The flipped classroom (FC), an innovative teaching and learning pedagogy has grown in medical education since last decade. In FC modality, students learn by means of print, audio or video-based material self-reliantly, before built-in teaching sessions in the classroom to overcome passive learning. In this review, the key concepts, benefits and best practices of the FC in health professions education have been described. The review was carried out using Medline, Scopus, Ovid, and Cochrane. The keywords were “Flipped method, Teaching strategy, Role of the teacher, and Medical students”. Flipped is an effective teaching modality which enables learners to be independent. Students do take ownership of what they learn. Tutors are also satisfied with what their learners acquire. The benefits of FC are robust and likely to augment the learning abilities of the students as well as supplementing the learning course content; group events can deliver added benefits too.
This case illustrates the issue of truth-telling about a diagnosis of a potentially terminal illness. A family member of an elderly patient requests that the treating doctor does not disclose the diagnosis to the mother for fear that it will distress her and cause her anxiety. The challenge of the treating doctor is how to deal with this in a professional and ethical manner.
Disease trajectory in children can be difficult to determine. This is primarily, despite the life limiting condition, healthcare professionals are unable to pin the exact time when these children’s lives will end. We illustrate an unusual case of dicephalic parapagus, an inseparable conjoined twin which was complicated by anomalies, psychosocial and safeguarding issues. Such case posed a challenge even to paediatric palliative care team as the trajectory of the disease, in this case, is rather difficult to predict. Anticipatory symptoms management perhaps is the best way forward, despite having to face many ethical challenges and medical enigma.
Professionalism is considered as one of the most inspiring as well as challenging proficiency to teach and evaluate, because of its multifaceted and context-specific nature. This paper defines an orderly and useful escort on how to incorporate the problem-based learning (PBL) as a teaching and assessing modality, within a course of medical professionalism. While answering Harden’s 10 questions, course planners shall find this approach doable, allowing them to design and utilising this in an undergraduate medical education context. An enlightening approach, as this will prepare our students to be future professional doctors, equipped with all necessary professionalism attributes, in our fast varying professional environment.
Chronic kidney disease (CKD) causes 70% of all death globally. The prevalence of CKD has shown an increasing trend for the past 20 years in Malaysia. Thus, determining the knowledge and awareness of CKD among healthcare students in preparing them to be a good healthcare provider in the future is important. This study aimed to determine the association between knowledge and awareness about CKD among International Islamic University Malaysia (IIUM) undergraduate students. A crosssectional study was conducted among 108 students using simple random sampling method. The questionnaire was given to the class representative to be self-administered to interested students. It had close-ended questions consisting of Part A to Part D. The scoring given for correctly answered items was one and the total score for Part C was 7 marks. Most of the students were female (70.4%). The mean knowledge score of CKD was 3.65 (SD = 1.12) with nearly half of the students (43.5%) classified as having poor knowledge. Most respondents were aware about CKD (99.1%) and have heard about it from medical personnel (48.1%) and the Internet (25.9%). Further analysis showed that only courses taken by the respondents were significantly associated with knowledge on CKD (p = 0.039). The level of knowledge among undergraduate students is still poor, yet they are aware about the existence of CKD and its aetiology. Therefore, the health sciences curriculum should emphasise on CKD management from a multidisciplinary aspect of care. It is recommended to conduct similar research among different student populations to create awareness and obtain important baseline findings.
Validity evidence can be supported by five sources that are content, response process, internal structure, relation to other variables, and consequences. Response process validity measures the thought processes of users of the tested inventory as they respond to the assessment tool. These are commonly evaluated in the form of clarity of instructions and language used in the assessment tool, as well as the comprehension of instruction after training or an observation session. Response process validity contributes to the overall validity of an assessment tool; therefore, it should be quantified systematically based on the evidence and best practice. This paper describes a systematic approach to quantify response process validity in the form of face validity index based on the evidence.
Simulated patient (SP) is defined as a layperson who simulates to portray the role of a patient with health-related conditions based on varying levels of training. SP allows students to practice various skills under guided experience in a realistic, safe, and controlled setting. The purpose of this integrative review is to examine original research relating to the experience towards simulated patient-based simulation session. A rapid review included three electronic databases search of articles published between 2008 to 2018 with inclusive and exclusive criteria. Seventeen articles were eventually selected for inclusion in the review. These articles were subjected to basic thematic analysis. Descriptive analysis of the study design, study location, professional area, and study variables were reported. Six themes were identified: SP’s perspective, evaluation of SP’s performance, euthenticity of SP role play, SP feedback, student’s development, and evaluation of student’s performance. SP methodology has been widely used to train healthcare students in the development of medical knowledge, clinical skills, as well as important soft skills. SPs, students, and facilitators play a role to ensure the success of an SP-based simulation session. The outcome of the training with SP was examined through an assessment of either the student’s performance or the SP’s performance. The outcome of the review concluded that SPs’ development indirectly influences students’ development.
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
Introduction: Poor sleep quality among university students has become an important issue to be concerned as it can hugely influence the students especially on their academic performance. However, there are inadequate studies published on the sleep quality of medical students in Malaysia.
Objective: This study aimed at determining the sleep quality of pre-clinical medical students in Universiti Putra Malaysia (UPM) and Universiti Malaya (UM). Methods: This is a cross-sectional study that used self-administered questionnaire to collect data from the pre-clinical medical students
of UPM and UM. Sleep quality of the students was measured using Pittsburgh Sleep Quality Index (PSQI) questionnaire. All data were analysed by SPSS version 21.
Results: Findings revealed that 63.9% respondents with poor sleep quality (PSQI score: more than 5). The prevalence of poor sleepers
in UM (67%) was slightly higher compared to UPM (60.9%). However, the comparison of PSQI score showed no significant difference between UPM and UM respondents (p = 0.082). Meanwhile, the average sleep duration per night among respondents was 5 hours 39 minutes (± 1.21 hrs), whereas
only 6.1% students practiced recommended sleep value per night (> 7 hrs). Significant association was found between caffeine intake and sleep quality. Besides, this present study showed no association between sleep quality with gender and year of study.
Conclusion: Majority of the pre-clinical students in UPM and UM had poor sleep quality and short sleep duration. Only a small number of students practiced recommended sleep value per night.
Personality researchers have proposed five dimensions of personality that are extroversion,
conscientiousness, agreeableness, neuroticism, and openness. The five-factor model offers a theoretical basis for medical educators to understand the impact of personality traits on medical students’ psychological health during stressful medical training. This study attempted to investigate on which personality traits have favour impact on psychological health of medical students during a stressful period – the final examination of first year. A cross-sectional study was conducted on medical students in a public medical school. Personality traits were measured by USM Personality Inventory and psychological health parameters were measured by 21-item Depression Anxiety Stress Scale. Pearson correlation test was performed by SPSS to determine correlation between personality trait and psychological health parameters. A total of 174 medical students participated in this study. Extroversion (rstress = –0.44, ranxiety = -0.41, rdepression = –0.56), conscientiousness (rstress= –0.38, ranxiety =–0.36, rdepression= –0.51), agreeableness (rstress = –0.28, ranxiety = –0.25, rdepression = –0.47) and openness
(rstress = –0.34, ranxiety = –0.31, rdepression = –0.47) negatively correlated with stress, anxiety and depression. Neuroticism (rstress = 0.53, ranxiety = 0.47, rdepression = 0.60) positively correlated with stress, anxiety and depression. Extroversion, conscientiousness, agreeableness and openness demonstrated favourable impact and neuroticism demonstrated unfavourable impact on stress, anxiety and depression of the medical students during a stressful period.
Introduction: Detecting sources of stress of medical students is important for planning wellness
program to improve their psychological wellbeing. One of instruments to detect the sources of stress
is the Medical Student Stressor Questionnaire (MSSQ). A systematic review was performed to find
out evidence to support its validity in term of content, response process, internal structure, relation
to other variables, and consequences. Method: The author planned, conducted and reported this
study according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses)
standard of quality for reporting meta-analyses. Systematic search was performed on EBSCOhost,
Scopus, Proquest, PubMed, Web of Science and Google Scholar databases. Result: The author
yielded 613 relevant articles based on search terms, 44 articles had used MSSQ, and after critical
appraisal, only 18 articles provided evidence to support validity MSSQ and thus were included in
the systematic review. Conclusion: This systematic review supports the validity of MSSQ in relation
to content, response process, internal structure, relations to other variables, and consequences of
its scores. MSSQ is a valid tool to detect sources of stress in medical students and its results can be
utilised as a guide to plan wellness program or intervention to improve medical students’ wellbeing.
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.
Introduction: Neuro-Linguistic Programming (NLP) is continuously used as one of the
psychological intervention in medicine, sport, and education settings. NLP through employing its
techniques and language patterns could make certain changes in connections between neurological
processes and therefore, restructure individuals’ cognition and reform their behaviours. This
contributes to certain advantages in educational-therapeutic sessions concerning helping athletes with
emotional hardship, resulting from physical injuries. Objective: To examine a tailored intervention
of the NLP model adapted for educational-therapeutic purposes to reduce competitive state anxiety
of two elite basketball players after their rehabilitation programme from physical injuries. Method:
This study used a case study approach, and employed the NLP model’s collapsing anchoring,
perceptual positions, and meta-model language patterns, to help both athletes to restructure their
dysfunctional thoughts and memories. The athletes experienced anxiety related negative thoughts and
felt emotionally difficult to perform in training and competition. Results: The intervention showed
promising strategies in helping the athletes to reduce their competitive state anxiety. Also, the results
obtained from the interview sessions, and the quantitative analysis showed that the NLP intervention
had successfully helped the athletes to cope with dysfunctional thoughts and emotionally related
anxiety. Conclusions: The NLP-based intervention, to some degree, helped the athletes to deal with
dysfunctional thoughts of their past injury experiences, reducing their competitive state anxiety to
compete again in the upcoming competition.
Objective: To determine the validity and reliability of Incontinence Praying Ability (I-PA) among
Muslim childbearing-aged women. Methods: A cross sectional study was conducted among Muslim
women under childbearing age attended clinics in a university teaching hospital. Two measures were
used in the present study and there were I-PA and Incontinence Quality of Life (I-QoL). I-PA was
developed in Malay language and its construct validity had not been explored. The questionnaires
were handed to the Muslim women during their visit to the clinics in Hospital Universiti Sains
Malaysia. Exploratory Factor Analysis (EFA) was conducted to determine the construct validity
and the Cronbach’s alpha was used to examine the internal consistency reliability of I-PA. Pearson
correlation was used to examine the correlation between I-PA and the subscales of I-QoL. Validity was
further supported if both scales were significantly correlated. Results: A total of 162 Muslim women
completed and returned the questionnaires to the researchers. The mean age of participants was 32.4
(SD = 5.87). Based on EFA result, all the 10 items of I-PA were remained in the model under one
factor and no item deletion was required. The factor loadings were ranged from 0.70 to 0.91. The
internal consistency of I-PA was satisfactory with Cronbach’s Alpha of 0.94. There were significant
correlations between I-PA and I-QoL’s subscales, ranged from 0.64 to 0.71. Conclusion: I-PA was
considered a valid and reliable questionnaire measuring incontinence quality of life in the aspect of
praying ability or spirituality among Muslim childbearing-aged women.
Assessment of medical professionalism is often challenged by the subjectivity of its construct and
lack of feedback practice to nurture professional growth. However transmitting professionalism alone
has not been shown to improve professional behaviour therefore professionalism need to be assessed
if it is viewed as relevant. The authors provided description and guidelines on the use of Simplified
Thematic Engagement of Professionalism Scale (STEPS) as summative and formative assessment
tool for assessing professionalism attributes. STEPS was developed based on the Professionalism
Mini-Evaluation Exercise (P-MEX) format that utilise multiple short encounter assessment and
incorporated professionalism values from a local study. The formative component has 15 attributes
that were categorised into personal, profession, patient and public. This is assessed using seven scale
rubric that promotes feedback practice using feed up, feed back and feed forward concept. The
summative component utilises global rating that will be collated longitudinally to form a more robust
evaluation of student professionalism. Current investigations are ongoing especially to ascertain the
usability and validity of STEPS as peer assessment and self-assessment tool.