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: 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: Tertiary education environment has always been regarded as highly stressful to students. Medical training further adds to the already stressful environment. The stress of medical training was associated with negative consequences to the mental and physical health of medical students. We describe in this article a stress-management program known as the 'Medical Student Well-Being Workshop' in our medical school.
Methodology: The workshop was run over two half-days over a weekend. Prior to the workshop the society announced the workshop to the students and participation was voluntary. It was open to students from all years of the medical course except for first year students. A separate stress management workshop is planned for them.
Results: A total of 55 students participated in the workshop, out of which 55 (82%) were female students. The years of study were almost equally represented; 14 students (26%) from years two and three, 20 (37%) from year four and 6 (11%) from year five. All sessions were rated as highly useful; the lowest rated, the introduction session, obtained an overall usefulness rating of 3.73 out of the possible 5 (74.6%).
Conclusion: Medical Students Well-being Workshop is a promising intervention program in improving medical students' ability in managing stress. Perhaps similar approach can be considered relevant to be incorporated in other medical schools.
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
For the purpose of teaching statistics, lecturers often rely on data from real studies, text book examples or painstakingly created datasets. The process of creating a dataset can be made easier with the utilization of PASW Statistics to generate random values. The objective of this article is to demonstrate the creation of data which are measured on continuous scale, using PASW Statistics menus and syntax.
Introduction: A clear concept and understanding about the measure and the measuring tools is essential for good practice of assessment. Assessors need to have information about the full range of assessment tools inclusive of psychometric validity and purpose of its use. Subjective inferences drawn from the readily available data as numbers of summative scores over the years and statistical evidences of reliability and validity of assessment tools used to measure student’s performance are good sources of feedback for competent assessment program. It also provides meaningful evaluation of learning and teaching in medical education. Method: A retrospective study of 119 candidates was carried out to analyze the summative assessment scores of their certifying examination of Masters of Surgery in School of Medical Sciences (SMS) at Universiti Sains Malaysia. Subjective judgment of raw data followed by internal consistency as reliability, convergent validity and discriminant validity as constructs of individual assessment tool was analyzed. Finally each assessment tool as a measure of written or clinical construct was evaluated against six aspects of Messick’s criteria for quality control. Result: The correlation coefficient for validity and Cronbach’s alpha for reliability was evaluated for clinical measures. However, the test of internal reliability was not possible for essay being the only measure in written construct of summative assessment in surgery. All measures of clinical construct were found highly reliable with Cronbach’s alpha between 0.962-0.979. Long case and the short cases have shown excellent correlations (r=0.959 at p
Introduction: Emotional intelligence (EI) is deemed an important aspect of being good medical doctors. Universiti Sains Malaysia (USM) Emotional Quotient Inventory (USMEQ-i) is an EI inventory in Malay language developed primarily as medical student selection tool in USM. Although it was already validated by exploratory factor analysis (EFA), EFA is considered insufficient evidence of construct validity, thus confirmatory factor analysis (CFA) was conducted. Objectives: To determine measurement model validity and construct validity of USMEQ-i among medical degree program applicants in USM by CFA. Methods: USMEQ-i data file for medical degree program applicants in USM for year 2010/2011 and 2011/2012 academic sessions were obtained from Medical Education Department in USM. A random sample of 512 cases was drawn from the data file. Of the sample, only 453 cases were valid study sample after preliminary data screening and assumption checking. CFA was conducted on the sample using maximum likelihood (ML) estimation with bootstrapping technique due to violation of multivariate normality assumption. USMEQ-i measurement model was proposed as a second-order EI factor with seven first-order factors of EI and a Faking Index (FI) factor, with correlation between second-order EI factor and FI factor. Results: The proposed model could not be fit into the study sample data. EI factors and FI factor had to be analyzed separately due to non-positive definite problem. After modifications to the model, CFA of EI factors were suggestive of two-factor model instead of the proposed seven-factor model. Consciousness, Maturity and Control (CoMaCt). CFA of FI factor maintained one-factor model and also valid in term of construct. Conclusion: The modified USMEQ-i, which consisted of separate EI and FI models, was proven to have valid measurement models and reliable constructs. It is considered to be suitable for use among applicants to medical degree program in USM. However, its use as medical student selection tool may require further research, especially how predictive USMEQ-i scores with real performance of medical students, generalizability of the inventory and its stability over time.
In today’s challenging and highly complex health care settings nurses must be able to think critically.
With the current traditional and rote methods of learning, the critical thinking skills among the
students are seen to diminish. As nurse educators must find a different method in their teaching on
how to encourage students to engage in analytical thinking and how to make the analytical thinking
process part of their daily practice due to increase safety of the patients. This will give challenge for
the nurse educators to reshape education by adopting instructional strategies to equip students with
foundational knowledge in critical thinking, creative problem solving and collaboration. Through
concept mapping, students should be able to transfer applied didactic objectives from the classroom
to the clinical practice, where critical thinking and problem solving skills are needed for success. It also
provide nurse educators with the ability to help students learn how to organise data, prioritise patient
needs and can relate patient medical illness and nursing intervention.
In recent years, the popularity of using complementary and alternative medicine (CAM) as a health care option has increased dramatically all over the world especially in developing countries. As Malaysian statistics showed an increased in chronic diseases among our population, the demand to consume CAM for healing process as well as in pursuit of health and well-being also has increased. Thus it increased patient’s interest to request more information from medical practitioners and nurses who are front health care providers. The objective of this study is to compare the knowledge, attitudes, and practice (KAP) of CAM among final year nursing and medical students in Universiti Sains Malaysia (USM). A cross-sectional comparative study was conducted among final year medical and nursing students using self administered questionnaire. This study utilized the Knowledge-Attitude-Practice (KAP) model to explain how level of knowledge may reflect nursing and medical students’ attitudes and practice of CAMs. There were 74 students participated where 33 of them were nursing students, and 41 were medical students. Independent t-test was used to compare the KAP of CAM between both groups of students and there was a significant different. As a conclusion, this study revealed that nursing students were more knowledgeable about CAM, possessed positive attitudes, and more willing to practice CAM compared to medical students.
Context: Community-based medical education (CBME) has become widely accepted as an important innovation in undergraduate medical education. In curriculum featuring CBME, students are acquainted with the community early in their studies however; the impact of this training can be judged best to see them practice the required aspects of CBME. Malaysia is a multiracial country with a very strong community dependant life style. Main national health problems have called for a change in health profession education from traditional hospital based health care to community-based delivery system. Three major university's medical schools that either practice community oriented or community based medical education in undergraduate medical curriculum are evaluated. Universiti Sains Malaysia (USM) has a community based medical education (CBME) curriculum as Community and Family Case Study (CFCS) compared to a community oriented education curriculum (COE) adopted by Universiti Malaya (UM) and Universiti Kebangsaan Malaysia (UKM). However, UM at the time of undertaking this study back in 2005 was though practicing COE has also later opted CBME as CFCS.
Objective: To determine whether medical graduates from USM with a community-based medical education in its curriculum for more than 25 years are inspired to have stronger commitment towards community health as shown in their on-job practice of medicine compared to other graduates from UM and UKM, who have adopted community-oriented medical education program.
Method: A questionnaire-based pilot study with 12 items (variables) was designed to obtain supervisor's opinion on commitment of interns towards the health of community they serve. The questionnaire was administered to a randomized group of 85 specialists supervising the internship training program in five major disciplines including internal medicine, surgery, orthopaedic, gynaecology and obstetrics and paediatric medicine. The data received from 62 respondents from five major disciplines was analyzed utilizing SPSS version 12.0.1.
Result: The responses received from 62 supervisors on an inventory in which 9 out of 12 variables were directly related to community commitments of interns. It was shown that the USM graduates who were taught through a CBME curriculum have performed better than the graduates from UM and UKM who followed a COE curriculum. P-value (< 0.001) was highly significant and consistent with higher mean score in those variables.
Conclusion: The graduates taught through a CBME curriculum performed better in community commitments towards patients care compared to graduates from COE curriculum.
Food is considered as a social responsibility of caregivers to their children. It has cultural connotation for all races notwithstanding their background and religious belief; that social responsibility should not be separated even in terminally ill patients. We recorded a case scenario of a terminally ill child who faced difficult end of life with inability to take oral fluids or food due to mechanical obstruction of duodenum by the pelvic rhabdomyosarcoma. From cultural context, the physical act of giving food and fluids to a sick person is considered “a display of one’s affection”. It is understandable that, once the dying phase has reached, and the body starts to shut down, administering fluids may not be useful despite it is deemed necessary from cultural point of view. This case illustrates an ethical dilemma in managing a child with end stage metastatic disease with multiple systemic complications, compounded with futility of medical care and complex social circumstances. It is quite challenging for physicians and relatives to provide good end of life care to patients in palliative care setting. Ensuring good quality of care, quality of life and quality of death are paramount to avoid suffering and distress among the patients and family members.
For pre-post and cross-over design analysis of numerical data, paired t-test is the simplest analysis to perform. Planning such study, it is imperative to calculate appropriate sample size required for the test to detect hypothesized difference. However, the sample size formula requires determination of standard deviation of difference, which is not commonly reported. In this article, the author guides the reader to calculation of standard deviation of difference from standard deviation of each separate occasion.
The community placement programme was first introduced to our medical students in 2007. The objectives of this community service programme are to enable students to explore and understand the importance of various skills such as leadership, teamwork and interest towards community services, as well as to improve their skills in those areas for becoming better students and future doctors. The first year medical students were tasked to plan, organize and implement activities in selected communities such as disabled people, orphans, neglected elderly, the poor, HIV positive single mothers and children. Amongst the activities conducted were sharing experiences and thoughts, games, donation and ‘gotong-royong’. The objective of this study was to evaluate the students’ perception on the successfulness of the community placement programme in building their professional qualities. A cross-sectional study was conducted among the first year medical students using a self-administered questionnaire. The questionnaire consists of 5 elements of professional qualities such as leadership and team work skills, interest towards community services, volunteerism and empathy. Self-reflection sessions were also held to explore the learning points gained. A total of 147 students answered the questionnaires. The students rated the overall programme as highly useful (80.6%) and as achieving the objectives (80.1%). They perceived that this programme helped them to improve their personal and professional skills such as leadership (70.0%), team work (71.4%), interest towards community services (87.1%), volunteerism (85.0%), and empathy (89.1%). Self-reflection revealed that the programme made them realize the role of doctors in a community, appreciate the spirit of teamwork and helped them to understand the need of vulnerable groups. As a conclusion, this programme was well-accepted and perceived as assisting medical students to build professional qualities to become caring and competent doctors.
Breaking bad news is a crucial communication delivered by healthcare professionals. This skill was
taught in Management and Science University, Malaysia using lecture previously. Realising the
instructional delivery gap, breaking bad news workshops was introduced involving not only the theory
of the skills but the hands on experience as well. This workshop incorporated peer-assisted learning
method in providing a friendly and conducive environment for the best learning experience for the
students. Five workshops were conducted with a total of 204 students. Students (n = 38–42 per
session) were given materials a week prior to the session to familiarise themselves with the workshop.
Trained peer-assisted tutors (n = 8) guided role-playing sessions as well as giving feedbacks. Students
found that the workshop to be useful adjunct to learning communication skills, specifically in breaking
bad news. Students considered peer-assisted learning method provided them with a safe environment
where mistakes were allowed, corrected and proper skills reiterated. In conclusion, learning breaking
bad news is feasible with peer-assistance.
This paper discusses the ethical issues of patient autonomy based on a case of a patient who refused medication during Ramadhan fasting period. Issues on patient autonomy include the right of a patient to refuse medication, informed decision making, the importance of effective communication and the physician roles and responsibilities are discussed. In conclusion, patient autonomy must be respected and valued. However, the need of effective communication in facilitating informed decision making to improve doctor-patient relationship, should not be overlooked and compromised.
Autonomy is widely accepted to be the third pillar of medical ethics. However, if it comes to refusal of life saving treatments, some extra considerations are necessary, especially if decisions are made by surrogate decision makers. Four cases of problematic decision making are presented here, followed by a discussion about the cultural and religious misconceptions about the rights of surrogate decision makers.
Introduction: Attitudes towards animal welfare are important in influencing how animals are treated. Studies of attitudes towards animal welfare in veterinary students are scarce. It is hope that the findings will enhace a diverse research in the future in order to explore variety of factors in relation to animal welfare since such study is currently limited.
Objective: The study is to determine the associations of gender,year of study and empathy level of undergraduate DVM students in UPM into their attitude towards animal welfare.
Method: Questionnaires were given to 440 Doctor of Veterinary Medicine undergraduate students in UPM to study the associations between gender,year of study and empathy level with attitudes towards animal welfare. Data were collected from respondents through two sets of self guided questionnaires. Interpersonal Reactivity Index (IRI) which assessed empathy level where only two sub-scales from the IRI were used. Empathic Concern (EC) and Perspective Taking (PT). Animal Attitude Scales (AAS) were used to assess attitudes towards animal welfare. Data collected were analysed using Statistical Package for Social Science (SPSS) version 20.
Result: 367 (83.4%) out of 440 students participated in this study. Antu-animal welfare attitude (74.9%) was the highest compared to the pro-animal welfare attitude (25.1%). Analysis showed a significant difference (p0.005) between gender and attitudes towards animal welfare (p=0.057) as well as between empathy level and attitudes towards animal welfarefor empathic concern sub-scale (p=0.194) and perspective taking sub-scale (p=0.320).
Conclusion: Majority of sudents were categorized as anti-animal welfareand the attitudes were significantly different among years of study. Female and malestudents have nomsignificant differences in their attitudes towards animal welfare. Students with ggod and poor empathy level also have no significant difference in their attitudes towards animal welfare.
Objective: To determine association between academic performance and absenteeism in classroom among first year medical students.
Methods: A one-year prospective study was conducted on 196 first year medical students. Academic performance was measured by examination scores at four examinations. Absenteeism score was measured by the cumulative number of absence in an academic session of each student recorded by academic office at the end of the first year of medical training. The academic performance was categorized into pass and fail for analysis purpose. Data was analyzed by SPSS version 20.
Results: The independent-t analysis showed that, in all examinations, students who passed the examinations had significantly lower absenteeism scores than those who failed (p < 0.001).
Conclusion: This study found significant associations between academic performances and absenteeism scores among first year medical students. Medical schools should pay more attention on this matter since it may result in poor academic performances.
Introduction: Metacognition is the awareness of knowledge how one learns in addition to what
one learns and to understand how a task will be performed. Metacognitive skill as self-assessment
is recognised as an important contributor to the development of critical capacity, reflective attitude
and autonomous life-long learning. Accurate, self-assessment of knowledge and skills is essential for
students to maintain and improve through self-directed learning. Objective: The objective of this
study was to explore, how well students’ evaluate their own level of understanding for lectures to
reflect their metacognitive skill that can be used in educational strategy to promote students’ personal
and professional growth. Methods: To assess the metacognition of the students, a questionnaire based
on three items was designed. All 60 (17 male and 43 female) preclinical, first-year medical students
were included in this study. The metacognition as planning, monitoring and evaluating the lecture was
judged through students’ response on 33 lectures in terms of understanding of knowledge, clearing
of misconceptions and presenting of a well prepared material respectively in the field of haematology
and parasitology. Metacognition as reflected in the lecture understanding level (LUL) score, lectures
preparation level (LPL) score and students question level (SQL) score was estimated for its correlation
with student’ achievement score in pre-clinical phase of MBBS program. Results: The data was
analysed for correlation between metacognition and overall students’ achievement scores and a
statistically significant correlation between LUL and multiple true false (MTF) of 268 (p = .039),
LPL and MTF of .282 (p = .029) as well as between SQL and MTF of .360 (p = .005) was compared
to poor correlation between LUL, LPL and SQL and the other three assessment tools (short essay
questions [SEQ], problem-based questions [PBQ] and objectively structured practical examination
[OSPE]) was found. Conclusion: The significant correlation of students’ metacognition and their
achievement score in classroom setting with MTF and poor correlation with SEQ, PBQ and OSPE is
attributed to multiple factors discussed in this study, imperative to students’ personal and professional
growth.
Background: The weekly held clinical pathologic case conference popularly known as CPC provides an effective and regular educational media of collaborative learning for inter-disciplinary exchange of knowledge among the faculty members of an institution. CPC has been routinely practiced for the last two decades in School of medical Sciences (SMS) at Universiti Sains Malaysia (USM). An hour session primarily involves a case presentation hiding the diagnosis followed by discussion on differential diagnosis and floor interaction on interesting clinical cases. It also gives an opportunity to new teaching staff in the institution to experience an in-house practice of presenting the clinical cases; witch can readily be reproduced as a case report for publication. An effort to follow the original format of CPC is comprehended as an essential outcome of this study to keep up the sanctity of CPC as a case method of learning medicine in future. Methodology: A questionnaire-based survey was recently conducted to evaluate the weekly held CPC in SMS. It was a cross sectional survey in which a questionnaire comprising of 23 items was administered to a targeted population of faculty members of School of Medical Sciences. The items in questionnaire were grouped into 5 clusters. All respondents were adequately briefed through a letter addressing the objectives and importance of survey and its appraisal aiming to revamp the CPC guided by the out-come of study. Questionnaires were administered to 240 academic staff, covering > 80% of the target population of 294 faculty members. 159 (66.2%) members of sample population completed the questionnaires. Total non-responses were 81 (33.7%) and item non-responses were 320 (8.7%) Result: All the items in questionnaire were found significant (p 0.016) except those two items related to, observing a difference in preparing for a case presentation verses a formal CPC presentation and its promotion (p 0.556 and 0.197 respectively). It was also established that the major respondents were unaware of the original format of CPC (p 0.003) in which a presenter select and prepares a case, which is discussed with participating faculty members for its differential diagnoses. 51.6% faculty members did not follow the formal CPC format (p 0.016) in their presentations. A lack of awareness about the format of CPC was shown by (61.0%) faculty members (p 0.003). Conclusion : It was concluded that emphasis to discuss the differential diagnosis by a competent discussant was lacking, as presenters did not follow the formal CPC format. It was critically observed that a number of presentations made in this weekly program deviate from the original format adapted by SMS in USM. However, the out-come appraisal of this survey was the pledge shown by the majority faculty members to adapt the guidelines as a reverence to the formal CPC format.