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.
Recurrent respiratory papillomatosis (RRP) is a rare cause of childhood stridor which typically presents before the age of five years and results from the vertical transmission of the human papilloma virus. Genotypes 11 and 6 are commonly implicated in RRP. Following vertical transmission, the human papilloma virus (HPV) causes overgrowth of the airway epithelium which causes partial airway obstruction and the symptoms of stridor. The mainstay management is surgical debridement of the papillomata but the recurrence rate subsequent to surgery is high, such that most children will require repeated surgical procedures at regular interval. Medical adjuvant therapy can be used, but data is limited and the medications are used on an off-label basis. This case highlights the ethical considerations that need to be made when using off-label medications in paediatric patients.
Many researchers have emphasized the importance of teaching stress management and self-care skills to medical students as they are vulnerable to develop psychological health problems. The researchers designed a 4-hour intervention based on the DEAL model to address these problems. This study aimed to determine outcomes of the DEAL-based intervention on medical students’ stress, anxiety and depression symptoms. Methods: A randomized controlled trial study was conducted on 171 medical students. Their stress, anxiety and depression symptoms were measured by the 21-item Depression Anxiety Stress Scale at five intervals; at 2 weeks before the intervention, and at 1 week, 8 weeks, 16 weeks and 32 weeks after the intervention. The mixed model ANCOVA was applied to determine the effect of the intervention on the participants’ psychological health at five intervals. Results: A total of 153 medical students (intervention = 73 and control = 80) completed this study. Results showed that the intervention group experienced significantly lower stress and depression symptoms than the control group. Although anxiety scores are consistently lower in the intervention group, no significant differences between groups were found. Conclusion: These results support the favourable outcomes of the intervention on psychological health of medical students. It is a promising intervention to be considered by medical schools as it consumes minimal amount of time, money, training and man power as well can be implemented easily.
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: Ratings are known to have a generosity error, provide limited discrimination and distorted interpretation, and often fail to document serious deficits. A potential source of these problems is rater judgement. These problems compromise the capability of raters to maintain the standards of rating. The authors propose a simple grading system to improve this situation including providing feedback to raters. Method: The authors developed a grading system named the Discrepancy-Agreement Grade (DAG) to provide feedback on rater judgments. Dependent-t and intraclass correlation tests were applied to determine discrepancy and agreement levels of raters. Rater judgments were then classified into grades A, B, C or D. This grading system was tested in an examination and a student selection interview to assess rating judgments of examiners and interviewers. The purpose was to evaluate the practicability of the grading system to provide feedback on examiners’ and interviewers’ rating judgements. Results: in the examination, five short essays were rated by five pairs of senior lecturers. Out of 5 pairs, 2 (40%) obtained grade A and 3 (60%) obtained grade B. In the student selection interview, a total of 48 pairs of interviewers interviewed ten applicants. Out of 48 pairs, 20 (41.7%) obtained grade A, 1 (2.1%) obtained grade B, 23 (47.9%) obtained grade C and 4 (8.3%) obtained grade D. Conclusion: The grading system showed variability of rater judgments on medical students’ and applicants’ performance in an examination and interview session respectively. It provided feedback on the examiners’ and interviewers’ judgments on candidate performances. This exercise demonstrated practicability of the grading system to provide feedback on rater judgements.
The Delphi technique is a widely used and accepted method to obtain consensus among the
experts. This technique uses a judgement to prove the accuracy of the content item when evaluating
instrument. The objective of this study is to discuss the process of the three rounds Delphi technique
to obtain consensus of concept mapping care plan and multiple choice questions (MCQ) in Diabetic
Mellitus subject. In the first round, participants were given a structured questionnaire regarding item
of concept mapping care plan and MCQ in Diabetic Mellitus subject. In the second round, the mean
and median values of round one were added. In the third round, the mean and median values of round
two were added. Participants were asked to rate the categorised responses from Round 1 on a scale of
1 to 5, with 1 being “Very Irrelevant” and 5 being “Very Relevant”. This technique does not require
that participants be collocated or meet face-to-face, thereby making it useful to conduct surveys
with qualified people over a wide geographic area. The feedback process allows and encourages the
selected Delphi participants to reassess their initial judgements about the information provided in
previous iterations. The analysis of consensus data of the experts was done based on median, inter
quartile range and quartile deviation on round one, two and three data. The median score was used to
analyse the level of consensus of experts and result shows that in all three rounds Delphi the medium
result more than 4. It reported that level of importance of the statements were high. As a conclusion,
the concept mapping care plan and MCQ have meets the consensus by using three rounds of Delphi
techniques. Therefore, the Delphi technique is the best method to obtain consensus in health care
education research.
Objective: To determine the construct validity and the internal consistency of the Postgraduate Stressor Questionnaire (PSQ) among postgraduate medical trainees hence it could be used as a valid and reliable instrument to identify stressors among them.
Methods: Items of the PSQ were derived from a review of literature on the subject and a discussion with experts in the field. It comprised of 28 items with seven hypothetical groups. The content and face validity was established through discussion with experts from field of Medical Education and Psychiatry. It was administered to all participants (N = 34) of postgraduate personal and professional development programme in a Malaysian university. Data was analysed using Statistical Package Social Sciences (SPSS) version 18. Factor analysis was applied to test construct validity whereas reliability analysis was applied to test internal consistency of the PSQ.
Results: Thirty three postgraduate medical trainees participated in this study. Factor analysis found that the 28 items of the PSQ were loaded nicely into the seven pre-determined groups as their factor loading values were more than 0.3. The reliability analysis showed that the Cronbach's alpha value for The PSQ was 0.95. Whereas, The Cronbach's alpha values for academic, poor relationship with superior, bureaucratic constraints, work-family conflicts, poor relationship with colleagues, performance pressure, and poor job prospect domains were 0.63, 0.84, 0.81, 0.65, 0.73, 0.78, and 0.70 respectively.
Conclusion: This study showed that the PSQ is a reliable and valid instrument to identify stressors of postgraduate medical trainees. It is a promising instrument that can be used in future to explore further on this area.
Introduction: Bioethics subject which is part of the curriculum in higher education has a slightly different orientation compared to the science subjects. This study investigates the challenges of teaching bioethics subject to the health sciences students and the outcome of using mixed educational background classes in bioethics. Methods: Discussions among lecturers of bioethics were conducted to determine the possible challenges when teaching bioethics to the health sciences students who are accustomed to the format of science subjects. Results of written bioethics tests (multiple choice questions [MCQs] versus short essays) were also analysed among students from nine different health sciences background (biomedical sciences, nursing, speech pathology, dietetics, nutrition, medical radiation, audiology, sports science, and occupational safety and health) as a measure of the students’ understanding of the bioethics subject. Findings: The challenges of bioethics teaching were divided into five categorical themes; (i) attitude/discipline, (ii) background knowledge, (iii) reasoning/critical thinking, (iv) knowledge/jargon, and (v) diverse educational background. Excellence performances were demonstrated by the students across the ten disciplines in the direct MCQs while they did very poorly (p < 0.01) in the critical thinking short essay questions. Conclusions: Bioethics proof to be a challenging subject for the health sciences students as this subject deal with complex issues of ethical concerns which differ with most science subjects. Combined efforts of the educators and students are needed in order to address these challenges and stimulate the understanding of bioethics.
It is generally accepted that assessment is a single powerful tool that drives students’ learning.
However, assessment of anatomy subject in medical curriculum is disputable as it focusses more on
testing the low order thinking skills. In medical education context, it is of paramount importance to
align the assessment with the curriculum (i.e., learning outcomes) and teaching methods as to enhance
learning through a meaningful learning experience. Hence, the use of learning taxonomy should be
emphasised in designing a proper and suitable assessment for anatomy subject. Among the most
commonly used taxonomies in higher education, are the Bloom’s taxonomy, Miller’s pyramid, SOLO
taxonomy, Krathwohl’s taxonomy of affective domain, and Simpson’s psychomotor domain. However,
being a core basic medical subject with high cognitive input, it is often difficult to achieve contextual
learning in anatomy through application of these taxonomies. Therefore, with raising concern of lack
in the evaluation of higher order thinking skills, affective and psychomotor domains, the anatomy
assessment in modern medical curriculum have been improvised to address the aforementioned
issues. The modern form of assessment in anatomy facilitates the contextual learning with beneficial
attributes gained by students including better understanding of anatomy knowledge, synthesis of
anatomical concept, appreciation of the clinical importance of anatomy, increases communication
skills, and increase in the confidence level.
It is well established that accidental and non-accidental injuries/child abuse and neglect (CAN) are a
major public health problem globally. Not only do they affect individuals, injuries affect families, the
community, government and internationally as well. Injuries span throughout childhood and into
adulthood. Purpose of this study is to identify what are the difficulties and challenges in identifying
and reporting CAN cases at the emergency (ED) department in Malaysian hospitals. Thirty in-depth
interviews were conducted at the ED in three major hospitals in the Klang Valley, Malaysia which
consists of specialists, medical officers, nurses and medical assistants. The study found that there is a
significant gap identified in medical professionals’ knowledge and skills related to understanding,
identifying and detecting CAN, particularly among medical officers who are in charge of diagnosis and
reports in the hospital. Those who had previous experience or encounters in dealing with CAN cases
would have higher suspicion index compared to those who haven’t. Other medical professionals such
as nurses and medical assistants although do not have the mandate to diagnose or report of CAN cases,
needed to have the basic knowledge and awareness and play more active role in their respective settings.
Professionalism is considered as one of the most inspiring as well as challenging proficiency to teach and evaluate, because of its multifaceted and context-specific nature. This paper defines an orderly and useful escort on how to incorporate the problem-based learning (PBL) as a teaching and assessing modality, within a course of medical professionalism. While answering Harden’s 10 questions, course planners shall find this approach doable, allowing them to design and utilising this in an undergraduate medical education context. An enlightening approach, as this will prepare our students to be future professional doctors, equipped with all necessary professionalism attributes, in our fast varying professional environment.
Background: Recently many medical schools have incorporated Evidence Based Medicine (EBM) as part of their undergraduate teaching. The aim is to provide a firm base of EBM to the medical students early on, so that they can understand the importance of EBM. Medical schools are encouraged to teach EBM to students but yet the education setting, learner level, modes of instruction, skills covered and teaching methods are not standardised and varies worldwide. In Cyberjaya University College of Medical Sciences (CUCMS), EBM was incorporated in the curriculum since 2009. EBM concepts was taught formally to the MBBS students during four weeks Research and Evidence Based Medicine Course (REBM). Students were exposed to the various thinking processes, formulation of clinical questions, searching evidence, intermediate biostatistics, research methodology and critical appraisal. Besides that, Good Clinical Practice (GCP) and research proposal development also include in the course. The objective of this paper is to describe
CUCMS experience of teaching EBM for undergraduate medical students.
Methods: This report analysed students feedback using a questionnaire which included a Likert scale and open-ended questions.
Result: Overall, three batches of students gave positive feedbacks regarding the course with constructive suggestions on room for improvement.
Conclusion: From our first three years’ experience in conducting the course, we concluded that the four-week EBM course offered was practical in instilling EBM principles.
Lecturers are expected to teach effectively and evaluating their teaching effectiveness are essential to
ensure students get the best learning experience. A systematic evaluation of teaching behaviours with a
proper feedback mechanism will help to improve their teaching effectiveness. Improvement of teaching
effectiveness will result in better students’ learning experience, and thus attaining the intended
educational outcomes. This study aimed to evaluate teaching effectiveness among lecturers by
assessing their teaching behaviours during lectures. A cross-sectional study was conducted on lecturers
in a Malaysian public medical school. Their teaching behaviours were rated by 30 trained pre-clinical
medical students using Teacher Behaviour Inventory (TBI) on seven aspects – organisation, speechpacing,
clarity, enthusiasm, interaction, rapport, and disclosure. A total of 55 lecturers were rated
by the medical students. The organisation and speech-pacing aspects were highly rated as the mean
scores were 4.02 and 4.15, respectively. The clarity, enthusiasm, interaction, and rapport aspects
attained satisfactory level as the mean scores ranged from 3.10 to 3.59. The disclosure aspect was
poorly rated as the mean score was 2.20. Eventhough all lecturers in this school are considered expert
in their area, findings from this study suggest that some teaching behaviour need some improvement.
Findings from this study also provide useful data for the medical school to chart direction of faculty
development activities to improve their lecturers’ teaching effectiveness during lectures.
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.
The impact of good assessment in medical education depends on how appropriately the tools measure the clinical performance and how reliable, valid and feasible they are to achieve the logical decision. The traditional methods of clinical examination using long and short cases and orals are often argued for its subjectivity, low reliability and inadequate context specificity. Oral test though comparatively more valid due to its face-to-face questions are considered less reliable for problems of unstandardized questions, inconsistent marking and lack of sufficient testing time. Development of an “objective structured clinical examination” (OSCE) was sought as a solution to these problems. But the fragmented representation of the context in a number of stations in OSCE makes it less authentic for an integrated judgment of performance. Yet another method to thought of, was the workplace-based assessment (WPBA) but it takes a snapshot as a predefined attribute of a more complex integrated assessment such as long case. However due to the problem of feasibility it is less likely that high stakes examination as summative assessment will ever be able to attain workplace-based assessment such as Mini-CEX and DOPS. A TOACS (task oriented assessment of clinical skills) format currently used in high stakes fellowship examination in one of the center and claimed to have more active role for examiners was analyzed and compared with OSCE. Author however, did not find a difference except the difference of acronyms of the two formats. Both have multiple, fragmented static or interactive stations of 5-10 minutes duration with or without examiners, patients or exhibits and a marking scheme comprising of checklist or global rating. In the backdrop of this context a new assessment format named the ‘task integrated objective structured clinical examination” or TIOSCE modified from OSCE is currently developed in School of Medical Sciences (SMS) at USM. However, it is a different version of OSCE in which though the principle concept is the same as that of an OSCE, the continuum of clinical skill’s work up of the same patient’s is followed through to test multiple short attributes of clinical competences. As it retains most of the favorable features, TIOSCE also addresses some of the odds features of OSCE.
To address the diverse preferred learning styles, one of the oft-cited recommendations for educatorsis to tailor teaching instructions accordingly. This pedagogy however, lacks scientific evidences.Furthermore, in medical curriculum, tailoring instructions according to preferred learning styles isnot pragmatic. This is because different subjects and in different settings matter may be best deliveredin specific delivery mode. Furthermore, patients’ presentations are often multi-sensorial. As such, theonus is on the students themselves to adjust the amount of learning efforts they put in according totheir preferred or not preferred learning styles.
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.
Simulation-based medical education enables knowledge, skills and attitudes to be taught in a safe,
realistic manner. Flipped classroom teaching encourages self-learning. Emergency medicine exposes
students to diverse group of patients and physicians’ decision making. This study aims to determine
students’ perception on knowledge, skills and confidence after combined flipped classroom and
simulated teaching. Two cohorts of Semester 7 students Group 1 (n = 120) and Group 2 (n = 78)
completed a 5-point Likert scale questionnaire. Group 1 completed the questionnaire after a lapse
of six months while Group 2 at the end the posting. Responses from both cohorts were compared
using the Mann-Whitney U test. Of 198 (Groups 1 and 2) students, 91.41% (n = 181) felt the
simulated sessions helped better understand care of emergency patients. The sessions helped identify
knowledge gaps (89.90%; n = 178), improve knowledge and understanding of oxygen therapy devices
(85.35%; n = 169), and airway equipment (90.91%; n = 180). They prepared better for the flipped
classroom teaching than traditional sessions (80.81%; n = 160). They felt that their communication
skills (82.32%; n = 163) and confidence (63.64%; n = 126) improved. Significant differences noted
to questions (p = 0.006, p = 0.005, p = 0.041 respectively) targeting knowledge on oxygen therapy
devices, confidence, and identification of gaps in knowledge respectively. Combined simulation and
flipped classroom teaching was well received by students though this requires more preparation.
Introduction: Entrepreneurship CMIE 1022 module was introduced in February 2012 and was made compulsory to all first year undergraduate students in all faculties of Universiti Kebangsaan Malaysia (UKM). The main objective of CMIE 1022 is to expose the students to entrepreneurship with implementation of online teaching and business game simulation.
Method: Module evaluation form was distributed among medical and nursing students at the end of the module.
Result: One hundred seventy-seven students responded to the survey with 50.3% of the respondents agreed that their soft skill have improved, 37.8% for increased awareness of entrepreneurship, 25.6% has increased their interest in entrepreneurship and 22.22% agreed to apply in their own courses. More than three quarter of the students agreed that the lecturers and teaching assistants teaching methodology were acceptable. However, only 18.4% agreed that this course should be taken by all students of UKM.
Conclusion: This study showed despite increase in soft skills and interests including high performance of the academics, most students disagreed on the introduction of CMIE 1022 course to all UKM students. It is suggested that the course curriculum to be reviewed in order to achieve the objectives.
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.