This paper presents observation made during a brief observation of the PBL programme at School of Medical Sciences (SMS), Universiti Sains Malaysia (USM). It provides a classification for the type of PBL offered at USM highlights the main aspects of the tutorial process there and reviews the experience of students and tutors engaged in PBL at this SMS. The paper proposes a series of recommendations with regards to the planned 2014 curricular reform.
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.
Objective: The objectives of this study were to determine the effect of a one and a half year educational intervention on the job dissatisfaction of teachers in 30 Community Based Rehabilitation (CBR) centres in Kelantan, Malaysia, and to identify the factors influencing changes in job dissatisfaction following the intervention. Method: Ten educational modules were administered to the teachers. A validated Malay version of Job Content Questionnaire (JCQ) was used pre intervention, mid intervention and post intervention. Result: Repeated Measure ANOVA revealed there was a statistically significant reduction in the mean of job dissatisfaction (p = 0.048). Multiple Linear Regression revealed that co- worker support (β= 0.034 (95% CI = 0.009, 0.059)), having less decision authority (β: -0.023; 95% CI: -0.036, -0.01) and being single (β: -0.107; 95% CI: -0.176,-0.038) were significantly associated with decreases in job dissatisfaction. Conclusion: The intervention program elicited improvement in job satisfaction. Efforts should be made to sustain the effect of the intervention in reducing job dissatisfaction by continuous support visits to CBR centres.
Due to cost containment considerations, it is common to have medical schools being
located in buildings or campuses built for some other purposes. These buildings are converted into
medical schools which often compromising the functional architectural aspects. Objectives: The
paper examines, explores and proposes an architectural concept of a purpose-built medical school. The
architectural design proposed is sensitive to the values and norms of many schools around the globe.
Methods: An Internet search and personal communication were conducted, focusing on the concepts
of the functionality of medical school. It emphasises on general design of the main building, keeping
in mind the various kinds of teaching, learning and assessment activities. We examined lecture hall,
pre-clinical laboratory, skill laboratory, general facilities of Objective Structured Practical Examination
(OSPE) and Objective Structured Clinical Examination (OSCE). Results: We present hypothetical
structural designs based on built-functions concepts. For example, for the better vision of students
around a demonstration table, an inclined floor surface is proposed. The concept is as illustrated by
anatomy dissection area built inclined upward from the cadaver table. It inevitably provides a better
visual access to the students around the table. Other teaching and learning areas are also illustrated
wherever appropriate in the text. Conclusion: The paper is hypothetical and explores innovative
structural designs of modern medical schools. While most are built to meet the demands of current
technology, it cannot however completely replace face-to-face teaching and learning processes.
Research in architectural designs of education buildings and facilities may be further developed into a
new research niche of medical education.
Background: Single best answer (SBA) as multiple-choice items are often advantageous to use for
its reliability and validity. However, SBA requires good number of plausible distractors to achieve
reliability. Apart from psychometric evaluation of assessment it is important to perform item analysis
to improve quality of items by analysing difficulty index (DIF I), discrimination index (DI) and
distractor efficiency (DE) based on number of non-functional distractors (NFD). Objective: To
evaluate quality of SBA items administered in professional examination to apply corrective measures
determined by DIF I, DI and DE using students’ assessment score. Method: An evaluation of post
summative assessment (professional examination) of SBA items as part of psychometric assessment
is performed after 86 weeks of teaching in preclinical phase of MD program. Forty SBA items and
160 distractors inclusive of key were assessed using item analysis. Hundred and thirty six students’
score of SBA was analysed for mean and standard deviation, DIF I, DI and DE using MS Excel 2007.
Unpaired t-test was applied to determine DE in relation to DIF I and DI with level of significance.
Item-total correlation (r) and internal consistency by Cronbach’s alpha and parallel-form method was
also computed. Result: Fifteen items had DIF I = 0.31–0.61 and 25 items had DIF I (≤ 0.30 or ≥
0.61). Twenty six items had DI = 0.15 – ≥ 0.25 compared to 14 items with DI (≤ 0.15). There were 26
(65%) items with 1–3 NFD and 14 (35%) items without any NFD. Thirty nine (32.50%) distractors
were with choice frequency = 0. Overall mean DE was 65.8% and NFD was 49 (40.5%). DE in
relation to DIF I and DI were statistically significant with p = 0.010 and 0.020 respectively. Item-total
correlation for most items was < 0.3. Internal consistency by Cronbach’s alpha in SBA Test 1 and 2
was 0.51 and 0.41 respectively and constancy by parallel-form method was 0.57 between SBA Test 1
and 2. Conclusion: The high frequency of difficult or easy items and moderate to poor discrimination
suggest the need of items corrective measure. Increased number of NFD and low DE in this study
indicates difficulty of teaching faculty in developing plausible distractors for SBA questions. This has
been reflected in poor reliability established by alpha. Item analysis result emphasises the need of
evaluation to provide feedback and to improve quality of SBA items in assessment.
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.
To ensure the reliability of manual blood pressure (BP) readings in a clinical trial, sources of error due to measurement must be reduced as much as possible. Apart from following standard procedure for BP measurement and ensuring good equipments, the measurement errors that come from the assessors themselves should be assessed. Objective: To demonstrate the use of two-way random effects, interactions absent, absolute agreement (Type A), single measures (Type 1) intraclass correlation coefficient (ICC) in the assessment of reliability of manual BP readings among assessors involved in a clinical trial using manual BP measurement, by using an interrater reliability study conducted by the authors as an example study. Methods: The steps involved in obtaining ICC in the study were discussed. Sample size given the number of assessors in the study was calculated. BP was measured using regularly maintained mercury sphygnomanometers, following recommendations by Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) for BP measurement in office setting. The outcomes were systolic and diastolic BP readings. A type of ICC, two-way random effects, interactions absent, absolute agreement (Type A), single measures (Type 1) ICC was chosen for the analysis and specifically discussed. Pre-requisite assumptions for ICC were meticulously checked and described. The interrater reliability for systolic and diastolic BP readings as expressed by ICC (single measure) were presented with confidence interval (CI). The ICCs obtained in the example study were discussed and concluded. The flaws of the study were also criticised. Results: The interrater reliability for systolic and diastolic BP measurements as expressed by ICC (single measure) were 0.87 (95% confidence interval [CI] 0.722, 0.956) and 0.77 (95% CI 0.560, 0.918) respectively. Conclusion: We demonstrated the steps required to obtain ICC. Since the use of manual BP measurement using mercury sphygmomanometer is still considered as gold standard of BP measurement, it is important that studies in which the BP outcome is measured using such method conduct interrater reliability studies properly.
Introduction: Emotional intelligence (EI) is deemed an important aspect of being good medical doctors. Universiti Sains Malaysia (USM) Emotional Quotient Inventory (USMEQ-i) is an EI inventory in Malay language developed primarily as medical student selection tool in USM. Although it was already validated by exploratory factor analysis (EFA), EFA is considered insufficient evidence of construct validity, thus confirmatory factor analysis (CFA) was conducted. Objectives: To determine measurement model validity and construct validity of USMEQ-i among medical degree program applicants in USM by CFA. Methods: USMEQ-i data file for medical degree program applicants in USM for year 2010/2011 and 2011/2012 academic sessions were obtained from Medical Education Department in USM. A random sample of 512 cases was drawn from the data file. Of the sample, only 453 cases were valid study sample after preliminary data screening and assumption checking. CFA was conducted on the sample using maximum likelihood (ML) estimation with bootstrapping technique due to violation of multivariate normality assumption. USMEQ-i measurement model was proposed as a second-order EI factor with seven first-order factors of EI and a Faking Index (FI) factor, with correlation between second-order EI factor and FI factor. Results: The proposed model could not be fit into the study sample data. EI factors and FI factor had to be analyzed separately due to non-positive definite problem. After modifications to the model, CFA of EI factors were suggestive of two-factor model instead of the proposed seven-factor model. Consciousness, Maturity and Control (CoMaCt). CFA of FI factor maintained one-factor model and also valid in term of construct. Conclusion: The modified USMEQ-i, which consisted of separate EI and FI models, was proven to have valid measurement models and reliable constructs. It is considered to be suitable for use among applicants to medical degree program in USM. However, its use as medical student selection tool may require further research, especially how predictive USMEQ-i scores with real performance of medical students, generalizability of the inventory and its stability over time.
Objective: To determine the validity and reliability of Incontinence Praying Ability (I-PA) among
Muslim childbearing-aged women. Methods: A cross sectional study was conducted among Muslim
women under childbearing age attended clinics in a university teaching hospital. Two measures were
used in the present study and there were I-PA and Incontinence Quality of Life (I-QoL). I-PA was
developed in Malay language and its construct validity had not been explored. The questionnaires
were handed to the Muslim women during their visit to the clinics in Hospital Universiti Sains
Malaysia. Exploratory Factor Analysis (EFA) was conducted to determine the construct validity
and the Cronbach’s alpha was used to examine the internal consistency reliability of I-PA. Pearson
correlation was used to examine the correlation between I-PA and the subscales of I-QoL. Validity was
further supported if both scales were significantly correlated. Results: A total of 162 Muslim women
completed and returned the questionnaires to the researchers. The mean age of participants was 32.4
(SD = 5.87). Based on EFA result, all the 10 items of I-PA were remained in the model under one
factor and no item deletion was required. The factor loadings were ranged from 0.70 to 0.91. The
internal consistency of I-PA was satisfactory with Cronbach’s Alpha of 0.94. There were significant
correlations between I-PA and I-QoL’s subscales, ranged from 0.64 to 0.71. Conclusion: I-PA was
considered a valid and reliable questionnaire measuring incontinence quality of life in the aspect of
praying ability or spirituality among Muslim childbearing-aged women.
Chronic kidney disease (CKD) causes 70% of all death globally. The prevalence of CKD has shown an increasing trend for the past 20 years in Malaysia. Thus, determining the knowledge and awareness of CKD among healthcare students in preparing them to be a good healthcare provider in the future is important. This study aimed to determine the association between knowledge and awareness about CKD among International Islamic University Malaysia (IIUM) undergraduate students. A crosssectional study was conducted among 108 students using simple random sampling method. The questionnaire was given to the class representative to be self-administered to interested students. It had close-ended questions consisting of Part A to Part D. The scoring given for correctly answered items was one and the total score for Part C was 7 marks. Most of the students were female (70.4%). The mean knowledge score of CKD was 3.65 (SD = 1.12) with nearly half of the students (43.5%) classified as having poor knowledge. Most respondents were aware about CKD (99.1%) and have heard about it from medical personnel (48.1%) and the Internet (25.9%). Further analysis showed that only courses taken by the respondents were significantly associated with knowledge on CKD (p = 0.039). The level of knowledge among undergraduate students is still poor, yet they are aware about the existence of CKD and its aetiology. Therefore, the health sciences curriculum should emphasise on CKD management from a multidisciplinary aspect of care. It is recommended to conduct similar research among different student populations to create awareness and obtain important baseline findings.
The Ministry of Higher Education introduced the integrated cumulative grade point average (iCGPA)
system in 2016 as an aspiration to produce holistic and well-balanced graduates based on Malaysian
Qualification Agency’s (MQA) learning domains. In this article, we provide a comparison of iCGPA
with other established medical competency frameworks and share our experience in implementing
iCGPA in the medical faculty. Throughout the process, it was noted that medical educators require
several core competencies in order to successfully implement iCGPA in their courses. Two of the most
important core competencies are understanding the pedagogies of the 21st century (heutagogies,
paragogies, and cybergogies) and apprehending the concept of outcome-based education. On top of
the requirement of core competencies, there were also challenges in tailoring teaching and learning to
meet the requirement of the Industrial Revolution 4.0. We also describe in detail the benefits and other
challenges of iCGPA implementation in our faculty. We conclude this article with our recommendation
for successful iCGPA implementation in the future for the medical faculty.
Myth, believe in powerful ‘being’ commonly known as jinn and usage of ‘bomoh’ as the medium is still widespread in our community in Kelantan especially among the Malay community. This believe and practice of usin ‘bomoh’ to cure and help with known and unknown disease believe to be caused by the jinn, occasionally poses a significant complication and threat to the management of patient in the hospital. Our case is just one of many cases that happen in our local hospital, and we hope by sharing this case will illustrate how ethical discussion occasionally surpassed the four common ethical pillars.
Phy-Antastic is the pioneering horizontally-integrated pedagogy that adopts physiology-oriented
anatomy teaching. A decline in time allocation for basic medical sciences (BMS) modules triggers
the conflict of interests among educators. “Physiology-then-Anatomy” temporal synchronisation
(and therefore Phy-Antastic) facilitates deep learning. The five highlighted features of Phy-Antastic
are: (i) explicit declaration of learning outcomes and prerequisite knowledge as groundwork for
the forthcoming topics; (ii) explanation of subject-related glossary to improve comprehension;
(iii) elucidation of the related physiological mechanism to calibrate the learners into appreciating
the cardinal anatomical features; (iv) the creative utilisation of multimodal teaching aids to simulate
consolidated learning experience; (v) lesson was concluded by revisiting learning objectives, reflection
on principal inquiry questions and recapitulating fundamental elements. The strength of Phy-Antastic
depends on homeostatic teaching with rigorous educational outcome set-point and interdisciplinary
feedback mechanisms. Small group discussion, problem-based learning and technology-assisted
teaching can easily incorporate Phy-Antastic. Inertia among BMS educators in embracing
interdisciplinary collaborative teaching remains the institutional barrier to the implementation of
Phy-Antastic. This article proposes a prospective advancement in anatomical education for the
contemplation of educators.
Histology, a branch of anatomy is a correlational science between structure of tissues and their
functions. Knowledge of histology is emphasised for undergraduate medical students as a basic for
clinical knowledge and research. To impart retainable and reproducible knowledge in histology, a new
laboratory manual with images and clinical correlates was introduced to the Year I MBBS students
in the Academic Session 2017/2018 during their general anatomy module. The objective structured
practical examination marks between 101 students of Batches 2016/17 and 2017/18 were analysed.
The difference in marks between both the batches were analysed using SPSS 20. Batch 2017/18
students who used the new lab manual scored better than the previous batch who used the old
manual. Independent t-test was not statistically significant. The students who used the new manual
fared better than their seniors. Since the difference was not statistically significant, it can be concluded
that if existent, drawbacks in the lab manual should be improved and adequate usage of the manual by
the students should be emphasised. Nevertheless, usage of the new lab manual shows that the students
could understand the subject and score better with less study hours.
Objective: This paper intended to review and analyse relevant published articles which have studied or applied multimedia as the educational medium for patients or their caregivers. The benefits were also recorded.
Method: The search was performed across the databases EBSCO Host, Springer Link, Science Direct and PubMed for relevant studies. Only full-text articles using English as a language of publication were included. Eligible articles included any usage of multimedia intervention as health information delivery for patients or caregivers. No restriction for publication date was set to permit a wider capture.
Result: Twenty articles met the inclusion criteria involving a total of 1,797 respondents. The studies have been conducted in various countries mostly in North American region followed by Europe. The focused disease for each study varied from asthma to cognitive impairment but most were on cancer. Problems in caregiving and depression were also reported. The overall data suggested that the multimedia-based education had generated modest improvement in self-efficacy, patient satisfaction, coping skills, and perceptions of social support. Cost benefits were also recorded. Additionally, patients’ behavioural changes were well maintained in parallel with the intervention programme.
Conclusion: The evolution of multimedia as an educational medium is growing and its incorporation has benefited health education management especially in improving patients’ and their family’s psychosocial outcomes. However, due to still limited scientific evidence to support its value, further multimedia-based interventions should be developed out of the need to share information and knowledge among patients as well as caregivers.
Introduction: USMaP-i is an English, 66-item self-administered inventory, consisting of personality
(60 items, 5 factors) and faking (one factor) components, which was mainly developed to measure
personality traits among Malaysian students based on local cultures and values. The personality
component was based on the Big Five dimensions as suggested by numerous personality researchers.
Previous exploratory studies showed promising validity, reliability and stability of USMaP-i.
Objective: To provide further validity evidence of USMaP-i for use among medical degree program
applicants by confirmatory factor analysis (CFA). Methods: Data were collected as a part of screening
of medical degree program applicants for year 2010–2013 intakes in Universiti Sains Malaysia
(USM), of which 657 cases were suitable for analyses following a data screening measures. CFA was
performed by bootstrap maximum likelihood estimation due to non-normality of items at multivariate
level. Results: Although the revised five-factor model of personality showed good model fit (X2(df) =
144.36(55), P-value < 0.001; CFI = .944, TLI = .921; RMSEA = .050; SRMR = .032, Bollen-Stine
bootstrap P-value = 0.004), the reliability of the factors is very poor (composite reliabilities (CR) =
.483 to .650). In contrast, the unidimensional faking component exhibited good model fit (X2(df)
= 14.15(5), P-value = 0.015; CFI = .984, TLI = .968; RMSEA = .053; SRMR = .011, BollenStine
bootstrap P-value = 0.068) and factor reliability (CR = 0.731). Conclusion: The personality
component should be revised and revalidated due to poor reliability, despite showing good model fit.
In contrast, the faking component showed good model fit and reliability. Further validation studies are
recommended before its use among medical degree program applicants.
Floods are known to be commonly occurring natural disasters in most part of the world. In 2014, the
east coast of Peninsular Malaysia was affected by the worst flood ever recorded in history. The worst
flood affected area were Kelantan, Terengganu and Pahang. The 2014 flood caused physical and
monetary losses amounting nearly millions of dollars. Among the worst hit infrastructures in 2014 flood
disaster were hospitals. This has led to the realization of hospital disaster preparedness and management
is important which needs to be closely monitored and addressed. This paper investigates the disaster
preparedness level of selected hospitals affected by flood disasters in Kelantan. Guided interviews with
the flood-affected hospital disaster committees were carried out and summarized in a summary table to
give a clear picture of the level of hospital disaster preparedness during the 2014 flood disaster. The
results show that despite the existence of disaster action plan and protocols there is no standard disaster
preparedness model being used by hospitals.
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.
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.
Objective: To determine the factor structure of the Health Promoting Behaviours (HPB) component of Health Promoting Lifestyle Profile-II among undergraduate students in Universiti Sains Malaysia (USM) by confirmatory factor analysis (CFA).
Methods: A cross sectional study was conducted among undergraduate students. The data was collected in the USM campus using a proportionate cluster sampling method. The HPB questionnaire was handed to students in the lecture hall and collected immediately when the lecture finished. CFA was conducted using robust maximum likelihood estimation due to violation of multivariate normality assumption. A three-factor model was tested for measurement model validity and construct validity.
Results: A total of 788 students participated in the study. CFA of a 21-item, three-factor model yielded an adequate goodness-of-fit values. The measurement model also showed a good convergent and discriminant validity after model re-specification.
Conclusion: The health promoting behaviours scale was proven to have a valid measurement model and reliable constructs. It was deemed suitable for use to measure the health promoting behaviours components of a healthy lifestyle among Malaysian undergraduate students. It was recommended to further conduct cross-validation studies in other Malaysian public universities to provide additional empirical evidence to support its use.