Introduction: Various studies had been done on medical students stress, but there is yet no comparative study done between universities in Asia and Europe. Universiti Sains Malaysia (USM) and Universiteit Maastricht (UM) share a lot in common in terms of medical education as both actively apply PBL-oriented education into their curriculum. It will be interesting to find out the effect of differing culture, one Eastern and another Western, on the prevalence of stress and stressors among medical students of both universities.
Method: A comparative study was conducted on medical students from USM and UM. Psychological distress was measured by the 12 item General Health Questionnaire and stressors were measured by the 40 item Medical Student Stressor Questionnaire. The calculated sample size was 215 per university. The collected data was analyzed using Statistical Package for Social Sciences (SPSS) version 20.
Result: Results showed that the overall prevalence of psychological distress among medical students of USM and UM was 25.9% and no significant difference was found between the two universities. Binary logistic regression test showed that medical students in pre-clinical phase were 1.84 times more likely to develop psychological distress than medical students in clinical phases (B = 0.612, odd ratio (CI95%) = 1.84 (1.16, 2.93), p = 0.010). The major stressors were related to academic requirements, UM medical students perceived the stressors as causing less stress than USM medical students (t-stat (df) = 5.33 (380), p-value < 0.001).
Conclusion: Psychological health among medical students in the two universities was comparable. Academic requirements were the most stressful events as perceived by the students, but UM medical students had more positive perception toward the stressors than USM medical students. Pre-clinical students experienced higher psychological pressures than the clinical students. The medical schools should provide more attention to pre-clinical students because they might need psychological support from them.
Context: Community-based medical education (CBME) has become widely accepted as an important innovation in undergraduate medical education. In curriculum featuring CBME, students are acquainted with the community early in their studies however; the impact of this training can be judged best to see them practice the required aspects of CBME. Malaysia is a multiracial country with a very strong community dependant life style. Main national health problems have called for a change in health profession education from traditional hospital based health care to community-based delivery system. Three major university's medical schools that either practice community oriented or community based medical education in undergraduate medical curriculum are evaluated. Universiti Sains Malaysia (USM) has a community based medical education (CBME) curriculum as Community and Family Case Study (CFCS) compared to a community oriented education curriculum (COE) adopted by Universiti Malaya (UM) and Universiti Kebangsaan Malaysia (UKM). However, UM at the time of undertaking this study back in 2005 was though practicing COE has also later opted CBME as CFCS.
Objective: To determine whether medical graduates from USM with a community-based medical education in its curriculum for more than 25 years are inspired to have stronger commitment towards community health as shown in their on-job practice of medicine compared to other graduates from UM and UKM, who have adopted community-oriented medical education program.
Method: A questionnaire-based pilot study with 12 items (variables) was designed to obtain supervisor's opinion on commitment of interns towards the health of community they serve. The questionnaire was administered to a randomized group of 85 specialists supervising the internship training program in five major disciplines including internal medicine, surgery, orthopaedic, gynaecology and obstetrics and paediatric medicine. The data received from 62 respondents from five major disciplines was analyzed utilizing SPSS version 12.0.1.
Result: The responses received from 62 supervisors on an inventory in which 9 out of 12 variables were directly related to community commitments of interns. It was shown that the USM graduates who were taught through a CBME curriculum have performed better than the graduates from UM and UKM who followed a COE curriculum. P-value (< 0.001) was highly significant and consistent with higher mean score in those variables.
Conclusion: The graduates taught through a CBME curriculum performed better in community commitments towards patients care compared to graduates from COE curriculum.
Several studies reveal high rates of alcohol use among college students affecting their health and performances. This cross-sectional survey was done to study medical students' drinking pattern, its predictors and to develop any possible link between their academic performance and alcohol consumption. Data was collected using newly designed, validated questionnaire from students (n= 348) who consumed and not consumed alcohol. The response rate was 60% (209/348). 94% of drinkers started consuming alcohol before entering into the medical school. Most of them (85%) drank with parents' awareness. Among drinkers, 63% were of Chinese race and 35% of Indian race. None of the Malay respondents reported of drinking. 63% of drinkers and 23% of non-drinkers reported that most of their friends consumed alcohol. Drinking was not associated with smoking or drug abuse. There were no statistically significant differences in exam scores between drinkers and nondrinkers. Non-drinkers considered religious and moral obligations for not consuming alcohol. In conclusion, at our Institute, students did not allow their alcohol use to interfere with their academic performance. The drinking habit developed during school time is more likely to continue during college years. Those who have non-drinking friends are more likely not to consume alcohol themselves. Moral and religious obligations have positive impact on alcohol intake.
This case illustrates the role of a woman's autonomy in deciding her medical management and the ethical issue which occurred when a husband refuses the management for her even though it was clearly indicated.
Background: One of important educational climate roles is to provide an environment that promotes positive development of medical students' psychological wellbeing during training. Unfortunately, many studies have reported that educational climate in medical education are not favourable to them. Therefore, it is a real need for a simple, valid, reliable and stable tool that will help medical schools to screen psychological wellbeing of their students so that early intervention could be done.
Objective: This study aimed to explore the psychometric properties of the Medical Student Wellbeing Index (MSWBI) to measure psychological wellbeing at different interval of measurements in a cohort of medical students.
Method: A prospective study was done on a cohort of medical students. MSWBI was administered to the medical students at five different intervals. The confirmatory factor analysis, Cronbach's alpha and intra-class correlation analysis were applied to measure construct validity, internal consistency and agreement level at different interval of measurements.
Result: A total of 153 (89.5%) medical students responded completely to the MSWBI. The MSWBI showed that the one-factor model had acceptable values for most of the goodness of fit indices signified its construct was stable across multiple measurements. The overall Cronbach's alpha values for the MSWBI at the five measurements ranged between 0.69 and 0.78. The ICC coefficient values for the MSWBI total score was 0.58 to 0.59.
Conclusion: This study found that the MSWBI had stable psychometric properties as a screening tool for measuring psychological wellbeing among medical students at different time and occasions. Continued research is required to refine and verify its psychometric credentials at different educational settings.
Introduction: Self-awareness and reflective-skill are important components of personal and professional development of medical students.
Objective: The objective of this study was to determine whether self awareness and reflective skill could be improved by direct teaching intervention.
Method: This was a cross sectional intervention study conducted among 75 third year medical students of UKM Medical Centre Malaysia in 2010. Malaysian Emotional Quotient Inventory (MEQI) was used to measure self-awareness and reflective writing scripts were used to measure the reflective skills of the respondents before and after teaching intervention. Experimental group comprised of 30 students while the control group constituted the rest 45 students selected randomly. The factors contributing to self awareness with gender and learning styles were determined.
Result: There was no significant improvement observed in self-awareness of the respondents but reflective skills was significantly improved (p=0.007) following intervention. A non-significant relationship between self-awareness and gender (p=0.588) as well as self-awareness and learning styles (p=0.435) was also noticed.
Conclusion: It is concluded that intervention programs improved students' reflective skills but not their self-awareness. Effectiveness of the intervention programme is an important factor. Continuous effort should be focused to train students in an effective way in order to be more self-reflective, self-regulative as well as self-corrective, to ensure a high level of personal and professional development in their daily practices.
Introduction: Just-in-Time Teaching (JiTT) is a novel method of teaching-learning used in various disciplines of science and humanities. It is a technique that scaffolds the students learning process by reducing the cognitive load which is the load related to the executive control of working memory. Just in time teaching underpins the concept that expertise in learning originates from the knowledge already stored in long term memory and with subsequent interaction between the learner and teacher motivates enhanced active learning and optimizes the intellectual performance.
Objective: The objective of the study is to assess the acceptability of JiTT over traditional lecture teaching among the medical students.
Method: In a cross sectional pilot study, three hundred thirty five students participated in a questionnaire based study that grades the various aspects of the traditional lecture series. After the implementation of JiTT method for a period of four months, three hundred two students completed the questionnaire, grading the same variables for JiTT. The analysis was done by using SPSS version 11 applying Paired t test and McNemar's Test.
Result: The results of our study highlighted that JiTT technique was perceived superior to traditional teaching with statistically significant outcomes in the clarity of the topic (p=0.003,) duration of the session (p=0.002), knowledge gained and orientation for exams (p=0.044). The students perceived JiTT method as less monotonous (p=0.005) increasing their alertness during these sessions (p=0.002).
Conclusion: We therefore propose that Just-in-Time Teaching method is a more interactive and acceptable teaching-learning tool shifting the nature of teaching to a more student-centric approach as perceived by the medical students. This is the first pioneer study on JiTT to be performed on undergraduate medical students so far.
Objective: To determine association between academic performance and absenteeism in classroom among first year medical students.
Methods: A one-year prospective study was conducted on 196 first year medical students. Academic performance was measured by examination scores at four examinations. Absenteeism score was measured by the cumulative number of absence in an academic session of each student recorded by academic office at the end of the first year of medical training. The academic performance was categorized into pass and fail for analysis purpose. Data was analyzed by SPSS version 20.
Results: The independent-t analysis showed that, in all examinations, students who passed the examinations had significantly lower absenteeism scores than those who failed (p < 0.001).
Conclusion: This study found significant associations between academic performances and absenteeism scores among first year medical students. Medical schools should pay more attention on this matter since it may result in poor academic performances.
Objective: The study aimed to obtain the perspective and teaching practice of novice lecturers serving at the training institutions, Ministry of Health Malaysia (MOH).
Method: A qualitative research was conducted on 4 novice lecturers at the Medical Assistant College, Seremban. Data were obtained from interview and observation on their teaching in the lecture rooms. The data analysis was performed by using NVivo 9 software.
Result: In the aspect of the teaching perspective, the finding showed that there were two main themes; teaching concept and the teaching method. As far as the teaching concept is concerned, respondents perceived that lecturers were the source of knowledge and those who transfered the knowledge to the students. Meanwhile, the second perspective related to the teaching approach in which lecturers need to use their experiences, they need to be knowledgeable and creative in their teaching. The integration of the themes has formed the main perspective, which was the lecturer-centered teaching. In turn, in the teaching practice, it was consistent with their perspective whereby the approach of teaching is lecturer-centered.
Conclusion: This study showed that new lecturers would employ the lecturer-centered approach. Apart from that, they were also lacking of the skills in terms of class control and value inculcation. The deficiency in both these aspects needs to be overcome as it can affect the effectiveness of the teaching, also the quality of the graduates produced.
The significance of learning research methodology and performing research has been accepted by various medical schools in Malaysia as well as in other countries. The aim of integrating research into medical curriculum is to inculcate the research culture and form part of the evidence-based practice among medical professionals. Hence, the Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak has incorporated the research component into the preclinical year of the medical curriculum. A survey was conducted to gauge the second year medical students' level of knowledge of research process at the end of the course using a set of questionnaires. Seventy nine of second year medical students participated in the study. The outcome of the study shows significant improvement in the students’ knowledge on research components after completing the one year course (p
This paper discusses the ethical issues of patient autonomy based on a case of a patient who refused medication during Ramadhan fasting period. Issues on patient autonomy include the right of a patient to refuse medication, informed decision making, the importance of effective communication and the physician roles and responsibilities are discussed. In conclusion, patient autonomy must be respected and valued. However, the need of effective communication in facilitating informed decision making to improve doctor-patient relationship, should not be overlooked and compromised.
Autonomy is widely accepted to be the third pillar of medical ethics. However, if it comes to refusal of life saving treatments, some extra considerations are necessary, especially if decisions are made by surrogate decision makers. Four cases of problematic decision making are presented here, followed by a discussion about the cultural and religious misconceptions about the rights of surrogate decision makers.
Introduction: Crime is an immoral act capable of tearing the well-being of society and the nation. Various factors have been accredited as potential factors for crime engagement for example natural inclination, nurture or a combination of these factors. Within the domain of natural inclination, lack of self-control is often viewed as the primary cause of crime and delinquency. However, there are no valid and reliable Malay language psychometric instruments to measure the level of self-control among Malaysians.
Objective: The aim of this study was to validate the Self Control Scale (SCS) for use among Malay speaking populations. Henceforth the Malay language version is identified as SCS-M.
Method: A cross-sectional study was carried out on 150 inmates incarcerated within two prisons in Peninsular Malaysia in June 2012. Forward and Backward translations of the original SCS were carried out followed by content and face validation processes. Exploratory factor analysis and Cronbach's Alpha reliability analysis were performed.
Result: Both content and face validation processes showed promising and good outcomes. Preliminary analysis for factor analysis supported factorability of the items. The factor loadings of SCS-M items did not correspond to the original six SCS dimensions. Since SCS is often administered as a unidimensional scale, a forced one factor analysis was performed and items with factor loadings exceeding 0.3 were retained. The result of internal consistency reliability of SCS-M demonstrated a good Cronbach's alpha value of 0.80.
Conclusion: The findings supported that SCS-M is a valid and reliable unidimensional scale to measure the level of self-control among Malay speaking populations. It is anticipated that the emergence of SCS-M is vital for self-control assessment, treatment, and rehabilitation purposes.
This paper presents observation made during a brief observation of the PBL programme at School of Medical Sciences (SMS), Universiti Sains Malaysia (USM). It provides a classification for the type of PBL offered at USM highlights the main aspects of the tutorial process there and reviews the experience of students and tutors engaged in PBL at this SMS. The paper proposes a series of recommendations with regards to the planned 2014 curricular reform.
One of the most common reasons why researchers seek help from statistician is sample size calculation. However despite the common believe that it only involves formula and calculation, researchers often ignore other aspects of research design that leads to proper sample size calculation. In this article, the author outlines basic steps toward sample size calculation. The author also introduces the logic behind sample size calculation for single mean and single proportion in simplified and less intimidating forms to those not statistically inclined.
Introduction: Medical and allied health educators around the globe agreed that an optimal educational climate is a vital aspect for effective learning to take place. Without a doubt, appraisal of the educational climate has been emphasized as a key to the delivery of high quality medical education. In addition, the appraisal provides useful feedback to particular institution to improve their curriculum.
Objective: This study was employed as part of the School of Medical Sciences (SMS) Universiti Sains Malaysia curriculum review process. It aimed to explore the strengths and weaknesses of the current medical curriculum thus could provide useful information to guide the curriculum review committee during the review process.
Method: A cross sectional study was conducted on a total of 656 medical students from the first, third and fifth year of study. Purposive sampling method was applied. DREEM was administered to the medical students to evaluate the educational climate in the studied medical school.
Result: A total of 511 (77.9%) medical students completely responded to the 50 statements of DREEM. The mean global score across phases of medical training was 128.36/200. The global scores for year 1, year 3 and year 5 were 138.94/200, 122.27/200 and 125.49/200 respectively. Results showed that; 1) the medical school had reasonably level of educational climates across phases of medical training; 2) the medical teachers were knowledgeable and well prepared for the teaching; 3) the students were overloaded with factual knowledge; 4) the medical teachers were quite harsh to students during teaching session especially in clinical phase; 5) students experienced a significant amount of stress that led to poor memory; 6) the learning process was inclined toward teacher-centered rather than student-centered learning; 7) students had a considerable healthy social relationships with peers as well as others; and 8) academic dishonesty became more apparent in the clinical phase.
Conclusion: The medical school's educational environment across different phases of study was more positive than negative. However, there are plenty of rooms for improvement as perceived by the medical students. The medical school should address various important issues highlighted in this article during the curriculum review process.
Anatomy is an important knowledge for medical practice. Insufficient anatomy knowledge leading to errors in identification of anatomical structures during medical practices has been reported in many countries. Many medical students seem to have difficulties in learning anatomy and retaining the knowledge for future practice, thus this might reflect the possible flaws in anatomy education. In order to achieve optimum anatomy education environment and to close the gaps in education, measuring the students' perception on anatomy teaching and learning is a pre-emptive measure needed by educationists. At present, there is no valid and reliable inventory available to specifically evaluate the anatomy education environment. Therefore, this article highlights the importance of having such inventory.
Teaching stress management skills for medical students has been echoed as an important educational component in medical education. Discussions about approaches to teaching stress management in medical education context are largely unexplored despite of a large number of articles have emphasized on its importance. This paper describes four elements in a framework as an approach to teaching stress management skills in medical education. As one moves through the framework, it provides a greater degree of insight on stress management ability as is acquired through one's awareness, experience and conscious effort that allow stressful situations to be handled effectively and efficiently. It may provide a useful educational framework for medical teachers to teach and assess stress management skills of medical students. It also may be used as an aid in planning, implementing and evaluating stress management programs in medical schools. The authors discuss about the implications of this framework for future research in medical education.
Objective: To determine the sensitivity, specificity and internal consistency of the Malay version GHQ-30 among medical student population. This study also determined the level of agreement between GHQ-30 and M-BDI.
Methods: The Malay version GHQ-30 and Malay version Beck Depression Inventory (M-BDI) were administered to 190 medical students. ROC curve analysis was applied to determine the sensitivity and specificity of the GHQ-30 by testing against the M-BDI diagnoses. Reliability and Kappa analysis were applied to test internal consistency of the GHQ and to determine the level of agreement between GHQ-30 and M-BDI respectively.
Results: 141 (74.2%) medical students participated in this study. The GHQ-30 sensitivity and specificity at cut-off point of 5/6 was 87.5% and 80.6% respectively with positive predictive value (PPV) of 70% as well as area under ROC curve was 0.84. The Cronbach’s alpha value of the GHQ-30 was 0.93. The Kappa coefficient was 0.64 (p<0.001).
Conclusion: This study showed the Malay version GHQ-30 is a valid and reliable screening tool in detecting distressed medical students. The GHQ-30 score equal to or more than 6 was considered as significant distress. The GHQ-30 showed a good level of agreement with M-BDI in detecting distressed medical students.
Keywords: Kelantan; Malaysia; medical student
Objective: To determine the construct validity and the internal consistency of the Postgraduate Stressor Questionnaire (PSQ) among postgraduate medical trainees hence it could be used as a valid and reliable instrument to identify stressors among them.
Methods: Items of the PSQ were derived from a review of literature on the subject and a discussion with experts in the field. It comprised of 28 items with seven hypothetical groups. The content and face validity was established through discussion with experts from field of Medical Education and Psychiatry. It was administered to all participants (N = 34) of postgraduate personal and professional development programme in a Malaysian university. Data was analysed using Statistical Package Social Sciences (SPSS) version 18. Factor analysis was applied to test construct validity whereas reliability analysis was applied to test internal consistency of the PSQ.
Results: Thirty three postgraduate medical trainees participated in this study. Factor analysis found that the 28 items of the PSQ were loaded nicely into the seven pre-determined groups as their factor loading values were more than 0.3. The reliability analysis showed that the Cronbach's alpha value for The PSQ was 0.95. Whereas, The Cronbach's alpha values for academic, poor relationship with superior, bureaucratic constraints, work-family conflicts, poor relationship with colleagues, performance pressure, and poor job prospect domains were 0.63, 0.84, 0.81, 0.65, 0.73, 0.78, and 0.70 respectively.
Conclusion: This study showed that the PSQ is a reliable and valid instrument to identify stressors of postgraduate medical trainees. It is a promising instrument that can be used in future to explore further on this area.