaling procedure not only produced a comprehensive hierarchical scale that could accurately order a person along HIV/AIDS stigmatising attitude, but also demonstrated a unidimensional and reliable measurement tool which could be used in future studies. The principal component analysis confirmed the accuracy of the Mokken scale analysis in correctly detecting the unidimensionality of this scale. We recommend future works to study the generalisability of this scale in a new population.
  11. Tackett S, Shochet R, Shilkofski NA, Colbert-Getz J, Rampal K, Abu Bakar H, et al.
    BMC Med Educ, 2015;15:105.
    PMID: 26081751 DOI: 10.1186/s12909-015-0388-0
    Perdana University Graduate School of Medicine (PUGSOM), the first graduate-entry medical school in Malaysia, was established in 2011 in collaboration with Johns Hopkins University School of Medicine (JHUSOM), an American medical school. This study compared learning environments (LE) at these two schools, which shared the same overarching curriculum, along with a comparator Malaysian medical school, Cyberjaya University College of Medical Sciences (CUCMS). As a secondary aim, we compared 2 LE assessment tools - the widely-used Dundee Ready Educational Environment Measure (DREEM) and the newer Johns Hopkins Learning Environment Scale (JHLES).
  12. Subramaniam A, Silong AD, Uli J, Ismail IA
    BMC Med Educ, 2015;15:129.
    PMID: 26268222 DOI: 10.1186/s12909-015-0407-1
    Effective talent development requires robust supervision. However, the effects of supervisory styles (coaching, mentoring and abusive supervision) on talent development and the moderating effects of clinical learning environment in the relationship between supervisory styles and talent development among public hospital trainee doctors have not been thoroughly researched. In this study, we aim to achieve the following, (1) identify the extent to which supervisory styles (coaching, mentoring and abusive supervision) can facilitate talent development among trainee doctors in public hospital and (2) examine whether coaching, mentoring and abusive supervision are moderated by clinical learning environment in predicting talent development among trainee doctors in public hospital.
  13. Liew SC, Sidhu J, Barua A
    BMC Med Educ, 2015;15:44.
    PMID: 25889887 DOI: 10.1186/s12909-015-0327-0
    Learning styles and approaches of individual undergraduate medical students vary considerably and as a consequence, their learning needs also differ from one student to another. This study was conducted to identify different learning styles and approaches of pre-clinical, undergraduate medical students and also to determine the relationships of learning preferences with performances in the summative examinations.
  14. Ilic D, Nordin RB, Glasziou P, Tilson JK, Villanueva E
    BMC Med Educ, 2015;15:39.
    PMID: 25884717 DOI: 10.1186/s12909-015-0321-6
    BACKGROUND: Few studies have been performed to inform how best to teach evidence-based medicine (EBM) to medical trainees. Current evidence can only conclude that any form of teaching increases EBM competency, but cannot distinguish which form of teaching is most effective at increasing student competency in EBM. This study compared the effectiveness of a blended learning (BL) versus didactic learning (DL) approach of teaching EBM to medical students with respect to competency, self-efficacy, attitudes and behaviour toward EBM.
    METHODS: A mixed methods study consisting of a randomised controlled trial (RCT) and qualitative case study was performed with medical students undertaking their first clinical year of training in EBM. Students were randomly assigned to receive EBM teaching via either a BL approach or the incumbent DL approach. Competency in EBM was assessed using the Berlin questionnaire and the 'Assessing Competency in EBM' (ACE) tool. Students' self-efficacy, attitudes and behaviour was also assessed. A series of focus groups was also performed to contextualise the quantitative results.
    RESULTS: A total of 147 students completed the RCT, and a further 29 students participated in six focus group discussions. Students who received the BL approach to teaching EBM had significantly higher scores in 5 out of 6 behaviour domains, 3 out of 4 attitude domains and 10 out of 14 self-efficacy domains. Competency in EBM did not differ significantly between students receiving the BL approach versus those receiving the DL approach [Mean Difference (MD)=-0.68, (95% CI-1.71, 0.34), p=0.19]. No significant difference was observed between sites (p=0.89) or by student type (p=0.58). Focus group discussions suggested a strong student preference for teaching using a BL approach, which integrates lectures, online learning and small group activities.
    CONCLUSIONS: BL is no more effective than DL at increasing medical students' knowledge and skills in EBM, but was significantly more effective at increasing student attitudes toward EBM and self-reported use of EBM in clinical practice. Given the various learning styles preferred by students, a multifaceted approach (incorporating BL) may be best suited when teaching EBM to medical students. Further research on the cost-effectiveness of EBM teaching modalities is required.
  15. Frantz JM, Bezuidenhout J, Burch VC, Mthembu S, Rowe M, Tan C, et al.
    BMC Med Educ, 2015;15:28.
    PMID: 25879491 DOI: 10.1186/s12909-015-0320-7
    In 2008 the sub-Saharan FAIMER Regional Institute launched a faculty development programme aimed at enhancing the academic and research capacity of health professions educators working in sub-Saharan Africa. This two-year programme, a combination of residential and distance learning activities, focuses on developing the leadership, project management and programme evaluation skills of participants as well as teaching the key principles of health professions education-curriculum design, teaching and learning and assessment. Participants also gain first-hand research experience by designing and conducting an education innovation project in their home institutions. This study was conducted to determine the perceptions of participants regarding the personal and professional impact of the SAFRI programme.
  16. Mitra NK, Barua A
    BMC Med Educ, 2015;15:29.
    PMID: 25884641 DOI: 10.1186/s12909-015-0318-1
    BACKGROUND: The impact of web-based formative assessment practices on performance of undergraduate medical students in summative assessments is not widely studied. This study was conducted among third-year undergraduate medical students of a designated university in Malaysia to compare the effect, on performance in summative assessment, of repeated computer-based formative assessment with automated feedback with that of single paper-based formative assessment with face-to face feedback.
    METHODS: This quasi-randomized trial was conducted among two groups of undergraduate medical students who were selected by stratified random technique from a cohort undertaking the Musculoskeletal module. The control group C (n = 102) was subjected to a paper-based formative MCQ test. The experimental group E (n = 65) was provided three online formative MCQ tests with automated feedback. The summative MCQ test scores for both these groups were collected after the completion of the module.
    RESULTS: In this study, no significant difference was observed between the mean summative scores of the two groups. However, Band 1 students from group E with higher entry qualification showed higher mean score in the summative assessment. A trivial, but significant and positive correlation (r(2) = +0.328) was observed between the online formative test scores and summative assessment scores of group E. The proportionate increase of performance in group E was found to be almost double than group C.
    CONCLUSION: The use of computer based formative test with automated feedback improved the performance of the students with better academic background in the summative assessment. Computer-based formative test can be explored as an optional addition to the curriculum of pre-clinical integrated medical program to improve the performance of the students with higher academic ability.
  17. Griffiths AW, Cheong WL, Saw PS, Parveen S
    BMC Med Educ, 2020 Mar 20;20(1):82.
    PMID: 32192471 DOI: 10.1186/s12909-020-1972-5
    BACKGROUND: One of the major challenges worldwide is the stigma associated with dementia. There is limited dementia awareness within Malaysian communities, including levels of confusion regarding the differences between dementia and the usual ageing progress, which can lead to delays in support seeking. The need for additional training and education for healthcare professionals has been highlighted. The present study aimed to evaluate the benefits of a one-hour dementia education session (Dementia Detectives workshop) for pharmacy and medicine undergraduate students at a Malaysian university.

    METHODS: Participants attended the workshop and completed pre- (Time 1) and post-workshop (Time 2) questionnaires consisting of validated measures exploring attitudes towards dementia and older people more broadly.

    RESULTS: A total of 97 students were recruited. Attitudes towards people with dementia showed significant positive changes between Time 1 and Time 2, whereas no differences were found for attitudes towards older people.

    CONCLUSIONS: As medical and pharmacy students develop theoretical knowledge, practical skills and professional attitudes during their undergraduate studies, it is important for students to also learn about the humanistic side of diseases and conditions through workshops such as the one presented here. Further research should now be conducted to consider how Dementia Detectives can be delivered to non-healthcare students and what the barriers and facilitators to wider delivery are.

  18. Yadav H, Jegasothy R, Ramakrishnappa S, Mohanraj J, Senan P
    BMC Med Educ, 2019 Jun 18;19(1):218.
    PMID: 31215454 DOI: 10.1186/s12909-019-1662-3
    BACKGROUND: Ethical behavior and professionalism is an ideal characteristic required of medical students and included as 'must achieve' and critical aspect of medical students' curriculum. This study proposes to determine the perceived unethical and unprofessional behavior among medical students in a private medical university from year 1 to year 5 of the medical curriculum.

    METHODS: A cross-sectional study was conducted among year 1 to year 5 medical students in a private medical university. A self-administered questionnaire was used with the 3 major domains of professionalism and ethics i.e. discipline plagiarism and cheating.

    RESULTS: A total of 464 respondents responded to the survey and they included medical students from year 1 and year 2 (pre-clinical) and years 3-5 (clinical years). Majority of the students, 275 (59.2%) answered that they had not seen any form of unethical behavior among other students. The females seem to have a larger number 172(63%) among the same gender compared to the males. Majority 352 (75%) of them had not heard of the 'Code of Professional Conduct by the Malaysian Medical Council'. About fifty three (53.1%) of the students answered that the training was sufficient.

    CONCLUSIONS: This study showed that the perception of unethical behavior was 58.8% in the 1st year (pre-clinical) and it increased to 65.2% in the 5th year (clinical). The 3 main discipline issues were students do not show interest in class (mean 2.9/4), they are rude to other students (mean 2.8/4) and talking during class (mean 2.6/4). Despite the existence of unethical behavior among the students majority of them (71.7%) claimed that they had adequate training in ethics and professionalism. It is proposed that not only the teaching of ethics and professionalism be reviewed but an assessment strategy be introduced to strengthen the importance of professionalism and ethics.

  19. Ismail MA, Ahmad A, Mohammad JA, Fakri NMRM, Nor MZM, Pa MNM
    BMC Med Educ, 2019 Jun 25;19(1):230.
    PMID: 31238926 DOI: 10.1186/s12909-019-1658-z
    BACKGROUND: Gamification is an increasingly common phenomenon in education. It is a technique to facilitate formative assessment and to promote student learning. It has been shown to be more effective than traditional methods. This phenomenological study was conducted to explore the advantages of gamification through the use of the Kahoot! platform for formative assessment in medical education.

    METHODS: This study employed a phenomenological design. Five focus groups were conducted with medical students who had participated in several Kahoot! sessions.

    RESULTS: Thirty-six categories and nine sub-themes emerged from the focus group discussions. They were grouped into three themes: attractive learning tool, learning guidance and source of motivation.

    CONCLUSIONS: The results suggest that Kahoot! sessions motivate students to study, to determine the subject matter that needs to be studied and to be aware of what they have learned. Thus, the platform is a promising tool for formative assessment in medical education.

  20. Chew KS, van Merrienboer JJG, Durning SJ
    BMC Med Educ, 2019 Jan 10;19(1):18.
    PMID: 30630472 DOI: 10.1186/s12909-018-1451-4
    BACKGROUND: Establishing a diagnosis is a complex, iterative process involving patient data gathering, integration and interpretation. Premature closure is a fallacious cognitive tendency of closing the diagnostic process before sufficient data have been gathered. A proposed strategy to minimize premature closure is the use of a checklist to trigger metacognition (the process of monitoring one's own thinking). A number of studies have suggested the effectiveness of this strategy in classroom settings. This qualitative study examined the perception of usability of a metacognitive mnemonic checklist called TWED checklist (where the letter "T = Threat", "W = What if I am wrong? What else?", "E = Evidence" and "D = Dispositional influence") in a real clinical setting.

    METHOD: Two categories of participants, i.e., medical doctors (n = 11) and final year medical students (Group 1, n = 5; Group 2, n = 10) participated in four separate focus group discussions. Nielsen's 5 dimensions of usability (i.e. learnability, effectiveness, memorability, errors, and satisfaction) and Pentland's narrative network were adapted as the framework to study the usability and the implementation of the checklist in a real clinical setting respectively.

    RESULTS: Both categories (medical doctors and medical students) of participants found that the TWED checklist was easy to learn and effective in promoting metacognition. For medical student participants, items "T" and "W" were believed to be the two most useful aspects of the checklist, whereas for the doctor participants, it was item "D". Regarding its implementation, item "T" was applied iteratively, items "W" and "E" were applied when the outcomes did not turn out as expected, and item "D" was applied infrequently. The one checkpoint where all four items were applied was after the initial history taking and physical examination had been performed to generate the initial clinical impression.

    CONCLUSION: A metacognitive checklist aimed to check cognitive errors may be a useful tool that can be implemented in the real clinical setting.

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