Introduction: Task-based learning (TBL) has been accepted as an effective tool in teaching and learning activities in most medical schools. Many studies have looked at competencies and learning outcomes essential for undergraduates. Among the essential competencies are interpersonal skills and the ability to engage in a group discussion which this study has focused on. The evidence supporting higher interpersonal skills is however limited because many relevant competencies are hard to measure and require long observational periods.
Objective: To determine students’ self-perceived value of TBL in enhancing their interpersonal skills during the clinical phase.
Material and Methods: All students’ (semesters 6-10) in the clinical school of International Medical University (IMU) were invited to participate in this cross-sectional study done in December 2007 utilising a self-administered questionnaire with a 5-point Likert scale. It assessed the students’ perception on TBL sessions conducted during their clinical attachments in the various disciplines. Mean-scores, standard deviations, and confidence interval were used.
Results: Response rate was 62%. The results indicated that students were favorable in their opinion on TBL as a suitable forum for active communication and participation in group discussion. The results also show that both male and female students’ have similar perception. As for the comparison according to semesters, this showed that students’ maturity does not influence their perception as well.
Conclusion: In conclusion, the study has shown positive students’ perception on the effect of TBL on acquired skills such as interpersonal communication. Our findings are consistent with many earlier studies which show students’ perception of the method of learning as important factor in the enhancement of their interpersonal skills which is fundamental to clinical practice. Further research is necessary; long-term and larger scale observational studies would undoubtedly be optimal to minimise response bias.
The International Medical University (IMU) has encouraged and facilitated research activities since 2001. Research activities by undergraduates, postgraduates, and faculty members have increased substantially since then. The governance aspects of research activities are closely monitored by the Institutional Review Board which is the IMU-Joint Committee on Research and Ethics. (Copied from article)
Pharmacogenomics (or pharmacogenetics), the study of the effects of genetic differences on a person’s response to drugs, can help in optimizing drug efficacy and minimizing adverse drug reactions. Interperson difference in drug metabolism is one of the important consequences of such genetic variation. This variation is determined in part by mutations in cytochrome P450 enzymes (CYPs). IMU is part of a major collaborative research project in the area of phamacogenetics and drug metabolism. Working together with USM and UiTM, our group has, since 2000, generated useful population database on genetic polymorphism of various CYP isoforms. We have successfully genotyped three major ethnic groups, Malay, Indian and Chinese for their allelic frequency of important isoforms. These include CYP2D6, CYP2C9, CYP2C8 and CYP2A6. Data generated so far collectively have contributed to our effort in mapping and constructing genomic database for Malaysian population.
Since early 2002, our research has been focusing on developing in vitro methods in studying the functional consequences of genetic polymorphism of CYP enzymes. Using site-directed mutagenesis, CYP mutants, carrying nucleotide changes as reported in known alleles in human populations, were generated and expressed in E. coli system, and the expressed recombinant proteins were characterized using enzyme assays to determine the functional consequences of mutations. We have established a series of HPLC (high performance liquid chromatography)-based and fluorescence-based assays to investigate CYP activities. Assays that have been developed include tolbutamide methylhydroxylase, paclitaxel 6α-hydroxylase, dextromethorphan O-demethylation, testosterone 6β-hydroxylation and coumarin 7-hydroxylase assays. These assays serve as activity markers allowing comparison of catalytic activities of mutant proteins generated. Another focus of our work is to use the developed assays as a screening tool to investigate drug-herb interactions. This was achieved by co-incubation of herbal extracts and active constituents with the probe substrates in the assays followed by characterization of the kinetic behaviors of the enzymes involved using various pharmacokinetic parameters such as Km, Vmax, IC50 and Ki. This work is currently carried out with collaboration from the Institute for Medical Research (IMR) and is supported by MOSTI’s eScienceFund under RM9. It is envisaged that this screening work will give us insights on the potential of the commonly used herbs to cause pharmacokinetic interactions with other drug substrates, and allow us to elucidate the mechanisms involved in the interactions.
Background: Circumcision though not mentioned in the Quran is believed to be a compulsory practice among the Muslims. In Malaysia, although there are several methods of circumcision available and traditional circumcision is still popular.
Methods: A cross-sectional survey was carried out in a small fishing village of Kedah to study the methods of circumcision available to the villagers. This was followed with an in-depth interview conducted with ‘Tok Mudim’, a practitioner of traditional method of circumcision.
Results: Forty three of the eligible 71 subjects participated in the study giving the response rate as 60.5%. The most common age for circumcision was 9 years old. Despite private clinics being the most common place of circumcisions, there was an increasing number of boys going to the ‘Tok Mudim’ for circumcision. A Mass Circumcision Ceremony is traditionally practiced. The ‘Tok Mudim’ described the procedure in detail and was of the opinion that the reason traditional method is still popular was because of the fear of injections and impotency among the parents. Most common complication faced by the ‘Tok Mudim’ was bleeding and infection.
Discussion and Conclusion: Till the community shifts entirely to using modern medicine, there is a need to integrate traditional practitioners into the system. Training the ‘Tok Mudim’ to use modern instruments and aseptic techniques should be considered.
Abstract: Ampicillin-sulbactam combination is the most frequently prescribed antibiotic in diabetic foot ulcers. We conducted a retrospective study to evaluate the antibiotic sensitivity of bacteria isolated to this antibiotic. In 33 patients with diabetic foot ulcer (September 2008-March 2009), 67% were culture positive in which Citrobacter spp accounted for 36% of these isolates. The rest isolated included Pseudomonas aeruginosa (22%), Proteus spp (18%), Acinetobacter spp (9%), Klebsiella pneumoniae (5%), Escherichia coli (5%) and Staphylococcus aureus (5%). These isolates were more likely to be ampicillin-resistant (n=18) than were ampicillin-sensitive isolates (n=4). Ampicillin resistance has raised our concern about current practice of prescribing ampicillin/ sulbactam as monotherapy for majority of our patients with such ulcers.
Appreciation of learning styles can be of use to help both educators and students to enhance the effectiveness of an educational experience. It has been noticed that some students at this College are not very good at expressing themselves in either written or spoken English. Our study aimed to identify the student’s learning styles; assess whether there is any correlation between learning style, baseline demographic data and self rated proficiency in English language; and assess their associations with the assessment performance.
A group of third year medical students voluntarily participated in a questionnaire study to provide us with their learning styles, demographic information and self-rated proficiency in English language. This data was compared to the students’ performance in the assessment at the end of their junior clinical rotations.
This cohort of students (60% Malay, 35% Chinese and 5% Indian) who were mostly visual learners, considered themselves proficient in English. Students with predominantly Visual learning styles and those with poorer English, score significantly lower during their clinical long case examinations. These two predictors appear to be independent of each other.
These results may suggest that our current teaching modalities may disadvantage students with predominant visual learning styles. It also suggests that the long case clinical examination may favour those with more verbal learning styles.
It is ironical to realize that a perfect and free nutritional product, individually produced and naturally distributed to all families, is not universally used. This product is of course breast milk that nurtures the optimal health, growth and development of the human young. Breast milk also protects infants and young children from and prevents diseases in the short and long term. (Copied from article)
Gestational breast cancer (GBC) or pregnancy-associated breast cancer was defined as breast cancer diagnosed during pregnancy and within 1 year of delivery. Breast cancer is the second commonest cancer after cervical seen in pregnancy and lactation. Nevertheless, the incidence is low and accounts for approximately 1 in 3000 of pregnancies. A delay in diagnosis is common and 70% to 89% of patients with operable primary lesions already have positive axillary lymph nodes. Breast cancer identified during pregnancy can be extremely distressing for the mother despite it has similar course of disease and prognosis seen in non-pregnant women of the same age and stage of disease. Diagnostic and treatment options should be carefully decided to prevent further harm to the mother or any potential risk to the developing fetus.
Background: To assess the effect of cement vertebroplasty on the activity of daily living of elderly patients who have sustained a vertebral osteoporotic fracture.
Patients and Methods: Seven patients with clinically significant and radiologically proven osteoporotic vertebral compression fractures suitable to be treated with percutaneous cement vertebroplasty were recruited. Evaluation was based on pre- and postprocedure activity by clinical documentation (including interview) and by a self-developed questionnaire (including quality of life).
Results: Following the procedure, 54% of patients resumed their activities of daily living with minimal pain while 46% of patients were able to do so without any pain (p
Background: The World Health Organization recommends the practice of exclusive breastfeeding of infants for the first 6 months after birth. The objective of present study was to estimate the prevalence and the factors influencing exclusive breastfeeding. The perceptions of mothers about breastfeeding in an urban slum area of Western India were also enquired.
Methods: This cross sectional study was conducted over six months amongst 200 mothers of children in the age group of 6 – 12 months attending the growth and development clinic in one of the urban health centres. Data was collected using a pre-tested, structured questionnaire on breastfeeding practices. Factors related to exclusive breastfeeding were analysed using bivariate and multivariate analysis.
Results: Prevalence of exclusive breastfeeding reported by the participants was 61.5%. Having a male child, maternal age < 30 years, level of education of mother parity, receiving infant feeding advice, initiation of breastfeeding within one hour of birth and administration of colostrum to the baby were associated with exclusive breastfeeding (p
Since the outbreak of the novel influenza H1N1 in April 2009 in Mexico, more then half a million cases have been recorded with more then 6000 deaths.In contrast to seasonal flu, this virus appears to have a predilection for the young, obese and pregnant.It’s most important and almost fatal complication is Acute Respiratory Distress Syndrome (ARDS). Intensive care units (ICU) around the world have scrambled to upgrade various treatment modalities including high frequency oscillation ventilation, inotropes, antivirals and antibiotics in an effort to reduce the mortality arising out of this complication. More importantly, this complication appears reversible if adequate and early therapy is instituted. In particular, rescue therapies that allow the lung to rest appear to have brought success in some clinical settings. This article describes the experiences of seven centers that have used various modalities as rescue therapy in patients having Acute Respiratory Distress Syndrome (ARDS). The experiences in 13 patients at the University of Michigan, 58 in Mexico, 168 in Canada, 180 patients at Leicester UK, 194 in Australia and New Zealand and case reports from Hong Kong and Singapore are described.
Background: Nosocomial infection is among the leading problem in many major hospitals resulting in soaring cost expenditure in managing its affect.Hand washing practice is a crucial preventive way to contain such mischief but many ignored its importance. This is perhaps due to lack of appropriate role modeling from senior practitioners.
Subjects and methods: Our study examined the prevalence of hand washing practice among medical students from year 3 to 5 and compared it to their knowledge and level of awareness on its importance in clinical practice. 142 students were randomly observed during their clinical work in the wards on this practice and questionnaires were later distributed to 268 students from all semesters on their knowledge on the technique and awareness on its importance.
Results: Out of 142, almost 80% washed their hands but only 41.6% performed effective hand washing. In contrary, 80 to 90% showed good level of knowledge and awareness as well as perception about its importance in clinical practice.
Conclusions: The contradictory findings between the actual practice of hand washing and knowledge as well as awareness suggest that enforcement on the practice is necessary. This requires motivation and cooperation from all health alliances and higher authority in the health system. Remedial measures are much needed in order to contain high incidence of nosocomial infection in our local practice.
Background: Hypertension is estimated to cause4.5% of the global disease burden. The prevalence of hypertension in Malaysia is 32.2%.
Objective: To determine the prevalence of hypertension and its associated risk factors in two rural communities in Penang, Malaysia.
Methods: This cross sectional study was conducted among all consenting residents aged 18 years and above from two villages in Penang. Besides the baseline demographic information, blood pressure was measured using a manual sphygmomanometer according to the American Heart Association Guidelines.
Results: 50 out of 168 people were hypertensive, giving a prevalence rate of 29.8%. 50.0% of those found with hypertension were undiagnosed and 48.0% of those who were diagnosed with hypertension had uncontrolled blood pressure. Logistic regression analysis showed that age, history of alcohol consumption and BMI were found to be independently associated with hypertension.
Conclusions: Age, education level, alcohol consumption and BMI are important risk factors associated with the prevalence of hypertension among the villagers. These risk factors are comparable to those reported in National Health and Morbidity Survery 2006 in Malaysia.
Objective: To evaluate the factors that contributes to the decision for termination of pregnancy in prenatally diagnosed fetal anomaly cases.
Methods: A retrospective analysis of all cases of prenatally diagnosed fetal anomaly who delivered between 1 January 2007 and 30 June 2009 in two tertiary hospitals in Malaysia.
Results: A total of seventy-two (72) prenatally diagnosed pregnancies with fetal anomalies were identified. Mean maternal age was 29.8 ± 5.5 years and mean parity 1.47 ± 1.8. 70.8% of patients were ethnic Malay, 15.3% Chinese and 12.5% ethnic Indian. 22 (30.6%) fetuses were lethally abnormal. The overall pregnancy termination rate was 29.2%. 50% of pregnancies with lethally abnormal fetuses were terminated compared to 20% of pregnancies with non-lethal abnormality (p
Background: Problem based learning (PBL) is a student-centered curriculum delivery tool believed to promote active student participation. Though the PBL is student-centered, the facilitator plays an important role in maintaining the integrity of this system by providing balance in group interaction and discussion of learning issues. In International Medical University (IMU) one of the strategies to ensure the quality of the facilitators was the pre and post PBL meetings. This study aimed to gauge its usefulness in ensuring the quality of PBL facilitation.
Method: The questionnaire to study the perceptions of PBL facilitators on the pre and post PBL meetings included close ended questions on pre and post PBL meeting’s attendance and their scored opinion in improving PBL facilitation skills, open ended questions inviting suggestions to improve these meetings and PBL facilitation in IMU as a whole and self-evaluation as an effective PBL facilitator using a six point Likert scale to a list of statements.
Results: 84.2% of facilitators agreed the meetings were beneficial. Self-evaluation of their facilitator effectiveness showed on average ratings of seven out of ten indicating strong confidence in facilitating skills. Suggestions ensuring facilitator quality included content expert briefing in pre PBL meetings and student appraisals of facilitators given weightage in staff appraisal.
Conclusion: Pre and post PBL meetings enhanced facilitator comfort with the triggers, adding to their confidence and provided a venue to obtain feedback on the triggers.
The importance of incorporating medical (or health) informatics into the education of medical students and medical practitioners is being increasingly recognised. The advances in information and communication technology and the pervasion of the Internet into everyday life have important implications for healthcare services and medical education. Students and practitioners should learn to utilise biomedical information for problem solving and decision making based on evidence. The extensive introduction of electronic health information systems into hospitals and clinics and at the enterprise level in Malaysia and elsewhere is driving a demand for health professionals who have at least basic skills in and appreciation of the use of these technologies. The essential clinical informatics skills have been identified and should be incorporated into the undergraduate medical curriculum. It is recommended that these be introduced in stages and integrated into existing programmes rather than taught as a separate module. At the same time, medical schools should support the integration of e-learning in the educational process in view of the numerous potential benefits.
Malaysia has good environmental laws to protect the outdoor environment and public health. However there are no laws governing indoor air quality (IAQ) and the knowledge among the public about its importance is also lacking. Environmental professionals think it is not a priority and this influences the policy decisions in the country. Therefore there is a need to create awareness by way of research, education and other promotional activities. What is much needed at this time is the establishment of standards for the conduct of risk assessment studies. To establish standards we need reliable data which can be used to develop appropriate guidelines for the purpose of mitigation and adaptation programmes. IAQ can have significant influence on health resulting in drop in productivity and economy of a country. It has been estimated that in the US, building related illnesses (BRI) symptoms have a relationship with decrease (3 to 5%) in work performance in an affected population resulting in an annual loss of US$60 billion in revenue. However, based on efficient management programmes they have also projected that the potential annual savings can be in the region of US$10 to 30 billion. This establishes that fact that good management programmes based on efficient guidelines is of economic value to a country and wellbeing of the population. The IMU has embarked on a research programme to collect the much-needed data for the framing of a good IAQ guideline for Malaysia.
Pneumonia continues to a disease of potentially high morbidity and mortality, sparing no children or healthy adults. Over the years, clinical practice guidelines and institution-initiated management protocols have been introduced with the intention of improving outcomes by ensuring appropriate assessment and management of pneumonia. Correct assessment of pneumonia type and severity will lead to appropriate course of action. This is especially true when deciding whether the patient can be treated at home and the type of empiric antibiotic(s) that should be prescribed. The latter has a strong evidence-base when examined in the light of clinical practice guidelines. Non-guideline adherent empiric antibiotic regimes used in hospitalized community acquired pneumonia (CAP) are adversely associated with time to clinical stability, time to switch therapy, length of hospital stay, hospital survival and hospital re-admission rates. Our own local study on hospitalized patients with Klebsiella pneumoniae pneumonia, a highranking community-acquired organism in Malaysia, also testified to the association of adverse hospital outcomes with inappropriate choice of empiric antibiotic(s). (Copied from article).
In the last decade or so, Medical education all over the world has been inundated with innovations in education, which include innovations in curricular design, delivery as well as assessments. There is a need to reflect on the effectives of these innovations
on the learner. Hence the theme chosen for the 2009 International Medical Education Conference (IMEC 2009) was “Reflections on Innovations”. The Organising Committee felt that it was timely for medical educators everywhere to reflect and evaluate the effect of the many innovations adopted by their schools. (Copied from article)
Item analysis is the process of collecting, summarizing and using information from students’ responses to assess the quality of test items. Difficulty index (P) and Discrimination index (D) are two parameters which help evaluate the standard of MCQ questions used in an examination, with abnormal values indicating poor quality. In this study, 120 test items of 12 Type A MCQ tests of Foundation 1 multi-disciplinary summative assessment from M2 / 2003 to M2 / 2006 cohorts of International Medical University were selected and their P-scores in percent and D-scores were estimated using Microsoft Office Excel. The relationship between the item difficulty index and discrimination index for each test item was determined by Pearson correlation analysis using SPSS 11.5. Mean difficulty index scores of the individual summative tests were in the range of 64% to 89%. One-third of total test items crossed the difficulty index of 80% indicating that those items were easy for the students. Sixty seven percent of the test items showed acceptable (> 0.2) discrimination index. Forty five out of 120 test items showed excellent discrimination index. Discrimination index correlated poorly with difficulty index (r = -0.325). In conclusion, a consistent level of test difficulty and discrimination indices was maintained from 2003 to 2006 in all the twelve summative type A MCQ tests.