Introduction: During the last three decades hematopoietic stem cell transplantation (HSCT) has become a well-established treatment for many hematologic malignancies. The most important limitation for HSC transplantation is the low number of hematopoietic stem cells (HSC) that can lead to delayed engraftment or graft failures. Numerous attempts have been made to improve in vitro HSC expansion via optimization of various methods such as isolation techniques, supplementing with growth factors, utilizing stromal cells as feeder layer and other culture conditions. Objective: This project is aimed to decipher the efficiency of an isolation technique and retrieval of culture expanded HSC from feeder layer using two different harvesting methods. Materials and Methods: Hematopoietic stem cells from human umbilical cord blood were isolated via MACS mediated CD34+ double sorting. Then, the cells were cultured onto MSC feeder layer for 3 and 5 days. Culture expanded cells were harvested using two different harvesting method namely cell aspiration and trypsinization methods. Hematopoietic stem cell expansion index were calculated based on harvesting methods for each time point. Results: The numbers of HSC isolated from human umbilical cord blood were 1.64 x 106 and 1.20 x106 cells at single and double sortings respectively. Although the number of sorted cells diminished at the second sorting yet the yield of CD34+ purity has increased from 43.73% at single sorting to 81.40% at double sorting. Employing the trypsinization method, the HSC harvested from feeder layer showed a significant increase in expansion index (EI) as compared to the cell aspiration harvesting method (p≤ 0.05). However, the purity of CD34+ HSC was found higher when the cells were harvested using aspiration method (82.43%) as compared to the trypsinization method (74.13%). Conclusion: A pure population of CD34+ HSC can be retrieved when the cells were double sorted using MACS and expanded in culture after being harvested using cell aspiration method.
Ergonomic is important in classroom. Sitting for protracted period in class may lead students to develop musculoskeletal disorders. Their physical health and performance in the class may increase by designing school furniture that match with human body. In Malaysia, there is a lack of ergonomic assessment for school environment especially in urban areas. The aim of this study is to determine the mismatch between the furniture dimension and anthropometric parameters among primary school children in Putrajaya. This is a cross-sectional study which involved 100, Year 1 and Year 6 primary school students randomly selected in Putrajaya. Five anthropometric measurements (popliteal height, buttock popliteal length, elbow height, shoulder height (sitting), hip breadth) as well as five furniture dimensions (seat height, seat depth, seat width, backrest height and seat to desk height) were measured. Instrument used is Martin type anthropometer set, SECA body meter, and SECA weighing scale. Calculation for determining mismatch between the furniture and anthropometric measures were calculated using a standard mismatch formula. There was 100% mismatch for seat height, seat depth, and seat to seat to desk height for Year 1. As for Year 6, mismatch was reported 100% for backrest height and seat to desk height. There were significance difference for parameters of popliteal height between Year 1 and Year 6 and between male and female of Year 1. There was a presence of mismatch between furniture dimension and children anthropometric measurement. Proposed dimension of furniture shows decrease in percentage of mismatch for the most parameter of anthropometric measurement.
A functional magnetic resonance imaging (fMRI) study was conducted on 4 healthy male and female subjects to investigate brain activation during passive and active listening. Two different experimental conditions were separately used in this study. The first condition requires the subjects to listen to a simple arithmetic instruction (e.g. one-plus-two-plus-three-plus-four) - passive listening. In the second condition, the subjects were given the same series of arithmetic instruction and were required to listen and perform the calculation - active listening. The data were then analysed using the Statistical Parametric Mapping (SPM5) and the MATLAB 7.4 (R2007a) programming softwares. The results obtained from the fixed (FFX) and random effects analyses (RFX) show that the active-state signal intensity was significantly higher (p < 0.05) than the resting-state signal intensity for both conditions. The results also indicate significant differences (p < 0.001) in brain activation between passive and active listening. The activated cortical regions during passive listening, as obtained from the FFX of the first condition is symmetrical in the left and right temporal and frontal lobes covering the cortical auditory areas. However, for the second condition, which was active listening, more activation occurs in the left hemisphere with a reduction in the number of activated voxels and their signal intensity in the right hemisphere. Activation mainly occurs in the middle temporal gyrus, precentral gyrus, middle frontal gyrus, superior temporal gyrus and several other areas in the frontal lobes. The point of maximum signal intensity has been shifted to a new coordinates during active listening. It is also observed that the magnetic resonance signal intensity and the number of activated voxel in the right and left superior temporal lobes for the second condition have been reduced as compared to that of the first condition. The results obtained strongly suggest the existence of functional specialisation. The results also indicate different networks for the two conditions. These networks clearly pertain to the existence of functional connectivity between activation areas during listening and listening while performing a simple arithmetic task.
Many researchers have emphasized the importance of teaching stress management and self-care skills to medical students as they are vulnerable to develop psychological health problems. The researchers designed a 4-hour intervention based on the DEAL model to address these problems. This study aimed to determine outcomes of the DEAL-based intervention on medical students’ stress, anxiety and depression symptoms. Methods: A randomized controlled trial study was conducted on 171 medical students. Their stress, anxiety and depression symptoms were measured by the 21-item Depression Anxiety Stress Scale at five intervals; at 2 weeks before the intervention, and at 1 week, 8 weeks, 16 weeks and 32 weeks after the intervention. The mixed model ANCOVA was applied to determine the effect of the intervention on the participants’ psychological health at five intervals. Results: A total of 153 medical students (intervention = 73 and control = 80) completed this study. Results showed that the intervention group experienced significantly lower stress and depression symptoms than the control group. Although anxiety scores are consistently lower in the intervention group, no significant differences between groups were found. Conclusion: These results support the favourable outcomes of the intervention on psychological health of medical students. It is a promising intervention to be considered by medical schools as it consumes minimal amount of time, money, training and man power as well can be implemented easily.
Introduction: Emotional intelligence (EI) refers to the ability to perceive, control and evaluates emotion. Research results found that EI is relevant to organizational development and manpower development. It is also important to academic success, emotional adaptability, stress management and other lifestyle issues. EI principles help one to understand and assess people's behaviors, interpersonal skills, attitudes and potentials. It also plays an important role in human resource planning, job placement and recruitment interviews and selection, business development, customer care services, and more. The study focused on exploring students’ EI, subscales of EI (i.e., personal competencies and social competencies) and its associated factors. Methods: A cross-sectional study was conducted on 571 medical students from year 1, 3 and 5. Years of study, gender, and ethnic groups were included as factor variables. USM Emotional Quotient Inventory (USMEQ-i) was used to measure EI, personal competence and social competence. Results: Years of study significantly associated with EI (F = 18.41, p < 0.001), personal competency (F = 16.93, p < 0.001) and social competency levels (F = 12.92, p < 0.001). There was a decreasing pattern of EI, personal competency and social competency level as medical training progresses. Male significantly had a higher EI (t = -1.99, p < 0.05) and personal competence (t = -1.99, p < 0.05) levels than female medical students. Nevertheless, male and female students had equal levels of social competence (t = -1.39, p = 0.730). Ethnic groups demonstrated no significant association with EI, personal competency and social competency level. Conclusion: This study found that years of study were the main associated factor, followed by gender. In addition, there is a cause of concern regarding the decreasing pattern of EI throughout medical training. Further research is required to investigate this concern, so that appropriate intervention can be taken to alleviate the concern.
Introduction: Clinical educators around the globe agreed that an optimal educational climate is a vital aspect for effective learning to take place. This study was conducted to evaluate the perceptions of graduates toward the quality of clinical education climate in USM medical school. Methods: A cross-sectional study was conducted on a cohort of USM medical graduates. Questionnaires were administered to the graduates to measure their perception on four aspects of clinical education climate that include structure of clinical rotation, clinical teaching and learning activities, quality of lecturers and end clinical rotation assessment across 13 clinical rotations. The graduates were requested to respond to seven-Likert scale ranging from 1(poor) to 7(excellent). Scores of equal to or more than 5 was considered as positive areas, scores of between 4 and 5 were considered as areas for improvement, and scores less than 4 were considered as areas of concern. Data analysis was performed using SPSS version 20. Results: A total of 105 (96.3%) graduates responded to the questionnaire. Results showed only the paediatric rotation obtained positive ratings on all areas of the clinical rotation structure. With regards to teaching and learning activities, the graduates scored most of the clinical rotations between 4 and 5. With regards to the quality of lecturers, most of the clinical rotations obtained score more than 5. Most of the areas related to the end-of-assessment of clinical rotation obtained score more than 5 except for the feedback adequacy, indicating inadequacy of feedback they received. Conclusion: USM medical graduates positively perceived the quality of lecturers during clinical training, however several areas of clinical education related to clinical rotation structure, clinical teaching and learning activities, and feedback practice were perceived by them as areas for improvement. Medical schools should introduce strategic measures to address the concerns raised by the graduates to ensure the best clinical learning experience are provided to the current and future medical students.
Expectation Maximization (EM) algorithm has experienced a significant increase in terms of usage in many fields of study. In this paper, the performance of the said algorithm in finding the Maximum Likelihood for the Gaussian Mixed Models (GMM), a probabilistic model normally used in fraud detection and recognizing a person’s voice in speech recognition field, is shown and discussed. At the end of the paper, some suggestions for future research works will also be given.
The oral health awareness and status among the Universiti Kebangsaan Malaysia first year dental students were studied. Seventy-three subjects underwent two components of assessment: questionnaire assessing oral health awareness and behaviour, and clinical examination of oral health status. Indices used including Plaque, Calculus, Community Periodontal Index for Treatment Needs (CPITN) and total score of Decayed, Missing, Filled and teeth indicated for Extraction (DMFX[T]). More than 90% of the subjects were reported to brush their teeth twice or more daily and used supplemental cleaning tools. They also knew the importance of healthy oral condition, the various causes and prevention of tooth decay and gum diseases. Although 70.3% felt they need dental treatment, the majority (81.9%) visited the dentist only when they feel it is necessary to do so. Clinical examination showed low scores of 0.99 and 0.40 for mean plaque and calculus indices, respectively, while 80.8% of the subjects have mild calculus accumulation. Code 2 of the CPITN Index was the highest (70.3%) among the subjects. The total DMFX was 291, with mean score of 0.14 per subject and the decayed component was the highest (D=186 teeth). These findings suggest that the subjects have acceptable oral health awareness, and also good existing oral health status.
Perkembangan kognitif dan pertumbuhan fizikal di kalangan kanak-kanak bergantung kepada status pemakanan mereka, termasuklah tabiat pengambilan sarapan pagi. Objektif kajian ini adalah untuk melihat pengaruh pengambilan sarapan pagi sebelum ke sekolah ke atas pencapaian kognitif kanak-kanak sekolah rendah. Satu kajian hirisan lintang dijalankan di kalangan kanak-kanak sekolah rendah di bandar dan luar bandar. Subjek kajian mengandungi 165 pelajar Melayu yang berusia 10 tahun. Tiga jenis subskala daripada ujian Wechsler Wechsler Intelligence Scale For Children-III digunakan untuk mengukur tahap kognitif kanak-kanak tersebut iaitu arithmatik, pengkodan dan digit span. Hasil kajian didapati kanak-kanak yang mengambil sarapan pagi mencatatkan pencapaian yang tinggi secara signifikan dalam arithmetik (p
Kajian garis pangkal pengimejan resonans magnet kefungsian (fMRI) telah dijalankan ke atas 2 orang subjek lelaki sihat dominan tangan kanan dan kiri. Kajian ini menggunakan gerakan jari tangan kanan dan kiri untuk merangsang aktiviti neuron di dalam korteks serebrum. Subjek diarahkan supaya menekan jari-jari pada ibu jari secara bergilir-gilir semasa imbasan fMRI dilakukan. Paradigma 5 kitar aktif-rehat digunakan dengan setiap kitar mengandungi satu blok aktif dan satu blok rehat dengan 10 siri pengukuran untuk setiap blok. Seratus isipadu imej fMRI bagi setiap subjek dianalisis menggunakan pekej perisian MatLab dan SPM2. Model linear am (GLM) digunakan untuk menganggar secara statistik parameter yang mencirikan model rangsangan hemodinamik bagi gerakan jari. Kesimpulan mengenai pengaktifan otak yang diperhatikan dijana secara statistik berasaskan teori medan rawak (RFT) Gaussian. Keputusan menunjukkan bahawa rantau otak yang aktif akibat gerakan jari adalah pada girus presentral merangkumi kawasan motor primer. Pengaktifan otak adalah secara kontralateral terhadap gerakan jari tangan kanan dan kiri. Keamatan isyarat keadaan aktif didapati lebih tinggi secara bererti (p < 0.001) daripada keamatan isyarat keadaan rehat. Bilangan voksel yang aktif didapati lebih tinggi pada hemisfera otak yang mengawal gerakan jari bagi tangan yang tidak dominan untuk kedua-dua subjek. Keputusan ini menyokong fakta bahawa kawasan pengaktifan motor pada hemisfera otak semasa gerakan jari tangan yang tidak dominan mengalami rangsangan hemodinamik yang lebih tinggi dan kawasan pengaktifan yang lebih luas berbanding dengan kawasan pengaktifan pada hemisfera otak yang mengawal gerakan jari bagi tangan yang dominan.
This study was carried out to investigate the effects of noisy background on brain activation during a working memory task. Fourteen healthy male subjects underwent silent functional Magnetic Resonance Imaging (fMRI) scans while listening to words presented verbally against quiet (WIS) and noisy (WIN) backgrounds. The stimuli were binaurally presented to the subjects at 70 dB sound pressure level (SPL) in both conditions. Group results indicated significant (p < 0.001) bilateral widespread of brain activations in the primary auditory cortex, superior temporal gyrus, inferior frontal gyrus, supramarginal gyrus and inferior parietal lobes during WIS. Additional significant activation was observed in the middle cingulate cortex and anterior cingulate cortex during WIN, suggesting the involvement of cingulate cortex in working memory processing against a noisy background. The mean percentage of signal change in all regions was higher during WIN as compared to WIS. Right hemispheric predominance was observed for both conditions in primary auditory cortex and middle frontal gyrus and this could be attributed to the increased difficulty of the tasks. The results obtained from this study demonstrated that background noise increased task demand and difficulty. Task demand was found to play an important role in determining the activation magnitude in the brain areas during working memory task.
Objective: The involvement of families in assisting health professionals in providing care for their family members who suffer a stroke during hospitalization is common in Malaysia. Family caregivers are accountable in providing for the first-ever stroke survivor’s needs, including maintaining functional improvements gained in rehabilitation and the long-term well-being of the stroke survivors. The objective of this study was to determine the predictors of life satisfaction among family caregivers of hospitalized first-ever stroke patients. Methods: This was a cross-sectional community research design study with purposive sampling. It involved 102 family caregivers of hospitalized first-ever stroke patients of two tertiary hospitals in Kelantan. The Bakas Caregiving Outcomes Score (BCOS) was used to measure life satisfaction. Multiple linear regression was used to determine the predictors of life satisfaction. Results: Out of 102 respondents, 21 were males and 81 were females with age range of 16 to 76 years. Significant predictors of life satisfaction of caregivers while caring for their hospitalized first-ever stroke family members were caregivers’ health (β: -2.875, 95%CI: -5.725, -0.025, p = 0.048), patients’ age (β: - 4.251, 95% CI: - 6.379, -2.123, p
Background: One of important educational climate roles is to provide an environment that promotes positive development of medical students' psychological wellbeing during training. Unfortunately, many studies have reported that educational climate in medical education are not favourable to them. Therefore, it is a real need for a simple, valid, reliable and stable tool that will help medical schools to screen psychological wellbeing of their students so that early intervention could be done.
Objective: This study aimed to explore the psychometric properties of the Medical Student Wellbeing Index (MSWBI) to measure psychological wellbeing at different interval of measurements in a cohort of medical students.
Method: A prospective study was done on a cohort of medical students. MSWBI was administered to the medical students at five different intervals. The confirmatory factor analysis, Cronbach's alpha and intra-class correlation analysis were applied to measure construct validity, internal consistency and agreement level at different interval of measurements.
Result: A total of 153 (89.5%) medical students responded completely to the MSWBI. The MSWBI showed that the one-factor model had acceptable values for most of the goodness of fit indices signified its construct was stable across multiple measurements. The overall Cronbach's alpha values for the MSWBI at the five measurements ranged between 0.69 and 0.78. The ICC coefficient values for the MSWBI total score was 0.58 to 0.59.
Conclusion: This study found that the MSWBI had stable psychometric properties as a screening tool for measuring psychological wellbeing among medical students at different time and occasions. Continued research is required to refine and verify its psychometric credentials at different educational settings.
Introduction: Medical and allied health educators around the globe agreed that an optimal educational climate is a vital aspect for effective learning to take place. Without a doubt, appraisal of the educational climate has been emphasized as a key to the delivery of high quality medical education. In addition, the appraisal provides useful feedback to particular institution to improve their curriculum.
Objective: This study was employed as part of the School of Medical Sciences (SMS) Universiti Sains Malaysia curriculum review process. It aimed to explore the strengths and weaknesses of the current medical curriculum thus could provide useful information to guide the curriculum review committee during the review process.
Method: A cross sectional study was conducted on a total of 656 medical students from the first, third and fifth year of study. Purposive sampling method was applied. DREEM was administered to the medical students to evaluate the educational climate in the studied medical school.
Result: A total of 511 (77.9%) medical students completely responded to the 50 statements of DREEM. The mean global score across phases of medical training was 128.36/200. The global scores for year 1, year 3 and year 5 were 138.94/200, 122.27/200 and 125.49/200 respectively. Results showed that; 1) the medical school had reasonably level of educational climates across phases of medical training; 2) the medical teachers were knowledgeable and well prepared for the teaching; 3) the students were overloaded with factual knowledge; 4) the medical teachers were quite harsh to students during teaching session especially in clinical phase; 5) students experienced a significant amount of stress that led to poor memory; 6) the learning process was inclined toward teacher-centered rather than student-centered learning; 7) students had a considerable healthy social relationships with peers as well as others; and 8) academic dishonesty became more apparent in the clinical phase.
Conclusion: The medical school's educational environment across different phases of study was more positive than negative. However, there are plenty of rooms for improvement as perceived by the medical students. The medical school should address various important issues highlighted in this article during the curriculum review process.
Teaching stress management skills for medical students has been echoed as an important educational component in medical education. Discussions about approaches to teaching stress management in medical education context are largely unexplored despite of a large number of articles have emphasized on its importance. This paper describes four elements in a framework as an approach to teaching stress management skills in medical education. As one moves through the framework, it provides a greater degree of insight on stress management ability as is acquired through one's awareness, experience and conscious effort that allow stressful situations to be handled effectively and efficiently. It may provide a useful educational framework for medical teachers to teach and assess stress management skills of medical students. It also may be used as an aid in planning, implementing and evaluating stress management programs in medical schools. The authors discuss about the implications of this framework for future research in medical education.
One of the most interesting water management case studies in Iran is the case of Zayandehrud River, the main river that supplies water to Isfahan Province which is located in Gavkhuni River Basin (GRB). This paper examines the present and future demands for water and determines the extent to which water will be available for agricultural use by the year 2020. Although demand and supply conditions in 2000 were more or less in balance, there was an increase in the supply of some 28% by 2010 due to the completion of the third trans-basin diversion and the development of other local water sources. However, the demand exceeded its supply in 2010 and the basin fell into severe deficit. In this condition, the only way to keep supply and demand in balance is to reduce allocations to agriculture. By 2020, agriculture would only have 5% more water than the present and water supply is only 90% that of the normal, and this would then shrink from 2025 onwards. In other words, agriculture would have to be sacrificed in order to ensure full supplies of water for the other sectors. The scenarios examined reveal that a sustainable agriculture can only be accomplished by water saving practices and management measures, which may further lead to reduced demand, control supplies, and improve the efficiency of water use.
Knowledge about the hemodynamic model that mediates synaptic activity and measured magnetic resonance signal is essential in understanding brain activation. Neural efficacy is a hemodynamic parameter that would change the evoked hemodynamic responses. In this work, brain activation and neural efficacy of the activated brain areas during simple addition task in two different backgrounds were studied using fMRI. The objectives were to determine the activated areas during the performance of arithmetic addition in quiet (AIQ) and noisy (AIN) background and to investigate the relationship between neural efficacy and height extent of activation for the respective areas. Eighteen healthy male participants performed simple arithmetic addition in quiet and in noise. Bilateral cerebellum, superior temporal gyrus (STG), temporal pole (TP) and supplementary motor area (SMA) were significantly (p < 0.05) activated during AIQ and AIN. Left middle frontal gyrus (L-MFG), right superior frontal gyrus (R-SFG), right superior orbital gyrus (R-SOG) and bilateral insula were more active in quiet as compared to in noise while the left middle cingulate cortex (L-MCC), left amygdala (L-AMG), right temporal pole (R-TP) and left cerebellum (L-CER) were more active in noise as compared to in quiet. The t value for most of the activated regions was found to be inversely proportional to the neural efficacy. Significant (p < 0.05) negative relationship between t value and neural efficacy were found for R-STG and bilateral cerebellum during AIQ, while for AIN, similar relationships were found in R-CER, R-STG and R-TP. This study suggests that while being significantly activated, the hemodynamic responses of these brain regions could have been suppressed by the stimulus resulting in an intensity decrease with increasing neural efficacy.
Several binary and ternary medium- and long-chain triacylglycerol (MLCT)-enriched margarine formulations were examined for their solid fat content, heating profile, polymorphism and textural properties. MLCT feedstock was produced through enzymatic esterification of capric and stearic acids with glycerol. The binary formulations were produced by mixing MLCT feedstock blend (40%–90%) and palm olein (10%–60%) with 10% increments (w/w). Solid fat profiles of commercial margarines were used as a reference to determine the suitability of the formulations for margarine production. The solid fat content of the binary formulations of MO 82 and MO 91 (M, MLCT, O, palm olein) were similar to the commercial margarines at 25°C which met the basic requirement for efficient dough consistency. Ternary formulations using reduced MLCT feedstock blend proportion (from 80%–90% to 60%–70%) were also developed. The reduction of MLCT feedstock blend was
done as it had the highest production cost (3USD/kg) in comparison to palm olein (0.77USD/kg) and palm stearin (0.7USD/kg). The proportions of 5%–15% of palm stearin were substituted with palm olein in MO 64 and MO 73 (M, MLCT; O, palm olein) formulations with 5% increment (w/w). As a result, MOS 702010 and MOS 603010 (M, MLCT; O, palm olein; S, palm stearin) margarine formulations showed similar SFC % to the commercial margarines at 25ºC. These formulations were subsequently chosen to produce margarines. The onset melting and complete melting points of MLCT-enriched margarine formulations were high (51.04ºC –57.93ºC) due to the presence of a high amount of long chain saturated fatty acids. Most of the formulations showed β΄- crystals. MOS 702010 was selected as the best formulation due to values for textural parameters comparable (P
In this multiple-subject study, intrinsic couplings between the primary motor (M1) and supplementary motor areas (SMA) were investigated. Unilateral (UNIright and UNIleft) self-paced tapping of hand fingers were performed to activate M1 and SMA. The intrinsic couplings were analysed using statistical parametric mapping, dynamic causal modeling (DCM) and Bayesian model analysis. Brain activation observed for UNIright and UNIleft showed contralateral and ipsilateral involvement of M1 and SMA. Ten full connectivity models were constructed with right and left M1 and SMA as processing centres. DCM indicated that all subjects prefer M1 as the intrinsic input for UNIright and UNIleft as indicated by a large group Bayes factor (GBF). Positive evidence ratio (PER) that showed strong evidence of Model 3 and Model 6 against other models in at least 12 out of 16 subjects, supported GBF results. The GBF and PER results were later found to be consistent with that of BMS for group studies with high expected posterior probability and exceedance probability. It was concluded that during unilateral finger tapping, the contralateral M1 would act as the input centre which in turn triggered the propagation of signals to SMA in the same hemisphere and to M1 and SMA in the opposite hemisphere.
Context: Question vetting is important to ensure validity, reliability, and other quality indicators of assessment tools, including the MCQ. Faculty members invest a substantial amount of time and effort into the MCQ vetting process. However, there is shortage of scientific evidence showing its effectiveness and at which level it needs to be focused on. This study aimed to provide scientific evidence regarding the effects of question vetting process on students’ examination performance by looking at their scores and pass-fail outcomes.
Method: A parallel randomized control trial was conducted on third year medical students in a medical school. They were randomly assigned into two equal groups (i.e. control and experimental). Two mock examinations were conducted (i.e. time I and time II). At time I, non-vetted MCQs were administered to both groups as a baseline measurement. At time II, vetted MCQs were administered to the experimental group, while the same non-vetted MCQs were administered to the control group.
Results: Out of 203 students, 129 (63.5%) participated in both mock examinations. 65 students were in the control group and 64 students were in the experimental group. Statistical analysis showed no significant differences (p > 0.05) in mean examination scores and pass-fail outcomes between or within the control and experimental groups.
Conclusion: This study indicated that the MCQ vetting process did not influence examination performance. Despite these findings, the MCQ vetting process should still be considered an important activity to ensure that test items are developed at the highest quality and standards. However, it can be suggested that such activity can be done at the departmental level rather than at the central level.