MyMedR

Does central vetting improve construct quality of one-best-answer items in medical school: An audit

Kwa, Siew Kim, Zainab Majeed, Shane Varman

International e-Journal of Science, Medicine & Education, 2017;11(3):3-9.

MyJurnal

Introduction: Assessment is an integral aspect of
teaching. One-best-answer (OBA) items, if properly
constructed are able to drive learning. In-house OBA
items are notoriously poorly-constructed. The role of
a central vetting committee is to review test items and
ensure that they adhere to expected standards. Hence,
the objective of this audit is to determine whether
central vetting has improved the construct quality of
OBA items.
Methods: We audited the psychiatry end-of posting
OBA items from before and after central vetting to
compare the quality of the items before and after
central vetting was instituted. Quality was evaluated
on appropriateness of test content, items with higher
cognition and items without flaws. A standard was not
set for this first audit.
Results: Seventy six of 181 psychiatry OBAs items
retrieved from 2011 to August 2012 had undergone
first level (department) vetting only and the remainder
105 (58.0%) had two levels of vetting; department and
central vetting committee (CVC).
Appropriateness of content increased from 92.1% to
98.1%. Items with higher order thinking doubled from
21.1% to 42.9%. Items with clinical scenario increased
by 8.4% to 78.1%. Logical ordering of options however,
remained around 50%.

Two-level vetting markedly reduced problematic
lead-in questions (67.1 to 13.3%), non-homogenous
options (42.1 to 9.5%), vague and implausible options
(39.5 to 6.7%), and spelling and grammar mistakes
(19.7 to 5.7%).
Conclusion: Two-level vetting had improved the
quality of OBAs and should be continued. This could
be enhanced by training all Faculty on writing quality
OBA items and careful selection and empowerment
of CVC members. A re-audit is to be conducted after
Faculty training.

Fulltext Notes for primary care teachers: how do adults learn?

Kwa SK

Malays Fam Physician, 2007;2(1):25-6.

PMID: 25606073

Delay and misdiagnosis in adult myasthenia gravis: A case report

Kwa, Siew Kim, Zainab Abdul Majeed, Tan, Kah Nian

International e-Journal of Science, Medicine & Education, 2016;10(3):37-39.

MyJurnal

Myasthenia gravis (MG) is a rare autoimmune disorder
characterised by fluctuating and variable combination
of muscle weakness and fatigue. Most cases are due to
T-cell mediated autoantibodies against post-synaptic
acetylcholine receptors (AChR-Ab), thus preventing
acetylcholine from binding and signalling skeletal
muscle to contract.1
The annual incidence is 7-23 new cases per million.1
It can occur at any age but with two peaks; an earlyonset
(20-40 years) female-predominant and a late-onset
(60-80 years) male-predominant peak. MG is classified
into ocular and generalised (80%). More than half the
patients initially present with ptosis and diplopia but half
will progress to generalised disease with involvement of
bulbar, limb and respiratory weakness. Those presenting
as generalised MG can also develop eye signs later.1
It is important to recognise MG early because it is
highly treatable. Untreated disease leads to permanent
weakness.2 Treatment reduces mortality from lifethreatening
myasthenic crisis.1,3 Misdiagnosis leads to
potentially harmful interventions and inappropriate
management.4,5 Diagnosis in late-onset MG is easily
missed2,3,4,5 because of overlapping symptoms with
other diseases common in the elderly. We report a case
of delay and misdiagnosis in an elderly patient with
co-morbidities. (Copied from article).

On managing emergency contraception

Kwa SK

Family Physician, 2000;11(1):12-3.

Nonsurgical female sterilization with quinacrine pellets: Malaysian experience

Arshat H, Ang Eng Suan, Kwa Siew Kim

Malays J Reprod Health, 1987 Dec;5(2):61-9.

PMID: 12315185

Breastfeeding and the use of maternal health services in Sarawak

Kwa SK

Malays J Reprod Health, 1993 Jun;11(1):8-19.

PMID: 12318984

An increase in the use of health services and contraception is usually associated with a decrease in breastfeeding. This study seeks to establish the relationship between maternal use of health services and breastfeeding practice. Data was obtained from the Sarawak Population and Family Survey of 1989. The breastfeeding pattern of 1583 children born to 1047 women aged between 15-49 years in the five years preceding the study were analyzed and compared among the various groups using maternal health services and contraception. Results showed that Sarawak has a very short mean duration of about 6 months for breastfeeding. Women attending antenatal and postnatal clinics had shorter breastfeeding durations but higher initiation rates compared to those who did not. Those whose delivered by doctors and those delivering in private hospitals were least likely to breastfeed. Contraceptive use was also negatively associated with breastfeeding duration. Whilst it is commendable that the use of maternal health facilities is high in Sarawak, the inverse relationship to breastfeeding can offset its health benefits. Health policies can play a part to arrest this decline which is also related to socioeconoic development.

Fulltext Issues in emergency contraception for the adolescent

Kwa SK, Sivalingam N

Malays Fam Physician, 2012;7(1):37-40.

PMID: 25606245 MyJurnal

Fulltext Oral hyperpigmented lesions--a case study

Kwa SK, Gupta ED

Aust Fam Physician, 2013 Jul;42(7):490-1.

PMID: 23826603

An overweight woman, aged 58 years, presented for follow up of hypertension, diabetes and dyslipidaemia. She was noted to have hyperpigmented brown macules on the inner surface of the lower lip and buccal mucosa (Figure 1). She stated that she had first noticed these lesions when aged in her 40s. Her mother died at age 58 years from gastric cancer with extensive metastases, and her brother died at age 45 years from colon cancer with spread to the liver and lungs.

An innovative method of teaching clinical therapeutics through role-play

Loh KY, Kwa SK

Med Educ, 2009 Nov;43(11):1101-2.

PMID: 19874515 DOI: 10.1111/j.1365-2923.2009.03501.x

Fulltext Notes for the primary care teacher: teaching in the family practice clinics

Kwa SK, Yong Rafidah A

Malays Fam Physician, 2008;3(2):101-3.

PMID: 25606127

Fulltext Cicatricial alopecia - a case study

Kwa SK, Das Gupta E

Aust Fam Physician, 2015 Jul;44(7):476-8.

PMID: 26590492

Fulltext Neonatal rash - a case study

Kwa SK, Sinniah D, Tan KK

Aust Fam Physician, 2012 Sep;41(9):707-9.

PMID: 22962649

An infant, aged 48 days, is brought in by her mother to her doctor because of a rash that started during the neonatal period.

Palliative medicine as an elective posting for undergraduates

Loh KY, Kwa SK, Nurjahan MI

Med Educ, 2006 Nov;40(11):1131-2.

PMID: 17054631

Paramedic insertion of intrauterine device in a Malaysian family planning clinic

Kwa Siew Kim, Arshat H, Abdul Jalil AH, Ang Eng Suan, Suhaimi A

Malays J Reprod Health, 1987 Jun;5(1):11-6.

PMID: 12269176

Fulltext Avoiding common errors in key feature problems

Kwa SK, Sheikh Mohd Amin MM, Ng AC

Malays Fam Physician, 2007;2(1):18-21.

MyJurnal

Questions on Key Features Problems (KFP) are an important component of the theory paper for Part 1 of the membership examination of the Academy of Family Physicians of Malaysia (MAFP) and the Fellowship for the Royal Australian College of General Practitioners (FRACGP).This paper will attempt to provide information on the format and marking scheme of KFP. Expected answers for some KFP cases will be discussed and common errors made by candidates highlighted with suggestions on how to avoid them.

A study of the acceptability and effectiveness of Norplant (R) contraceptive implants in Kuala Lumpur, Malaysia

Arshat H, Rachagan SP, Kwa Siew Kim, Ang Eng Suan, Karim HA, Ismail MT

Malays J Reprod Health, 1990 Jun;8(1):21-9.

PMID: 12316341

Fulltext Morbidity and process of care in urban Malaysian general practice: the impact of payment system

Teng CL, Syed Aljunid SM, Cheah M, Leong KC, Kwa SK

Med J Malaysia, 2003 Aug;58(3):365-74.

PMID: 14750376

BACKGROUND: The majority of primary care consultations in Malaysia occur in the general practice clinics. To date, there is no comprehensive documentation of the morbidity and practice activities in this setting.
OBJECTIVES: We reported the reasons for encounter, diagnoses and process of care in urban general practice and the influence of payment system on the morbidity and practice activities.
METHODS: 115 clinics in Kuala Lumpur, Ipoh and Penang participated in this study. General practitioners in these clinics completed a 2-page questionnaire for each of the 30 consecutive patients. The questionnaire requested for the following information: demographic data, reasons for encounter, important physical findings, diagnoses, investigations ordered, outpatient procedures performed, medical certificate given, medication prescribed and referral made. The morbidity (reasons for encounter and diagnoses) was coded using ICPC-2 and the medication data was coded using MIMS Classification Index.
RESULTS: During 3481 encounters, 5300 RFEs (152 RFEs per 100 encounters) and 3342 diagnoses (96 diagnoses per 100 encounters) were recorded. The majority of the RFEs and diagnoses are in the following ICPC Chapters: Respiratory, General and unspecified, Digestive, Neurological, Musculoskeletal and Skin. The frequencies of selected aspects of the process of care (rate per 100 encounters) were: laboratory investigations 14.7, outpatient procedures 2.4, sick certification 26.9, referral 2.4, and medication prescription 244. Consultation for chronic diseases and acute infections were influenced more by demographic variables (age, employment) rather than payment system. Cash-paying patients were more likely to receive laboratory investigations and injections.
CONCLUSION: This study demonstrated the breadth of clinical care in the general practice. Relatively fewer patients consulted specifically for preventive care and treatment of chronic diseases. The frequencies of outpatient procedures and referrals appeared to be low. Payment system results in important differences in patient mix and influences some types of practice activities.

Fulltext Diabetes literacy and knowledge among patients with type 2 diabetes mellitus attending a primary care clinic in Seremban, Malaysia

Lee CL, Chee WSS, Arasu K, Kwa SK, Mohd Ali SZ

Malays J Nutr, 2019;25(4):435-444.

MyJurnal DOI: 10.31246/mjn-2019-0031

Introduction: Good health literacy and knowledge are associated with improved outcomes in diabetes. The purpose of this study was to determine diabetes-specific literacy and knowledge levels, and its associated socio-demographic factors, among adults with type 2 diabetes mellitus (T2DM).
Methods: This cross-sectional study was conducted among 196 adults from the Indian, Chinese, and Malay ethnic groups with T2DM who attended a primary care clinic in Seremban, Malaysia. The Literacy Assessment for Diabetes and Diabetes Knowledge Test 2 were used to assess diabetes-specific literacy and knowledge, respectively.
Results: The majority of participants (75.0%) had literacy scores that corresponded to Ninth Grade Level but only 3.6% of participants had a good knowledge of diabetes. Literacy scores explained up to 19.8% of the variance in knowledge scores (r=0.445, p<0.01). Indian participants had the lowest literacy and knowledge scores when compared to Chinese and Malays (p<0.05). Participants with higher education had better literacy
and knowledge scores (p<0.05). Educational level was more likely than ethnicity to predict both literacy and knowledge scores (p<0.001), while gender and age did not significantly predict either score. The majority of participants could answer general questions about physical activity, diabetes-related complications and healthy eating. Knowledge of diabetes and its relation to specific foods and the effect of diet on glucose control were limited among the participants.
Conclusion: Education and ethnicity were associated with literacy and knowledge on diabetes. There existed a deficit of diabetes-related nutrition knowledge among the participants. These findings may help healthcare providers tailor individualised patient educational interventions.
Keywords: Diabetes literacy, diabetes knowledge, type 2 diabetes

Validation of a 'Work Readiness Scale' for health professional (HP) graduates

Syed Aznal SS, Nadarajah VDV, Kwa SK, Seow LL, Chong DW, Molugulu N, et al.

Med Teach, 2021 Jul;43(sup1):S33-S38.

PMID: 31854254 DOI: 10.1080/0142159X.2019.1697434

BACKGROUND: There is a continuing concern about how graduate work readiness (WR) reflects on the success of universities meeting the requirements of employment. This study is to establish a valid and reliable instrument measuring WR in health professions (HP) graduates of medicine, pharmacy and dentistry.

METHODS: The study from March 2016 to April 2017 was conducted to validate the 'Work Readiness Scale' (WRS; Deakin University) using Principal Component Analysis and Cronbach - α for internal consistency. It was modified to a four-item even-point scale and distributed as an online survey to 335 final year students of the three programs.

RESULTS: A reduction from 64 to 53 items provided good internal consistency in all factors: WC 0.85, OA 0.88, SI 0.88 and PC 0.71. The PC domain had the greatest item reduction from 22 to 6, whilst the SI domain increased in items from 8 to 19. These changes may be associated with difference in understanding or interpretation of the items in the SI domain.

CONCLUSION: The modified WRS can be used to evaluate job readiness in HP graduates. However, it needs further refinement and validation in specific educational and employment contexts.

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