Introduction: Undergraduate medical education should be broad-based, holistic, integrated and should promote a framework for the development of higher order cognitive skills like communication, professionalism and teamwork to prepare the student for a life-long challenging medical career. Recent calls for a competency-based medical education require, in addition, competency in clinical and procedural skills prior to graduation. This study investigates how often opportunities exist for medical students to perform four common ward procedures prior to graduation.
Method: A prospective cross-sectional study to assess the opportunities a medical student have in performing four common ward procedures, comprising intravenous cannulation, nasogastric tube insertion, urinary catheterisation and chest tube insertion, in a State General hospital in Malaysia was done.
Results: A medical student has sufficient opportunity to perform only intravenous cannulation prior to graduation. He has a remote chance to insert a urinary catheter and is unlikely to have the opportunity to insert a nasogastric tube or insert a chest tube prior to graduation.
Conclusion: Although competency in clinical skills and procedural skills prior to graduation are desirable, this is increasingly difficult to achieve due to shortage of clinical material, teachers to supervise, the large numbers of medical students and house officers, the short time spent on the main disciplines and the failure of many universities to invest heavily in skills laboratories staffed by full time clinicians. The calls to introduce competency-based medical education in undergraduate medical education, particularly in procedural competence, should take into account the challenges in delivery and the realities in the hospitals today. This is necessary to avoid demoralising students who are unable to achieve their quota of procedures through no fault of theirs.
Keywords: procedural competency, medical education, Malaysia
The International Medical University, Kuala Lumpur (IMU) has just completed 20 years of success and had a series of events to celebrate its 20th anniversary as well as its achievements in 2012. As part of the 20th anniversary celebrations, IMU successfully co-hosted the Ottawa conference with the European Medical Education Association in Kuala Lumpur. This was the first time this conference was hosted in Asia and it was one of the biggest and most successful of the Ottawa Conference series ever held. This conference focuses on medical education with the major emphasis on assessment.
Building on two decades as a private health professional university, the International Medical University prepares for the third decade, taking stock of the challenges in changing epidemiology and pattern of disease, changing demography and healthcare, as well as explosion in knowledge and information technology. The Global Independent Commission1 provided a framework for instructional and institutional reforms, and the IMU will use its 3 I’s (insight, imagination & innovation) in adopting these measures. Some of the instructional reforms are already in place, others need to be further nurtured and promoted. In its third decade, competency based curriculum, inter-professional learning, IT, global collaboration, educational resources, new professionalism and emphasis on quality improvement will help ensure IMU train and produce competent, caring and ethical health professionals fit to tackle 21st century challenges.
This cross sectional study was done to identify the areas of lack of knowledge, practice and awareness of students about the effective use of personal protective equipment (PPE). A total of 40 students were selected when they were posted to the accident and emergency unit (A&E) in Seremban Hospital; all of them answered a questionnaire and were observed unaware on the effective use of PPE in the A&E.
This study examined the trend of major congenital anomalies (CA) in the state of Penang using the ICD 10 database from 1999 to 2004. The data was collected from various health centres and hospitals. The aim was to study the magnitude of the problem for congenital anomalies in the state of Penang in terms of trends and also to calculate the incidence rate by districts. If a trend was noticed, this in turn will determine whether to carry out further in-depth studies in the future and to find out the linkages to the environment if any.
There have been significant achievements in research at IMU as indicated by the increasing amount of external funds obtained, and number of publications and postgraduate students produced since it started its research activities in the year 2000. However, it is a great challenge indeed to ensure sustainability of our research, which is currently heavily dependent on internal funding. There is a need to realign our strategies to further enhance our competitiveness in securing external funding for research. In line with this, the Institute for Research, Development and Innovation (IRDI) was officially established on 18 September 2012. The Institute will serve as a platform to support all research activities at IMU. There are four Centres of Excellence based on the identified thrust areas under
IRDI, namely 1) Centre for Bioactive Molecules and Drug Discovery; 2) Centre for Environmental and
Population Health; 3) Centre for Cancer and Stem Cell Research, and 4) Centre for Health Professional Education Research. Major findings based on research in these four thrust areas are reviewed in this paper. With the strategic planning and establishment of IRDI, it is our aspiration to bring research at IMU to a higher level.
Cancer research is an extremely broad topic covering many scientific disciplines including biology (e.g. biochemistry and signal transduction), chemistry (e.g. drug discover and development), physics (e.g. diagnostic devices) and even computer science (e.g. bioinformatics). Some would argue that
cancer research will continue in much the same way as it is by adding further layers of complexity to the scientific knowledge that is already complex and almost beyond measure. But we anticipate that cancer research will undergo a dramatic paradigm shift due to the recent explosion of new discoveries in cancer biology. This review article focuses on the latest horizons in cancer research concerning cancer epigenetics, cancer stem cells, cancer immunology and cancer metabolism.
Surgeries are seen as stressors that trigger preoperative anxiety. Preparing the patients for surgery through preoperative teaching becomes crucial to allay anxiety level. In a cross sectional descriptive study conducted on eighty patients (age: 18–65 yr) who had undergone open abdominal surgery, 78.8% (n=63) stated that they experienced anxiety prior to surgery. Among these anxious respondents, 47.5% (n=38) experienced high state anxiety. Three of the top information that patients perceived as important to allay anxiety towards major surgery were: details of surgery, details of nursing care to surgery and information on anaesthesia. Nurses working in the surgical wards need to proactively address patients’ psychological concerns towards surgery and provide preoperative information based on patients’ needs to allay anxiety.
Solitary adrenal metastasis is a rare presentation in breast cancer and it presents the clinician with a difficult therapeutic dilemma as there are no existing guidelines for optimal management. On literature review, we only found one published case report of solitary adrenal metastasis from infiltrating ductal carcinoma of the breast. Here we present a case of a 75 year-old lady who presented with a right breast lump which was subsequently confirmed to be infiltrating ductal carcinoma. She underwent a right mastectomy and axillary clearance. Computerised tomography
(CT) staging revealed a solitary adrenal metastasis. She was treated with aromatase inhibitors and her tumour markers which were initially raised has now normalised.
The nature, extent and definition of a collaboration varies between individuals, disciplines, departments and institutions. It depends upon such factors as the people involved, the nature of the research problem, the research environment, the institutional culture and demographic factors. This paper will examine the concept of collaborative research and discuss its place and position in an evolving university.
We previously evaluated the biochemical changes induced by the local product TCM for diabetes (TCM-D™) on blood glucose levels and other biochemical changes in normal mice fed orally with the recommended human dose (30 ml/kg daily) and ten times this dose for eight weeks. TCM-D™ is an aqueous extract of the roots of Trichosanthes kirilowii Maxim, Paeonia lactiflora Pall, Glycyrrhiza uranlensis Fisch. and Panax ginseng Meyer (red) combined at the dry weight proportions of 36%, 28%, 18% and 18% respectively. The study showed that at these dosages the blood glucose levels as well as the body weights in treated mice were significantly reduced when compared with pretreatment values and control animals. The present study evaluated the effect of the extract in a mouse model of Type 1 diabetes mellitus.
Preclinical drug testing is an important area in new drug development where animals are used. An ideal animal model for this is one which is simple, reliable and can be extrapolated to humans. Topical drugs for inflammation are conventionally tested on the skin of animals after induction of inflammation. A gingival model would be simple as inflammation can be induced naturally by the action of plaque. Rats are a popular animal model for testing drugs as well as to study various diseases of the periodontium. Periodontal disease including gingival inflammation develops in
rats in relation to indigenous plaque or experimentally induced bacterial products. A number of features of rats ranging from anatomy, histology and response to bacterial insult can be seen mirrored to a great extent in humans. There is a lot similarity in the development and resolution of inflammation as well as the gingival wound healing of rats and humans. This paper tries to explore the feasibility of using the rat gingival model for preclinical testing of drugs acting on or influencing inflammation and concludes by identifying potential areas of research using this model. The addition of such a simple and inexpensive model for preclinical testing of drugs will be welcomed by the drug developers.
Shock is a clinical challenge to neonatal intensivists and pediatricians alike. It occurs in critically ill babies for many reasons, but the main cause is sepsis that kills more than a million newborn
globally every year. This article is designed to help young doctors and trainees have a better understanding of shock in the neonatal period and its management. The paper reviews the basic pathophysiology, risk factors, clinical investigation, management, supportive care, and complications in the common types of shock seen in neonates. Treatment is governed largely by the underlying cause, with the ultimate goal of achieving adequate tissue perfusion with delivery of oxygen and substrates to the cells, and removal of toxic metabolic waste products. Intervention needs to be anticipatory and urgent to prevent progression to uncompensated and irreversible shock respectively. Early recognition and urgent effective management are crucial to successful outcomes.
Important bioactive molecules are molecules that are pharmacologically active derived from natural sources and through chemical synthesis. Over the years many of such molecules have been discovered through bioprospective endeavours. The discovery of taxol from the pacific yew tree bark that has the ability in stabilising cellular microtubules represents one of the hallmarks of success of such endeavours. In recent years, the discovery process has been aided by the rapid development
of techniques and technologies in chemistry and biotechnology. The progress in advanced genetics and computational biology has also transformed the way hypotheses are formulated as well as the strategies for drug discovery. Of equal importance is the use of advanced drug delivery vehicles in enhancing the efficacy and bioavailability of bioactive molecules. The availability of suitable animal models for testing and validation is yet another major determinant in increasing the prospect for
clinical trials of bioactive molecules.
The global environment is in a dynamic flux due to rapid development. As a result of this, new
diseases are emerging and old diseases are re-emerging in many parts of the world. Therefore there is a constant need for appropriate data for formulation of effective policies to mitigate the adverse effects of environmental degradation on human health. The Kyoto Protocol of 1997 is a milestone that sets the direction for good environmental management initiatives and the success
of this depends on good data. Malaysia currently has the Environmental Quality Act 1974 in place to
control environment related problems. However good guidelines must be developed to keep the initiatives for good environmental management on course, for this we need good data. The Centre for Environmental and Population Health at IMU, coordinates research activities in specific thrust areas in an endeavour to produce important data that is required for developing appropriate guidelines for environmental health.
A 3-year old preschool boy presented with a pruritic red streak at the dorsum of his right foot traveling
upward from the affected site which was red and swollen. Insect sting was the more likely trigger which had caused the cellulitis and subsequently the acute lymphangitis.
Healthcare investment is critically important for the health and well-being of the population, and different health systems are developed to meet the needs and priorities of each country. What has become clear has been that despite major advances in medicine, science and technology, there are major issues related to access and equity as well as quality and patient safety in healthcare services. The issue of patient safety was highlighted by the reports of the Institute of Medicine, USA1,2 and this had received worldwide attention. It is also an irony that despite being in an age of major advances in medicine, science and technology, with the acceptance of evidence-based medicine, so much of medicine and healthcare delivered is of little or no proven value. This poses a major challenge on health policy, and on how this can be addressed in any health reform process that focuses on improving access, equity, efficiency and effectiveness in healthcare services.
Urethral catheterisation is a common and safe procedure performed routinely. The small size of the urethra in a child necessitates the use of an infant feeding tube (Size 5 to 8 F) for catheterisation. Knotting within the bladder is a rare complication with significant morbidity often necessitating surgical or endoscopic removal. Insertion of an excessive length of tube contributes to coiling and knotting. We report an instance of knotting of an infant feeding tube in the proximal penile urethra of a 4 year-old male child requiring urethrotomy to remove it. Awareness of the risk and proper technique can reduce this complication.
A review of current information related to the likely incidences of thyroid diseases in the aged population of Malaysia, raising issues such as the need for further epidemiological studies of iodine intake in relation to thyroid diseases within different geographical regions and population subtypes, the need for general country-wide iodization of salt, and the screening of elderly Malaysians for so-called “occult” thyroid diseases.
Bacillus thuringiensis is an anaerobic, spore forming bacterium that produces various toxic proteins both during its vegetative stage and sporulative stage. During its sporulative stage, it produces parasporal proteins that have long been used in the agriculture fields as insecticides. Although anticancer effect of Bacillus thuringiensis parasporal proteins can be dated back to the 1970s, research in this area went through a giant leap in the late 1990s, with much of the work being done in Japan. It has been found that some strains of non-insecticidal Bacillus thuringiensis produce parasporal proteins that exhibit anticancer activity. Due to their selectivity against human cancer cells but not normal cells, some of these proteins have been extensively studied for their anticancer effect and the mechanism of action by which these proteins kill cancer cells have also been widely explored in Japan and Malaysia with sporadic reports from other parts of the world. The abundance of these bacilli in nature and their selectivity have made them potential candidates for cancer treatment. However, literature on the in vivo effect of these proteins is scarce. Since different Bacillus thuringiensis strains produce different cytotoxic proteins with wide variations in their anticancer effect and mechanism of action, further investigations are necessary and their effect in vivo must be well established before they can be used in human subjects.