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Fulltext Medical education research and the ethics of different publication models

Muhamad Saiful Bahri Yusoff, Monrouxe, Lynn

Education in Medicine Journal, 2014;6(3):54-57.
MyJurnal

Journal business models are basically classified based on the source of income to cover publication costs and in general there are two main journal business models which are the toll-access and open-access. These leading to a question that still remains around the ethics of publishing academic work across the different journal business models in terms of (a) editorial decision-making and (b) the dissemination of research that has not been appropriately peer-reviewed for quality and rigor. This paper discussed about these two areas based on the literature and the authors' observations.
Fulltext Item response theory for medical educationists

Wan Nor Arifin, Muhamad Saiful Bahri Yusof

Education in Medicine Journal, 2017;9(3):69-81.
MyJurnal

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.
Fulltext Experiences of the public on the services in emergency department: a qualitative study

Aung,Khin Thandar, Fatin Izzati Saiful Bahri

International Journal of Care Scholars, 2018;1(2):1-4.
MyJurnal

Objective: The purpose of this study was to explore the experiences of the public on the services provided in the Emergency Department (ED) of Hospital Tengku Ampuan Afzan (HTAA). Methods: An exploratory, descriptive design was used to understand public experiences on the services in the ED. Ten respondents who fit the inclusion criteria were selected using purposive sampling method during their visit to the ED. They were interviewed for 30 to 45 minutes and were audio-recorded with the permission of the participants. The general meaning and the tone conveyed by the respondents were determined through coding, descriptions, and the themes that emerged. Results: Four major themes emerged from the study including waiting time, ED staff, information regarding the ED, and expectation on the ED services. Conclusion: As a result, there is a need to improve the practices in the ED and a need for an awareness program on the real functions and services of the ED
Fulltext An overview of meta-analysis in health science

Samia Amin, Sayed Mahmud Saiful Amin

Malaysian Journal of Medical Research, 2017;1(2):28-37.
MyJurnal

Meta-analysis is a subset of systematic review; a technique for systematically combining pertinent qualitative
and quantitative study data from numerous selected studies to broaden a single conclusion that has more
statistical power. This inference is statistically stronger than the analysis of any single study, due to increase
numbers of topics, greater variety amongst subjects, or collected effects and outcomes. The aim of this review
article is to highlight the definition, history, purpose, characteristics, use, advantage, disadvantage, validity,
and steps in conducting meta-analysis.
Pore interconnectivity analysis of porous three dimensional scaffolds of poly (3-Hydroxybutyric Acid) (PHB) and Poly(3-Hydroxybutyric-co-3-Hydroxyvaleric Acid) (PHBV) through non-invasive color staining method

Athanasios Mantalaris, Alexander Bismarck, Saiful Irwan Zubairi

Sains Malaysiana, 2015;44:1351-1356.

Polyhydroxyalkanoates (PHAs) has been investigated for more than eighty years. Ever since then, the scientists are kept on synthesizing and developing new polymers and application to suit human interests nowadays. The resourcefulness of PHAs has made them a good candidates for the study of their potential in a variety of areas from biomedical/medical fields to food, packaging, textile and household material. In medical field (specifically in tissue engineering application), producing a biocompatible 3-D scaffold with adaptable physical properties are essential. However, to the best of our knowledge, scaffolds from PHB and PHBV with thickness greater than 1 mm have not been produced yet. In this work, PHB and PHBV porous 3-D scaffolds with an improved thickness greater than 4 mm was fabricated using conventional method of solvent-casting particulate-leaching (SCPL). A preliminary assessment on the improved thickness 3-D scaffolds was carried out to examine its pore interconnectivity by using non-invasive color staining method. The vertical cross sections image of the stained scaffolds was analyzed by image analyzer software. This technique was considered simple, fast and cost effective method prior to the usage of super accurate analytical instruments (micro-computed tomography). The results showed that over 80% of the pores have been interconnected with the adjacent pores. Moreover, there was a good correlation between the predicted pore interconnectivity and porosity. These results indicated how well a simple technique can do by giving an overview of the internal morphology of a porous 3-D structure material.
Fulltext Physical, rheological and textural characterization of herbal seasoning enriched with oyster mushroom (pleurotus sajor-caju) powder

Saiful Bahri, S., Wan Rosli, W. l.

International Food Research Journal, 2017;24(4):1445-1452.
MyJurnal

The influence of oyster mushroom (pleurotus sajor-caju, PSC) powder on the physical
properties of herbal seasoning (HS) was investigated. The pH, total solid, viscosity, rheology
and texture of semi solid HS containing different PSC powder level (0%, 20%, 40%, 60%,
8%, 100% w/w) of coconut milk powder were measured. The pH of the products were in the
range of 4.05 - 4.15. Rheological behavior was characterized by oscillatory rheometry. Stress
sweep, frequency sweep and steady stress experiments were conducted to study the behavior
of the products. The products showed non Newtonian characteristic or shear thinning. All
samples were G’> G’’ showed the gel like network. In addition, the back extrusion rig texture
analysis showed the correlation among the samples were also studied. Total substitution of PSC
powder (100% w/w) in the formulation resulted more viscous product and the combination
of the coconut milk powder and PSC powder showed the best spreadability and flow to the
product characteristics. No added PSC powder (0% w/w) showed the least viscous products
and the less moduli among the samples studied. The present study suggested the incorporation
of more than 40% PSC powder to replace coconut milk powder give better flowability and not
affect the viscosity of the products.
Fulltext Simplified Thematic Engagement of Professionalism Scale (STEPS): promoting feedback practice in nurturing professionalism

Nurhanis Syazni Roslan, Muhamad Saiful Bahri Yusof

Education in Medicine Journal, 2017;9(1):87-97.
MyJurnal

Assessment of medical professionalism is often challenged by the subjectivity of its construct and
lack of feedback practice to nurture professional growth. However transmitting professionalism alone
has not been shown to improve professional behaviour therefore professionalism need to be assessed
if it is viewed as relevant. The authors provided description and guidelines on the use of Simplified
Thematic Engagement of Professionalism Scale (STEPS) as summative and formative assessment
tool for assessing professionalism attributes. STEPS was developed based on the Professionalism
Mini-Evaluation Exercise (P-MEX) format that utilise multiple short encounter assessment and
incorporated professionalism values from a local study. The formative component has 15 attributes
that were categorised into personal, profession, patient and public. This is assessed using seven scale
rubric that promotes feedback practice using feed up, feed back and feed forward concept. The
summative component utilises global rating that will be collated longitudinally to form a more robust
evaluation of student professionalism. Current investigations are ongoing especially to ascertain the
usability and validity of STEPS as peer assessment and self-assessment tool.
Discrepancy-agreement grading provides feedback on rater judgements

Yusoff MS

Med Educ, 2012 Nov;46(11):1122.
PMID: 23078712 DOI: 10.1111/medu.12057
Psychometric properties of DREEM in a sample of Malaysian medical students

Yusoff MS

Med Teach, 2012;34(7):595-6.
PMID: 22489970 DOI: 10.3109/0142159X.2012.675104
Isolation, complete amino acid sequence and characterization of a previously unreported post-synaptic neurotoxin - AlphaN3, from the venom of Bungarus candidus

Karsani SA, Othman I

Biochem Biophys Res Commun, 2009 Nov 13;389(2):343-8.
PMID: 19728988 DOI: 10.1016/j.bbrc.2009.08.145

The Malayan krait (Bungarus candidus) is one of the medically most important snake species in Southeast Asia. The venom from this snake has been shown to posses both presynaptic and post-synaptic neurotoxins. We have isolated a previously uncharacterized post-synaptic neurotoxin - alphaN3 from the venom of B. candidus. Isolation of the toxin was achieved in three successive chromatography steps - gel filtration on a Sephadex G75 column, followed by ion exchange chromatography (Mono-S strong cationic exchanger) and a final reverse-phase chromatography step (PRO-RPC C18 column). Purified toxin alphaN3 was shown to have an apparent molecular weight of approximately 7 to 8 kDa on SDS-PAGE. The complete amino acid sequence of toxin alphaN3 was determined by Edman degradation and was found to share a high degree of homology with known post-synaptic neurotoxins (93% with alpha-bungarotoxin from Bungarus multicinctus, 50% with alpha cobratoxin from Naja kaouthia). The intravenous LD(50) of toxin alphaN3 was determined to be 0.16+/-0.09 microg/g in mice which is comparable to alpha-bungarotoxin from B. multicinctus. Experiments with isolated nerve-muscle preparations suggested that toxin alphaN3 was a post-synaptic neurotoxin that produced complete blockade of neuromuscular transmission by binding to nicotinic acetylcholine receptors.
Comparison between Personality, Emotional, and Educational Outcomes of Multiple Mini Interviews and Personal Interview

Yusoff MSB

Oman Med J, 2020 Nov;35(6):e199.
PMID: 33214913 DOI: 10.5001/omj.2020.90

Objectives: This study investigated the outcomes of multiple mini interviews and personal interview on personality traits, emotional intelligence, perceived educational environment, and stressors.
Methods: This is a comparative cross-sectional study on two cohorts of pre-clinical medical students who were selected by multiple mini interviews and personal interview, respectively. Their personality traits, emotional intelligence, perceived educational environment, and perceived stressors were measured using different measurement tools.
Results: Multiple mini interviews and personal interview demonstrated a similar ability to recruit medical students with a high level of emotional intelligence. The main advantage of personal interviews over multiple mini interviews in terms of personality traits is that it recruited candidates who had a higher level of conscientiousness trait. The main advantage of multiple mini interviews over personal interview on the educational environment is that medical students chosen by multiple mini interviews had a higher level of satisfaction with social aspects of medical training. Regardless of admission processes, the medical students were equally vulnerable to psychological distress due to various stressful events throughout medical training particularly related to academic loads.
Conclusions: This study provided evidence to support the outcomes that multiple mini interviews and personal interview have on medical students' emotional intelligence, personality traits, perceived educational environment, and perceived stressors during the pre-clinical medical training. Interestingly, personal interview had a better outcome on conscientiousness while multiple mini interviews had a better outcome on the social aspect.
Fulltext Management of phosphate abnormalities in hemodialysis patients: Findings from Malaysia

Mohamed Koya SNM

Saudi J Kidney Dis Transpl, 2019 6 30;30(3):670-677.
PMID: 31249232 DOI: 10.4103/1319-2442.261343

Studies have shown that the mean or median phosphate levels were related to certain factors although applying this finding into the clinical setting is challenging. In this study, we attempted to determine treatment characteristics for patients with end-stage renal disease (ESRD) on maintenance hemodialysis (MHD) having hyperphosphatemia or hypophosphatemia in comparison with those with normal phosphate level. This was a cross-sectional survey conducted at HD units of Central Pahang Cluster Hospitals, Malaysia, in April 2017 involving 110 ESRD patients on MHD. About 40% of the study patients had normo-or hyperphosphatemia. As many as 84.5% (n = 93) of our patients were prescribed calcium carbonate (CC); the phosphate level was not affected by phosphate binder (PB) adherence. None of our patients received more than one type of PBs. Although there were no significant differences in any factors between normo- and hyperphosphatemic patients, 64% (n = 28) of the hyperphosphatemic patients did not receive the recommended maximum PB dose. In addition, 42% (n = 30) of patients with normo- and hyperphosphatemia prescribed CC received more than the recommended daily elemental calcium. On the other hand, our hypophosphatemic patients tended to be significantly older and had lower HD duration compared to normophosphatemic patients. No other significant differences were found in medication factors between normo- and hypophos-phatemic patients. There is potential to maximize phosphate control in hyperphosphatemic patients in Malaysia by maximizing PB therapy. On the other hand, proactive supervision is required in caring and prescribing for hypophosphatemic patients, especially the older patients.
Fulltext Development and validation of the knowledge and clinical reasoning of acute asthma management in emergency department (K-CRAMED)

Mohd Muzammil Ozair, Kamarul Aryffin Baharuddin, Saiful Azlan Mohamed, Wafaak Esa, Muhamad Saiful Bahri Yusof

Education in Medicine Journal, 2017;9(2):1-17.
MyJurnal

Suboptimal management of asthma can lead to increase morbidity and mortality. Unfortunately, this has become global issue and approximately 40% of asthmatic patients received suboptimal management in emergency department. Therefore, this study aimed to develop a tool to assess knowledge and clinical reasoning of healthcare providers on acute asthmatic management in emergency setting.
Method: The tool was developed via three phases: (a) domain identification, (b) domain blueprinting based the Global Initiative of Asthma (GINA) and the British Thoracic Society (BTS) guidelines, and (c) item generation for each domain for assessing knowledge and clinical reasoning. Three forms of validity evidence related to content, response process and internal structure were appraised. Content validity index (CVI), face validity index (FVI), and intraclass correlation coefficient (ICC) estimate the content validity, response process and internal structure of the tool.
Results: A new tool was developed, named as Knowledge and Clinical Reasoning of Acute Asthma Management in Emergency Department (K-CRAMED), which assesses knowledge and clinical reasoning on three domains related to management of acute asthma – diagnosis, treatment and disposition. CVI values for the three domains were more than 0.83. FVI values for the three domains among doctors and paramedics were at least 0.83. The ICC between scores given by emergency specialists was 0.989 (CI 95% 0.982, 0.994, p-value < 0.001).
Conclusion: The newly developed tool, named as K-CRAMED, is a valid tool to assess knowledge and clinical reasoning of healthcare providers who manage patients with acute asthma. Further validation is required to verify its validity in other setting.
Niche separation in flycatcher-like species in the lowland rainforests of Malaysia

Mansor MS, Ramli R

Behav Processes, 2017 Jul;140:121-126.
PMID: 28438691 DOI: 10.1016/j.beproc.2017.04.010

Niche theory suggests that sympatric species reduce interspecific competition through segregation of shared resources by adopting different attack manoeuvres. However, the fact that flycatcher-like bird species exclusively use the sally manoeuvre may thus challenge this view. We studied the foraging ecology of three flycatcher-like species (i.e. Paradise-flycatcher Terpsiphone sp., Black-naped Monarch Hypothymis azurea, and Rufous-winged Philentoma Philentoma pyrhoptera) in the Krau Wildlife Reserve in central Peninsular Malaysia. We investigated foraging preferences of each bird species and the potential niche partitioning via spatial or behavioural segregation. Foraging substrate was important parameter that effectively divided paradise-flycatcher from Black-naped Monarch and Rufous-winged Philentoma, where monarch and philentoma foraged mainly on live green leaves, while paradise-flycatcher foraged on the air. They also exhibited different foraging height preferences. Paradise-flycatcher, for instance, preferred the highest studied strata, while Black-naped Monarch foraged mostly in lower strata, and Rufous-winged Philentoma made use of the lowest strata. This study indicates that niche segregation occurs among sympatric species through foraging substrate and attack manoeuvres selection.
Fulltext The sensitivity, specificity and reliability of the Malay version 30-item General Health Questionnaire (GHQ-30) in detecting distressed medical students

Yusoff MSB

Education in Medicine Journal, 2010;2(1):12-21.
MyJurnal

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
Fulltext Professional behaviour: what does it means?

Yusoff MSB

Education in Medicine Journal, 2009;1(1):1-5.
MyJurnal

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.
Fulltext Scientometric properties of education in medicine journal

Yusoff MSB

Education in Medicine Journal, 2014;6(3):1-4.
MyJurnal

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.
Fulltext Which personality traits have favourable impact on psychological health during stressful condition?

Yusoff MSB

Education in Medicine Journal, 2018;10(1):35-42.
MyJurnal

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.
Fulltext A systematic review on validity evidence of Medical Student Stressor Questionnaire

Yusoff MSB

Education in Medicine Journal, 2017;9(1):1-16.
MyJurnal

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.
Fulltext Foraging niche segregation in Malaysian babblers (Family: Timaliidae)

Mansor MS, Ramli R

PLoS One, 2017;12(3):e0172836.
PMID: 28253284 DOI: 10.1371/journal.pone.0172836

Tropical rainforests are considered as hotspots for bird diversity, yet little is known about the system that upholds the coexistence of species. Differences in body size that are associated with foraging strategies and spatial distribution are believed to promote the coexistence of closely related species by reducing competition. However, the fact that many babbler species do not differ significantly in their morphology has challenged this view. We studied the foraging ecology of nine sympatric babbler species (i.e., Pellorneum capistratum, P. bicolor, P. malaccense, Malacopteron cinereum, M. magnum, Stachyris nigriceps, S. nigricollis, S. maculata, and Cyanoderma erythropterum) in the Krau Wildlife Reserve in Peninsular Malaysia. We investigated; i) how these babblers forage in the wild and use vegetation to obtain food, and ii) how these trophically similar species differ in spatial distribution and foraging tactics. Results indicated that most babblers foraged predominantly on aerial leaf litter and used gleaning manoeuvre in intermediate-density foliage but exhibited wide ranges of vertical strata usage, thus reducing interspecific competition. The principal component analysis indicated that two components, i.e., foraging height and substrate are important as mechanisms to allow the coexistence of sympatric babblers. The present findings revealed that these bird species have unique foraging niches that are distinct from each other, and this may apply to other insectivorous birds inhabiting tropical forests. This suggests that niche separation does occur among coexisting birds, thus following Gause' law of competitive exclusion, which states two species occupying the same niche will not stably coexist.

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