Background: Problem based learning (PBL) is both a constructivist pedagogic philosophy and an
instructional format for promoting contextual, co-operative and self-directed learning; it is traditionally
conducted as face-to-face tutorials. This study explored the utility of the live online chat application
Google Hangouts, which we refer to as LOVE-PBL, for running synchronous PBL tutorials that
included participants in different locations. Method: Data were collected from student participants
using a mixed-methods approach, comprising a self-administered questionnaire and focus groups.
We evaluated student participants’ perceptions of their learning experience and the effectiveness
of online PBL via Google Hangouts. Results: More than 70% of participants agreed that learning
outcomes were met using the Google Hangouts platform, and 50% felt that the ability to record the
sessions was useful for learning and reflection. The major factors for effective online PBL were reliable
internet connectivity, a conducive environment, and technical familiarity with the chat application
and its functionality. Conclusion: Although online discussions do not fully equate to face-to-face
conversations with regard to utility and enjoyment, learning outcomes are not compromised. Online
chat applications thus extend the utility of PBL, and their use adds to the accessibility, flexibility and
convenience that learners expect of higher education in a digital age.
Psychosocial issues have been seen as minor in medicine despite the importance for holistic medical
care involving emotional, spiritual and psychological domains. Most patients with chronic conditions
have complex and complicated psychosocial needs especially when dealing children with life limiting
conditions. These needs have a dynamic extension to patients’ care as their impact can also affect the
extended family members. Across the trajectory of the illnesses, the pattern of psychosocial needs
changes and, this demands attending physicians to perform accurate psychosocial assessment and
understanding issues from patients and caregivers perspective. Non-judgmental decision making
is essential to avoid friction and misunderstanding between the healthcare providers and caregivers
especially during the consultative process. Resolving psychosocial issue may involve various techniques
from moral support, bridging the services to helping the family, counseling on relationship issues and
many other areas. There is a need to equip healthcare workers with different skills in order to deliver a
better psychosocial care and input even after the bereavement period.
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.
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.
Disease trajectory in children can be difficult to determine. This is primarily, despite the life limiting condition, healthcare professionals are unable to pin the exact time when these children’s lives will end. We illustrate an unusual case of dicephalic parapagus, an inseparable conjoined twin which was complicated by anomalies, psychosocial and safeguarding issues. Such case posed a challenge even to paediatric palliative care team as the trajectory of the disease, in this case, is rather difficult to predict. Anticipatory symptoms management perhaps is the best way forward, despite having to face many ethical challenges and medical enigma.
Introduction: Investigation on spiritual issue in healthcare practice received less attention. Muslims valued pray activity or known as salat as one of the important daily activity. However, negligible study is available on salat as the end goal of occupational therapy intervention. This study aims to investigate the awareness and the impact of Muslim-culture on occupational therapists in Malaysia. Methods: A cross-sectional survey study was conducted via internet-based and manual paper-and-pencil survey throughout occupational therapists in Malaysia. Descriptive and inferential statistics using percentage, Cronbach’s alpha and Chi-square was implemented on the findings. Results: In total, 119 occupational therapists responded. The questionnaire has overall internal consistency ofα = 0.74. Occupational therapists have positive perceptions on spiritual activity but poorly translated into service implementation and faced challenges. Factors such as level of education, years of experience, religion, working location and work setting were significant on the awareness, perception, practice and challenges. Cultural-based practice is challenging for occupational therapy even in the majority-practice context. Occupational therapists should differentiate between belief and activity in spiritual issue to provide a better assistance for the clients. Conclusion: This study showed continuing education is desired to drive the occupational therapy profession for a better cultural-sensitivity service delivery.
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.
Introduction: Crime is an immoral act capable of tearing the well-being of society and the nation. Various factors have been accredited as potential factors for crime engagement for example natural inclination, nurture or a combination of these factors. Within the domain of natural inclination, lack of self-control is often viewed as the primary cause of crime and delinquency. However, there are no valid and reliable Malay language psychometric instruments to measure the level of self-control among Malaysians.
Objective: The aim of this study was to validate the Self Control Scale (SCS) for use among Malay speaking populations. Henceforth the Malay language version is identified as SCS-M.
Method: A cross-sectional study was carried out on 150 inmates incarcerated within two prisons in Peninsular Malaysia in June 2012. Forward and Backward translations of the original SCS were carried out followed by content and face validation processes. Exploratory factor analysis and Cronbach's Alpha reliability analysis were performed.
Result: Both content and face validation processes showed promising and good outcomes. Preliminary analysis for factor analysis supported factorability of the items. The factor loadings of SCS-M items did not correspond to the original six SCS dimensions. Since SCS is often administered as a unidimensional scale, a forced one factor analysis was performed and items with factor loadings exceeding 0.3 were retained. The result of internal consistency reliability of SCS-M demonstrated a good Cronbach's alpha value of 0.80.
Conclusion: The findings supported that SCS-M is a valid and reliable unidimensional scale to measure the level of self-control among Malay speaking populations. It is anticipated that the emergence of SCS-M is vital for self-control assessment, treatment, and rehabilitation purposes.
Introduction: In Malaysia, the concept of Interprofessional Learning is not yet established, however it has begun to develop over the past few years.
Methods: Three scenarios were developed for undergraduate students from medicine, nursing and emergency medicine; Acute Myocardial Infarction (AMI), Chronic Obstructive Pulmonary Disease (COPD) and trauma. The Interprofessional Learning Package (IPLP) adopted scenario - based learning and hybrid simulation; mannequin and simulated patient which focused on patient management. Each session employed experiential, interactive and contextualised sessions. The created learning sessions required the students to work in a small interprofessional team. The IPLP was validated by a panel of experts.
Results: Content analyses were carried out for analysing the strategies that were performed during the development process. Focused group discussion showed that nursing students had positive views towards interprofessional learning. Document analysis on the curriculum showed that there were loopholes where the programmes needed to improve and expose students to interprofessional learning in order to achieve the faculty learning outcomes. Literature review gave an idea on the creating of the scenario and panel experts’ input was also important as it reflected the created scenarios which were common sense and logically designed.
Conclusion: This study managed to developed the Interprofessional Learning (IPL) package with simulation and scenario approached which can encourage students to learn with, from and about other programmes as well as managing a patient as a team.
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.
ntroduction: In the marking of objective structured clinical examination (OSCE), checklist scoring and global rating are two commonly used scoring systems. Objective: The purpose of this study was to examine correlations between checklist scores and global ratings for four OSCE stations of different station type. Method: Data for this study was obtained from the Final Year OSCE (n=185). Each station’s score sheet consisted of a detailed checklist of items examined. A global rating scale was also included for the examiner to indicate the global assessment for the station. Spearman’s rho correlation coefficients between checklist scores and global ratings were computed for four stations of different station type. For each station, correlations between checklist scores and global ratings were also checked across the three parallel circuits running concurrently and throughout the four rounds. Result: Spearman’s rho correlation coefficients (ρ) between checklist scores and global ratings for the four stations ranged between 0.62 to 0.88, at p
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: The weekly held clinical pathologic case conference popularly known as CPC provides an effective and regular educational media of collaborative learning for inter-disciplinary exchange of knowledge among the faculty members of an institution. CPC has been routinely practiced for the last two decades in School of medical Sciences (SMS) at Universiti Sains Malaysia (USM). An hour session primarily involves a case presentation hiding the diagnosis followed by discussion on differential diagnosis and floor interaction on interesting clinical cases. It also gives an opportunity to new teaching staff in the institution to experience an in-house practice of presenting the clinical cases; witch can readily be reproduced as a case report for publication. An effort to follow the original format of CPC is comprehended as an essential outcome of this study to keep up the sanctity of CPC as a case method of learning medicine in future. Methodology: A questionnaire-based survey was recently conducted to evaluate the weekly held CPC in SMS. It was a cross sectional survey in which a questionnaire comprising of 23 items was administered to a targeted population of faculty members of School of Medical Sciences. The items in questionnaire were grouped into 5 clusters. All respondents were adequately briefed through a letter addressing the objectives and importance of survey and its appraisal aiming to revamp the CPC guided by the out-come of study. Questionnaires were administered to 240 academic staff, covering > 80% of the target population of 294 faculty members. 159 (66.2%) members of sample population completed the questionnaires. Total non-responses were 81 (33.7%) and item non-responses were 320 (8.7%) Result: All the items in questionnaire were found significant (p 0.016) except those two items related to, observing a difference in preparing for a case presentation verses a formal CPC presentation and its promotion (p 0.556 and 0.197 respectively). It was also established that the major respondents were unaware of the original format of CPC (p 0.003) in which a presenter select and prepares a case, which is discussed with participating faculty members for its differential diagnoses. 51.6% faculty members did not follow the formal CPC format (p 0.016) in their presentations. A lack of awareness about the format of CPC was shown by (61.0%) faculty members (p 0.003). Conclusion : It was concluded that emphasis to discuss the differential diagnosis by a competent discussant was lacking, as presenters did not follow the formal CPC format. It was critically observed that a number of presentations made in this weekly program deviate from the original format adapted by SMS in USM. However, the out-come appraisal of this survey was the pledge shown by the majority faculty members to adapt the guidelines as a reverence to the formal CPC format.
Immediate feedback assessment technique (IF-AT) are self-scoring answer sheets, based on the
concepts of immediate feedback for choosing the correct answer in multiple choice questions (MCQs)
during group readiness assurance tests (GRATs) in team-based learning (TBL). IF-AT scratch card
system rewards a student with partial credit for proximate knowledge. This technique motivates
students to pursue learning with just-in-time feedback and gives them the opportunity for collaborative
learning and analytic reasoning among group members. A rubric for partial credit is decided pre-hand
depending upon the number of options used in MCQs. In this study, we assessed students’ perception
about immediate feedback assessment technique before and after the training. To determine students’
perception of the IF-AT scratch card system in instruction and assessment. Students perceptions
about the IF-AT system has been explored using a 25-item questionnaire administered to 60 students
assigned randomly to control and training groups using pre-test and post-test analysis. Paired-sample
t-test and independent-sample t-test statistics were employed and the data was analysed. Descriptive
statistics observed for mean (SD) was found greater in trained group = 58.48 (4.87) vs. control group
= 66.43 (5.81) with t-statistics significant at p = < 0.001. A significant difference in mean (SD) of
pre-test minus post-test scores (5.16) of control and trained group = 5.37 (4.85) and 10.53 (8.36)
respectively was also found with independent t-test analysis. It was found highly significant with
t = –2.92, p < 0.05 and the effect size of 78.1%, established by Cohen’s d criteria. The IF-AT system
provides an individualised and instantaneous instruction as feedback in an assessment, which is
marked with collaborative learning as in team-based learning. The IF-AT system promotes analytic
reasoning with problem solving skills through partial credit for proximate knowledge. Students’
perceive the concept of immediate feedback and partial credit for proximate knowledge as the most
important features of the IF-AT scratch card system.
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
Breaking bad news is a crucial communication delivered by healthcare professionals. This skill was
taught in Management and Science University, Malaysia using lecture previously. Realising the
instructional delivery gap, breaking bad news workshops was introduced involving not only the theory
of the skills but the hands on experience as well. This workshop incorporated peer-assisted learning
method in providing a friendly and conducive environment for the best learning experience for the
students. Five workshops were conducted with a total of 204 students. Students (n = 38–42 per
session) were given materials a week prior to the session to familiarise themselves with the workshop.
Trained peer-assisted tutors (n = 8) guided role-playing sessions as well as giving feedbacks. Students
found that the workshop to be useful adjunct to learning communication skills, specifically in breaking
bad news. Students considered peer-assisted learning method provided them with a safe environment
where mistakes were allowed, corrected and proper skills reiterated. In conclusion, learning breaking
bad news is feasible with peer-assistance.
Workplace learning is essentially informal that is unstructured, unintended and opportunistic from educational view point. Recall of factual knowledge and applying skills is central in workplace so learning becomes meaningful and evidence based. To maximise their learning, the learners must take active participation in their own learning, set goals and march towards achieving these goals. The objective of the teacher at this juncture is obliging to the needs of the learners and of the patients. This review aims to address the teaching and learning theories that impact the workplace learning, factors influencing workplace based learning, identifying opportunities for learning to occur parallel with work and strategies that maximise successful workplace learning.
Medical education in Malaysia is facing challenges related to the increasing number of local private
and foreign medical universities. The key issue is whether the system is producing doctors who have
adequate competencies for fundamental patient-centred care. The Malaysian Medical Licensing
Examination (MMLE) was proposed by the Ministry of Health (MOH) as a common licensing
examination for which all graduates must sit prior to obtaining registration to practice. Currently, this
exam is only taken by Malaysian students graduating from foreign medical colleges. However, the local
Malaysian universities, both public and private, have different curricula for preparing undergraduates
for future housemanships. The question is whether the educational programs of these universities
are robust enough in delivering curricula that produce safe and competent doctors. Moving forward,
it must be determined whether there is a need for extending the Malaysian Medical Licensing
Examination (MMLE) to all graduates of both local and foreign medical universities, thereby creating
a marker of excellence by which to measure Malaysian education and practice.
Context: Question vetting is important to ensure validity, reliability, and other quality indicators of assessment tools, including the MCQ. Faculty members invest a substantial amount of time and effort into the MCQ vetting process. However, there is shortage of scientific evidence showing its effectiveness and at which level it needs to be focused on. This study aimed to provide scientific evidence regarding the effects of question vetting process on students’ examination performance by looking at their scores and pass-fail outcomes.
Method: A parallel randomized control trial was conducted on third year medical students in a medical school. They were randomly assigned into two equal groups (i.e. control and experimental). Two mock examinations were conducted (i.e. time I and time II). At time I, non-vetted MCQs were administered to both groups as a baseline measurement. At time II, vetted MCQs were administered to the experimental group, while the same non-vetted MCQs were administered to the control group.
Results: Out of 203 students, 129 (63.5%) participated in both mock examinations. 65 students were in the control group and 64 students were in the experimental group. Statistical analysis showed no significant differences (p > 0.05) in mean examination scores and pass-fail outcomes between or within the control and experimental groups.
Conclusion: This study indicated that the MCQ vetting process did not influence examination performance. Despite these findings, the MCQ vetting process should still be considered an important activity to ensure that test items are developed at the highest quality and standards. However, it can be suggested that such activity can be done at the departmental level rather than at the central level.
Introduction: Just-in-Time Teaching (JiTT) is a novel method of teaching-learning used in various disciplines of science and humanities. It is a technique that scaffolds the students learning process by reducing the cognitive load which is the load related to the executive control of working memory. Just in time teaching underpins the concept that expertise in learning originates from the knowledge already stored in long term memory and with subsequent interaction between the learner and teacher motivates enhanced active learning and optimizes the intellectual performance.
Objective: The objective of the study is to assess the acceptability of JiTT over traditional lecture teaching among the medical students.
Method: In a cross sectional pilot study, three hundred thirty five students participated in a questionnaire based study that grades the various aspects of the traditional lecture series. After the implementation of JiTT method for a period of four months, three hundred two students completed the questionnaire, grading the same variables for JiTT. The analysis was done by using SPSS version 11 applying Paired t test and McNemar's Test.
Result: The results of our study highlighted that JiTT technique was perceived superior to traditional teaching with statistically significant outcomes in the clarity of the topic (p=0.003,) duration of the session (p=0.002), knowledge gained and orientation for exams (p=0.044). The students perceived JiTT method as less monotonous (p=0.005) increasing their alertness during these sessions (p=0.002).
Conclusion: We therefore propose that Just-in-Time Teaching method is a more interactive and acceptable teaching-learning tool shifting the nature of teaching to a more student-centric approach as perceived by the medical students. This is the first pioneer study on JiTT to be performed on undergraduate medical students so far.