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Transformative learning in clinical reasoning: a meta-synthesis in undergraduate primary care medical education

Abdul Rahman NF, Davies N, Suhaimi J, Idris F, Syed Mohamad SN, Park S

Educ Prim Care, 2023 Jul;34(4):211-219.
PMID: 37742228 DOI: 10.1080/14739879.2023.2248070

Clinical reasoning is a vital medical education skill, yet its nuances in undergraduate primary care settings remain debated. This systematic review explores clinical reasoning teaching and learning intricacies within primary care. We redefine clinical reasoning as dynamically assimilating and prioritising synthesised patient, significant other, or healthcare professional information for diagnoses or non-diagnoses. This focused meta-synthesis applies transformative learning theory to primary care clinical reasoning education. A comprehensive analysis of 29 selected studies encompassing various designs made insights into clinical reasoning learning dimensions visible. Primary care placements in varying duration and settings foster diverse instructional methods like bedside teaching, clinical consultations, simulated clinics, virtual case libraries, and more. This review highlights the interplay between disease-oriented and patient-centred orientations in clinical reasoning learning. Transformative learning theory provides an innovative lens, revealing stages of initiation, persistence, time and space, and competence and confidence in students' clinical reasoning evolution. Clinical teachers guide this transformation, adopting roles as fortifiers, connoisseurs, mediators, and monitors. Patient engagement spans passive to active involvement, co-constructing clinical reasoning. The review underscores theoretical underpinnings' significance in shaping clinical reasoning pedagogy, advocating broader diversity. Intentional student guidance amid primary care complexities is vital. Utilising transformative learning, interventions bridging cognitive boundaries enhance meaningful clinical reasoning learning experiences. This study contributes insights for refining pedagogy, encouraging diverse research, and fostering holistic clinical reasoning development.
Fulltext COVID-19 Pandemic Fatigue and Its Sociodemographic, Mental Health Status, and Perceived Causes: A Cross-Sectional Study Nearing the Transition to an Endemic Phase in Malaysia

Abdul Rashid MR, Syed Mohamad SN, Tajjudin AIA, Roslan N, Jaffar A, Mohideen FBS, et al.

Int J Environ Res Public Health, 2023 Mar 02;20(5).
PMID: 36901486 DOI: 10.3390/ijerph20054476

This study aimed to explore the socio-demographic characteristics, mental health status, and perceived causes of pandemic fatigue with COVID-19 pandemic fatigue among the general population of Malaysia. The data was collected online during the transition from the COVID-19 pandemic phase to the endemic phase in Malaysia from 1 to 30 April 2022. Sociodemographic data, Depression Anxiety Stress Scale-21 (DASS-21), perceived causes of pandemic fatigue, and the Fatigue Assessment Scale (FAS) were included in the survey. The chi-square test and a simple logistic regression analysis were used to identify predictors of pandemic fatigue. The completed survey (N = 775) included individuals aged 18 years or above [mean 31.98 (SD = 12.16)] from all states in Malaysia. Pandemic fatigue prevalence was 54.2%. Severe to extremely severe depression, anxiety, and stress symptoms were detected in 11.2%, 14.9%, and 9.1% of the participants, respectively. Younger age, non-Malay ethnicity, living alone, and higher income categories were significantly higher in the fatigued group. Higher DASS-21 scores on all domains were associated with higher FAS scores. Meanwhile, high scores for perceived tiredness from complying with the COVID-19 Standard Operating Procedure (SOP), perceived risk of infection from COVID-19, perceived hardship due to the pandemic, perceived public complacency during the pandemic, and perceived changes due to the pandemic were associated with a higher FAS score. This study provides valuable information for policymakers and mental health professionals worldwide on pandemic fatigue and its associated factors, including mental health status in Malaysia.
Fulltext Self-system and mental health status among Malaysian youth attending higher educational institutions: A nationwide cross-sectional study

Mohd Azlan S, Mohamad F, Dahlan R, Ismail IZ, Kadir Shahar H, Kamaruddin KN, et al.

Malays Fam Physician, 2024;19:12.
PMID: 38496770 DOI: 10.51866/oa.34l

INTRODUCTION: Mental health disorders (MHDs) are a global health burden with an increasing prevalence. During the COVID-19 pandemic, depression was the commonest MHD, followed by anxiety and stress. This nationwide study aimed to determine the prevalence and associated factors of depression, anxiety and stress among Malaysian students attending higher educational institutions.
METHODS: A cross-sectional study was conducted from June to December 2021. Institutions were selected via stratified random sampling and students via convenience sampling. A self-administered questionnaire comprising questions on socio-demographic characteristics, academic background, substance abuse, childhood abuse, religiosity and the Depression Anxiety Stress Scale-21 was used. Data were analysed using SPSS version 27; descriptive, point-biserial correlation, chi-square and multiple binary logistic regression analyses were conducted.
RESULTS: Sex and adverse childhood experiences significantly predicted all three MHDs (P<0.05). The students from public institutions (odds ratio [OR]=0.71, 95% confidence interval [CI]=0.56-0.90, P=0.004) had a lower risk of depression than those from private institutions. The smokers/vapers (OR=1.43, 95% CI=1.02-2.02, P=0.041) a higher risk of depression than the non-smokers/non-vapers. The social science students (OR=1.29, 95% CI= 1.01-1.65, P=0.039) had a higher risk of anxiety than the science students. The students who highly engaged in organisational religious activity (OR=0.91, 95% CI=0.84-0.98, P=0.015) had a lower risk of anxiety than their counterparts.
CONCLUSION: Anxiety is the commonest MHD among Malaysian youth, followed by depression and stress. Childhood abuse is a crucial related factor requiring further attention. Screening, surveillance, preventive measures and comprehensive interventions for MHDs should be initiated among youth.
The mediating effect of mental health status between self-system and sexual risk behaviour among university students in Malaysia

Azlan SM, Mohamad F, Mohd Nazan AIN, Dahlan R, Kamaruddin KN, Shibraumalisi NA, et al.

Med J Malaysia, 2025 Mar;80(2):183-190.
PMID: 40145161

INTRODUCTION: Young adults' engagement in sexual risk behaviour (SRB) is a growing concern worldwide. Addressing this issue is crucial as it can lead to various detrimental effects on individuals, including psychological, behavioural, and, in severe cases, suicidal tendencies and mortality. This nationwide study aimed to determine the mediating roles of depressive, anxiety, and stress symptoms in the relationship between adverse childhood experiences (ACE), religiosity, knowledge on sexuality, attitude towards premarital sex, and SRB among young Malaysian adults using structural equation modelling (SEM).
MATERIALS AND METHODS: A quantitative, cross-sectional design was employed in this study. Respondents were recruited from June to December 2021 among students attending higher education institutions in Malaysia. Institutions were sampled using stratified random sampling and the respondents were selected via convenience sampling. Data were collected via an online survey that inquired about respondents' socio-demographic characteristics, ACE, religiosity, knowledge on sexuality, attitude towards premarital sex, mental health status (MHS), and engagement in SRB. The data were analysed using SPSS version 27 for descriptive analysis, and SPSS AMOS version 27 for structural equation modelling (SEM) analysis.
RESULTS: A total of 1171 respondents were recruited in this study. From the SEM analysis, the proposed model indicated a good fit, and it explained 26% of the SRB variance. There was a partial mediation effect of the relationship between ACE on SRB through MHS (p<0.05), as well as religiosity on SRB through MHS (p<0.05). There was no significant mediation effect was found for the other variables.
CONCLUSION: This study highlighted the mediation effect of MHS between ACE on SRB, as well as between religiosity and SRB. Apart from addressing ACE and religiosity of the young adults, MHS should also need to be explored when dealing with SRB issues and vice versa. Preventive measures should be considered at younger stage to prevent high risk behaviour among young adults.