We describe a case of nephrotic syndrome case who defaulted treatment but presented with acute medical complication due to non-compliance to treatment. He subsequently developed neurological sequalae following definitive hemodialysis. Due to disease severity and its complication, active dialysis has been abandoned. There are many factors leading to this decision, but are palliative care physician right to follow the primary team’s decision, in palliating a patient with chronic kidney disease with potential hyperkalaemia consequences? The article focuses on potential ethical dilemma faced by the palliative care team in the subsequent management of this scenario.
Students-t test is the most popular statistical test. The test compares two mean values to judge if they are different or not. For small data it is possible to conduct it using manual calculation – however that is not the case. Researchers would need to use statistical software and packages to conduct their analysis. This guide will help the junior researchers to conduct independent- and paired-t test using STATA software.
Personality researchers have proposed five dimensions of personality that are extroversion,
conscientiousness, agreeableness, neuroticism, and openness. The five-factor model offers a theoretical basis for medical educators to understand the impact of personality traits on medical students’ psychological health during stressful medical training. This study attempted to investigate on which personality traits have favour impact on psychological health of medical students during a stressful period – the final examination of first year. A cross-sectional study was conducted on medical students in a public medical school. Personality traits were measured by USM Personality Inventory and psychological health parameters were measured by 21-item Depression Anxiety Stress Scale. Pearson correlation test was performed by SPSS to determine correlation between personality trait and psychological health parameters. A total of 174 medical students participated in this study. Extroversion (rstress = –0.44, ranxiety = -0.41, rdepression = –0.56), conscientiousness (rstress= –0.38, ranxiety =–0.36, rdepression= –0.51), agreeableness (rstress = –0.28, ranxiety = –0.25, rdepression = –0.47) and openness
(rstress = –0.34, ranxiety = –0.31, rdepression = –0.47) negatively correlated with stress, anxiety and depression. Neuroticism (rstress = 0.53, ranxiety = 0.47, rdepression = 0.60) positively correlated with stress, anxiety and depression. Extroversion, conscientiousness, agreeableness and openness demonstrated favourable impact and neuroticism demonstrated unfavourable impact on stress, anxiety and depression of the medical students during a stressful period.
When patients are tethered with uncontrolled pain, health care practitioners usually resort to several
modes of symptomatic relief for their patients. In palliative care the goal is identifying and managing
the cause of pain in addition to addressing associated problems. To administer effective symptom
control in patient with chronic non-cancer associated pain, healthcare professionals may need to
consider alternative non-pharmacological modes of treatment such as psychological intervention. Pain
perception can be influenced by non-organic factors such as emotional, psychosocial status of the
patient and their religious and spiritual beliefs. Taking these factors into consideration are an essential
part of treatment goals. The paper illustrates an ethical dilemma which has arisen in the aggressive
management of pain and highlights the importance of multi-disciplinary involvement in patient care.
Failure to consider these aspects of care can cause patient and parental anxiety, poor symptom control
and could compromise doctor-patient relationship.
This case illustrates the role of a woman's autonomy in deciding her medical management and the ethical issue which occurred when a husband refuses the management for her even though it was clearly indicated.
Introduction: Student selection is important for selecting the best candidates into medical courses.
The Multiple Mini Interview (MMI) is a valid selection tool for the task. The School of Medical
Sciences (SMS), Universiti Sains Malaysia (USM) has employed MMI as a medical admission
tool to select potential candidates into its medical program. Objective: This paper described the
implementation of the MMI and reported the preliminary evaluation data on its validity evidence.
Method: A 9-station MMI (with 5 manned and 4 rest stations) was employed for the 2015 student
selection exercise. Interview data were analysed and questionnaire surveys were administered to both
interviewers and candidates. Validity, reliability, feasibility and acceptability were determined. Results:
Unidimensional construct on confirmatory factor analysis (CFA) and interviewer comments provided
evidence of construct validity. Overall reliability was 0.94, good enough for high-stakes decisions.
Interviewers and candidates’ comments on feasibility and acceptability were also generally positive.
The consistency of the difficulty and discrimination indices of similar stations between sessions was
identified as among the areas for improvement. Conclusions: We are cautiously optimistic regarding
the utility of the MMI in the SMS; future improvements are planned but the present implementation
seems sufficient for the stated purposes
Objective: To determine the validity and reliability of Incontinence Praying Ability (I-PA) among
Muslim childbearing-aged women. Methods: A cross sectional study was conducted among Muslim
women under childbearing age attended clinics in a university teaching hospital. Two measures were
used in the present study and there were I-PA and Incontinence Quality of Life (I-QoL). I-PA was
developed in Malay language and its construct validity had not been explored. The questionnaires
were handed to the Muslim women during their visit to the clinics in Hospital Universiti Sains
Malaysia. Exploratory Factor Analysis (EFA) was conducted to determine the construct validity
and the Cronbach’s alpha was used to examine the internal consistency reliability of I-PA. Pearson
correlation was used to examine the correlation between I-PA and the subscales of I-QoL. Validity was
further supported if both scales were significantly correlated. Results: A total of 162 Muslim women
completed and returned the questionnaires to the researchers. The mean age of participants was 32.4
(SD = 5.87). Based on EFA result, all the 10 items of I-PA were remained in the model under one
factor and no item deletion was required. The factor loadings were ranged from 0.70 to 0.91. The
internal consistency of I-PA was satisfactory with Cronbach’s Alpha of 0.94. There were significant
correlations between I-PA and I-QoL’s subscales, ranged from 0.64 to 0.71. Conclusion: I-PA was
considered a valid and reliable questionnaire measuring incontinence quality of life in the aspect of
praying ability or spirituality among Muslim childbearing-aged women.
Objective: To determine the factor structure of the Health Promoting Behaviours (HPB) component of Health Promoting Lifestyle Profile-II among undergraduate students in Universiti Sains Malaysia (USM) by confirmatory factor analysis (CFA).
Methods: A cross sectional study was conducted among undergraduate students. The data was collected in the USM campus using a proportionate cluster sampling method. The HPB questionnaire was handed to students in the lecture hall and collected immediately when the lecture finished. CFA was conducted using robust maximum likelihood estimation due to violation of multivariate normality assumption. A three-factor model was tested for measurement model validity and construct validity.
Results: A total of 788 students participated in the study. CFA of a 21-item, three-factor model yielded an adequate goodness-of-fit values. The measurement model also showed a good convergent and discriminant validity after model re-specification.
Conclusion: The health promoting behaviours scale was proven to have a valid measurement model and reliable constructs. It was deemed suitable for use to measure the health promoting behaviours components of a healthy lifestyle among Malaysian undergraduate students. It was recommended to further conduct cross-validation studies in other Malaysian public universities to provide additional empirical evidence to support its use.
The Delphi technique is a widely used and accepted method for gathering data from participantswithin domain of expertise. The objective of this study is to discuss the process of the three roundsDelphi technique in seeking a consensus of concept mapping structure and Multiple Choice Questions(MCQ) in Diabetic Mellitus subject. In the first, round, participants were given a structuredquestionnaire regarding item of concept mapping structure and MCQ in Diabetic Mellitus subject.The second were added mean and median value of round one. In the third round were add meanand median value of round two were added. Participants were asked to rate the categorised responsesfrom Round 1 on a scale of 1 to 5, with 1 being “Very irrelevant” and 5 being “Very relevant”. Thistechnique does not require participants to meet face-to-face, thereby making it useful to conductsurveys with qualified people over a wide geographic area. The feedback process allows and encouragesthe selected Delphi participants to reassess their initial judgements about the information providedin previous iterations. Data is then analysed to check for consistency of experts’ responses betweenrounds. Instrument developed from the Delphi technique research findings is also examined forvalidation from experts in educational medical health sciences on content and constructs validity.Analysis on the consensus of data from experts was based on median, inter quartile range and quartiledeviation on Round 1, 2 and 3 data. Therefore, the Delphi technique is an appropriate method foridentifying significant issues related with academic.
Background: Reflection on the process of learning is an essential ingredient in transforming novice into expert learners. Learning to compile portfolio encourages reflective skills, which help students to work systemically in translating metacognition into self-regulatory control in order to adjust their action and monitor their learning objectives. Introducing to compile portfolio in the early years of postgraduate training is an effective tool to stimulate students’ reflective abilities. Reflective learners are better motivated than the conventional learners to take the responsibilities as researcher in future. Reflective skills achieve both learning in right direction and learning for whole life. However, use of formal methods of reflective portfolio to monitor the learning objectives is an uncommon practice in postgraduate training, primarily due to intensive time and labor required. Challenged with those constraints in Master’s of Surgery Program of Otolaryngology and Head-Neck Surgery in School of Medical Sciences at Universiti Sains Malaysia, a structured self-reflective portfolio was introduced to determine its feasibility and acceptance among supervisors and trainees. Portfolio was practiced as one of the tool for formative assessment and for making recommendations to certify independent thyroid surgery allowed to practice in future. Methodology: A self-reflective structured portfolio was introduced to monitor the learning objectives in trainees of 2007 cohort, using a model as "mentor-system for authentic and structured learning with self-reflective assessment" (MASSRA). Initially a semi-structured portfolio comprising of 12 items and guidelines to compile a portfolio was followed by a structured format in training of thyroid module in sub-specialty of Head and Neck Surgery. Mentoring was organized by putting one-mentor verses 9 students to provide general pastoral guidance to compile portfolio as two entries a year. Mentors held the counseling session with student twice a year after evaluating the portfolios to monitor their progress. Besides, candidates were also observed for their performance in thyroid surgery during a 4-years training program. Those identified with problems for their level of training were referred to "Joint Committee for Surgical Training" comprising of 3 supervisors from Head and Neck Surgery Sub-specialty and a chairman supposedly the head of the department. 7 randomly selected students were also interviewed for direct feedback to evaluate this model. Result: 28 trainees at different level of their training compiled a self-reflection structured portfolio minimum twice a year with instructional feedback from the mentor, which was used as a tract for their personal development plan (produced by each trainee) for training in thyroid surgery. Initial analysis of portfolio revealed interesting feedback from the trainees reflecting on their knowledge, surgical skills and attitude towards thyroid surgery seen in tables 2-4. Conclusion: Self-reflections about each structured items in portfolio-helped trainees to identify their problems, seek mentors guidance and work systemically to help adjust their actions by revising learning objectives. Though time and labor intensive, portfolio was rated as feasible and practical.
Background: Single best answer (SBA) as multiple-choice items are often advantageous to use for
its reliability and validity. However, SBA requires good number of plausible distractors to achieve
reliability. Apart from psychometric evaluation of assessment it is important to perform item analysis
to improve quality of items by analysing difficulty index (DIF I), discrimination index (DI) and
distractor efficiency (DE) based on number of non-functional distractors (NFD). Objective: To
evaluate quality of SBA items administered in professional examination to apply corrective measures
determined by DIF I, DI and DE using students’ assessment score. Method: An evaluation of post
summative assessment (professional examination) of SBA items as part of psychometric assessment
is performed after 86 weeks of teaching in preclinical phase of MD program. Forty SBA items and
160 distractors inclusive of key were assessed using item analysis. Hundred and thirty six students’
score of SBA was analysed for mean and standard deviation, DIF I, DI and DE using MS Excel 2007.
Unpaired t-test was applied to determine DE in relation to DIF I and DI with level of significance.
Item-total correlation (r) and internal consistency by Cronbach’s alpha and parallel-form method was
also computed. Result: Fifteen items had DIF I = 0.31–0.61 and 25 items had DIF I (≤ 0.30 or ≥
0.61). Twenty six items had DI = 0.15 – ≥ 0.25 compared to 14 items with DI (≤ 0.15). There were 26
(65%) items with 1–3 NFD and 14 (35%) items without any NFD. Thirty nine (32.50%) distractors
were with choice frequency = 0. Overall mean DE was 65.8% and NFD was 49 (40.5%). DE in
relation to DIF I and DI were statistically significant with p = 0.010 and 0.020 respectively. Item-total
correlation for most items was < 0.3. Internal consistency by Cronbach’s alpha in SBA Test 1 and 2
was 0.51 and 0.41 respectively and constancy by parallel-form method was 0.57 between SBA Test 1
and 2. Conclusion: The high frequency of difficult or easy items and moderate to poor discrimination
suggest the need of items corrective measure. Increased number of NFD and low DE in this study
indicates difficulty of teaching faculty in developing plausible distractors for SBA questions. This has
been reflected in poor reliability established by alpha. Item analysis result emphasises the need of
evaluation to provide feedback and to improve quality of SBA items in assessment.
One of the challenges in mentoring relationships is to understand the real issues faced by the mentees. A mechanism has been established to offer a credible mentoring inventory. The aim of the study was to determine the construct validity and reliability index of the Universiti Sains Malaysia Mentoring Inventory (USM-MT-i) among early phase medical students in a Malaysian public medical school. A cross-sectional study was conducted in June 2017 among 208 early phase of the medical students of School of Medical Sciences, Universiti Sains Malaysia. USM-MT-i is a self-administered inventory and was established based on the information gained from the mentors and mentees. The prevalidated inventory entailed 44 primary items. Exploratory factor analysis (EFA) and Cronbach’s alpha reliability analysis were utilised to determine the construct validity and reliability of such inventory. The result revealed three potential constructs with 39 items extracted from the USMMT- i; academic leadership (19 items), communication skills (12 items) and examination competence (8 items) with factor loading ranges from 0.50–0.77, 0.51–0.80 and 0.65–0.87, respectively. Internal consistency reliability (Cronbach’s alpha) for each domain were 0.95, 0.93 and 0.92, respectively. The overall Cronbach’s alpha was 0.96. The present study promoted that the three factors with 39 items of the USM-MT-i has a good validity and reliability value to survey for mentoring needs among medical students in their early phase.
Introduction: Neuro-Linguistic Programming (NLP) is continuously used as one of the
psychological intervention in medicine, sport, and education settings. NLP through employing its
techniques and language patterns could make certain changes in connections between neurological
processes and therefore, restructure individuals’ cognition and reform their behaviours. This
contributes to certain advantages in educational-therapeutic sessions concerning helping athletes with
emotional hardship, resulting from physical injuries. Objective: To examine a tailored intervention
of the NLP model adapted for educational-therapeutic purposes to reduce competitive state anxiety
of two elite basketball players after their rehabilitation programme from physical injuries. Method:
This study used a case study approach, and employed the NLP model’s collapsing anchoring,
perceptual positions, and meta-model language patterns, to help both athletes to restructure their
dysfunctional thoughts and memories. The athletes experienced anxiety related negative thoughts and
felt emotionally difficult to perform in training and competition. Results: The intervention showed
promising strategies in helping the athletes to reduce their competitive state anxiety. Also, the results
obtained from the interview sessions, and the quantitative analysis showed that the NLP intervention
had successfully helped the athletes to cope with dysfunctional thoughts and emotionally related
anxiety. Conclusions: The NLP-based intervention, to some degree, helped the athletes to deal with
dysfunctional thoughts of their past injury experiences, reducing their competitive state anxiety to
compete again in the upcoming competition.
Myth, believe in powerful ‘being’ commonly known as jinn and usage of ‘bomoh’ as the medium is still widespread in our community in Kelantan especially among the Malay community. This believe and practice of usin ‘bomoh’ to cure and help with known and unknown disease believe to be caused by the jinn, occasionally poses a significant complication and threat to the management of patient in the hospital. Our case is just one of many cases that happen in our local hospital, and we hope by sharing this case will illustrate how ethical discussion occasionally surpassed the four common ethical pillars.
Delivery and implementation strategies are key to curriculum success. There is growing evidence
that team-based learning (TBL) is an effective way of interactive teaching. TBL is a method that uses
learning teams to enhance student engagement and quality of learning. Individual accountability for
out-of-class reading is followed by individual and group assessment. In-class application exercises,
which is the hallmark of team-based learning promotes both learning and team development. TBL
uses educational principles of transforming traditional content into application of knowledge
and problem solving skills in an interactive learning environment. To experience the structural
framework and to determine the students’ perception about TBL in clinical setting of MBBS
program in a Malaysian medical school. A total of 120 students assigned to 22 small subgroups of
5–6 per group underwent a number of TBL sessions delivered in three phases. In Phase I, students
were assigned reading material. In Phase II, students were assessed through One Best Answer
(OBA) items for individual and group readiness assessment test as individual readiness assessment
test (IRAT) and group readiness assurance test (GRAT) respectively followed by a mini-lecture.
In Phase III, in-class application of learning activity was performed. Finally, peer assessment
evaluated the contribution of peer in TBL. A TBL Classroom Evaluation Inventory (TBLCEI)
developed to probe student’s perception of TBL, comprised of 40 items composite scale with
Cronbach’s alpha at 0.881. In addition, students were asked to provide their estimated grade in
end of the posting assessment. Grades were categorised into excellent pass >85%, high pass 70%–
84%; average to good pass 50%–69% and fail
Objective: To determine the sensitivity, specificity and internal consistency of the Malay version GHQ-30 among medical student population. This study also determined the level of agreement between GHQ-30 and M-BDI.
Methods: The Malay version GHQ-30 and Malay version Beck Depression Inventory (M-BDI) were administered to 190 medical students. ROC curve analysis was applied to determine the sensitivity and specificity of the GHQ-30 by testing against the M-BDI diagnoses. Reliability and Kappa analysis were applied to test internal consistency of the GHQ and to determine the level of agreement between GHQ-30 and M-BDI respectively.
Results: 141 (74.2%) medical students participated in this study. The GHQ-30 sensitivity and specificity at cut-off point of 5/6 was 87.5% and 80.6% respectively with positive predictive value (PPV) of 70% as well as area under ROC curve was 0.84. The Cronbach’s alpha value of the GHQ-30 was 0.93. The Kappa coefficient was 0.64 (p<0.001).
Conclusion: This study showed the Malay version GHQ-30 is a valid and reliable screening tool in detecting distressed medical students. The GHQ-30 score equal to or more than 6 was considered as significant distress. The GHQ-30 showed a good level of agreement with M-BDI in detecting distressed medical students.
Keywords: Kelantan; Malaysia; medical student
Objective: This paper describes the patterns of professional identity development (PID) among
medical graduates of a SPICES (i.e., Student-centred/teacher-centred; Problem-based/information
gathering; Integrated/discipline-based; Community based; Elective/uniform; and Systematic/
apprenticeship-based) curriculum implemented by the School of Medical Sciences, Universiti Sains
Malaysia (USM). Methods: The phenomenological study design evaluated 50 medical graduates of
USM who underwent housemanship at government hospitals in the Peninsular of Malaysia. Focus
group interviews (FGI) were conducted to explore and capture the experience of the participants
in relation to PID during medical training. Eight FGI sessions were conducted at a specific place
as agreed by both researchers and participants. A thematic analysis technique assisted by Atlas.ti
software was used to analyse the qualitative data. Results: The thematic analysis revealed that there
were two themes: self-development and professional development. The self-development theme was
represented by four categories: self-confidence, internal and external motivation, communication skills,
and problem solving. The professional development theme was represented by five categories: social
adjustment, leadership skills and management, team work, hands-on skills, and creativity. Conclusion:
The formation of professional identity among USM medical graduates was related to self-development
and professional development. This suggests that the USM medical curriculum is vital in shaping
professionalism attributes among its medical graduates that are balanced among knowledge, skills,
behaviours and values. Producing balanced medical graduates will ensure the highest quality of
healthcare sevices provided to the country. The implications of this study and recommendations are
discussed.
Anatomy is an important knowledge for medical practice. Insufficient anatomy knowledge leading to errors in identification of anatomical structures during medical practices has been reported in many countries. Many medical students seem to have difficulties in learning anatomy and retaining the knowledge for future practice, thus this might reflect the possible flaws in anatomy education. In order to achieve optimum anatomy education environment and to close the gaps in education, measuring the students' perception on anatomy teaching and learning is a pre-emptive measure needed by educationists. At present, there is no valid and reliable inventory available to specifically evaluate the anatomy education environment. Therefore, this article highlights the importance of having such inventory.
Universiti Sains Malaysia (USM) Attitudes toward Statistics (USM-AS) is a newly developed, selfadministered inventory for measuring attitudes toward statistics among postgraduate students. The
USM-AS consists of three factors (affect, cognition, and behavior) and 58 items. This study was
aimed to validate the USM-AS and provide evidence of its construct validity by investigating its
internal structure. This study consists of four validation studies, which were conducted consecutively
among postgraduate students (master’s degree and PhD students) in the medical and health sciences.
The revised USM-AS, consisting of three factors and 12 items, was found to have good construct
validity, which was demonstrated by good model fit, high factor loadings (0.62 to 0.92), high
construct reliability (0.84 to 0.89), good discrimination between factors and good test-retest reliability
(intraclass correlation coefficients = 0.63 to 0.82). However, validity was limited to postgraduate
students in the medical and health sciences in Malaysia. Further validation studies among
postgraduate students in other scientific fields are recommended to provide additional construct
validity evidence of the USM-AS.
Introduction: In Malaysian nursing education, concept mapping is not widely practiced among nurse
educators and students. Therefore, the researcher aims to develop and evaluate the impact of the
Rusnani Concept Mapping (RCM) protocol on academic achievement and clinical practices among
diploma nursing students. RCM is one of the teaching learning methods that specifies guidelines for
nurse educators to harmonise classroom and clinical setting methods. Method: RCM is a concept
mapping protocol guideline developed by the researcher and is validated with content and face validity
and the Delphi technique. The study design is quasi-experimental with two groups. The experimental
and control groups received education using RCM and the lecture method, respectively. Data were
analysed using descriptive and inferential statistics using paired t-tests. P values less than 0.05 were
interpreted as significant. Results: In the pre-test, the students taught using RCM had a mean
achievement score of 11.23 with and SD = 2.59, while at post-test, the mean achievement score was
13.19 with and SD = 1.71 and a mean gain score of 1.96. In contrast, students taught using lecture
method had a mean achievement score of 10.71 and SD = 2.23 in the pre-test and a mean score of
12.60, SD = 1.64 in post-test achievement with a mean gain score of 1.89. The post-test scores of the
experimental and control group were significantly different (t = 2.53, p < 0.05). The mean concept
mapping care plan score was 59.33 and 65.23, respectively, for the control group and experimental
group. The paired t-test revealed that there was a significant difference between experimental and
control groups, p value < 0.05. The result of students’ perceptions regarding concept mapping in the
experimental group showed as positive moderate with a mean score of 3.44. Conclusion: This study
provides additional evidence that RCM is instructionally valuable as a learning method and is an active
learning strategy for meaningful learning and motivating superior achievement in students.