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.
Several studies reveal high rates of alcohol use among college students affecting their health and performances. This cross-sectional survey was done to study medical students' drinking pattern, its predictors and to develop any possible link between their academic performance and alcohol consumption. Data was collected using newly designed, validated questionnaire from students (n= 348) who consumed and not consumed alcohol. The response rate was 60% (209/348). 94% of drinkers started consuming alcohol before entering into the medical school. Most of them (85%) drank with parents' awareness. Among drinkers, 63% were of Chinese race and 35% of Indian race. None of the Malay respondents reported of drinking. 63% of drinkers and 23% of non-drinkers reported that most of their friends consumed alcohol. Drinking was not associated with smoking or drug abuse. There were no statistically significant differences in exam scores between drinkers and nondrinkers. Non-drinkers considered religious and moral obligations for not consuming alcohol. In conclusion, at our Institute, students did not allow their alcohol use to interfere with their academic performance. The drinking habit developed during school time is more likely to continue during college years. Those who have non-drinking friends are more likely not to consume alcohol themselves. Moral and religious obligations have positive impact on alcohol intake.
Reflection is a process of reviewing an experience of practice in order to describe, analyse and evaluate information. This leads to critical reflection which one can view and focus on self-experience within the context of his/her own life. Objective: The study aims to understand palliative care values with the use of reflective diary following home visit to patients who require palliative care.
Method: Interview was performed during the house visit by the undergraduate medical students. This outreach house visits were supervised under community palliative care nurse. The students were required to develop a learning activity, using assessment of palliative care patients’ needs, through qualitative questionnaire. This was recorded in the reflective diary upon return of such activity. The questions asked covered explorative learning and holistic medical tasks such as the impact of patient’s life from emotional, psychosocial, medical and spiritual perspective. Guided questioning was done to avoid
unnecessary communication issues that may aggravate emotional distress. Students were asked to probe using vetted and agreed questions, and explore multidimensional issues in relation to culturally naïve Kelantanese population.
Result: Enjoyful learning experience was recorded. The reality of thisdealing with patients with chronic disease has put forth a positive intention to perform better as future doctors.
Conclusion: Reflective diary is an effective tool in community palliative care learning. It documents patients’ plight and students’ sense of responsibility to community. This has invaluable and indirect learning impact as part of the students’ soft skills development.
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.
Community and family case study (CFCS) is a community based educational (CBE) programme commenced in 1980 at School of Medical Sciences, Universiti Sains Malaysia. It serves to help and resolve health needs of the individual patients, family and their community. This will help to develop generic skills such as organization, communication and problem solving in relation to local norms, beliefs and socio-cultural influences. Students should have good awareness, sensitivity and empathic response based on health needs and environment that they are living in. Knowledge, skills, attitudes, emotions and values are repeatedly exposed to inculcate optimal learning environment with the community, as well as triggered response by the student to give back to the community by volunteerism. CFCS activism can be revitalized within the individual and group context. This can be achieved by multi-dimensional learning, collaborative effort, effective leadership and supervision, creative programme initiation, effectual research activities and sustainable service to the community. It is hopeful with active community engagement, life experiences learning process, self-directed and reflective learning, students are able to acquire refined attributes such as skills, behaviour, knowledge and attitudes, towards successful personal growth and advancement.
When patients are tethered with uncontrolled pain, health care practitioners usually resort to several
modes of symptomatic relief for their patients. In palliative care the goal is identifying and managing
the cause of pain in addition to addressing associated problems. To administer effective symptom
control in patient with chronic non-cancer associated pain, healthcare professionals may need to
consider alternative non-pharmacological modes of treatment such as psychological intervention. Pain
perception can be influenced by non-organic factors such as emotional, psychosocial status of the
patient and their religious and spiritual beliefs. Taking these factors into consideration are an essential
part of treatment goals. The paper illustrates an ethical dilemma which has arisen in the aggressive
management of pain and highlights the importance of multi-disciplinary involvement in patient care.
Failure to consider these aspects of care can cause patient and parental anxiety, poor symptom control
and could compromise doctor-patient relationship.
Palliative care for life limiting conditions usually starts at birth. In neonatal period, planning,
discussion and goal of care should focus towards improving the baby quality of life. It does not mean
palliative care in this age group mainly as end of life care. We illustrate a complex 30 weeks baby
who was born with genetic abnormality complicated with intracranial bleeding and acute myeloid
leukaemia. There were various ethical issues related to the approach of death and dying infant and
psychosocial challenges surrounding the case.
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.
The paper discusses on the complexity of the issues surrounding a patient with subluxation of cervical spine in a Down syndrome child. Several relevant issues are discussed including consent in a minor, conflicting decision making between parents and doctors, end-of-life issues, supporting handicapped child with minimal co-morbidities, community ethics, neglect of care by the caregiver and decision making after allowing zonal of parental discretion. Despite the difficulties surrounding parental actions, there are still ethical priorities which have to be considered individually to alleviate the suffering of the patients and the family members. Dealing with patients with chronic illnesses is a challenge for any medical doctors. The case warrants sensitive approach to allow appropriate respect for parental decision despite in disagreement with the clinical team. The term ‘zone of parental discretion’ refers to a controversial area of decision making; and has still many potential conflicts on day to day clinical cases, especially among the conservative society in the East Coast of Peninsular Malaysia.
Introduction: Attitudes towards animal welfare are important in influencing how animals are treated. Studies of attitudes towards animal welfare in veterinary students are scarce. It is hope that the findings will enhace a diverse research in the future in order to explore variety of factors in relation to animal welfare since such study is currently limited.
Objective: The study is to determine the associations of gender,year of study and empathy level of undergraduate DVM students in UPM into their attitude towards animal welfare.
Method: Questionnaires were given to 440 Doctor of Veterinary Medicine undergraduate students in UPM to study the associations between gender,year of study and empathy level with attitudes towards animal welfare. Data were collected from respondents through two sets of self guided questionnaires. Interpersonal Reactivity Index (IRI) which assessed empathy level where only two sub-scales from the IRI were used. Empathic Concern (EC) and Perspective Taking (PT). Animal Attitude Scales (AAS) were used to assess attitudes towards animal welfare. Data collected were analysed using Statistical Package for Social Science (SPSS) version 20.
Result: 367 (83.4%) out of 440 students participated in this study. Antu-animal welfare attitude (74.9%) was the highest compared to the pro-animal welfare attitude (25.1%). Analysis showed a significant difference (p0.005) between gender and attitudes towards animal welfare (p=0.057) as well as between empathy level and attitudes towards animal welfarefor empathic concern sub-scale (p=0.194) and perspective taking sub-scale (p=0.320).
Conclusion: Majority of sudents were categorized as anti-animal welfareand the attitudes were significantly different among years of study. Female and malestudents have nomsignificant differences in their attitudes towards animal welfare. Students with ggod and poor empathy level also have no significant difference in their attitudes towards animal welfare.
Simulated patient (SP) is defined as a layperson who simulates to portray the role of a patient with health-related conditions based on varying levels of training. SP allows students to practice various skills under guided experience in a realistic, safe, and controlled setting. The purpose of this integrative review is to examine original research relating to the experience towards simulated patient-based simulation session. A rapid review included three electronic databases search of articles published between 2008 to 2018 with inclusive and exclusive criteria. Seventeen articles were eventually selected for inclusion in the review. These articles were subjected to basic thematic analysis. Descriptive analysis of the study design, study location, professional area, and study variables were reported. Six themes were identified: SP’s perspective, evaluation of SP’s performance, euthenticity of SP role play, SP feedback, student’s development, and evaluation of student’s performance. SP methodology has been widely used to train healthcare students in the development of medical knowledge, clinical skills, as well as important soft skills. SPs, students, and facilitators play a role to ensure the success of an SP-based simulation session. The outcome of the training with SP was examined through an assessment of either the student’s performance or the SP’s performance. The outcome of the review concluded that SPs’ development indirectly influences students’ development.
Introduction: Appropriate professional conduct of clinical teacher is vital in their medicine practice. In UKM medical centre Malaysia, personal and professional development (PPD) of future medical professionals is greatly emphasized. The objective of this study was to determine the medical students' perception about the professional conduct of their clinical teachers at UKM medical centre. Methods: It was an online questionnaire survey conducted among the clinical students enquiring about the professional conduct of their clinical teachers. There were five statements and one open ended question which described students' preference about PPD teaching- learning method, expectation on PPD session, need of teachers training and experience about the excellent and inappropriate professional conduct of clinical teachers. The open ended question described what students had observed regarding the 'doctor-patient relationship' medical ethics and 'student-teacher relationship. A total of 77 questionnaires were returned after complete evaluation. The data were compiled and analysed using SPSS version 20 and the answers to the open ended questions were transcribed. Result: Role modelling was the preferred teaching-learning method for PPD as stated by 38% respondents; subsequent preferred methods were small group (30%), role play (24%), large group (7%) and reflective writing (1%). Majority (67.5%) respondents indicated that professional conduct of their clinical teachers was frequent enough as they had expected while 29.9% claimed that professional conduct was infrequently emphasized. Excellent professional conduct of clinical teachers was witnessed by 73% respondents while 27% indicated that they had never seen excellent conduct. When asked about inappropriate professional behaviours by clinical teachers, 53% indicated to have witnessed. Qualitative data also revealed both positive and negative experiences as reflected in open comments. According to 70% respondents clinical teachers required training to apply PPD in their daily practices. Conclusion: Professional conduct of clinical teachers as perceived by the students was excellent and frequents enough with experience of inappropriate behaviour too. Role modeling was the preferred teaching method while attention needed on reflective assignment. Educators must emphasize on role modelling in their daily practices and curriculum planners should give due importance on training needs of clinical teachers to apply PPD in their daily practices.
Mastering the art of conducting a research along with the competitive era of publishing papers showed the importance of undergraduate research. The purpose of this research was to study the impact of undergraduate research “Special Study Module (SSM)” on Universiti Kebangsaan Malaysia (UKM) medical students and alumni.
Methodology: This was a cross-sectional study whereby 64 fifth year UKM medical students of academic-session 2014/2015 and 49 alumni of year 2010 were participated on their SSM research activities. The questionnaire administered online which enquired on participants’ level of interest, confidence and SSM research experiences. Frequency and percentage distribution were used for descriptive analysis.
Result: Out of 119 participants,113 responded giving a response rate of 95%. More than 90% respondents in both group felt that SSM experience was enriching and 80%–90% felt SSM experience was pleasant. In both groups 47%–50% respondents believed, SSM experience contributed their high level of interest on research. The most influencing factors on their level of interest were supervisor guidance as reported by73%–80% respondents. It was said that SSM supervisor was academically stimulating, impressive as role model and supportive. The most confidence skill was the ability to function within a group and least confidence skill was manuscript writing.
Conclusion: Undergraduate SSM research showed positive impact on participants’ research activities. More in-depth analysis should be considered especially on manuscript writing as the students were least confident in this skill.
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.
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.
In recent years, the popularity of using complementary and alternative medicine (CAM) as a health care option has increased dramatically all over the world especially in developing countries. As Malaysian statistics showed an increased in chronic diseases among our population, the demand to consume CAM for healing process as well as in pursuit of health and well-being also has increased. Thus it increased patient’s interest to request more information from medical practitioners and nurses who are front health care providers. The objective of this study is to compare the knowledge, attitudes, and practice (KAP) of CAM among final year nursing and medical students in Universiti Sains Malaysia (USM). A cross-sectional comparative study was conducted among final year medical and nursing students using self administered questionnaire. This study utilized the Knowledge-Attitude-Practice (KAP) model to explain how level of knowledge may reflect nursing and medical students’ attitudes and practice of CAMs. There were 74 students participated where 33 of them were nursing students, and 41 were medical students. Independent t-test was used to compare the KAP of CAM between both groups of students and there was a significant different. As a conclusion, this study revealed that nursing students were more knowledgeable about CAM, possessed positive attitudes, and more willing to practice CAM compared to medical students.
The main purpose of formative assessment is to improve students' learning and it
should be seen as a part of the learning process. Game-based learning has become more common in
the education and one of the emerging game-based learning platform used in education institutions is
Kahoot. This paper investigated the perception of students towards Kahoot as a formative assessment
tool in undergraduate medical education and its association with gender. Methods: A cross-sectional
study was carried out on first year medical students in a Malaysian public medical school. The study
employed a survey that consists of 12 items through Kahoot survey platform. Result: A total of 113
subjects participated in this study; majority was female (68.1%) and Malay (58.4%). The students
highly perceived Kahoot as fun, effective and better than e-learning platform for feedback as its
median score was 4. The rest of items were satisfactorily perceived by the students as indicated by
the score of 3 except for simplifying complex subjects that obtained unsatisfactory level. There were
significant median score differences between male and female students for motivation and perceived
knowledge retention, whereby males scored higher than females (p < 0.05). Conclusion: Kahoot is a
promising formative assessment tool that is feasible, practical and makes learning fun and enjoyable. It
can be used to motivate students to learn. However, Kahoot was not the best tool to simplify complex
subjects as perceived by medical students.
Introduction: Teaching strategy for nursing students need to be varied for the future preparation and to increase confident level in delivering quality care to patients. Interprofessional learning (IPL) is a way to encourage collaboration among health professional teams that will drive them to collaborate with, from and about other profession and thus, it allow students to have greater knowledge. Currently, they are unable to learn together during the clinical posting due to professional boundaries. Objective: To explore nursing student knowledge and perception on interprofessional learning. Method: This paper presents a focus group discussion with a group of nursing students (n= 8). A semi structured guide was used and focused on knowledge, experiences and benefit related to IPL. Result: Data was analysed and four major themes emerged; 1. learning with, from and about other health professionals, 2. communication skills, 3. teamwork and 4. future preparation. Conclusion: This study suggested that the interprofessional learning in the teaching and learning strategy should be introduced to the nursing students as to involve them with interprofessional learning and extend their understanding on other health professionals roles. In addition, it is an opportunity for them to work collaboratively with other health professionals.