This is a cross sectional study conducted in July 2010 at the International Medical University, Seremban, Malaysia. The objective of this study was to ascertain the relationship between working memory capacity of final MBBS medical students using the digit span backward test and their academic achievement based on the total score at the modified
essay questions (MEQ) which was the principal component of the theory examination. Seventy eight final year medical students were recruited,41 (52.6%) were females and remaining 37 (47.4%) were males. Working memory capacity was measured by digit span backward test (DSBT) which ranged from3 to 8 digits. The mean digit score was 6.6 ± 1.1 falling under the category of ‘above average’ score. There was no significant difference between working memory capacity and gender (p>0.05). There was no significant difference in the MEQ mean score and the different categories of working memory capacity (p>0.05).
The DBST shows uniformity in working memory adequate to pass the modified essay questions. Medical students appear to use encoding and retrieval process in problem solving based on functionality and pattern recognition in tackling the problems in the MEQ.
Acute appendicitis is an infrequent yet the commonest surgical emergency in pregnancy occurring in about 1:1500 pregnancies. The classical abdominal pain in the right lower quadrant of the abdomen is the only reliable clinical sign. Delay in diagnosis is attributed to presence of symptoms commonly seen in pregnancy like nausea and vomiting and difficulty in localizing abdominal pain due to displacement of the appendix with advancing gestation. Perforated appendix and generalized peritonitis impacts adversely on pregnancy contributing to increases in miscarriage, pre-term delivery, fetal loss and even maternal mortality. Imaging studies like abdominal ultrasonogram, helical computerized tomography and magnetic imaging have been utilized to complement clinical suspicion and decrease ‘negative appendectomies’ but robust data on their routine use is awaited. Although the laparoscopic approach is a useful diagnostic and therapeutic tool in early pregnancy, its use as the primary approach for appendicectomy in pregnancy requires further evaluation as increases in the incidence of fetal loss of 5.6% has been reported compared to 3.1% in open access surgery
The simultaneous presence of polycystic ovary syndrome with pelvic endometriosis presents compounded gynecological effects on women with subfertility and pelvic pain as the common symptoms. We describe one such case. The molecular basis for etiology is discussed and the need for individualized treatment is suggested.
Mentoring in academic medicine requires the trained mentor to commit time, purpose and dedication for the personal and professional development of three categories of protégés or mentees i.e. medical students, the clinician-trainee and the clinical-educator. Conventionally, assigned mentors monitor the progress of the first two categories of personnel as their career pathway is clearly defined. On the other hand the clinician–educator in academic medicine could be a scientist or a career clinician expected to contribute to medical education activities and research. The clinician educator has grown in complexity as he multitasks in providing clinical care, assists in delivering the medical curriculum and is expected to do research and publish. Although there is dearth of research in mentoring the clinician-educator, it is clear that mentored clinicaleducators are more productive by way of scientific publications. Trained mentors are expected to identify the needs of the mentee with regards to the level of his career development and his aptitude to move up the academic ladder, successfully nurturing the maturation process. Processes of mentoring in the clinical setting, attributes of the successful mentor and facilitating the mentee in overcoming challenges in academic medicine are discussed.
In recent years, the internet has become an increasingly popular tool for people to obtain information due to the overwhelming availability of material. As internet access becomes more readily available, the newer generation of patients, medical students and doctors are starting to prefer the internet as a source of reference to acquire medical knowledge. The main objectives of this study were to determine the accuracy of using Google search in establishing a clinical diagnosis based on information provided from the New England Journal of Medicine (NEJM) and to determine the concordance rate of Google diagnosis with the actual diagnosis from NEJM.
There has been an increase in the number of Motor
Vehicle Accidents (MVA) in Malaysia throughout
the years. Although blunt neck injury is uncommon,
it is associated with severe, permanent neurological
deficit with risk of mortality. This case is a classical
presentation of a young male involved in a MVA who
sustained head and neck injuries of varying severity.
After a short symptom free interval, the patient
started to develop neurological signs. Presenting signs
and symptoms include Horner’s syndrome, dysphasia,
hemiparesis, obtundation or monoparesis. A computed
tomography (CT) scan of brain must be done and if the
findings showed that there is no intracranial bleeding
(ICB), high suspicions with further evaluation should
be done. Confirmation can be obtained by Doppler
ultrasonography, magnetic resonance imaging, magnetic
resonance angiography (MRA), CT angiography (CTA)
or catheter angiography to rule out carotid artery injury.
Limb length discrepancy (LLD) is quite common.
Lower limb shortening is one of the causes of limb
length discrepancy. The common treatment that is
used is the llizarov technique for bone lengthening.
The new technique uses an intramedullary nail with
a monoplanar external fixator. Using this technique,
bone lengthening duration in patients can be reduced
and knee joint mobility can be improved without
jeopardizing bone regeneration. We report a case of a
27-year-old gentleman who had right femur shortening
from childhood and was referred to us for corrective
deformity. He underwent bone lengthening on the nail
which lenghthens and equalizes the leg while avoiding
stiffness and reduces joint mobility which leads to good
patient satisfaction outcome. The use of the external
fixator with intramedullary nailing to lengthen the
femur is one method that can reduce patient burden
mentally and physically. However although it has many
advantages we must watch out for the complications
during the regular visits to ensure good outcome.
The importance of incorporating medical (or health) informatics into the education of medical students and medical practitioners is being increasingly recognised. The advances in information and communication technology and the pervasion of the Internet into everyday life have important implications for healthcare services and medical education. Students and practitioners should learn to utilise biomedical information for problem solving and decision making based on evidence. The extensive introduction of electronic health information systems into hospitals and clinics and at the enterprise level in Malaysia and elsewhere is driving a demand for health professionals who have at least basic skills in and appreciation of the use of these technologies. The essential clinical informatics skills have been identified and should be incorporated into the undergraduate medical curriculum. It is recommended that these be introduced in stages and integrated into existing programmes rather than taught as a separate module. At the same time, medical schools should support the integration of e-learning in the educational process in view of the numerous potential benefits.
Item analysis is the process of collecting, summarizing and using information from students’ responses to assess the quality of test items. Difficulty index (P) and Discrimination index (D) are two parameters which help evaluate the standard of MCQ questions used in an examination, with abnormal values indicating poor quality. In this study, 120 test items of 12 Type A MCQ tests of Foundation 1 multi-disciplinary summative assessment from M2 / 2003 to M2 / 2006 cohorts of International Medical University were selected and their P-scores in percent and D-scores were estimated using Microsoft Office Excel. The relationship between the item difficulty index and discrimination index for each test item was determined by Pearson correlation analysis using SPSS 11.5. Mean difficulty index scores of the individual summative tests were in the range of 64% to 89%. One-third of total test items crossed the difficulty index of 80% indicating that those items were easy for the students. Sixty seven percent of the test items showed acceptable (> 0.2) discrimination index. Forty five out of 120 test items showed excellent discrimination index. Discrimination index correlated poorly with difficulty index (r = -0.325). In conclusion, a consistent level of test difficulty and discrimination indices was maintained from 2003 to 2006 in all the twelve summative type A MCQ tests.
The nature, extent and definition of a collaboration varies between individuals, disciplines, departments and institutions. It depends upon such factors as the people involved, the nature of the research problem, the research environment, the institutional culture and demographic factors. This paper will examine the concept of collaborative research and discuss its place and position in an evolving university.
Background: Facebook is a popular social networking site with more than five hundred million users. This study assessed whether Facebook Groups can be used to teach clinical reasoning skills.
Methods: Sixty-seven final year medical students from the International Medical University, Malaysia, were exposed to interactive online learning through a Facebook Group for a period of six months in this study. The purpose was to determine if supervised interactive online learning could be used to augment the deep learning that comes from learning medicine at the bedside of patients. The interactive online discussions were entirely triggered by clinical problems encountered in the medical wards of the general hospital to which these students were attached.
Results: A total of 10 topics were discussed in this forum during the duration of this study and an example of one such discussion is provided to illustrate the informal nature of this kind of learning. The results showed a high degree of student involvement with 76 percent of students actively participating in the discussions.
Conclusion: The high degree of voluntary participation in the clinical discussions through the Facebook Group in this study tells us that Facebook Groups are a good way of engaging students for learning and can be used in medical education to stimulate creative clinical thinking.
Anaphylaxis in the operating room although infrequent can be potentially fatal. The diagnosis of perioperative anaphylaxis is complex due to a multitude of factors. Firstly, patients under anesthesia cannot verbalize their complaints, the anesthetic agents themselves can alter vital parameters (e.g. heart rate and blood pressure) and cutaneous signs in a completely draped patient may be missed. Secondly, the differential diagnosis of intraoperative anaphylaxis is wide. Conditions such as asthma exacerbation, arrhythmia, hemorrhage, angioedema, mastocytosis, acute myocardial infarction, drug overdose, pericardial tamponade, pulmonary edema, pulmonary embolus, sepsis, tension pneumothorax, vasovagal reaction, venous air embolism, laryngospasm, blood transfusion reaction and malignant hyperthermia need to be considered. Thirdly, the diagnostic workup is challenging due to the multiple medications administered and other exposures encountered such as latex and chlorhexidene. However, through a timely allergy consultation and a systematic approach, identification of the culprit agent and safe alternatives can be established to prevent future occurrences as illustrated in the case below.
Interprofessional learning (IPL) promotes collaboration among healthcare professionals in providing quality healthcare. For the IPL to have a positive influence on inter-professional collaboration, opportunities must be made available for the healthcare students to learn together. Attitudinal factors have been identified as the major factor hindering the implementation of IPL. In Malaysia, little is known about attitudes of healthcare students towards IPL. Students from different health disciplines often have poor conception of each other’s roles as a member of the healthcare team. IPL increases this knowledge and gives students an understanding of the interpersonal skills needed for liaison and communication. Students from different disciplines who learn together develop interpersonal and teamwork skills, and gain knowledge of how other professionals work. IPL has been shown to create teams that work together better and improve patient experience. In general, IPL aims to improve patient safety, enhance patient satisfaction, and increase levels of innovation in patient care, and increase staff motivation, well-being and retention. There has been increasing emphasis on the important role that interprofessional education (IPE) must play in educating and developing present and future healthcare professionals. This review aims to examine how learning outcomes are articulated in the field of IPE and includes the benefits, importance, ethical concepts and application of IPL in nursing.
Amoebiasis is a parasitic infection caused by the
intestinal protozoan Entamoeba histolytica, most
prevalent in developing countries. It results in 40,000 to
100,000 deaths each year from amoebic colitis and extra
intestinal infections. Amoebic liver abscess (ALA)
is the most common extra intestinal site of infection
with an incidence of between 3% and 9% of all cases of
amoebiasis. Ultrasound which has a sensitivity of more
than 90% for detecting ALA is highly recommended
as an initial investigation followed by serological
demonstration of circulating antibodies specific to
Entamoeba histolytica.
Most countries around the world have experienced a shortage in organs needed for transplantation. Organ donation performance is widely attributed to two important factors: the legislation and the role of the family. Thus, this literature review aims to examine the willingness of people for organ donation while highlighting the importance of having a presumed consent system.
Objectives: Health-related quality of life (HRQoL) is
an essential dimension of overall human quality of life,
in which disparities have been hypothesised between
women and men, as well as between citizens and
non-citizens of a country in past literatures. This study
is to evaluate and compare the HRQoL of citizens and
non-citizens living in greater Kuala Lumpur and Johor
Bahru, as well as comparing HRQoL between genders.
Materials and Methods: The SF-8 questionnaire was
used to collect information from 1,708 respondents
(1,032 Malaysian citizens and 676 non-citizens),
via face-to-face interview between October and
December 2015.
Results: Overall, respondents reported moderate
HRQoL. Non-citizens reported better HRQoL than the
Malaysian citizens, while men reported better HRQoL
compared to women (for both citizens and non-citizens).
Conclusions: The HRQoL of both citizens and noncitizens’
in Malaysia could be improved. Measures should
be taken to remove the disparity in HRQoL between
men and women, aiming to achieve equal health status
for both genders.
The research mentorship programme is unique in that it is a planned journey undertaken by the mentor and mentee, preferably with well-defined milestones along the journey. During the journey, familiar landmarks will be pointed out by the mentor. In path-finding situations the experience and wisdom of the mentor and the critical appraisal of both mentor and mentee will contribute to learning from the encounter. In most mentor-mentee partnerships, a formal acceptance to the relationship, well-defined landmarks measuring progress in the journey, regular appraisal of the skills developed and acquired, and phased, judicious modification in the individual roles of that relationship will be required. Although there is no consensus on the elements of mentorship, there are some strategies which can contribute to the success of the relationship. Critical success factors include convergence of the research area within the broad expertise of the research mentor. The research mentor should have a proven research track record and is committed to serve in that official capacity. The research mentoring process is dynamic and characteristics of both mentor and mentee contribute to the robustness of that relationship. The mentee would have identified some attributes of the mentor that are desirable and is willing to work hard to achieve, build on, and improve upon. In the research setting endpoint measurements of success will be based on recognition of the research standing of the mentee, measurable outcomes such as number of papers in top tier journals, citation indices, etc. consultancies attracted as well as invitations to deliver plenaries in scientific conferences, patents filed and research findings translated and applied, and other measures of research productivity. In the pursuit of research excellence the mentee would have imbibed values of professionalism and ethics in research and would have constantly kept in mind that to be successful, the mentee would be able to excel beyond his mentor and that the next generation of researchers will seek mentorship from him.
The International Medical University (IMU) has encouraged and facilitated research activities since 2001. Research activities by undergraduates, postgraduates, and faculty members have increased substantially since then. The governance aspects of research activities are closely monitored by the Institutional Review Board which is the IMU-Joint Committee on Research and Ethics. (Copied from article)
There is no substantial difference in conducting research that is both ethical and responsive to the health needs in developing and developed nations. Differences are in financial constraints, technological expertise in identification and addressing needs, and in the perception of equal partnership of all stakeholders. There will be differences in emphasis of research but this is slowly blurred due to globalisation. Public health emergencies in developing countries need timely and effective global collaborative research to implement control strategies. Research needs should be based on predictive models with learning from past emergencies, technological advances, strategic critical appraisal of local and global health information, and dialogue with all stakeholders. Adequate funding will be challenging and resources from national, international and aid
foundations will be needed. Issues associated with such funding include deployment of international rapid response teams, collaborating researchers, transfer of technology, and intellectual property ownership. While all types of research ranging from basic, applied, clinical
studies, meta-analysis, and translational research are relevant, the relative importance and specific allocation of resources to these may differ. Is the choice related to responsiveness or based on researchers’ perception of their contributions to evidence-based practice and research? Ethical issues relating to vulnerable groups, risk distribution, quality issues, research integrity and oversight are just as important. Internationally funded
research including clinical trials must be sensitive to such issues to avoid allegations of exploitation. Thus the potential of utilisation and buy-in of research findings and recommendations must be considered.
Developing and adult worms of the human lymphatic filarial parasites (Wuchereria bancrofti,
Brugia malayi, and Brugia timori) are located mainly in the lymphatic system and occasionally in aberrant sites like subcutaneous and conjunctival cysts. Lymphatic
pathology ranging from dilatation of lymphatic channels and lymphangiectasia are detected on ultrasonography in apparently healthy, amicrofilaraemic, but filarial antigen positive individuals in endemic areas. Microfilariae are distributed in various organs and may be associated with immune mediated pathology at these sites; tropical pulmonary eosinophilia is characterized by intense immune mediated destruction of microfilariae in the lung parenchyma. In the spleen and other sites, nodular granulomatous lesions can occur where microfilariae are trapped and destroyed. The finding of Wolbachia endosymbionts in all stages of lymphatic filarial parasites has provided new insight on the adverse reactions
associated with anti-filarial chemotherapy. Inflammatory molecules mainly lipopolysaccharide (LPS)-like molecules released from endosymbionts on death of the
parasites are largely responsible for the adverse reactions encountered during anti-filarial chemotherapy. Prenatal tolerance or sensitization to parasite derived molecules can immune-modulate and contribute to both pathology and susceptibility/resistance to infection. Pathological responses thus depend not only on exposure to filarial antigens/infection, but also on host-parasiteendosymbiont factors and to intervention with antifilarial treatment. Treatment induced or host mediated death of parasites are associated with various grades of inflammatory response, in which eosinophils and LPS from endosymbionts play prominent roles, leading to death of the parasite, granulomatous formation, organization and fibrosis. The non-human primate (Presbytis spp.) model of
Brugia malayi developed for the tertiary screening of anti-filarial compounds has provided unique opportunities for the longitudinal study of the pathology associated with lymphatic filariasis. The pathology in this non-human primate model closely follows that seen in
human lymphatic filarial infections and correlates with clinical evidence of lymphatic pathology as detected with ultrasonography. These studies also show that successful treatment as detected by loss of motility and calcification of worms on ultrasonography is associated with reversal of early dilatations of lymphatic channels.