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  1. Prasad H, Foong CC, Hong WH
    Educ Prim Care, 2022 09;33(5):258-264.
    PMID: 35769041 DOI: 10.1080/14739879.2022.2077144
    In the last few decades, primary care medicine (PCM) is increasingly recognised as a cornerstone of an efficient and effective healthcare system. However, the PCM discipline is now facing challenges such as a shortage of doctors. One of the possible reasons could be the lack of comprehensive PCM curricular components in the undergraduate medical programmes. This study aimed to develop a list of core clinical topics suitable to be used as a shared PCM curriculum for undergraduate education in Malaysia. A Delphi survey that consisted of three iterative rounds with feedback was used in this research. The participants included PCM experts involved in the undergraduate level of PCM teaching. These experts were selected based on the criteria developed by two senior academicians in PCM medical education. The final developed list contained 34 core clinical topics that should be incorporated into the undergraduate PCM curriculum. The findings will be useful in establishing the policies and guidelines of PCM education for undergraduates in various medical schools. This study may also promote the field of PCM and encourage more doctors to take up the speciality. Lastly, it provides essential information to address the knowledge gap in PCM education among undergraduate medical students in Malaysia.
  2. Hong WH, Vadivelu J, Daniel EG, Sim JH
    Med Educ Online, 2015;20:27561.
    PMID: 26314338 DOI: 10.3402/meo.v20.27561
    Studies have shown the importance of metacognition in medical education. Metacognitive skills consist of two dimensions: knowledge of metacognition and regulation of metacognition.
  3. Sim JH, Tong WT, Hong WH, Vadivelu J, Hassan H
    Med Educ Online, 2015;20:28612.
    PMID: 26511792 DOI: 10.3402/meo.v20.28612
    INTRODUCTION: Assessment environment, synonymous with climate or atmosphere, is multifaceted. Although there are valid and reliable instruments for measuring the educational environment, there is no validated instrument for measuring the assessment environment in medical programs. This study aimed to develop an instrument for measuring students' perceptions of the assessment environment in an undergraduate medical program and to examine the psychometric properties of the new instrument.
    METHOD: The Assessment Environment Questionnaire (AEQ), a 40-item, four-point (1=Strongly Disagree to 4=Strongly Agree) Likert scale instrument designed by the authors, was administered to medical undergraduates from the authors' institution. The response rate was 626/794 (78.84%). To establish construct validity, exploratory factor analysis (EFA) with principal component analysis and varimax rotation was conducted. To examine the internal consistency reliability of the instrument, Cronbach's α was computed. Mean scores for the entire AEQ and for each factor/subscale were calculated. Mean AEQ scores of students from different academic years and sex were examined.
    RESULTS: Six hundred and eleven completed questionnaires were analysed. EFA extracted four factors: feedback mechanism (seven items), learning and performance (five items), information on assessment (five items), and assessment system/procedure (three items), which together explained 56.72% of the variance. Based on the four extracted factors/subscales, the AEQ was reduced to 20 items. Cronbach's α for the 20-item AEQ was 0.89, whereas Cronbach's α for the four factors/subscales ranged from 0.71 to 0.87. Mean score for the AEQ was 2.68/4.00. The factor/subscale of 'feedback mechanism' recorded the lowest mean (2.39/4.00), whereas the factor/subscale of 'assessment system/procedure' scored the highest mean (2.92/4.00). Significant differences were found among the AEQ scores of students from different academic years.
    CONCLUSIONS: The AEQ is a valid and reliable instrument. Initial validation supports its use to measure students' perceptions of the assessment environment in an undergraduate medical program.
    KEYWORDS: assessment environment; development; instrument; psychometric properties; validation
  4. Lee SS, Samarasekera DD, Sim JH, Hong WH, Foong CC, Pallath V, et al.
    Med Sci Educ, 2020 Mar;30(1):271-280.
    PMID: 34457667 DOI: 10.1007/s40670-019-00894-z
    Purpose: Research has shown that many undergraduate students struggle with self-regulated learning (SRL) in clinical year as they are insufficiently supported by the staff in the early year to prepare them for the transition. Hence, this study aims to find out the SRL strategies and the approaches that could promote SRL among pre-clinical students in two medical schools.

    Method: This is a mixed-method study. The Motivated Strategies for Learning Questionnaire (MSLQ) was used to collect student SRL strategies while semi-structured interviews with faculty members and focus group discussions with students were used to gather data on the approaches that promote SRL. Student MSLQ was analysed using descriptive statistics while interviews were transcribed verbatim and thematically analysed.

    Results: A pilot using MSLQ with 413 students recorded a Cronbach's alpha of 0.928 for the questionnaire. The actual study involved 457 Years 1 & 2 students. Students from both institutions are motivated by the Task Value, and they use Elaboration and Organisation strategies the most in their pre-clinical year. Three themes emerged from the qualitative analysis of this study: characteristics of strategies that promote SRL, hindrance in promoting SRL, and opportunities in promoting SRL.

    Conclusions: Our findings indicate that students' intrinsic motivation is generally high in pre-clinical year. However, metacognition and critical thinking strategies will need to be enhanced among students. Despite knowing teaching and learning approaches could promote these strategies, many teachers are still not confident in doing so and hence training dang sharing best practices might be helpful in promoting SRL.

  5. Sim JH, Foong CC, Pallath V, Hong WH, Vadivelu J
    Int J Med Educ, 2021 May 27;12:86-93.
    PMID: 34049286 DOI: 10.5116/ijme.6082.7c41
    Objectives: This study aimed to validate a Malaysian version of a revised learning space questionnaire, as well as to test the utility of the revised questionnaire as a tool to investigate learning space preferences in a Malaysian medical school.

    Methods:   This is a cross-sectional survey. A convenient sample of 310 preclinical students of a public medical school in Malaysia were invited to participate. Validation data were collected using a revised 40-item, 5-point Likert scale learning space questionnaire.  The questionnaires were administered online via a student e-learning platform.  Data analysis was conducted using IBM SPSS version 24.  Exploratory factor analysis was conducted to examine the factor structure of the revised questionnaire to provide evidence for construct validity.  To assess the internal consistency of the revised questionnaire, Cronbach's alpha coefficients (α) were computed across all the items as well as for items within each of the factor.

    Results: A total of 223 (71.94%) preclinical students completed and returned the questionnaire. In the final analysis, exploratory factor analysis with principal axis factoring and an oblimin rotation identified a six-factor, 20-item factor solution. Reliability analysis reported good internal consistency for the revised questionnaire, with an overall Cronbach's alpha of 0.845, and Cronbach's alpha ranging from 0.800 to 0.925 for the six factors.

    Conclusions:   This study established evidence for the construct validity and internal consistency of the revised questionnaire.  The revised questionnaire appears to have utility as an instrument to investigate learning space preferences in Malaysian medical schools.

  6. Liew SC, Pallath V, Rasali Y, Foong CC, Hong WH, Tan MP
    PLoS One, 2023;18(12):e0289176.
    PMID: 38117842 DOI: 10.1371/journal.pone.0289176
    INTRODUCTION: During the coronavirus disease 2019 (COVID-19) pandemic, the use of virtual consultations has accelerated to ensure continued access to healthcare despite lockdowns and physical distancing measures. We aimed to determine the knowledge (awareness) of, attitude (acceptability) to, and practice (exposure) [KAP] of virtual consultations (VC), the demographic factors associated with poor KAP, and the correlation between the three KAP domains.

    METHODS: A cross-sectional study, using a convenience sampling technique, was conducted from 13 September, 2021 to 28 November, 2021. We designed a 45-item VC KAP questionnaire. This was distributed to outpatient users attending cardiovascular, dermatology, geriatrics, haematology, endocrine, respiratory, gastroenterology, rheumatology, or neurology clinics at the University Malaya Medical Centre. It was completed during face-to-face, online, or telephone interviews. The data were analysed using SPSS version 24.0. Binary logistic regression was used to determine the demographic factors associated with KAP. Correlation between KAP domains was determined using Spearman's rho (r). A p-value of <0.05 was considered statistically significant.

    RESULTS: A total of 366 questionnaires were completed. Knowledge (awareness), attitude (acceptability), and practice (exposure) were considered good in 69.7%, 80.9%, and 24.6% of participants, respectively. There were no significant relationships between age, gender, ethnicity, and duration of hospital attendance (years) with knowledge (awareness), attitude (acceptability), and practice (exposure). A moderate positive correlation was seen between knowledge (awareness) and attitude (acceptability) (Attitude total [Atotal]) (r = 0.48, p<0.001), with no significant correlation between knowledge (awareness) and practice (exposure) (r = 0.04, p = 0.45), and attitude (acceptability) (Atotal) and practice (r = 0.01, p = 0.82).

    CONCLUSION: Overall, outpatient clinic users had good knowledge (awareness) of and were receptive towards VC but had poor practice (exposure). More opportunities for VC use in healthcare can increase exposure and subsequent utilisation. Interventions to increase the effectiveness of VC use should be explored in future studies.

  7. Foong CC, Bashir Ghouse NL, Lye AJ, Pallath V, Hong WH, Vadivelu J
    Ann Med, 2022 Dec;54(1):195-210.
    PMID: 35019800 DOI: 10.1080/07853890.2021.1967440
    BACKGROUND: Poor academic performance and failure can cause undesired effects for students, schools, and society. Understanding why some students fail while their peers succeed is important to enhance student performance. Therefore, this study explores the differences in the learning process between high- and low-achieving pre-clinical medical students from a theory of action perspective.

    METHODS: This study employed a qualitative instrumental case study design intended to compare two groups of students-high-achieving students (n = 14) and low-achieving students (n = 5), enrolled in pre-clinical medical studies at the Universiti Malaya, Malaysia. Data were collected through reflective journals and semi-structured interviews. Regarding journaling, participants were required to recall their learning experiences of the previous academic year. Two analysts coded the data and then compared the codes of high- and low-achieving students. The third analyst reviewed the codes. Themes were identified iteratively, working towards comparing the learning processes of high- and low-achieving students.

    RESULTS: Data analysis revealed four themes-motivation and expectation, study methods, self-management, and flexibility of mindset. First, high-achieving students were more motivated and had higher academic expectations than low-achieving students. Second, high-achieving students adopted study planning and deep learning approaches, whereas low-achieving students adopted superficial learning approaches. Third, in contrast to low-achieving students, high-achieving students exhibited better time management and studied consistently. Finally, high-achieving students proactively sought external support and made changes to overcome challenges. In contrast, low-achieving students were less resilient and tended to avoid challenges.

    CONCLUSION: Based on the theory of action, high-achieving students utilize positive governing variables, whereas low-achieving students are driven by negative governing variables. Hence, governing variable-based remediation is needed to help low-achieving students interrogate the motives behind their actions and realign positive governing variables, actions, and intended outcomes.Key MessagesThis study found four themes describing the differences between high- and low-achieving pre-clinical medical students: motivation and expectation, study methods, self-management, and flexibility of mindset.Based on the theory of action approach, high-achieving pre-clinical medical students are fundamentally different from their low-achieving peers in terms of their governing variables, with the positive governing variables likely to have guided them to act in a manner beneficial to and facilitating desirable academic performance.Governing variable-based remediation may help students interrogate the motives of their actions.

  8. Teng ZS, Ser GTZ, Hong WH, Teo CH, Abdul Aziz YF, Vadivelu J, et al.
    Hum Resour Health, 2024 Aug 22;22(1):59.
    PMID: 39174962 DOI: 10.1186/s12960-024-00939-4
    BACKGROUND: In recent years, there have been many instances of negative sentiments expressed by and resignations observed from doctors working in the Ministry of Health (MOH), Malaysia. However, little is known about the perspectives of medical students and their career intentions. This study aims to determine the current Malaysian medical students' career intentions immediately after graduation and upon completing the 2 years of housemanship and to establish the factors influencing these intentions.

    METHODS: This was a cross-sectional study of 859 Malaysian medical students from 21 medical schools who voluntarily completed a self-administered online questionnaire that was disseminated by representatives from medical schools nationwide and social media platforms of a national medical student society.

    RESULTS: 37.8% of the respondents were optimistic about a career with the Ministry of Health (MOH), Malaysia in the future. Most of the respondents (91.2%) plan to join and complete the MOH Housemanship programme as soon as possible after graduation, with the majority of them (66.2%) planning to complete it in their state of origin. After 2 years of Housemanship programme, only more than half of the respondents (63.1%) plan to continue their careers in MOH. Slightly more than a quarter (27.1%) of the total respondents plan to emigrate to practise medicine, with 80.7% of them planning to return to Malaysia to practise medicine after some years or after completing specialisation training. Combining the career intentions of Malaysian medical students immediately after graduation and upon completion of the 2 years housemanship programme, only a slight majority (57.5%) of the respondents plan to continue their career in MOH eventually. Most of the respondents (85.0%) intend to specialise.

    CONCLUSION: A concerning number of Malaysian medical students plan to leave the Ministry of Health workforce, the main healthcare provider in Malaysia, in the future. Urgent government interventions are needed to address the underlying factors contributing to the potential exodus of future doctors to prevent further straining of the already overburdened healthcare system, posing a significant threat to public well-being. An annual national study to track medical students' career intentions is recommended to gather crucial data for the human resources for health planning in Malaysia.

  9. Lee YK, Ng CJ, Sim JH, Firdaus A, Foong CC, Hong WH, et al.
    Malays Fam Physician, 2021 Nov 30;16(3):77-86.
    PMID: 34938395 DOI: 10.51866/oa1222
    Introduction: A compulsory research component is becoming increasingly common for clinical residents. However, integrating research into a busy clinical training schedule can be challenging. This study aimed to explore barriers to research supervision in specialist training programmes from the perspectives of clinical supervisors and trainees at a Malaysian university hospital.

    Methods: Qualitative interviews and focus group discussions were conducted (December 2016 to July 2017) with clinical supervisors (n=11) and clinical trainees (n=26) utilising a topic guide exploring institutional guidelines, research culture and supervisor-student roles. Interviews were transcribed verbatim and analysed thematically to identify barriers to research supervision.

    Results: Supervisors and trainees from 11 out of 18 departments participated. Both clinical supervisors and trainees struggled to successfully integrate a compulsory research component into residency training. Among the reasons identified included a lack of supervisory access due to the nature of clinical rotations and placements, clashing training priorities (clinical vs research) that discouraged trainees and supervisors from engaging in research, poor research expertise and experience among clinical supervisors hampering high-quality supervision, and a frustrating lack of clear standards between the various parties involved in research guidance and examination.

    Conclusion: Both clinical supervisors and trainees struggled to successfully integrate a compulsory research component into residency training. This was not only an issue of resource limitation since questions regarding clinical priorities and unclear research standards emerged. Thus, institutional coordinators need to set clear standards and provide adequate training to make research meaningful and achievable for busy clinical supervisors and trainees.

  10. Foong CC, Bashir Ghouse NL, Lye AJ, Khairul Anhar Holder NA, Pallath V, Hong WH, et al.
    BMC Med Educ, 2021 Jun 05;21(1):320.
    PMID: 34090439 DOI: 10.1186/s12909-021-02712-w
    BACKGROUND: Self-regulated learning (SRL) is an important contributing element to the academic success of students. Literature suggests that the understanding of SRL among medical students is obscure as there is still some uncertainty about whether high performing medical students use SRL. This study explored the characteristics of high performing medical students from the SRL perspective to gain a better understanding of the application of SRL for effective learning.

    METHODS: Twenty-one students who scored at the 90th percentile in written knowledge-based assessment consented to participate in this study. Each student wrote a guided reflective journal and subsequently attended a semi-structured interview. Students were prompted to explain the rationales for their answers. The data were then analysed using thematic analysis to identify patterns among these students from the SRL perspective. Two coders analysed the data independently and discussed the codes to reach a consensus.

    RESULTS: High performing students set goals, made plans, and motivated themselves to achieve the goals. They put consistent efforts into their studies and applied effective learning strategies. They also employed coping mechanisms to deal with challenges. High performing students regularly evaluated their performance and adopted new strategies.

    CONCLUSIONS: This study reported that high performing students applied SRL and described the rationales of practice. Medical schools could design SRL-driven interventions to enhance the learning experiences of medical students. Recommendations are made for students on how to apply SRL.

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