For the purpose of teaching statistics, lecturers often rely on data from real studies, text book examples or painstakingly created datasets. The process of creating a dataset can be made easier with the utilization of PASW Statistics to generate random values. The objective of this article is to demonstrate the creation of data which are measured on continuous scale, using PASW Statistics menus and syntax.
One of the most common reasons why researchers seek help from statistician is sample size calculation. However despite the common believe that it only involves formula and calculation, researchers often ignore other aspects of research design that leads to proper sample size calculation. In this article, the author outlines basic steps toward sample size calculation. The author also introduces the logic behind sample size calculation for single mean and single proportion in simplified and less intimidating forms to those not statistically inclined.
Planning a validation study of a questionnaire or measurement tool requires consideration for testing
the validity and reliability aspects of the measurement tool. When it comes to the reliability aspect,
a number of commonly used statistical coefficients such as Cronbach’s alpha, intraclass correlation,
kappa and Pearson’s correlation coefficients would be considered to provide empirical evidence of the
reliability of the tool during the validation process. To ensure that the reliability is accurately assessed,
a researcher must consider the sample size requirement for the statistical analyses. In this article, I will
introduce a newly developed web-based sample size calculator, which includes the ability to calculate
the sample sizes of these four important coefficients. I will also show how to use the calculator for each
of the coefficients.
Recently, the integration of mobile phone apps into healthcare system is increasing as a result of the availability of medical applications. This study determined the perception of readiness of community pharmacists on the use of mobile smartphone as a health monitoring tool and the relationships between perception and readiness with selected demographic variables of the respondents. Methods: A crosssectional survey was conducted by distributing a modified 15-item instrument to a convenience sample of pharmacists (n = 245) across Malaysia by post. Statistical analyses were performed using SPSS version 20. Results: Response rate was 31.4% (n= 77). The mean age of the respondents was 35.5 ± 6. 52 years. The sample consisted of mostly women (71.4%). Overall, there were moderate “positive responses” across the two domains. Positive perception ranged from 54.5% to 66.2% and positive readiness ranged from 55.8% to 64.9%. No significant associations between perception and readiness with the selected demographic variables were detected (age, gender, location and outlet type). Conclusions: This study demonstrated that there was generally positive perception of mobile phone use for pharmaceutical care among community pharmacists in Malaysia. They were also ready to adapt it to improve pharmaceutical care delivery to patients.
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.
Objective: The study aimed to obtain the perspective and teaching practice of novice lecturers serving at the training institutions, Ministry of Health Malaysia (MOH).
Method: A qualitative research was conducted on 4 novice lecturers at the Medical Assistant College, Seremban. Data were obtained from interview and observation on their teaching in the lecture rooms. The data analysis was performed by using NVivo 9 software.
Result: In the aspect of the teaching perspective, the finding showed that there were two main themes; teaching concept and the teaching method. As far as the teaching concept is concerned, respondents perceived that lecturers were the source of knowledge and those who transfered the knowledge to the students. Meanwhile, the second perspective related to the teaching approach in which lecturers need to use their experiences, they need to be knowledgeable and creative in their teaching. The integration of the themes has formed the main perspective, which was the lecturer-centered teaching. In turn, in the teaching practice, it was consistent with their perspective whereby the approach of teaching is lecturer-centered.
Conclusion: This study showed that new lecturers would employ the lecturer-centered approach. Apart from that, they were also lacking of the skills in terms of class control and value inculcation. The deficiency in both these aspects needs to be overcome as it can affect the effectiveness of the teaching, also the quality of the graduates produced.
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.
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.
Autonomy is widely accepted to be the third pillar of medical ethics. However, if it comes to refusal of life saving treatments, some extra considerations are necessary, especially if decisions are made by surrogate decision makers. Four cases of problematic decision making are presented here, followed by a discussion about the cultural and religious misconceptions about the rights of surrogate decision makers.
Introduction: Many tasks seem daunting for a new medical graduate who is starting houseman
posting; as educators, we must ask ourselves whether our graduates are ready to face emergency
situations as the first responders during a crisis. Exploration of undergraduate students’ perceptions
highlights needs in some areas, including acute care, practical skills and prescribing. Armed with basic
resuscitation skills, students could face emergencies with more confidence and skill. Method: Seven
cohorts of final-year students completed a one-and-a-half day cardiac life support course and were
assessed using megacode and pre- and post-course multiple choice questions. Results: The pre- and
post-test analysis using paired sample T-test demonstrated significant performance improvement
(p
Introduction: Peer mentoring is one of the mentoring essential components in any higher institution of learning. In the Medical Faculty of Universiti Malaysia Sarawak (UNIMAS), this mentoring system has existed long but has not undergone any formal evaluation. Objective: The main objective of this study is to determine the perception of peer mentoring among medical students of Faculty of Medicine and Health Sciences (FMHS), UNIMAS. Method: It was a cross-sectional study using self-administered questionnaire. All medical undergraduate students of FMHS were recruited. Data was analyzed using SPSS version 22. Result: A total of 234 respondents participated in this study. Peer mentoring system was preferred against other mentoring system. Majority of the respondents reported that academic gain was the main benefits they gained from peer mentoring system. Negative attitude of the mentee and poor time management for the meeting were the top two worst experience encountered by both mentors and mentees respectively. More than half of the mentor and mentee perceived that peer mentoring system was beneficial to them compared to other systems, with reason that the interaction between student themselves were more easier and comfortable. Nevertheless, there should be more interaction between the mentors and mentees. Conclusion: The findings indicated there is a positive contribution of peer mentoring towards the mentoring system of the faculty. There is a need to relook at the current mentoring system and consider peer mentoring to improve the student support.
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.
The aim of this study was to evaluate the effects of a DVDdelivered mindfulness-based intervention for reducing stress among medical students in a Malaysian university. Methods: A total of 76 medical students participated in the intervention program (Mindful-Gym DVD). They were stratified according to year of studies and randomly allocated to intervention (N = 38) and control groups (N = 38). The following outcome variables were measured at pre- and post-intervention: mindfulness (with Mindful Attention Awareness Scale, MAAS); perceived stress (with Perceived Stress Scale, PSS); mental distress (with Depression, Anxiety and Stress Scale, DASS); and self-efficacy (with General Selfefficacy Scale, GSE). Hierarchical multiple regression analyses were used to analyse the effect of group (Intervention vs. Control) on changes in the outcome variables. Results: One week after the intervention, participants in the intervention group reported significantly greater improvements with small to medium effect sizes in self-reported levels of mindfulness (β =0.19, ∆R2= 0.04, p = 0.028, f2= 0.07), perceived stress (β = -0.25, ∆R2=0.06, p = 0.006, f2= 0.11), mental distress (β = -0.27, ∆R2= 0.07, p =0.003, f2= 0.13), and self-efficacy (β = 0.27, ∆R2= 0.07, p = 0.003, f2= 0.13), compared to participants in the control group. The number needed to treat (NNT) to achieve ‘normal’ levels of depressive, anxiety, and stress symptoms (as indicated by the DASS scores) were 5, 8, and 6 respectively. Conclusions: This study found that the DVD-delivered mindfulness-based program is potentially a labour- and cost-effective and easily accessible stress reduction program for medical students.
Objectives: This investigation focused on finding the changes in learning approaches of students’ while experiencing physiology curriculum and to explore the reflection of changes if any, on their critical thinking skills.
Methods: In this longitudinal study, information on students’ learning approaches was obtained using the revised two factor study process questionnaire (R-SPQ-2F) at the commencement (pre-test) and completion (post-test) of first year MBBS course. The total score and the scores obtained in the critical thinking questions in four physiology assessments were analysed. Pre and post-tests scores in R-SPQ-2F and assessment scores were compared using independent samples t-test and one way repeated measure ANOVA respectively. Correlation of scores between assessments was done using Pearson correlation. A p value < 0.05 was taken as significant.
Results: A significant increase in students’ deep learning approach at the completion of the physiology curriculum when compared to commencement (p < 0.001) was observed. A progressive improvement in their scores as they experienced the curriculum was also noticed. A moderate correlation among critical thinking questions scores and a strong correlation between critical thinking questions and total essay scores were also recorded.
Conclusion: The study revealed improvement in students’ deep approach to learning in physiology which was reflected in their performance in critical thinking questions.
Study site: Melaka Manipal Medical College, Manipal University, India
Introduction: Nurses are generally trained on the procedures of blood transfusion during their years of service. However, the level of knowledge varies among individuals and healthcare centres. Thus, this study addresses a knowledge gap regarding nurses’ knowledge and transfusion safety in the local clinical setting. Objectives: This study aimed to determine nurses’ level of knowledge of various phases of blood transfusion and associate this knowledge with their socio-professional details. Methods: This was a cross-sectional, quantitative study. The target population was in-patient ward nurses at Hospital Pulau Pinang. The systematic random sampling method was used to select 185 nurses to participate in this study. Data were collected using a validated research questionnaire that consisted of 31 items (9 items related to socio-professional factors and 22 knowledge items). Data were analysed using descriptive and inferential analyses. Results: The overall knowledge score was moderate (mean = 70.44%, SD = 11.35). None of the nurses was able to answer all of the knowledge questions correctly. Of the participants, 72.29%, 71.75%, and 67.14% exhibited knowledge of blood bag collection and patient preparation; pre-transfusion nursing activities; and during and post-transfusion nursing responsibilities and management of transfusion reactions, respectively. Factors such as age, years of service, department, and availability of the transfusion policy in the ward significantly affected the mean knowledge scores. Conclusion: Nurses’ knowledge of blood transfusion at Hospital Pulau Pinang was moderate. More training and courses should be provided to improve their knowledge.
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.
Background: Competence-based curriculum has become the need of medical education to meet the objectives of institutions aiming to produce skilled physicians. To achieve the optimal competence and performance of graduates a number of traditional evaluation exercises have been practiced. Some of these e.g. OSCE although meet the acceptable standard of reliability and validity is the assessment done in a controlled environment. This leaves the room for performance-based assessment in real clinical situation such as mini clinical evaluation exercise (Mini-CEX). To practice and meet the challenges of Mini-CEX it is vital to undertake faculty development program with a comprehensively chalked down Mini-CEX protocol and its objectives to achieve the intended outcome. Objective: To undertake faculty development on Mini-CEX for its feasibility and acceptability as a method of formative assessment to evaluate the clinical competence of trainees in postgraduate program of Otolaryngology and Head-Neck Surgery. Method: 25 trainees from the four classes of master of surgery program of 2009 in Otolaryngology and Head-Neck Surgery (ORL-HNS) undertook Mini-CEX encounters and assessed by 9 supervisors in a 12-week period of study. Faculty development program was carried out through prior lectures deliberating on background, concept and procedure of Mini-CEX followed by demonstrations using video clip of Mini-CEX encounter recorded in own clinical environment. Students were also exposed to similar settings to take up the Mini-CEX encounter without any hesitation. Trainees were assessed in outpatient clinical setting. Program was evaluated for its feasibility and acceptability with respect to patient’s factors, clinical attributes, supervisor and trainee’s performance and their reported level of satisfaction.
Result: Faculty development and trainees orientation in Min-CEX was achieved as feasible and acceptable. Higher rating of satisfaction was reported by majority assessors and trainees as they found Mini-CEX acceptable for formative assessment. Among clinical skills highest rating was received in physical examination and lowest rating in therapeutic skills. Conclusion: A motivated faculty and organized approach towards a comprehensive knowledge on Mini-CEX for its background communication, demonstration of procedure and method to complete the rating forms is the useful guide to adopt Mini-CEX. The faculty and trainees in department of ORL-HNS found Mini-CEX as feasible and acceptable assessment tool to monitor educational activity of postgraduate program through performance-based evaluation in a real clinical situation.
Background: In order to achieve the desired performance of graduates a number of traditional evaluation exercises have been practiced to assess their competence as medical students. Many of these assessments are done in a controlled environment and mostly reflect on tests of competence than performance. Mini-CEX or direct observed procedural skills (DOPS) are the real performance-based assessment of clinical skills. Increased opportunity for observation and just-in-time feedback from the role model superiors produce a positive educational impact on students learning. This also provides trainees with formative assessment to monitor their learning objectives. However, to implement assessment strategies with Mini-CEX or DOPS needs to develop institution’s clear policy for a different teaching and learning culture of workplace based assessment. It also needs to develop user friendly rating form, checklist, elaboration of clinical competence and its attributes and procedural guidelines for practice. A precise role of these tools in the assessment of postgraduate program must be established before practicing them to evaluate and monitor trainee’s progress.
Objective: To determine DOPS for its acceptability and feasibility as a method of formative assessment of clinical skills in postgraduate program of Otolaryngology and Head-Neck Surgery.
Method: A total of 25 trainees were assessed for DOPS by 8 supervisors in this 12-weeks pilot study. A faculty development program for faculty members and trainees was run for DOPS. Trainees were advised to undertake at least one DOPS encounter out of 42 shortlisted procedures. Assessors were asked to mark trainees by completing a rating form using a checklist developed for each procedure. Trainees and assessors were asked to endorse their opinion on feasibility and acceptance of DOPS for practice of formative assessment in future. Data was analyzed to determine feasibility and acceptability of DOPS in assessment program. Result: Faculty development and trainees orientation in DOPS were found satisfactory for its acceptance and feasible for its practice. Trainees were mostly assessed in outpatient clinical setting. Majority reported higher rating of satisfaction by assessors and trainees. Among clinical skills higher rating was received in procedural skills performed by the senior trainees. Conclusion: DOPS was found feasible for practice of formative assessment of trainees in postgraduate program of Otolaryngology and Head-Neck Surgery in School of Medical Sciences (SMS) at Universiti Sains Malaysia (USM). It was well accepted by the trainees to help monitor their quality of procedural skills as self-directed learning.
Context: Community-based medical education (CBME) has become widely accepted as an important innovation in undergraduate medical education. In curriculum featuring CBME, students are acquainted with the community early in their studies however; the impact of this training can be judged best to see them practice the required aspects of CBME. Malaysia is a multiracial country with a very strong community dependant life style. Main national health problems have called for a change in health profession education from traditional hospital based health care to community-based delivery system. Three major university's medical schools that either practice community oriented or community based medical education in undergraduate medical curriculum are evaluated. Universiti Sains Malaysia (USM) has a community based medical education (CBME) curriculum as Community and Family Case Study (CFCS) compared to a community oriented education curriculum (COE) adopted by Universiti Malaya (UM) and Universiti Kebangsaan Malaysia (UKM). However, UM at the time of undertaking this study back in 2005 was though practicing COE has also later opted CBME as CFCS.
Objective: To determine whether medical graduates from USM with a community-based medical education in its curriculum for more than 25 years are inspired to have stronger commitment towards community health as shown in their on-job practice of medicine compared to other graduates from UM and UKM, who have adopted community-oriented medical education program.
Method: A questionnaire-based pilot study with 12 items (variables) was designed to obtain supervisor's opinion on commitment of interns towards the health of community they serve. The questionnaire was administered to a randomized group of 85 specialists supervising the internship training program in five major disciplines including internal medicine, surgery, orthopaedic, gynaecology and obstetrics and paediatric medicine. The data received from 62 respondents from five major disciplines was analyzed utilizing SPSS version 12.0.1.
Result: The responses received from 62 supervisors on an inventory in which 9 out of 12 variables were directly related to community commitments of interns. It was shown that the USM graduates who were taught through a CBME curriculum have performed better than the graduates from UM and UKM who followed a COE curriculum. P-value (< 0.001) was highly significant and consistent with higher mean score in those variables.
Conclusion: The graduates taught through a CBME curriculum performed better in community commitments towards patients care compared to graduates from COE curriculum.
Introduction: Metacognition is the awareness of knowledge how one learns in addition to what
one learns and to understand how a task will be performed. Metacognitive skill as self-assessment
is recognised as an important contributor to the development of critical capacity, reflective attitude
and autonomous life-long learning. Accurate, self-assessment of knowledge and skills is essential for
students to maintain and improve through self-directed learning. Objective: The objective of this
study was to explore, how well students’ evaluate their own level of understanding for lectures to
reflect their metacognitive skill that can be used in educational strategy to promote students’ personal
and professional growth. Methods: To assess the metacognition of the students, a questionnaire based
on three items was designed. All 60 (17 male and 43 female) preclinical, first-year medical students
were included in this study. The metacognition as planning, monitoring and evaluating the lecture was
judged through students’ response on 33 lectures in terms of understanding of knowledge, clearing
of misconceptions and presenting of a well prepared material respectively in the field of haematology
and parasitology. Metacognition as reflected in the lecture understanding level (LUL) score, lectures
preparation level (LPL) score and students question level (SQL) score was estimated for its correlation
with student’ achievement score in pre-clinical phase of MBBS program. Results: The data was
analysed for correlation between metacognition and overall students’ achievement scores and a
statistically significant correlation between LUL and multiple true false (MTF) of 268 (p = .039),
LPL and MTF of .282 (p = .029) as well as between SQL and MTF of .360 (p = .005) was compared
to poor correlation between LUL, LPL and SQL and the other three assessment tools (short essay
questions [SEQ], problem-based questions [PBQ] and objectively structured practical examination
[OSPE]) was found. Conclusion: The significant correlation of students’ metacognition and their
achievement score in classroom setting with MTF and poor correlation with SEQ, PBQ and OSPE is
attributed to multiple factors discussed in this study, imperative to students’ personal and professional
growth.