Autonomy is widely accepted to be the third pillar of medical ethics. However, if it comes to refusal of life saving treatments, some extra considerations are necessary, especially if decisions are made by surrogate decision makers. Four cases of problematic decision making are presented here, followed by a discussion about the cultural and religious misconceptions about the rights of surrogate decision makers.
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
Background: Tertiary education environment has always been regarded as highly stressful to students. Medical training further adds to the already stressful environment. The stress of medical training was associated with negative consequences to the mental and physical health of medical students. We describe in this article a stress-management program known as the 'Medical Student Well-Being Workshop' in our medical school.
Methodology: The workshop was run over two half-days over a weekend. Prior to the workshop the society announced the workshop to the students and participation was voluntary. It was open to students from all years of the medical course except for first year students. A separate stress management workshop is planned for them.
Results: A total of 55 students participated in the workshop, out of which 55 (82%) were female students. The years of study were almost equally represented; 14 students (26%) from years two and three, 20 (37%) from year four and 6 (11%) from year five. All sessions were rated as highly useful; the lowest rated, the introduction session, obtained an overall usefulness rating of 3.73 out of the possible 5 (74.6%).
Conclusion: Medical Students Well-being Workshop is a promising intervention program in improving medical students' ability in managing stress. Perhaps similar approach can be considered relevant to be incorporated in other medical schools.
Professional behavior is an area of medical education that has long been of concern to medical educator. Professional behavior is one of the domains of the professionalism and it’s a behavior reflection of professionalism. But in spite of its perceived importance, until recently it has not been actively taught or reliably assessed. The purposes of this writing are:
1) To provide appropriate definition of professional behavior.
2) To identify characteristics of professional behavior.
3) To identify valid and reliable assessment tools to assess professional behavior.
Evaluating scientific quality of a journal is a notoriously cumbersome problem that so far no standard consensus. Preferably, scientific journals should be examined by real experts in the field and given scores on quality according to standard guidelines. Nevertheless, information scientists (i.e. scientometricians) have developed a diverse range of tools to examine scientific merits of scientific publications that mainly depending on various indexes that counting citations. The impact factor (IF) is commonly used to examine the visibility of a journal. It is the average number of citations a paper of a journal attracts in the two years following its publication.
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.
Introduction: Detecting sources of stress of medical students is important for planning wellness
program to improve their psychological wellbeing. One of instruments to detect the sources of stress
is the Medical Student Stressor Questionnaire (MSSQ). A systematic review was performed to find
out evidence to support its validity in term of content, response process, internal structure, relation
to other variables, and consequences. Method: The author planned, conducted and reported this
study according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses)
standard of quality for reporting meta-analyses. Systematic search was performed on EBSCOhost,
Scopus, Proquest, PubMed, Web of Science and Google Scholar databases. Result: The author
yielded 613 relevant articles based on search terms, 44 articles had used MSSQ, and after critical
appraisal, only 18 articles provided evidence to support validity MSSQ and thus were included in
the systematic review. Conclusion: This systematic review supports the validity of MSSQ in relation
to content, response process, internal structure, relations to other variables, and consequences of
its scores. MSSQ is a valid tool to detect sources of stress in medical students and its results can be
utilised as a guide to plan wellness program or intervention to improve medical students’ wellbeing.
Phy-Antastic is the pioneering horizontally-integrated pedagogy that adopts physiology-oriented
anatomy teaching. A decline in time allocation for basic medical sciences (BMS) modules triggers
the conflict of interests among educators. “Physiology-then-Anatomy” temporal synchronisation
(and therefore Phy-Antastic) facilitates deep learning. The five highlighted features of Phy-Antastic
are: (i) explicit declaration of learning outcomes and prerequisite knowledge as groundwork for
the forthcoming topics; (ii) explanation of subject-related glossary to improve comprehension;
(iii) elucidation of the related physiological mechanism to calibrate the learners into appreciating
the cardinal anatomical features; (iv) the creative utilisation of multimodal teaching aids to simulate
consolidated learning experience; (v) lesson was concluded by revisiting learning objectives, reflection
on principal inquiry questions and recapitulating fundamental elements. The strength of Phy-Antastic
depends on homeostatic teaching with rigorous educational outcome set-point and interdisciplinary
feedback mechanisms. Small group discussion, problem-based learning and technology-assisted
teaching can easily incorporate Phy-Antastic. Inertia among BMS educators in embracing
interdisciplinary collaborative teaching remains the institutional barrier to the implementation of
Phy-Antastic. This article proposes a prospective advancement in anatomical education for the
contemplation of educators.
Among most important aspects in conducting a clinical trial are random sampling and allocation of subjects. The processes could be easier if done with familiar software used for data entry and analysis instead of relying on other programs or methods. The objective of this article is to demonstrate random sampling and allocation using SPSS in step-by-step manners using examples most relevant to clinicians as well as researchers in health sciences.
Multivariate analyses depend on multivariate normality assumption. Although the analyses are available in SPSS, it is not possible to assess the assumption from the basic package. Statistical assessment of the normality is available in a specialized package, SPSS Amos, in form of Mardia's multivariate kurtosis. However, graphical assessment of the normality by chi-square versus Mahalanobis distance plot is not available in both of the packages. The aim of this article is to present the steps to construct the plot in SPSS in a point-and-click manner as expected by most SPSS users.
Introduction: Emotional intelligence (EI) is deemed an important aspect of being good medical doctors. Universiti Sains Malaysia (USM) Emotional Quotient Inventory (USMEQ-i) is an EI inventory in Malay language developed primarily as medical student selection tool in USM. Although it was already validated by exploratory factor analysis (EFA), EFA is considered insufficient evidence of construct validity, thus confirmatory factor analysis (CFA) was conducted. Objectives: To determine measurement model validity and construct validity of USMEQ-i among medical degree program applicants in USM by CFA. Methods: USMEQ-i data file for medical degree program applicants in USM for year 2010/2011 and 2011/2012 academic sessions were obtained from Medical Education Department in USM. A random sample of 512 cases was drawn from the data file. Of the sample, only 453 cases were valid study sample after preliminary data screening and assumption checking. CFA was conducted on the sample using maximum likelihood (ML) estimation with bootstrapping technique due to violation of multivariate normality assumption. USMEQ-i measurement model was proposed as a second-order EI factor with seven first-order factors of EI and a Faking Index (FI) factor, with correlation between second-order EI factor and FI factor. Results: The proposed model could not be fit into the study sample data. EI factors and FI factor had to be analyzed separately due to non-positive definite problem. After modifications to the model, CFA of EI factors were suggestive of two-factor model instead of the proposed seven-factor model. Consciousness, Maturity and Control (CoMaCt). CFA of FI factor maintained one-factor model and also valid in term of construct. Conclusion: The modified USMEQ-i, which consisted of separate EI and FI models, was proven to have valid measurement models and reliable constructs. It is considered to be suitable for use among applicants to medical degree program in USM. However, its use as medical student selection tool may require further research, especially how predictive USMEQ-i scores with real performance of medical students, generalizability of the inventory and its stability over time.
To ensure the reliability of manual blood pressure (BP) readings in a clinical trial, sources of error due to measurement must be reduced as much as possible. Apart from following standard procedure for BP measurement and ensuring good equipments, the measurement errors that come from the assessors themselves should be assessed. Objective: To demonstrate the use of two-way random effects, interactions absent, absolute agreement (Type A), single measures (Type 1) intraclass correlation coefficient (ICC) in the assessment of reliability of manual BP readings among assessors involved in a clinical trial using manual BP measurement, by using an interrater reliability study conducted by the authors as an example study. Methods: The steps involved in obtaining ICC in the study were discussed. Sample size given the number of assessors in the study was calculated. BP was measured using regularly maintained mercury sphygnomanometers, following recommendations by Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) for BP measurement in office setting. The outcomes were systolic and diastolic BP readings. A type of ICC, two-way random effects, interactions absent, absolute agreement (Type A), single measures (Type 1) ICC was chosen for the analysis and specifically discussed. Pre-requisite assumptions for ICC were meticulously checked and described. The interrater reliability for systolic and diastolic BP readings as expressed by ICC (single measure) were presented with confidence interval (CI). The ICCs obtained in the example study were discussed and concluded. The flaws of the study were also criticised. Results: The interrater reliability for systolic and diastolic BP measurements as expressed by ICC (single measure) were 0.87 (95% confidence interval [CI] 0.722, 0.956) and 0.77 (95% CI 0.560, 0.918) respectively. Conclusion: We demonstrated the steps required to obtain ICC. Since the use of manual BP measurement using mercury sphygmomanometer is still considered as gold standard of BP measurement, it is important that studies in which the BP outcome is measured using such method conduct interrater reliability studies properly.
For the purpose of teaching statistics, lecturers often rely on data from real studies, text book examples or painstakingly created datasets. The process of creating a dataset can be made easier with the utilization of PASW Statistics to generate random values. The objective of this article is to demonstrate the creation of data which are measured on continuous scale, using PASW Statistics menus and syntax.
One of the most common reasons why researchers seek help from statistician is sample size calculation. However despite the common believe that it only involves formula and calculation, researchers often ignore other aspects of research design that leads to proper sample size calculation. In this article, the author outlines basic steps toward sample size calculation. The author also introduces the logic behind sample size calculation for single mean and single proportion in simplified and less intimidating forms to those not statistically inclined.
Item analysis (IA) is commonly used to describe difficulty and discrimination indices of multiple
true-false (MTF) questions. However, item analysis is basically a plain descriptive analysis with
limited statistical value. Item response theory (IRT) can provide a better insight into the difficulty
and discriminating ability of questions in a test. IRT consists of a collection of statistical models that
allows evaluation of test items (questions) and test takers (examinees) at the same time. Specifically,
this article focuses on two-parameter logistic IRT (2-PL IRT) model that is concerned with estimation
of difficulty and discrimination parameters. This article shows how 2-PL IRT analysis is performed in
R software environment, guides the interpretation of the IRT results and compares the results to IA on
a sample of MTF questions.
Planning a validation study of a questionnaire or measurement tool requires consideration for testing
the validity and reliability aspects of the measurement tool. When it comes to the reliability aspect,
a number of commonly used statistical coefficients such as Cronbach’s alpha, intraclass correlation,
kappa and Pearson’s correlation coefficients would be considered to provide empirical evidence of the
reliability of the tool during the validation process. To ensure that the reliability is accurately assessed,
a researcher must consider the sample size requirement for the statistical analyses. In this article, I will
introduce a newly developed web-based sample size calculator, which includes the ability to calculate
the sample sizes of these four important coefficients. I will also show how to use the calculator for each
of the coefficients.
Introduction: In order to produce competent physiotherapy graduates with the generic attributes much sought after by the health care providers in the country, the higher education institution needs to ensure the educational environment of the school is positive. Students' positive perception of their educational environment would facilitate their learning experience to be more meaningful and relevant. Objective: The aim of this study was to measure physiotherapy students' perception of their educational environment at the School of Physiotherapy AIMST University and Kolej Sains Kesihatan Bersekutu Sungai Buloh and to identify the areas of concern for remedial measures. Method: This research was a cross sectional study consisting of two phases using both quantitative followed by qualitative methods. The DREEM inventory consisting of 50 items under 5 domains was circulated to all the students (N=158) from both schools (AIMST and KSKB). The item mean scored below 2.00 were considered as problem areas and it was explored further through focus group discussion (N=12) as a qualitative study. Result: The overall mean score on the 50 items was 132.84 (SD 19.22) out of 200. Students' Perception of Learning (SPOL) scored the highest 32.34 (SD 4.17) followed by students' perception of Atmosphere (SPOA) 30.63 (SD 4.84), Students Perception of Teachers (SPOT) scored 30.52 (SD 3.98),Students Academic Self Perception (SASP) scored 22.03 (SD 3.20) and the last domain Students' Social Self Perception (SSSP) scored the least 17.32 (SD 19.22).All the domains scored toward more positive side of the educational environment. Four items scored less than 2.00 and these items were explored further with focus group discussion. Students from both schools had similarities as well as differences in their views over the concerned areas. Conclusion: This study revealed important information regarding the low scored items. Overall the students from both schools perceived their schools positively. Implementing the remedial measures for the problem areas would further enhance the respective educational environment and thus provide a conducive place for physiotherapy students to excel in their academic endeavour.
Introduction: Metacognition is the awareness of knowledge how one learns in addition to what
one learns and to understand how a task will be performed. Metacognitive skill as self-assessment
is recognised as an important contributor to the development of critical capacity, reflective attitude
and autonomous life-long learning. Accurate, self-assessment of knowledge and skills is essential for
students to maintain and improve through self-directed learning. Objective: The objective of this
study was to explore, how well students’ evaluate their own level of understanding for lectures to
reflect their metacognitive skill that can be used in educational strategy to promote students’ personal
and professional growth. Methods: To assess the metacognition of the students, a questionnaire based
on three items was designed. All 60 (17 male and 43 female) preclinical, first-year medical students
were included in this study. The metacognition as planning, monitoring and evaluating the lecture was
judged through students’ response on 33 lectures in terms of understanding of knowledge, clearing
of misconceptions and presenting of a well prepared material respectively in the field of haematology
and parasitology. Metacognition as reflected in the lecture understanding level (LUL) score, lectures
preparation level (LPL) score and students question level (SQL) score was estimated for its correlation
with student’ achievement score in pre-clinical phase of MBBS program. Results: The data was
analysed for correlation between metacognition and overall students’ achievement scores and a
statistically significant correlation between LUL and multiple true false (MTF) of 268 (p = .039),
LPL and MTF of .282 (p = .029) as well as between SQL and MTF of .360 (p = .005) was compared
to poor correlation between LUL, LPL and SQL and the other three assessment tools (short essay
questions [SEQ], problem-based questions [PBQ] and objectively structured practical examination
[OSPE]) was found. Conclusion: The significant correlation of students’ metacognition and their
achievement score in classroom setting with MTF and poor correlation with SEQ, PBQ and OSPE is
attributed to multiple factors discussed in this study, imperative to students’ personal and professional
growth.
Food is considered as a social responsibility of caregivers to their children. It has cultural connotation for all races notwithstanding their background and religious belief; that social responsibility should not be separated even in terminally ill patients. We recorded a case scenario of a terminally ill child who faced difficult end of life with inability to take oral fluids or food due to mechanical obstruction of duodenum by the pelvic rhabdomyosarcoma. From cultural context, the physical act of giving food and fluids to a sick person is considered “a display of one’s affection”. It is understandable that, once the dying phase has reached, and the body starts to shut down, administering fluids may not be useful despite it is deemed necessary from cultural point of view. This case illustrates an ethical dilemma in managing a child with end stage metastatic disease with multiple systemic complications, compounded with futility of medical care and complex social circumstances. It is quite challenging for physicians and relatives to provide good end of life care to patients in palliative care setting. Ensuring good quality of care, quality of life and quality of death are paramount to avoid suffering and distress among the patients and family members.
The Ministry of Higher Education introduced the integrated cumulative grade point average (iCGPA)
system in 2016 as an aspiration to produce holistic and well-balanced graduates based on Malaysian
Qualification Agency’s (MQA) learning domains. In this article, we provide a comparison of iCGPA
with other established medical competency frameworks and share our experience in implementing
iCGPA in the medical faculty. Throughout the process, it was noted that medical educators require
several core competencies in order to successfully implement iCGPA in their courses. Two of the most
important core competencies are understanding the pedagogies of the 21st century (heutagogies,
paragogies, and cybergogies) and apprehending the concept of outcome-based education. On top of
the requirement of core competencies, there were also challenges in tailoring teaching and learning to
meet the requirement of the Industrial Revolution 4.0. We also describe in detail the benefits and other
challenges of iCGPA implementation in our faculty. We conclude this article with our recommendation
for successful iCGPA implementation in the future for the medical faculty.