The Delphi technique is a widely used and accepted method to obtain consensus among the
experts. This technique uses a judgement to prove the accuracy of the content item when evaluating
instrument. The objective of this study is to discuss the process of the three rounds Delphi technique
to obtain consensus of concept mapping care plan and multiple choice questions (MCQ) in Diabetic
Mellitus subject. In the first round, participants were given a structured questionnaire regarding item
of concept mapping care plan and MCQ in Diabetic Mellitus subject. In the second round, the mean
and median values of round one were added. In the third round, the mean and median values of round
two were added. Participants were asked to rate the categorised responses from Round 1 on a scale of
1 to 5, with 1 being “Very Irrelevant” and 5 being “Very Relevant”. This technique does not require
that participants be collocated or meet face-to-face, thereby making it useful to conduct surveys
with qualified people over a wide geographic area. The feedback process allows and encourages the
selected Delphi participants to reassess their initial judgements about the information provided in
previous iterations. The analysis of consensus data of the experts was done based on median, inter
quartile range and quartile deviation on round one, two and three data. The median score was used to
analyse the level of consensus of experts and result shows that in all three rounds Delphi the medium
result more than 4. It reported that level of importance of the statements were high. As a conclusion,
the concept mapping care plan and MCQ have meets the consensus by using three rounds of Delphi
techniques. Therefore, the Delphi technique is the best method to obtain consensus in health care
education research.
Introduction: Concept mapping is an innovative teaching learning strategy for students who have
the ability to develop concept maps. A planned and well-developed concept mapping protocol is
needed, so that nursing educators have a teaching guideline, enabling them to improve their teaching
techniques through concept mapping. Therefore, the researcher seeks to develop and validate the
impact of the Rusnani Concept Mapping (RCM) protocol guideline for application among nursing
students. Objectives: To develop, validate, and test the reliability of the RCM protocol guideline.
Methods: The development of RCM based on Mohd Afifi Learning model (MoAFF), ADDIE model
and integrating with Kemp model. This model protocol has five phases: analysis, design, development,
implementation and evaluation. The validity of the protocol was determined based on content and
face validity and the Delphi technique. The content validity of this lesson plan was established through
expert review, involving seven expert panels. Results: After obtaining feedback from the expert panel,
the researcher analysed content validity, using a formula based on percentages. This formula suggested
that good content validity is indicated by a percentage of content validity achievement greater than
70%, whereas if the percentage of content validity is below 70%, it is advisable to recheck the content,
according to the study objective. Conclusion: The reliability of the protocol was 0.816, showing that
the RCM protocol has high reliability and validity. RCM is thus a positive and innovative teaching
method that could be helpful in improving the academic performance of nursing students.
The ultimate aim of faculty development programmes (FDPs) is to boost teachers’ competence in their journey of becoming a respectable educator. It takes place when a faculty member joins such activity with a hope of cultivating their knowledge and skills in desired areas such as pedagogy, research, motivation, and administration. However, to design the best practices of FDPs, it needs a great deal of consideration on numerous factors. This paper discusses principles of the best practice in FDPs, challenges and its solutions, its impacts on professional identity, and finally highlights the future trend of FDPs. Since it is beneficial in fostering professionalism of a faculty member, it is important for school administrators to address FDPs as a prominent agenda in seeking a professional medical teacher.
Journal business models are basically classified based on the source of income to cover publication costs and in general there are two main journal business models which are the toll-access and open-access. These leading to a question that still remains around the ethics of publishing academic work across the different journal business models in terms of (a) editorial decision-making and (b) the dissemination of research that has not been appropriately peer-reviewed for quality and rigor. This paper discussed about these two areas based on the literature and the authors' observations.
Introduction: Pregnancy is common among women in the reproductive age and is associated with several risks. Preconception care has thus been introduced to promote health before conception and to improve pregnancy-related outcomes. The aim of this study was to determine the level of knowledge, attitudes and practices regarding preconception care among women attending antenatal care appointments. Methodology: This was a cross-sectional study conducted from April to December 2012 at Klinik Kesihatan Bachok. A self-administered questionnaire was administered to 135 respondents from 18 to 45 years of age. The questionnaire consisted of four domains, assessing socio-demographic data and knowledge, attitudes and practice of preconception care. Results: The mean (SD) knowledge, attitude and practice scores were 11.37 (3.94), 15.39 (2.12) and 10.13 (2.30), respectively. In total, 98.5% of the respondents had good attitudes, 45.2% had good practices, and 51.9% had good knowledge of preconception care. Conclusion: Women in Bachok have fair knowledge of and good attitude towards preconception care. However, they have poor preconception care practices.
Suboptimal management of asthma can lead to increase morbidity and mortality. Unfortunately, this has become global issue and approximately 40% of asthmatic patients received suboptimal management in emergency department. Therefore, this study aimed to develop a tool to assess knowledge and clinical reasoning of healthcare providers on acute asthmatic management in emergency setting.
Method: The tool was developed via three phases: (a) domain identification, (b) domain blueprinting based the Global Initiative of Asthma (GINA) and the British Thoracic Society (BTS) guidelines, and (c) item generation for each domain for assessing knowledge and clinical reasoning. Three forms of validity evidence related to content, response process and internal structure were appraised. Content validity index (CVI), face validity index (FVI), and intraclass correlation coefficient (ICC) estimate the content validity, response process and internal structure of the tool.
Results: A new tool was developed, named as Knowledge and Clinical Reasoning of Acute Asthma Management in Emergency Department (K-CRAMED), which assesses knowledge and clinical reasoning on three domains related to management of acute asthma – diagnosis, treatment and disposition. CVI values for the three domains were more than 0.83. FVI values for the three domains among doctors and paramedics were at least 0.83. The ICC between scores given by emergency specialists was 0.989 (CI 95% 0.982, 0.994, p-value < 0.001).
Conclusion: The newly developed tool, named as K-CRAMED, is a valid tool to assess knowledge and clinical reasoning of healthcare providers who manage patients with acute asthma. Further validation is required to verify its validity in other setting.
Introduction: Student selection is important for selecting the best candidates into medical courses.
The Multiple Mini Interview (MMI) is a valid selection tool for the task. The School of Medical
Sciences (SMS), Universiti Sains Malaysia (USM) has employed MMI as a medical admission
tool to select potential candidates into its medical program. Objective: This paper described the
implementation of the MMI and reported the preliminary evaluation data on its validity evidence.
Method: A 9-station MMI (with 5 manned and 4 rest stations) was employed for the 2015 student
selection exercise. Interview data were analysed and questionnaire surveys were administered to both
interviewers and candidates. Validity, reliability, feasibility and acceptability were determined. Results:
Unidimensional construct on confirmatory factor analysis (CFA) and interviewer comments provided
evidence of construct validity. Overall reliability was 0.94, good enough for high-stakes decisions.
Interviewers and candidates’ comments on feasibility and acceptability were also generally positive.
The consistency of the difficulty and discrimination indices of similar stations between sessions was
identified as among the areas for improvement. Conclusions: We are cautiously optimistic regarding
the utility of the MMI in the SMS; future improvements are planned but the present implementation
seems sufficient for the stated purposes
Item analysis (IA) is commonly used to describe difficulty and discrimination indices of multiple
true-false (MTF) questions. However, item analysis is basically a plain descriptive analysis with
limited statistical value. Item response theory (IRT) can provide a better insight into the difficulty
and discriminating ability of questions in a test. IRT consists of a collection of statistical models that
allows evaluation of test items (questions) and test takers (examinees) at the same time. Specifically,
this article focuses on two-parameter logistic IRT (2-PL IRT) model that is concerned with estimation
of difficulty and discrimination parameters. This article shows how 2-PL IRT analysis is performed in
R software environment, guides the interpretation of the IRT results and compares the results to IA on
a sample of MTF questions.
Lecturers are expected to teach effectively and evaluating their teaching effectiveness are essential to
ensure students get the best learning experience. A systematic evaluation of teaching behaviours with a
proper feedback mechanism will help to improve their teaching effectiveness. Improvement of teaching
effectiveness will result in better students’ learning experience, and thus attaining the intended
educational outcomes. This study aimed to evaluate teaching effectiveness among lecturers by
assessing their teaching behaviours during lectures. A cross-sectional study was conducted on lecturers
in a Malaysian public medical school. Their teaching behaviours were rated by 30 trained pre-clinical
medical students using Teacher Behaviour Inventory (TBI) on seven aspects – organisation, speechpacing,
clarity, enthusiasm, interaction, rapport, and disclosure. A total of 55 lecturers were rated
by the medical students. The organisation and speech-pacing aspects were highly rated as the mean
scores were 4.02 and 4.15, respectively. The clarity, enthusiasm, interaction, and rapport aspects
attained satisfactory level as the mean scores ranged from 3.10 to 3.59. The disclosure aspect was
poorly rated as the mean score was 2.20. Eventhough all lecturers in this school are considered expert
in their area, findings from this study suggest that some teaching behaviour need some improvement.
Findings from this study also provide useful data for the medical school to chart direction of faculty
development activities to improve their lecturers’ teaching effectiveness during lectures.
Educational environment is an important determinant of medical students’ behaviour. It impacts their
academic performance, motivation, and psychological well-being. Quantitative evidence have shown
that there is a decrease in the positive perception of clinical medical students towards the educational
environment. The primary focus on this study was to explore the clinical education environment
through the lived experience of clinical medical students during medical training. Using hermeneutic
phenomenology we aimed to interpret participants’ experience of personal clinical learning journey
through free text input. Thematic analysis was performed to analyse the written texts. Various
measures were taken to enhance the trustworthiness of the findings. A total of 154 (74.8%) fourth year
students and 144 (74.6%) final year students participated in the study. We identified six overarching
themes of education environment in clinical setting that are personal development, teaching and
learning, assessment for learning, facility, support and nurturing curriculum. The overlapping
relationship of the themes is illustrated in the Clinical Education Environment Framework. While
many themes were consistent with existing framework, our findings also proposed assessment as an
important component to influence perception on education environment. The themes in this study
finding conform to the definition of education environment which covers physical, social, and
psychological aspects of students learning. Medical schools should take active measures to incorporate
a nurturing education environment especially in clinical year where students struggle with the hidden
curriculum.
This paper describes a systematic and practical guide on manuscript writing. A step-by-step approach
as easy as learning ABC to facilitate authors to plan their manuscript writing. Research has shown that
experienced writers plan extensively, in which a writing plan is a road map, without it we will probably
lose our way in circles. Generally, authors start writing a manuscript by introduction, methods, results,
discussion and conclusion. However, this paper proposes a different approach to start writing a
manuscript based on the ABC of manuscript writing worksheet.
Assessment of medical professionalism is often challenged by the subjectivity of its construct and
lack of feedback practice to nurture professional growth. However transmitting professionalism alone
has not been shown to improve professional behaviour therefore professionalism need to be assessed
if it is viewed as relevant. The authors provided description and guidelines on the use of Simplified
Thematic Engagement of Professionalism Scale (STEPS) as summative and formative assessment
tool for assessing professionalism attributes. STEPS was developed based on the Professionalism
Mini-Evaluation Exercise (P-MEX) format that utilise multiple short encounter assessment and
incorporated professionalism values from a local study. The formative component has 15 attributes
that were categorised into personal, profession, patient and public. This is assessed using seven scale
rubric that promotes feedback practice using feed up, feed back and feed forward concept. The
summative component utilises global rating that will be collated longitudinally to form a more robust
evaluation of student professionalism. Current investigations are ongoing especially to ascertain the
usability and validity of STEPS as peer assessment and self-assessment tool.
Background: Summative assessment in postgraduate examination globally employs multiple measures. A standard-setting method decides on pass or fail based on an arbitrarily defined cut-off point on a test score, which is often content expert’s subjective judgment. Contrary to this a standard-setting strategy primarily practices two approaches, a compensatory approach, which decides on overall performance as a sum of all the test scores and a conjunctive approach that requires passing performance for each instrument. However, the challenge using multiple measures is not due to number of measurement tools but due to logic by which the measures are combined to draw inferences on pass or fail in summative assessment. Conjoint University Board of Examination of Masters’ of Otolaryngology and Head-Neck Surgery (ORL-HNS) in Malaysia also uses multiple measures to reach a passing or failing decision in summative assessment. However, the standard setting strategy of assessment is loosely and variably applied to make ultimate decision on pass or fail. To collect the evidences, the summative assessment program of Masters’ of ORL-HNS in School of Medical Sciences at Universiti Sains Malaysia was analyzed for validity to evaluate the appropriateness of decisions in postgraduate medical education in Malaysia. Methodology: A retrospective study was undertaken to evaluate the validity of the conjoint summative assessment results of part II examination of USM candidates during May 2000-May 2011. The Pearson correlation and multiple linear regression tests were used to determine the discriminant and convergent validity of assessment tools. Pearson’s correlation coefficient analyzed the association between assessment tools and the multiple linear regression compared the dominant roles of factor variables in predicting outcomes. Based on outcome of the study, reforms for standard-setting strategy are also recommended towards programming the assessment in a surgical-based discipline. Results: The correlation coefficients of MCQ and essay questions were found not significant (0.16). Long and short cases were shown to have good correlations (0.53). Oral test stood as a component to show fair correlation with written (0.39-0.42) as well as clinical component (0.50-0.66). The predictive values in written tests suggested MCQ predicted by oral (B=0.34, P
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.
Feedback and students’ perception towards it has gained increasing attention in the educational literature recently, yet it is an underresearched area. The importance of feedback has not been perceived in a positive manner among medical students. This may be due to students’ lack of knowledge on the concept of feedback and their awareness of the benefits of feedback. This study focused on students’ knowledge on the concept of feedback and their perception towards the feedback system practiced in School of Medical Sciences, University Sains Malaysia. Methods: This was a cross-sectional study involving 433 numbers of students from year 1, 3 and 5 medical students. The variables that were included in this were the gender and their year of study. A validated questionnaire was used to perform this study. School and ethical committee clearance were obtained prior to the start of the study. Data obtained was analysed using Statistical Package for Social Sciences (SPSS) version 20. Results: Findings revealed that students have an average level of knowledge on the concept of feedback and have a neutral perception towards the feedback system that is practiced in School of Medical Sciences, USM. There was no association between students’ knowledge level on feedback and their perception with their year of study and gender differences. However, although there was not much difference in students’ perception level about feedback with their year of study but it was found those students’ perception level decreases as their year of study progresses. It was also found that there was a poor correlation between medical students’ knowledge level on feedback with their perception towards the feedback system in School of Medical Sciences, USM. Conclusions: The area in which it raised concern in students’ perception about feedback was the factors that are involved in feedback practice, which are the givers of feedback, timing of feedback and the mode of feedback. Further study addressing students’ poor engagement and involvement in feedback can be done and issues identified from this study can be included in together for further improvements of the feedback system.
Objective: To determine the internal consistency and construct validity of the Adult Learning Inventory (AL-i) among first year medical students in a Malaysian medical school. Methods: Cross sectional study was done on 196 first year medical student in Universiti Sains Malaysia (USM). The Cronbach’s alpha reliability analysis, exploratory factor analysis and confirmatory factor analysis were applied to measure internal consistency and construct validity of the AL-i respectively. These analyses were done using Predictive Analytics SoftWare (PASW) version 18 and Analysis of Moment Structure (AMOS) version 19. Result: A total of 196 medical students responded to this study. Exploratory factor analysis showed that two potential constructs would be extracted from the inventory. The confirmatory factor analysis showed the two factor model with six items had a good fit with the latent constructs (X2 (df) = 25.63 (8), p = 0.048, RMR = 0.045, GFI = 0.974, AGFI = 0.933, NFI = 0.974, RFI = 0.951, IFI = 0.987, TLI = 0.975, CFI = 0.987, RMSEA = 0.07). Each domain of the final model of the AL-i has three items. The Cronbach’s alpha value of the AL-i was 0.72. The Cronbach’s alpha values of andragogy and pedagogy domains were 0.87 and 0.86 respectively. Composite Reliability and Average Variance Extracted values were more than 0.6 and 0.5 respectively indicating good construct reliability and adequate convergent validity. Conclusion: This study suggested that the two factor model with 6 items of the AL-i has a good fit and shown good psychometric values. It is a valid and reliability measurement to determine types of leaner among first year medical students.
Objective: To determine the construct validity, convergent validity, construct reliability and internal consistency of the Medical Student Stressor Questionnaire (MSSQ) among first-year medical students in Malaysia. Methods: A multicenter cross-sectional study was done on 375 medical students of four medical schools in Malaysia. The confirmatory factor analysis and reliability analysis were applied to measure construct validity, construct reliability and internal consistency of the MSSQ. These analyses were done using Predictive Analytics SoftWare (PASW) version 18 and Analysis of Moment Structure (AMOS) version 19. The Composite Reliability and Average Variance Extracted of the final constructs were calculated manually to determine construct reliability and convergent validity. Results: A total of 359 (95.7%) medical students responded to this study. The confirmatory factor analysis showed the six factor model with 20 items had a good fit with the latent constructs (X2 (df) = 258.02 (155), p < 0.001, RMR = 0.055, GFI = 0.933, AGFI = 0.910, NFI = 0.931, RFI = 0.916, IFI = 0.971, TLI = 0.965, CFI = 0.971, RMSEA = 0.043). The Cronbach’s alpha value of the MSSQ was 0.92. The Cronbach’s alpha values of the six constructs were more than 0.7. Composite Reliability and Average Variance Extracted values of the six constructs were more than 0.6 and 0.5 respectively indicating good construct reliability and adequate convergent validity. Conclusion: This study suggested that the six factor model with 20 items of the MSSQ had a good fit and shown good psychometric values. It is a valid and reliability measurement to identify stressors among medical students across institutions in Malaysia.
Objective: To determine the internal consistency and construct validity of the Learning Approach Inventory (LA-i) among first year medical students in a Malaysian medical school. Methods: Cross sectional study was done on 196 first year medical students in Universiti Sains Malaysia (USM). The items of the LA-i were framed based on characteristics of three learning approaches. The Cronbach’s alpha reliability analysis, exploratory factor analysis and confirmatory factor analysis were applied to measure internal consistency and construct validity. These analyses were done using Predictive Analytics SoftWare (PASW) version 18 and Analysis of Moment Structure (AMOS) version 19. The Composite Reliability (CR) and Average Variance Extracted (AVE) were calculated manually to measure construct reliability and convergent validity. Result: A total of 196 medical students responded to this study. Exploratory factor analysis showed that three potential constructs were extracted from the inventory. The confirmatory factor analysis showed the three factor model with nine items had a good fit with the latent constructs (X2(df) = 26.07 (20), p = 0.163, RMR = 0.04, GFI = 0.969, AGFI = 0.93, NFI = 0.967, RFI = 0.941, IFI = 0.992, TLI = 0.985, CFI = 0.992, RMSEA = 0.04). Each domain of the final model of the LA-i has three items. The Cronbach’s alpha value of the AL-i was 0.86. The Cronbach’s alpha values of surface, strategic and deep approach domains were 0.62, 0.73 and 0.88 respectively. Most of learning approach domains had Composite Reliability and Average Variance Extracted values were more than 0.6 and 0.5 respectively indicating good construct reliability and adequate convergent validity. Conclusion: This study suggested that the three factor model with 9-items of the LA-i has a good fit and shown good psychometric values. It is a valid and reliability measurement to determine learning approaches among first year medical students.
Objective: To determine the construct validity and the internal consistency of the Postgraduate Stressor Questionnaire (PSQ) among postgraduate medical trainees hence it could be used as a valid and reliable instrument to identify stressors among them.
Methods: Items of the PSQ were derived from a review of literature on the subject and a discussion with experts in the field. It comprised of 28 items with seven hypothetical groups. The content and face validity was established through discussion with experts from field of Medical Education and Psychiatry. It was administered to all participants (N = 34) of postgraduate personal and professional development programme in a Malaysian university. Data was analysed using Statistical Package Social Sciences (SPSS) version 18. Factor analysis was applied to test construct validity whereas reliability analysis was applied to test internal consistency of the PSQ.
Results: Thirty three postgraduate medical trainees participated in this study. Factor analysis found that the 28 items of the PSQ were loaded nicely into the seven pre-determined groups as their factor loading values were more than 0.3. The reliability analysis showed that the Cronbach's alpha value for The PSQ was 0.95. Whereas, The Cronbach's alpha values for academic, poor relationship with superior, bureaucratic constraints, work-family conflicts, poor relationship with colleagues, performance pressure, and poor job prospect domains were 0.63, 0.84, 0.81, 0.65, 0.73, 0.78, and 0.70 respectively.
Conclusion: This study showed that the PSQ is a reliable and valid instrument to identify stressors of postgraduate medical trainees. It is a promising instrument that can be used in future to explore further on this area.