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Issues and priorities of medical education research in Asia

Majumder MA

Ann Acad Med Singap, 2004 Mar;33(2):257-63.
PMID: 15098645

This article addresses the roles, issues, approaches, rationale, pitfalls, priorities and balance of research in medical education, particularly its "disarray" status in Asia. Research in medical education has influenced education in many ways. Most importantly, it provides legitimate evidences to stakeholders on which to make educational decisions. It also has a wider social impact on teaching practice and subsequent clinical practice. However, in Asia, medical educational research has not substantially influenced educational policy and medical practices. Moreover, it fails to receive comparable attention as in developed countries. A number of constraints that have hampered the development of educational research in Asia are identified: low socio-economic condition of the region; cultural and religious values and beliefs of the people; lack of congruence between the mission and vision of medical schools; leadership crisis; lack of financial resources; inadequate exposure to medical educational research in undergraduate training; lack of collaboration and commitment; and unforeseeable short-term outcome of medical education. The article concludes with some specific recommendations to strengthen research and to create a research culture in the region, including active leadership and commitment of the institutes/organisations, careful assessment and strategic settings of the priorities of medical educational research, establishment of a regional centre for medical education research, availability of financial resources, wider dissemination of research findings, collaboration with the developed countries and initiative to publish regional-based medical education journals, including electronic journals. Appropriate research environment and culture will enable stakeholders to obtain evidence-based information from educational research to increase the relevance, quality, cost-effectiveness and equity of medical education and practice in Asia.
Geriatric training in problem-based learning: an Asian perspective

Majumder MA, Rahim AF, Rahman S

J Am Geriatr Soc, 2004 Jun;52(6):1038-9.
PMID: 15161490
Students' perceptions of 'technology-based' lecture handouts

Islam MN, Majumder MA, Ja'afar R, Rahman S

Malays J Med Sci, 2005 Jan;12(1):26-8.
PMID: 22605944

Lecture handouts are widely used instructional tools. Handouts supplement rather than substitute students' regular reading. It is now a common practice to supply PowerPoint handouts and publish lecture handouts on the web for students' access. A study was conducted among the first year medical students (n=142) of School of Medical Sciences (SMS), Universiti Sains Malaysia (USM) in order to determine their perceptions and expectations with regards to lecture handouts provided to them. The majority of the students reported that they read the lecture handouts as a reference and found them useful as a guide for future learning. More than half (68%) of the students expressed dissatisfaction with the overall presentation format of the handouts which is mainly technology-related i.e. PowerPoint and photocopying. This study indicated that students' expectations and experiences were positive towards the use of handouts. They used handouts as a means of supplementing rather than substituting their learning. Much care is needed when educators supply computer-based handouts, as this study shows a number of limitations when students use them. Medical schools should consider publishing web-based handouts with online and other facilities to make it interesting and effective.
Fulltext Aerobic Exercise and Endocannabinoids: A Narrative Review of Stress Regulation and Brain Reward Systems

Gupta S, Bharatha A, Cohall D, Rahman S, Haque M, Azim Majumder MA

Cureus, 2024 Mar;16(3):e55468.
PMID: 38440201 DOI: 10.7759/cureus.55468

Aerobic exercise is a widely adopted practice, not solely for enhancing fitness and reducing the risk of various diseases but also for its ability to uplift mood and aid in addressing depression and anxiety disorders. Within the scope of this narrative review, we seek to consolidate current insights into the endocannabinoid-mediated regulation of stress and the brain's reward mechanism resulting from engaging in aerobic exercise. A comprehensive search was conducted across Medline, SPORTDiscus, Pubmed, and Scopus, encompassing data available until November 30, 2023. This review indicates that a bout of aerobic exercise, particularly of moderate intensity, markedly augments circulating levels of endocannabinoids - N-arachidonoyl-ethanolamine (AEA) and 2-acylglycerol (2-AG), that significantly contributes to mood elevation and reducing stress in healthy individuals. The current understanding of how aerobic exercise impacts mental health and mood improvement is still unclear. Moderate and high-intensity aerobic exercise modulates stress through a negative feedback mechanism targeting both the hypothalamus-pituitary-adrenal (HPA) axis and the sympathetic nervous system, thereby facilitating stress regulation crucial role in endocannabinoid synthesis, ultimately culminating in the orchestration of negative feedback across multiple tiers of the HPA axis, coupled with its influence over cortical and subcortical brain structures. The endocannabinoid has been observed to govern the release of neurotransmitters from diverse neuronal populations, implying a universal mechanism that fine-tunes neuronal activity and consequently modulates both emotional and stress-related responses. Endocannabinoids further assume a pivotal function within brain reward mechanisms, primarily mediated by CB1 receptors distributed across diverse cerebral centers. Notably, these endocannabinoids partake in natural reward processes, as exemplified in aerobic exercise, by synergizing with the dopaminergic reward system. The genesis of this reward pathway can be traced to the ventral tegmental area, with dopamine neurons predominantly projecting to the nucleus accumbens, thereby inciting dopamine release in response to rewarding stimuli.
Internet use and addiction among medical students of Universiti Sultan Zainal Abidin, Malaysia

Haque M, Rahman NA, Majumder MA, Haque SZ, Kamal ZM, Islam Z, et al.

Psychol Res Behav Manag, 2016;9:297-307.
PMID: 27881928

BACKGROUND: The use of Internet has now become indispensable, and the technology has revolutionized the medical education and practice worldwide. Currently, medical students and professionals have an enormous opportunity to keep them always updated with the exponential growth of knowledge because of potential progression of Internet throughout the world that enables them to become a lifelong learner. Internet addiction is a widespread phenomenon among students and academicians at universities in Malaysia. Students use the Internet for recreational purpose and personal and professional development. The Internet has become an integral part of day-to-day life of the university students, including medical students. The aim of the present study was to examine the Internet use and addiction among students of Universiti Sultan Zainal Abidin, Malaysia.
METHODS: This was a cross-sectional study in which a questionnaire, Internet Addiction Diagnostic Questionnaire, developed by the Center for Internet Addiction, USA, was used. One hundred forty-nine medical students of Universiti Sultan Zainal Abidin participated in this study. Data were analyzed using Statistical Package for the Social Sciences software.
RESULTS: The mean scores were 44.9±14.05 and 41.4±13.05 for male and female participants, respectively, which indicated that both the genders were suffering from mild Internet addiction.
CONCLUSION: This study shows almost similar level of Internet usage among medical students irrespective of their socioeconomic background, with no statistically significant (p>0.05) differences, except among the years of study (p=0.007). Overall, from the research data and having worked with this cohort very closely, Universiti Sultan Zainal Abidin medical students can be labeled as wonted and recurring users of the Internet. Nevertheless, it is very difficult to define as Internet addicts or pathological users of the Internet because of small sample size and cross-sectional study.
Fulltext Self-medication of antibiotics: investigating practice among university students at the Malaysian National Defence University

Haque M, Rahman NAA, McKimm J, Kibria GM, Azim Majumder MA, Haque SZ, et al.

Infect Drug Resist, 2019;12:1333-1351.
PMID: 31190922 DOI: 10.2147/IDR.S203364

Background: Self-medication of drugs to alleviate symptoms is a common global behavior, helping relieve burdens on health services, but many drugs eg, antibiotics are prescription-only. Self-medication of antibiotics (SMA) is an irrational use of drugs, contributing to microbial resistance increasing health care costs and higher mortality and morbidity. This study aimed to assess SMA among university students. Methods: This was a cross-sectional study conducted among medical and non-medical students of the National Defence University of Malaysia. A validated instrument was used to gather data. Ethics approval was obtained. Random and universal sampling was adopted, and SPSS 21 was used for data analysis. Results: A total of 649 students participated in the study: 48.5% male and 51.5% female, 39.3% reported self-medicating with antibiotics. Penicillin, doxycycline, clarithromycin were the antibiotics most used with the majority reporting no adverse drug reactions. Cost savings and convenience were the principal reasons for SMA which were mainly obtained from local retail pharmacies. Despite medical students (particularly the more senior) having better knowledge of antibiotic use than non-medical students, 89% of all research participants responded that practicing SMA was a good/acceptable practice. Conclusion: SMA is common amongst Malaysian students and, despite understanding why SMA is unwise, even medical students self-medicate.
Disproportionate COVID-19 vaccine acceptance rate among healthcare professionals on the eve of nationwide vaccine distribution in Bangladesh

Alam ABMM, Azim Majumder MA, Haque M, Ashraf F, Khondoker MU, Mashreky SR, et al.

Expert Rev Vaccines, 2021 09;20(9):1167-1175.
PMID: 34224292 DOI: 10.1080/14760584.2021.1951248

BACKGROUND: Acceptance of the COVID-19 vaccine by the target groups would play a crucial role in stemming the pandemic. Healthcare professionals (HCPs) are the priority group for vaccination due to them having the highest risk of exposure to infection. This survey aimed to assess their acceptance of COVID-19 vaccines in Bangladesh.
RESEARCH DESIGN AND METHODS: A cross-sectional survey using an online questionnaire was conducted between January 3 to 25, 2021, among HCPs (n = 834) in Bangladesh.
RESULTS: Less than 50% of HCPs would receive the vaccine against COVID-19 if available and 54% were willing to take the vaccine at some stage in the future. Female participants (OR:1.64;95%CI:1.172-2.297), respondents between 18-34 years old (OR:2.42; 95% CI:1.314-4.463), HCPs in the public sector (OR:2.09; 95% CI:1.521-2.878), and those who did not receive a flu vaccine in the previous year (OR:3.1; 95% CI:1.552-6.001) were more likely to delay vaccination.
CONCLUSIONS: The study revealed that, if available, less than half of the HCPs would accept a COVID-19 vaccine in Bangladesh. To ensure the broader success of the vaccination drive, tailored strategies and vaccine promotion campaigns targeting HCPs and the general population are needed.