The significance of learning research methodology and performing research has been accepted by various medical schools in Malaysia as well as in other countries. The aim of integrating research into medical curriculum is to inculcate the research culture and form part of the evidence-based practice among medical professionals. Hence, the Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak has incorporated the research component into the preclinical year of the medical curriculum. A survey was conducted to gauge the second year medical students' level of knowledge of research process at the end of the course using a set of questionnaires. Seventy nine of second year medical students participated in the study. The outcome of the study shows significant improvement in the students’ knowledge on research components after completing the one year course (p
Introduction: In Malaysia, the concept of Interprofessional Learning is not yet established, however it has begun to develop over the past few years.
Methods: Three scenarios were developed for undergraduate students from medicine, nursing and emergency medicine; Acute Myocardial Infarction (AMI), Chronic Obstructive Pulmonary Disease (COPD) and trauma. The Interprofessional Learning Package (IPLP) adopted scenario - based learning and hybrid simulation; mannequin and simulated patient which focused on patient management. Each session employed experiential, interactive and contextualised sessions. The created learning sessions required the students to work in a small interprofessional team. The IPLP was validated by a panel of experts.
Results: Content analyses were carried out for analysing the strategies that were performed during the development process. Focused group discussion showed that nursing students had positive views towards interprofessional learning. Document analysis on the curriculum showed that there were loopholes where the programmes needed to improve and expose students to interprofessional learning in order to achieve the faculty learning outcomes. Literature review gave an idea on the creating of the scenario and panel experts’ input was also important as it reflected the created scenarios which were common sense and logically designed.
Conclusion: This study managed to developed the Interprofessional Learning (IPL) package with simulation and scenario approached which can encourage students to learn with, from and about other programmes as well as managing a patient as a team.
Background: Single best answer (SBA) as multiple-choice items are often advantageous to use for
its reliability and validity. However, SBA requires good number of plausible distractors to achieve
reliability. Apart from psychometric evaluation of assessment it is important to perform item analysis
to improve quality of items by analysing difficulty index (DIF I), discrimination index (DI) and
distractor efficiency (DE) based on number of non-functional distractors (NFD). Objective: To
evaluate quality of SBA items administered in professional examination to apply corrective measures
determined by DIF I, DI and DE using students’ assessment score. Method: An evaluation of post
summative assessment (professional examination) of SBA items as part of psychometric assessment
is performed after 86 weeks of teaching in preclinical phase of MD program. Forty SBA items and
160 distractors inclusive of key were assessed using item analysis. Hundred and thirty six students’
score of SBA was analysed for mean and standard deviation, DIF I, DI and DE using MS Excel 2007.
Unpaired t-test was applied to determine DE in relation to DIF I and DI with level of significance.
Item-total correlation (r) and internal consistency by Cronbach’s alpha and parallel-form method was
also computed. Result: Fifteen items had DIF I = 0.31–0.61 and 25 items had DIF I (≤ 0.30 or ≥
0.61). Twenty six items had DI = 0.15 – ≥ 0.25 compared to 14 items with DI (≤ 0.15). There were 26
(65%) items with 1–3 NFD and 14 (35%) items without any NFD. Thirty nine (32.50%) distractors
were with choice frequency = 0. Overall mean DE was 65.8% and NFD was 49 (40.5%). DE in
relation to DIF I and DI were statistically significant with p = 0.010 and 0.020 respectively. Item-total
correlation for most items was < 0.3. Internal consistency by Cronbach’s alpha in SBA Test 1 and 2
was 0.51 and 0.41 respectively and constancy by parallel-form method was 0.57 between SBA Test 1
and 2. Conclusion: The high frequency of difficult or easy items and moderate to poor discrimination
suggest the need of items corrective measure. Increased number of NFD and low DE in this study
indicates difficulty of teaching faculty in developing plausible distractors for SBA questions. This has
been reflected in poor reliability established by alpha. Item analysis result emphasises the need of
evaluation to provide feedback and to improve quality of SBA items in assessment.
Background: Recently many medical schools have incorporated Evidence Based Medicine (EBM) as part of their undergraduate teaching. The aim is to provide a firm base of EBM to the medical students early on, so that they can understand the importance of EBM. Medical schools are encouraged to teach EBM to students but yet the education setting, learner level, modes of instruction, skills covered and teaching methods are not standardised and varies worldwide. In Cyberjaya University College of Medical Sciences (CUCMS), EBM was incorporated in the curriculum since 2009. EBM concepts was taught formally to the MBBS students during four weeks Research and Evidence Based Medicine Course (REBM). Students were exposed to the various thinking processes, formulation of clinical questions, searching evidence, intermediate biostatistics, research methodology and critical appraisal. Besides that, Good Clinical Practice (GCP) and research proposal development also include in the course. The objective of this paper is to describe
CUCMS experience of teaching EBM for undergraduate medical students.
Methods: This report analysed students feedback using a questionnaire which included a Likert scale and open-ended questions.
Result: Overall, three batches of students gave positive feedbacks regarding the course with constructive suggestions on room for improvement.
Conclusion: From our first three years’ experience in conducting the course, we concluded that the four-week EBM course offered was practical in instilling EBM principles.
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.
Introduction: In Malaysian nursing education, concept mapping is not widely practiced among nurse
educators and students. Therefore, the researcher aims to develop and evaluate the impact of the
Rusnani Concept Mapping (RCM) protocol on academic achievement and clinical practices among
diploma nursing students. RCM is one of the teaching learning methods that specifies guidelines for
nurse educators to harmonise classroom and clinical setting methods. Method: RCM is a concept
mapping protocol guideline developed by the researcher and is validated with content and face validity
and the Delphi technique. The study design is quasi-experimental with two groups. The experimental
and control groups received education using RCM and the lecture method, respectively. Data were
analysed using descriptive and inferential statistics using paired t-tests. P values less than 0.05 were
interpreted as significant. Results: In the pre-test, the students taught using RCM had a mean
achievement score of 11.23 with and SD = 2.59, while at post-test, the mean achievement score was
13.19 with and SD = 1.71 and a mean gain score of 1.96. In contrast, students taught using lecture
method had a mean achievement score of 10.71 and SD = 2.23 in the pre-test and a mean score of
12.60, SD = 1.64 in post-test achievement with a mean gain score of 1.89. The post-test scores of the
experimental and control group were significantly different (t = 2.53, p < 0.05). The mean concept
mapping care plan score was 59.33 and 65.23, respectively, for the control group and experimental
group. The paired t-test revealed that there was a significant difference between experimental and
control groups, p value < 0.05. The result of students’ perceptions regarding concept mapping in the
experimental group showed as positive moderate with a mean score of 3.44. Conclusion: This study
provides additional evidence that RCM is instructionally valuable as a learning method and is an active
learning strategy for meaningful learning and motivating superior achievement in students.
Introduction: Many tasks seem daunting for a new medical graduate who is starting houseman
posting; as educators, we must ask ourselves whether our graduates are ready to face emergency
situations as the first responders during a crisis. Exploration of undergraduate students’ perceptions
highlights needs in some areas, including acute care, practical skills and prescribing. Armed with basic
resuscitation skills, students could face emergencies with more confidence and skill. Method: Seven
cohorts of final-year students completed a one-and-a-half day cardiac life support course and were
assessed using megacode and pre- and post-course multiple choice questions. Results: The pre- and
post-test analysis using paired sample T-test demonstrated significant performance improvement
(p
Background: Gastrointestinal illnesses and respiratory-related illnesses are common among
young children in Malaysia, especially those who are attending day care. During administration of
probiotic, the occurences of gastrointestinal and respiratory-related illnesses can be reduced. These
were observed by evaluation through a single questionnaire. However, currently no single tool exists
to simultaneously evaluate the domains of gastrointestinal and respiratory-related illnesses among
these young children. The current study aimed to develop a source questionnaire in English, translate
and validate into the Malay. Methods: Relevant domains of gastrointestinal and respiratory-related
illnesses were identified to generate items and formed a screening tool through literature reviews,
focus groups and opinions of experts. Results: The developed Basic Demographic and Lifestyle
Questionnaire (BDLQ) and Monthly Healthy Questionnaires (MHQ) showed item-level content
validity index (I-CVI) of 0.99 and 0.97, respectively, while the translated Malay versions showed I-CVI
of 1.00 and 0.99, respectively. Item-level face validity index (I-FVI) of 1.00 for both questionnaires
were obtained from 30 respondents showing that the items were clear and comprehensible.
Conclusion: This study showed good level of I-CVI and I-FVI in both developed questionnaires and
their Malay translated versions. These tools in English and Malay were valid and thus reliable to be
used for assessing gastrointestinal and respiratory-related illnesses in young children.
Background: Problem based learning (PBL) is both a constructivist pedagogic philosophy and an
instructional format for promoting contextual, co-operative and self-directed learning; it is traditionally
conducted as face-to-face tutorials. This study explored the utility of the live online chat application
Google Hangouts, which we refer to as LOVE-PBL, for running synchronous PBL tutorials that
included participants in different locations. Method: Data were collected from student participants
using a mixed-methods approach, comprising a self-administered questionnaire and focus groups.
We evaluated student participants’ perceptions of their learning experience and the effectiveness
of online PBL via Google Hangouts. Results: More than 70% of participants agreed that learning
outcomes were met using the Google Hangouts platform, and 50% felt that the ability to record the
sessions was useful for learning and reflection. The major factors for effective online PBL were reliable
internet connectivity, a conducive environment, and technical familiarity with the chat application
and its functionality. Conclusion: Although online discussions do not fully equate to face-to-face
conversations with regard to utility and enjoyment, learning outcomes are not compromised. Online
chat applications thus extend the utility of PBL, and their use adds to the accessibility, flexibility and
convenience that learners expect of higher education in a digital age.
Introduction: Bioethics subject which is part of the curriculum in higher education has a slightly different orientation compared to the science subjects. This study investigates the challenges of teaching bioethics subject to the health sciences students and the outcome of using mixed educational background classes in bioethics. Methods: Discussions among lecturers of bioethics were conducted to determine the possible challenges when teaching bioethics to the health sciences students who are accustomed to the format of science subjects. Results of written bioethics tests (multiple choice questions [MCQs] versus short essays) were also analysed among students from nine different health sciences background (biomedical sciences, nursing, speech pathology, dietetics, nutrition, medical radiation, audiology, sports science, and occupational safety and health) as a measure of the students’ understanding of the bioethics subject. Findings: The challenges of bioethics teaching were divided into five categorical themes; (i) attitude/discipline, (ii) background knowledge, (iii) reasoning/critical thinking, (iv) knowledge/jargon, and (v) diverse educational background. Excellence performances were demonstrated by the students across the ten disciplines in the direct MCQs while they did very poorly (p < 0.01) in the critical thinking short essay questions. Conclusions: Bioethics proof to be a challenging subject for the health sciences students as this subject deal with complex issues of ethical concerns which differ with most science subjects. Combined efforts of the educators and students are needed in order to address these challenges and stimulate the understanding of bioethics.
When patients are tethered with uncontrolled pain, health care practitioners usually resort to several
modes of symptomatic relief for their patients. In palliative care the goal is identifying and managing
the cause of pain in addition to addressing associated problems. To administer effective symptom
control in patient with chronic non-cancer associated pain, healthcare professionals may need to
consider alternative non-pharmacological modes of treatment such as psychological intervention. Pain
perception can be influenced by non-organic factors such as emotional, psychosocial status of the
patient and their religious and spiritual beliefs. Taking these factors into consideration are an essential
part of treatment goals. The paper illustrates an ethical dilemma which has arisen in the aggressive
management of pain and highlights the importance of multi-disciplinary involvement in patient care.
Failure to consider these aspects of care can cause patient and parental anxiety, poor symptom control
and could compromise doctor-patient relationship.
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.
Objective: This paper describes the patterns of professional identity development (PID) among
medical graduates of a SPICES (i.e., Student-centred/teacher-centred; Problem-based/information
gathering; Integrated/discipline-based; Community based; Elective/uniform; and Systematic/
apprenticeship-based) curriculum implemented by the School of Medical Sciences, Universiti Sains
Malaysia (USM). Methods: The phenomenological study design evaluated 50 medical graduates of
USM who underwent housemanship at government hospitals in the Peninsular of Malaysia. Focus
group interviews (FGI) were conducted to explore and capture the experience of the participants
in relation to PID during medical training. Eight FGI sessions were conducted at a specific place
as agreed by both researchers and participants. A thematic analysis technique assisted by Atlas.ti
software was used to analyse the qualitative data. Results: The thematic analysis revealed that there
were two themes: self-development and professional development. The self-development theme was
represented by four categories: self-confidence, internal and external motivation, communication skills,
and problem solving. The professional development theme was represented by five categories: social
adjustment, leadership skills and management, team work, hands-on skills, and creativity. Conclusion:
The formation of professional identity among USM medical graduates was related to self-development
and professional development. This suggests that the USM medical curriculum is vital in shaping
professionalism attributes among its medical graduates that are balanced among knowledge, skills,
behaviours and values. Producing balanced medical graduates will ensure the highest quality of
healthcare sevices provided to the country. The implications of this study and recommendations are
discussed.
Medical education in Malaysia is facing challenges related to the increasing number of local private
and foreign medical universities. The key issue is whether the system is producing doctors who have
adequate competencies for fundamental patient-centred care. The Malaysian Medical Licensing
Examination (MMLE) was proposed by the Ministry of Health (MOH) as a common licensing
examination for which all graduates must sit prior to obtaining registration to practice. Currently, this
exam is only taken by Malaysian students graduating from foreign medical colleges. However, the local
Malaysian universities, both public and private, have different curricula for preparing undergraduates
for future housemanships. The question is whether the educational programs of these universities
are robust enough in delivering curricula that produce safe and competent doctors. Moving forward,
it must be determined whether there is a need for extending the Malaysian Medical Licensing
Examination (MMLE) to all graduates of both local and foreign medical universities, thereby creating
a marker of excellence by which to measure Malaysian education and practice.
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 Ministry of Higher Education introduced the integrated cumulative grade point average (iCGPA)
system in 2016 as an aspiration to produce holistic and well-balanced graduates based on Malaysian
Qualification Agency’s (MQA) learning domains. In this article, we provide a comparison of iCGPA
with other established medical competency frameworks and share our experience in implementing
iCGPA in the medical faculty. Throughout the process, it was noted that medical educators require
several core competencies in order to successfully implement iCGPA in their courses. Two of the most
important core competencies are understanding the pedagogies of the 21st century (heutagogies,
paragogies, and cybergogies) and apprehending the concept of outcome-based education. On top of
the requirement of core competencies, there were also challenges in tailoring teaching and learning to
meet the requirement of the Industrial Revolution 4.0. We also describe in detail the benefits and other
challenges of iCGPA implementation in our faculty. We conclude this article with our recommendation
for successful iCGPA implementation in the future for the medical faculty.
Simulation-based medical education enables knowledge, skills and attitudes to be taught in a safe,
realistic manner. Flipped classroom teaching encourages self-learning. Emergency medicine exposes
students to diverse group of patients and physicians’ decision making. This study aims to determine
students’ perception on knowledge, skills and confidence after combined flipped classroom and
simulated teaching. Two cohorts of Semester 7 students Group 1 (n = 120) and Group 2 (n = 78)
completed a 5-point Likert scale questionnaire. Group 1 completed the questionnaire after a lapse
of six months while Group 2 at the end the posting. Responses from both cohorts were compared
using the Mann-Whitney U test. Of 198 (Groups 1 and 2) students, 91.41% (n = 181) felt the
simulated sessions helped better understand care of emergency patients. The sessions helped identify
knowledge gaps (89.90%; n = 178), improve knowledge and understanding of oxygen therapy devices
(85.35%; n = 169), and airway equipment (90.91%; n = 180). They prepared better for the flipped
classroom teaching than traditional sessions (80.81%; n = 160). They felt that their communication
skills (82.32%; n = 163) and confidence (63.64%; n = 126) improved. Significant differences noted
to questions (p = 0.006, p = 0.005, p = 0.041 respectively) targeting knowledge on oxygen therapy
devices, confidence, and identification of gaps in knowledge respectively. Combined simulation and
flipped classroom teaching was well received by students though this requires more preparation.
This study aimed to translate Oldenburg Burnout Inventory (OLBI) into Malay language, and test its
response process (face validity) and internal structure (factor structure and internal consistency). To
the author’s knowledge, OLBI is not yet validated in Malay language, thus this study aimed to produce
a validated Malay version of OLBI (OLBI-M) in order to measure burnout among the healthcare
learner population in Malaysia. OLBI has great potentials mainly due to its accessibility and free of
any cost to use it, thus might promote more researchers to conduct burnout research in Malaysia. The
forward-backward translation was performed as per standard guideline. The OLBI-M was distributed
to 32 medical students to assess face validity and later to 452 medical students to assess construct
validity. Data analysis was performed by Microsoft Excel, Statistical Package for the Social Sciences
(SPSS), and Analysis of Moment Structures (AMOS). The face validity index of OLBI-M was more
than 0.70. The two factors of CBI-M achieved good level of goodness of fit indices (Cmin/df = 3.585,
RMSEA = 0.076, GFI = 0.958, CFI = 0.934, NFI = 0.912, TLI = 0.905) after removal of several
items. The composite reliability values of the two factors ranged from 0.71 to 0.73. The Cronbach’s
alpha values of the three factors ranged from 0.70 to 0.74. This study shows OLBI-M is a reliable
and valid tool to measure burnout in medical students. Future burnout studies in Malaysia are highly
recommended to utilise OLBI-M. However, it is crucial for further validity to be carried out to verify
the credential of OLBI-M.
Immediate feedback assessment technique (IF-AT) are self-scoring answer sheets, based on the
concepts of immediate feedback for choosing the correct answer in multiple choice questions (MCQs)
during group readiness assurance tests (GRATs) in team-based learning (TBL). IF-AT scratch card
system rewards a student with partial credit for proximate knowledge. This technique motivates
students to pursue learning with just-in-time feedback and gives them the opportunity for collaborative
learning and analytic reasoning among group members. A rubric for partial credit is decided pre-hand
depending upon the number of options used in MCQs. In this study, we assessed students’ perception
about immediate feedback assessment technique before and after the training. To determine students’
perception of the IF-AT scratch card system in instruction and assessment. Students perceptions
about the IF-AT system has been explored using a 25-item questionnaire administered to 60 students
assigned randomly to control and training groups using pre-test and post-test analysis. Paired-sample
t-test and independent-sample t-test statistics were employed and the data was analysed. Descriptive
statistics observed for mean (SD) was found greater in trained group = 58.48 (4.87) vs. control group
= 66.43 (5.81) with t-statistics significant at p = < 0.001. A significant difference in mean (SD) of
pre-test minus post-test scores (5.16) of control and trained group = 5.37 (4.85) and 10.53 (8.36)
respectively was also found with independent t-test analysis. It was found highly significant with
t = –2.92, p < 0.05 and the effect size of 78.1%, established by Cohen’s d criteria. The IF-AT system
provides an individualised and instantaneous instruction as feedback in an assessment, which is
marked with collaborative learning as in team-based learning. The IF-AT system promotes analytic
reasoning with problem solving skills through partial credit for proximate knowledge. Students’
perceive the concept of immediate feedback and partial credit for proximate knowledge as the most
important features of the IF-AT scratch card system.
Delivery and implementation strategies are key to curriculum success. There is growing evidence
that team-based learning (TBL) is an effective way of interactive teaching. TBL is a method that uses
learning teams to enhance student engagement and quality of learning. Individual accountability for
out-of-class reading is followed by individual and group assessment. In-class application exercises,
which is the hallmark of team-based learning promotes both learning and team development. TBL
uses educational principles of transforming traditional content into application of knowledge
and problem solving skills in an interactive learning environment. To experience the structural
framework and to determine the students’ perception about TBL in clinical setting of MBBS
program in a Malaysian medical school. A total of 120 students assigned to 22 small subgroups of
5–6 per group underwent a number of TBL sessions delivered in three phases. In Phase I, students
were assigned reading material. In Phase II, students were assessed through One Best Answer
(OBA) items for individual and group readiness assessment test as individual readiness assessment
test (IRAT) and group readiness assurance test (GRAT) respectively followed by a mini-lecture.
In Phase III, in-class application of learning activity was performed. Finally, peer assessment
evaluated the contribution of peer in TBL. A TBL Classroom Evaluation Inventory (TBLCEI)
developed to probe student’s perception of TBL, comprised of 40 items composite scale with
Cronbach’s alpha at 0.881. In addition, students were asked to provide their estimated grade in
end of the posting assessment. Grades were categorised into excellent pass >85%, high pass 70%–
84%; average to good pass 50%–69% and fail