House officers who are suffering from stress, anxiety or depression are at risk of harm to themselves, colleagues and even patients, as well as affecting their livelihood. Objective: This
study is aimed to find the prevalence of stress, anxiety and depression among house officers working
in Kota Kinabalu, Sabah. Method: A cross-sectional study was done using a self-administered
questionnaire containing socio-demographic factors and Depression, Anxiety and Stress Scale (DASS)
21. Results: Prevalence of stress, anxiety and depression were 57.1%, 63.7%, and 42.9% respectively. Multiple logistic regression analysis found that house officers who thought of quitting Housemanship was associated with stress (adjusted OR = 3.64, 95% CI: (1.44, 9.20), p = 0.006), and depression (adjusted OR = 8.26, 95% CI: (2.96, 23.02), p < 0.001). House officers who perceives that they are bullied is associated with anxiety (adjusted OR = 4.16, 95% CI: (1.33, 13.07), p = 0.015). Work
experience of the house officers in months have a protective effect to stress (adjusted OR = 0.92, 95%
CI: (0.87, 0.97), p = 0.004), anxiety (adjusted OR = 0.93, 95% CI: (0.88, 0.98), p = 0.006) and
depression (adjusted OR = 0.92, 95% CI: (0.87, 0.98), p = 0.006). Conclusion: The prevalence of
stress, anxiety and depression among house officers in Kota Kinabalu, Sabah is high. Management
should look into the findings and understand the importance of addressing this problem as it may
affect patient care and safety, and the livelihood of house officers. Future studies identifying why
house officers are thinking of quitting service and why they do feel that they are being bullied may be
warranted.
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.
INTRODUCTION: Stress is a particularly important issue in education because it has the potential to decline learning and performance. However, little empirical evidence about the influence of stress in nurse students’ clinical practices.
Methods: There are 346 totals of respondents for this study. Perceived Stress Scale (PSS), which have six domains of stressors and Brief COPE inventory, consisted of 28 items which measure 14 different coping styles was used. By using Likert scale in order to measure the degree of stress for each stressor. Higher mean score indicates higher degree of stress.
Results: In this study, stress from clinical assignments and workload was the most stressful having by nursing students (Mean = 3.19, SD = 1.09). Among the 14 types of coping strategies, religion was the most frequently used, religion (Mean = 3.30, SD = 0.71).
Conclusion: The results provided valuable information for nurse educators, clinical educators and clinical staff in identifying students’ needs, facilitating their learning in the clinical setting and developing effective interventions to reduce the stress. Therefore it is important, especially nursing students can handle the pressure because it will affect the level of achievement in academic and thereby affecting student skills in the field of clinical nursing. And this affects the care of patients.
The Delphi technique is a widely used and accepted method for gathering data from participantswithin domain of expertise. The objective of this study is to discuss the process of the three roundsDelphi technique in seeking a consensus of concept mapping structure and Multiple Choice Questions(MCQ) in Diabetic Mellitus subject. In the first, round, participants were given a structuredquestionnaire regarding item of concept mapping structure and MCQ in Diabetic Mellitus subject.The second were added mean and median value of round one. In the third round were add meanand median value of round two were added. Participants were asked to rate the categorised responsesfrom Round 1 on a scale of 1 to 5, with 1 being “Very irrelevant” and 5 being “Very relevant”. Thistechnique does not require participants to meet face-to-face, thereby making it useful to conductsurveys with qualified people over a wide geographic area. The feedback process allows and encouragesthe selected Delphi participants to reassess their initial judgements about the information providedin previous iterations. Data is then analysed to check for consistency of experts’ responses betweenrounds. Instrument developed from the Delphi technique research findings is also examined forvalidation from experts in educational medical health sciences on content and constructs validity.Analysis on the consensus of data from experts was based on median, inter quartile range and quartiledeviation on Round 1, 2 and 3 data. Therefore, the Delphi technique is an appropriate method foridentifying significant issues related with academic.
To address the diverse preferred learning styles, one of the oft-cited recommendations for educatorsis to tailor teaching instructions accordingly. This pedagogy however, lacks scientific evidences.Furthermore, in medical curriculum, tailoring instructions according to preferred learning styles isnot pragmatic. This is because different subjects and in different settings matter may be best deliveredin specific delivery mode. Furthermore, patients’ presentations are often multi-sensorial. As such, theonus is on the students themselves to adjust the amount of learning efforts they put in according totheir preferred or not preferred learning styles.
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
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.
Introduction: Palliative care teaching has little emphasis during the undergraduate period. Most
teachings in medical school are geared towards preventive and curative approach. Competency in
palliative care including therapeutic and effective communication has been the taught indirectly
without emphasis on other areas. We investigate medical students’ preparedness on palliative care
subjects using past studies questionnaire to evaluate knowledge, attitudes and understanding on end
of life issues. Method: Cross sectional study was performed on the final year medical students (class
2015) from a public university in the northern state of Peninsular Malaysia. Proforma was adopted
from the previously published studies covering the aspect of knowledge, attitude, end-of-life, advanced
directive and bioethical principles in palliative care. Conceptual framework of final year medical
students’ preparedness was ascertained following impartment of palliative care knowledge, either
directly or indirectly, after the exposure and completion of the clinical attachment. Results: The
study elicited a 78.5% response rate where 133 students replied out of 177 total students. Overall the
knowledge and attitude of palliative care were good. There were some misconceptions especially the
use of morphine and role of physician in the management of dying patients. Conclusion: There were
gaps identified following the completion of the study. Misunderstanding in different aspect of care
should be remedied with more exposure and practicality suitable to undergraduate medical curriculum
learning
Reflection is a process of reviewing an experience of practice in order to describe, analyse and evaluate information. This leads to critical reflection which one can view and focus on self-experience within the context of his/her own life. Objective: The study aims to understand palliative care values with the use of reflective diary following home visit to patients who require palliative care.
Method: Interview was performed during the house visit by the undergraduate medical students. This outreach house visits were supervised under community palliative care nurse. The students were required to develop a learning activity, using assessment of palliative care patients’ needs, through qualitative questionnaire. This was recorded in the reflective diary upon return of such activity. The questions asked covered explorative learning and holistic medical tasks such as the impact of patient’s life from emotional, psychosocial, medical and spiritual perspective. Guided questioning was done to avoid
unnecessary communication issues that may aggravate emotional distress. Students were asked to probe using vetted and agreed questions, and explore multidimensional issues in relation to culturally naïve Kelantanese population.
Result: Enjoyful learning experience was recorded. The reality of thisdealing with patients with chronic disease has put forth a positive intention to perform better as future doctors.
Conclusion: Reflective diary is an effective tool in community palliative care learning. It documents patients’ plight and students’ sense of responsibility to community. This has invaluable and indirect learning impact as part of the students’ soft skills development.
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.
Recurrent respiratory papillomatosis (RRP) is a rare cause of childhood stridor which typically presents before the age of five years and results from the vertical transmission of the human papilloma virus. Genotypes 11 and 6 are commonly implicated in RRP. Following vertical transmission, the human papilloma virus (HPV) causes overgrowth of the airway epithelium which causes partial airway obstruction and the symptoms of stridor. The mainstay management is surgical debridement of the papillomata but the recurrence rate subsequent to surgery is high, such that most children will require repeated surgical procedures at regular interval. Medical adjuvant therapy can be used, but data is limited and the medications are used on an off-label basis. This case highlights the ethical considerations that need to be made when using off-label medications in paediatric patients.
Objectives: This investigation focused on finding the changes in learning approaches of students’ while experiencing physiology curriculum and to explore the reflection of changes if any, on their critical thinking skills.
Methods: In this longitudinal study, information on students’ learning approaches was obtained using the revised two factor study process questionnaire (R-SPQ-2F) at the commencement (pre-test) and completion (post-test) of first year MBBS course. The total score and the scores obtained in the critical thinking questions in four physiology assessments were analysed. Pre and post-tests scores in R-SPQ-2F and assessment scores were compared using independent samples t-test and one way repeated measure ANOVA respectively. Correlation of scores between assessments was done using Pearson correlation. A p value < 0.05 was taken as significant.
Results: A significant increase in students’ deep learning approach at the completion of the physiology curriculum when compared to commencement (p < 0.001) was observed. A progressive improvement in their scores as they experienced the curriculum was also noticed. A moderate correlation among critical thinking questions scores and a strong correlation between critical thinking questions and total essay scores were also recorded.
Conclusion: The study revealed improvement in students’ deep approach to learning in physiology which was reflected in their performance in critical thinking questions.
Study site: Melaka Manipal Medical College, Manipal University, India
Introduction: Nurses are generally trained on the procedures of blood transfusion during their years of service. However, the level of knowledge varies among individuals and healthcare centres. Thus, this study addresses a knowledge gap regarding nurses’ knowledge and transfusion safety in the local clinical setting. Objectives: This study aimed to determine nurses’ level of knowledge of various phases of blood transfusion and associate this knowledge with their socio-professional details. Methods: This was a cross-sectional, quantitative study. The target population was in-patient ward nurses at Hospital Pulau Pinang. The systematic random sampling method was used to select 185 nurses to participate in this study. Data were collected using a validated research questionnaire that consisted of 31 items (9 items related to socio-professional factors and 22 knowledge items). Data were analysed using descriptive and inferential analyses. Results: The overall knowledge score was moderate (mean = 70.44%, SD = 11.35). None of the nurses was able to answer all of the knowledge questions correctly. Of the participants, 72.29%, 71.75%, and 67.14% exhibited knowledge of blood bag collection and patient preparation; pre-transfusion nursing activities; and during and post-transfusion nursing responsibilities and management of transfusion reactions, respectively. Factors such as age, years of service, department, and availability of the transfusion policy in the ward significantly affected the mean knowledge scores. Conclusion: Nurses’ knowledge of blood transfusion at Hospital Pulau Pinang was moderate. More training and courses should be provided to improve their knowledge.
Mastering the art of conducting a research along with the competitive era of publishing papers showed the importance of undergraduate research. The purpose of this research was to study the impact of undergraduate research “Special Study Module (SSM)” on Universiti Kebangsaan Malaysia (UKM) medical students and alumni.
Methodology: This was a cross-sectional study whereby 64 fifth year UKM medical students of academic-session 2014/2015 and 49 alumni of year 2010 were participated on their SSM research activities. The questionnaire administered online which enquired on participants’ level of interest, confidence and SSM research experiences. Frequency and percentage distribution were used for descriptive analysis.
Result: Out of 119 participants,113 responded giving a response rate of 95%. More than 90% respondents in both group felt that SSM experience was enriching and 80%–90% felt SSM experience was pleasant. In both groups 47%–50% respondents believed, SSM experience contributed their high level of interest on research. The most influencing factors on their level of interest were supervisor guidance as reported by73%–80% respondents. It was said that SSM supervisor was academically stimulating, impressive as role model and supportive. The most confidence skill was the ability to function within a group and least confidence skill was manuscript writing.
Conclusion: Undergraduate SSM research showed positive impact on participants’ research activities. More in-depth analysis should be considered especially on manuscript writing as the students were least confident in this skill.
Introduction: Investigation on spiritual issue in healthcare practice received less attention. Muslims valued pray activity or known as salat as one of the important daily activity. However, negligible study is available on salat as the end goal of occupational therapy intervention. This study aims to investigate the awareness and the impact of Muslim-culture on occupational therapists in Malaysia. Methods: A cross-sectional survey study was conducted via internet-based and manual paper-and-pencil survey throughout occupational therapists in Malaysia. Descriptive and inferential statistics using percentage, Cronbach’s alpha and Chi-square was implemented on the findings. Results: In total, 119 occupational therapists responded. The questionnaire has overall internal consistency ofα = 0.74. Occupational therapists have positive perceptions on spiritual activity but poorly translated into service implementation and faced challenges. Factors such as level of education, years of experience, religion, working location and work setting were significant on the awareness, perception, practice and challenges. Cultural-based practice is challenging for occupational therapy even in the majority-practice context. Occupational therapists should differentiate between belief and activity in spiritual issue to provide a better assistance for the clients. Conclusion: This study showed continuing education is desired to drive the occupational therapy profession for a better cultural-sensitivity service delivery.
There is a growing concern of unintended consequences of inappropriate medications disposal on the environment and public health. Objective: The aims of this study are to determine patients’ medications disposal methods and their awareness of the pharmacy medications take back program.
Method: A cross sectional survey using a self-administered closed-ended questionnaire on information, medications disposal and views, awareness of medications take back program and reasons for their unwillingness to return the unused and unwanted medication to pharmacy or doctor. A convenient sample of 438 patients at Out Patient Pharmacy and Patient Registration areas in the hospital was collected and completed within three months.
Results: Only 44.5% had ever received information about medications disposal and were significantly more likely to return to pharmacy or doctor (29.2% versus 6.0%, p < 0.001). There were significant differences between tertiary and nontertiary with regard to not returning to pharmacy or doctor (22.8% versus 42.0 %, p = 0.004). Some common medications disposal methods were throwing medications away with household garbage, 38.3% (n = 168), returning to pharmacy or doctor, 35.1% (n = 154) and flushing medications down the toilet or sink 11.0% (n = 48). About 50.2% (n = 220) knew about medications take back program and were significantly more willing to return the medication to the assigned location (34.7 % versus 20.1%, p < 0.001). The main reasons for unwillingness were availability of time, not convenient or a bother and out-of-vicinity location.
Conclusion: There is a clear need to create public awareness about issues on safe medication disposal and medications take back program,
Study site: Outpatient pharmacy, and patient registration area in Sultanah Aminah Hospital, Johor, Malaysia
ntroduction: In the marking of objective structured clinical examination (OSCE), checklist scoring and global rating are two commonly used scoring systems. Objective: The purpose of this study was to examine correlations between checklist scores and global ratings for four OSCE stations of different station type. Method: Data for this study was obtained from the Final Year OSCE (n=185). Each station’s score sheet consisted of a detailed checklist of items examined. A global rating scale was also included for the examiner to indicate the global assessment for the station. Spearman’s rho correlation coefficients between checklist scores and global ratings were computed for four stations of different station type. For each station, correlations between checklist scores and global ratings were also checked across the three parallel circuits running concurrently and throughout the four rounds. Result: Spearman’s rho correlation coefficients (ρ) between checklist scores and global ratings for the four stations ranged between 0.62 to 0.88, at p
Introduction: Medical school expected to be a time of personal development, achievement, and well-being. However, research shows that there are many negative effects on students’ mental health due to the current educational process. Objective: This research aimed to determine the prevalence and risk factors of depression, anxiety, and stress among medical students of a private medical university in Malaysia. Method: Cross sectional study was conducted using self-administered questionnaires including socio-demographic factors, DASS-21 and MSSQ-40 questionnaires. Result: Prevalence of stress, anxiety, and depression were 46.9%, 76.2% and 60.2% respectively. Multiple logistic regression analysis showed that academic related stressors were only associated with stress [adjusted OR 1.78, 95% CI (1.23, 2.58), p=0.002]. Group activities related stressors were significantly associated with stress [adjusted OR=1.45, 95%CI (1.20, 1.75), p
Students-t test is the most popular statistical test. The test compares two mean values to judge if they are different or not. For small data it is possible to conduct it using manual calculation – however that is not the case. Researchers would need to use statistical software and packages to conduct their analysis. This guide will help the junior researchers to conduct independent- and paired-t test using STATA software.
The paper discusses on the complexity of the issues surrounding a patient with subluxation of cervical spine in a Down syndrome child. Several relevant issues are discussed including consent in a minor, conflicting decision making between parents and doctors, end-of-life issues, supporting handicapped child with minimal co-morbidities, community ethics, neglect of care by the caregiver and decision making after allowing zonal of parental discretion. Despite the difficulties surrounding parental actions, there are still ethical priorities which have to be considered individually to alleviate the suffering of the patients and the family members. Dealing with patients with chronic illnesses is a challenge for any medical doctors. The case warrants sensitive approach to allow appropriate respect for parental decision despite in disagreement with the clinical team. The term ‘zone of parental discretion’ refers to a controversial area of decision making; and has still many potential conflicts on day to day clinical cases, especially among the conservative society in the East Coast of Peninsular Malaysia.