Background: Medical schools have long been concerned with establishing a suitable process of
admission. The criteria used to select students have traditionally focussed on high academic achievement. Method: The International Medical University (IMU) accepts students from a wide range of pre-university entry qualifications for admission into the medical programme. The criteria for the various pre-university entry qualifications used by the IMU were agreed and accepted by the IMU Academic Council (AC), which consist of deans of the IMU’s partner medical schools (PMS). In this study, the various entry qualifications were first grouped into five categories based on the educational pedagogy. Then, this was aligned with the entry qualification data of all students who had been admitted into the IMU medical programme for the period of December 1993 to March 2000. During this period 1,281 students were enrolled into the IMU medical programme. The relationship between the five groups of pre-university entry qualifications and the students’ academic achievement in three end-ofsemester (EOS) examinations namely EOS 1, EOS 3, and EOS 5 were analysed. Results: Students with better grades in their preuniversity examinations showed better performance in their EOS examinations, regardless of the subjects that they took at the pre-university level. Cluster analysis revealed that students who came in with certain preuniversity qualifications generally performed poorly than the more conventional qualifications. However,
after their first year in medical school, there were no significant differences in the clustering of the students. Conclusion: Students with better grades in their preuniversity examinations showed better performance in their EOS examinations, regardless of the science subjects that they took at the pre-university level.
Background: Fetal surveillance in labour is performed mostly to identify fetuses at risk of hypoxia in order to reduce neonatal morbidity and mortality by initiating timely intervention. While normal and abnormal fetal heart rate (FHR) patterns have been well recognised and characterized for the first stage of labour, FHR patterns during the second stage of labour commonly showed some forms of abnormalities leading to problems in interpretation, particularly in predicting fetal hypoxia and acidosis. This study aims to identify patterns of FHR tracing during the second stage of labour associated with neonatal acidosis. Methods: A prospective cross sectional study was conducted in the Labour Ward of a state referral hospital. The study population were patients with low-risk
singleton pregnancies between 37 to 42 weeks gestation who had normal cardiotocograph (CTG) tracing in the first stage of labour. CTG was recorded during the second stage of labour and neonatal umbilical cord blood was obtained for acid-base analysis immediately after birth prior to the delivery of placenta. FHR patterns were grouped according to modified Melchior and Barnard’s
classification and matched with neonatal acid-base status. Patients with normal FHR pattern in the second stage acted as control. Results: A total of 111 matched pairs were analysed. Ninety nine (89.2%) second stage FHR tracings showed abnormal features when compared to control. There were significantly more neonatal acidosis and hypercapnia in type 1b, type 2a, type 2b and type 3 CTG patterns compared to control, in increasing order of severity. In addition, types 2b and 3 showed significant difference in the base excess. Conclusion: Certain second stage fetal heart rate
patterns were found to be associated with neonatal acidosis.
The only potential curative therapy for gastric cancer is the resection of both the tumor and the regional lymph nodes at the early stage of the disease. The majority of patients with gastric cancer in Malaysia have an advanced disease at initial diagnosis, and curative surgery is possible in less than 20% of operated cases. Acurate preoperative staging is crucial in determining the most suitable therapy and avoiding unnecessary attempts at curative surgery. While computed tomography remains as the most widely used imaging modality for gastric cancer staging, its ability to detect local invasion, peritoneal and liver metastases is limited. In the recent years laparoscopy has become an important component in the staging algorithm of gastric cancer. The aim of this review is to evaluate the efficacy of routine preoperative laparoscopic staging in the management of gastric cancer, and in particular describe the Malaysian experience.
This is a cross sectional study conducted in July 2010 at the International Medical University, Seremban, Malaysia. The objective of this study was to ascertain the relationship between working memory capacity of final MBBS medical students using the digit span backward test and their academic achievement based on the total score at the modified
essay questions (MEQ) which was the principal component of the theory examination. Seventy eight final year medical students were recruited,41 (52.6%) were females and remaining 37 (47.4%) were males. Working memory capacity was measured by digit span backward test (DSBT) which ranged from3 to 8 digits. The mean digit score was 6.6 ± 1.1 falling under the category of ‘above average’ score. There was no significant difference between working memory capacity and gender (p>0.05). There was no significant difference in the MEQ mean score and the different categories of working memory capacity (p>0.05).
The DBST shows uniformity in working memory adequate to pass the modified essay questions. Medical students appear to use encoding and retrieval process in problem solving based on functionality and pattern recognition in tackling the problems in the MEQ.
Background: Facebook is a popular social networking site with more than five hundred million users.
This study assessed whether Facebook Groups can be used to teach clinical reasoning skills. Methods: Sixty-seven final year medical students from the International Medical University, Malaysia, were exposed to interactive online learning through a Facebook Group for a period of six months in this study. The purpose was to determine if supervised interactive online learning could be used to augment the deep learning that comes from learning medicine at the bedside of patients. The interactive online discussions were entirely triggered by clinical problems encountered in the medical wards of the general hospital to which these students were attached. Results: A total of 10 topics were discussed in this forum during the duration of this study and an example of one such discussion is provided to illustrate the informal nature of this kind of learning. The results showed a high degree of student involvement with 76 percent of students actively participating in the discussions. Conclusion: The high degree of voluntary participation in the clinical discussions through the Facebook Group in this study tells us that Facebook Groups are a good way of engaging students for learning and can be used in medical education to stimulate creative clinical thinking.
Background: Peripheral venous catheterisation is indispensable in modern practise of medicine. The indications of venous access should be weighed against the risk of complications, the commonest being thrombophlebitis. Thrombophlebitis causes patient discomfort and the need for new catheter insertion and risk of developing further widespread infections. Methodology: This observational study was conducted on adult patients admitted to the surgical and medical ward of a tertiary hospital in Negeri Sembilan Malaysia in 2011. Four researchers visited patients daily and examined for signs of thrombophlebitis; warmth, erythema, swelling, tenderness or a palpable venous cord. Risks factors that were studied in this research were patient/s age and gender, duration of catheterization, use of catheter for infusion, size of catheter, site of catheter insertion and types of infusate. Thrombophlebitis was graded using a scale adapted from Bhandari et al. (1979). Results: In total, 428 patients were recruited with an incidence rate of thrombophlebitis of 35.2%. Among those who developed thrombophlebitis, 65% had mild thrombophlebitis, 19% moderate and 8% severe thrombophlebitis. Results showed that female patients had a significant increased risk of developing thrombophlebitis. Also risk increased significantly with increased duration of catheterization and usage of the catheter for infusion. The age of a patient, types of infusate use, size of catheter and site of catheter insertion did not significantly influence the development of thrombophlebitis. Conclusion: The study showed that risk of developing thrombophlebitis is significantly increased among female patients, and also with increased duration of catheterization and use of the peripheral venous catheter for infusion. We recommended elective replacement of catheter every 72 hours and daily examination of catheters for signs of thrombophlebitis by a healthcare personnel.
Realising possible unmet needs of final year medical students we initiated a weekly informal face-toface discussion forum between them and the teaching faculty of the department of medicine. Various academic and non-academic topics, as dictated by the students, were discussed in 19 weekly sessions. Evaluation by the students was subsequently done by means of an on-line questionnaire after the final examinations. The aim of this study was to evaluate this forum, undertaken for the first time in our institution, by assessing student feedback. We conclude that although the number of attendees and responders were small, feedback was generally positive. This type of forum can be improved upon and serve as another portal for benefitting students.
This paper reviews available reports on the omega-6 (linoleic acid, LA) and omega-3 fatty acid
[alpha-linolenic acid (ALA) + eicosapentaenoic acid (EPA) + docosahexaenoic acid) intakes amongst Malaysians against Malaysian Recommended Nutrient Intakes (RNI), focussing particularly on pregnant and lactating women because of the availability of data for these latter vulnerable groups. Overall, the omega-6 and omega-3 fatty acid nutrition amongst Malaysians are poor and far from desirable. The nutritional situation regarding these long-chain polyunsaturated fatty acids
(LCPUFA) amongst Malaysian pregnant and lactating women is alarming and warrants urgent attention in nutrition promotion activities/counselling. Daily consumption of LA by these women and other Malaysians studied ranged from 3.69 - 5.61 % kcal with 38-60% of individuals not meeting their RNIs. Daily intakes of omega-3 fatty acids faired worse, averaging 0.21- 0.33 % kcal with as high as 92% of subjects in one study not meeting their RNIs. The omega-6 to omega-3 fatty acid
ratios obtained in the studies reviewed are about 20:1, which is way above the World Health Organisationrecommended ratio of 5-10:1. Dietary sources of these omega- fatty acids in the subjects studied are chicken, fish and milk. Since local foods are not particularly rich in LCPUFA such as EPA and DHA, the options to improve EPA/DHA nutrition amongst Malaysians are
the greater consumption of omega-3 enriched foods and in the case of pregnant and lactating women, LCPUFA supplementation may warrant serious consideration.
Mentoring in academic medicine requires the trained mentor to commit time, purpose and dedication for the personal and professional development of three categories of protégés or mentees i.e. medical students, the clinician-trainee and the clinical-educator. Conventionally, assigned mentors monitor the progress of the first two categories of personnel as their career pathway is clearly defined. On the other hand the clinician–educator in academic medicine could be a scientist or a career clinician expected to contribute to medical education activities and research. The clinician educator has grown in complexity as he multitasks in providing clinical care, assists in delivering the medical curriculum and is expected to do research and publish. Although there is dearth of research in mentoring the clinician-educator, it is clear that mentored clinicaleducators are more productive by way of scientific publications. Trained mentors are expected to identify the needs of the mentee with regards to the level of his career development and his aptitude to move up the academic ladder, successfully nurturing the maturation process. Processes of mentoring in the clinical setting, attributes of the successful mentor and facilitating the mentee in overcoming challenges in academic medicine are discussed.
The research mentorship programme is unique in that it is a planned journey undertaken by the mentor and mentee, preferably with well-defined milestones along the journey. During the journey, familiar landmarks will be pointed out by the mentor. In path-finding situations the experience and wisdom of the mentor and the critical appraisal of both mentor and mentee will contribute to learning from the encounter. In most mentor-mentee partnerships, a formal acceptance to the relationship, well-defined landmarks measuring progress in the journey, regular appraisal of the skills developed and acquired, and phased, judicious modification in the individual roles of that relationship will be required. Although there is no consensus on the elements of mentorship, there are some strategies which can contribute to the success of the relationship. Critical success factors include convergence of the research area within the broad expertise of the research mentor. The research mentor should have a proven research track record and is committed to serve in that official capacity. The research mentoring process is dynamic and characteristics of both mentor and mentee contribute to the robustness of that relationship. The mentee would have identified some attributes of the mentor that are desirable and is willing to work hard to achieve, build on, and improve upon. In the research setting endpoint measurements of success will be based on recognition of the research standing of the mentee, measurable outcomes such as number of papers in top tier journals, citation indices, etc. consultancies attracted as well as invitations to deliver plenaries in scientific conferences, patents filed and research findings translated and applied, and other measures of research productivity. In the pursuit of research excellence the mentee would have imbibed values of professionalism and ethics in research and would have constantly kept in mind that to be successful, the mentee would be able to excel beyond his mentor and that the next generation of researchers will seek mentorship from him.
Background: A number of Traditional Chinese Medicine (TCM) preparations are being used for the treatment of diabetes mellitus. Some components of these preparations have biochemical effects other than those of lowering blood glucose and indeed have been used for other medical indications in traditional practice. The primary objective of the study was to determine the effect of the oral mixture of Traditional Chinese Medicine for diabetes (TCM-D™ complex) on blood glucose level and the biochemical changes if any, on the liver (ALT, AST, gamma-GT, albumin, globulin) and renal (blood creatinine, urea) functions in normal mice. The oral mixture is an aqueous extract of four wellknown traditional Chinese medicinal herbs and consists of Trichosanthes kirilowii Maxim., Paeonia lactiflora Pall., Glycyrrhiza uranlensis Fisch., and Panax ginseng (red) CA Meyer in the proportion of 36%, 28%, 18%, and 18% respectively of the dry weight. These herbs have
been shown to have blood glucose lowering activity and have been used for other traditional medicinal purposes.The safety of the combination was evaluated in the present study. Methods: Experimental Balb/c mice were treated orally via gastric tube with the extract at daily doses equivalent to 1 and 10 times the recommended human dose for 8 weeks. Blood glucose and other biochemical profiles were monitored at pre-treatment and monthly posttreatment until killed. Results: When compared to pre-treatment levels, the blood glucose levels were significantly lower in treated animals compared to those in the control group. At the recommended TCM-D™ dose the levels in treated animals were significantly lower than that of control animals and at pre-treatment. When compared with pre-treatment, the glucose levels were lowest at Week 8 of treatment, the mean levels being 111.23%, 83.32% and 70.33% in control, and in animals given 1 x and 10 x the recommended TCM-D™ dosage respectively. The blood glucose lowering effect was also associated with a significant weight loss in treated animals. There were transient increases in AST and ALT levels but these reverted to normal at Week 8 of treatment. The levels of bilirubin, g-GT, albumin, creatinine and blood urea were also not significantly different at Week 8 from pre-treatment levels in all groups. Conclusion: Even at 10 times the dosage recommended for humans, TCM-D™ did not affect the liver and renal functions of treated animals. Treated and control animals remained healthy and normal throughout the period of observation.
Each nursing student comes to nursing with a lay image of nursing portrayed by nurses they have seen. This lay perception of nursing that a nursing student holds is transformed to a more professional understanding that is acquired in nursing schools. This process is known as professional socialization. It is a process of learning the norms, attitudes, behaviours, skills, roles, and values of the profession. It involves the internalization of the values and norms of the profession in the individual’s own behaviour and self-concept. The ultimate goal of professional socialization is to internalize a professional identity of the profession. Professional socialization sets in to reduce the tension from the scenario of reality shock and facilitate adaptation during the transition process. This paper serves as a concept paper with the main purpose of introducing and explaining the concept of professional socialization in nursing to help the readers in gaining further understanding of the concept, especially within the local context. The first author has also incorporated her own personal reflections with regards to her socialization process to nursing.
This paper presents the solution to a calculation of the pH of a very dilute solution of a strong acid or base, taking into account the effect of the hydronium or hydroxyl ions generated from the ionisation of the strong acid or base on the ionisation of water, as a second very weak acid. To be solved successfully, this calculation involves the concepts of conservation of charge, pH and the application of the general solution to a quadratic equation. Such an exercise involves the application of skills in basic numeracy, and can provide a core of understanding that can prepare students for
many different sorts of calculations that represent reallife problems in the medical and biological sciences.A programme is presented in C++ which enables the work of students to be individualised so that each student in a class can work through a slightly different pH calculation, in such a way that a class supervisor can quickly check each student’s result for accuracy. This exercise is presented as a potential means of enabling students to undertake and master similar types of calculations involving simple or more complex equilibria.
Outcome and competency-based undergraduate and graduate medical education is the desired standard embraced by many medical educationists worldwide. Reflective capacity is an integral component of that strategy and reflective writing has shown tremendous potential as a delivery tool. But there are various challenges in the implementation of the initiative. Efficacy as a delivery tool, achievement of pedagogical outcomes, reliability issues, challenges in assessment outcomes/tools, and whether it can be taught and learnt, need to be addressed. Many questions are still not satisfactorily answered, and this review attempts to offer some perspective on the issues.
There has been a significant decline in maternal mortality from 540 per 100,000 live births
in I957 to 28 per 100,000 in 2010. This decline is due to several factors. Firstly the introduction of the rural health infrastructure which is mainly constructing health centres and midwife clinics for the rural population. This provided the accessibility and availability of primary health care and specially, antenatal care for the women. This also helped to increase the antenatal coverage for the women to 98% in 2010 and it increased the average number of antenatal visits per women from6 in 1980 to 12 visits in 2010 for pregnant women. Along with the introduction of health centres, another main feature was the introduction of specific programmes to address the needs of the women and children. In the 1950s the introduction of Maternal and Child Health (MCH) programme was an important
step. Later in the late 1970s there was the introduction of the High Risk Approach in MCH care and Safe Motherhood in the 1980s. In 1990, an important step was the introduction of the Confidential Enquiry into Maternal Deaths (CEMD). Another significant factor in the reduction is the identification of high risk mothers and this is being done by the introduction of the colour coding system in the health centres. Other factors include the increase in the number of safe deliveries by skilled personnel and the reduction in the number of deliveries by the Traditional Birth Attendants (TBAs). The reduction in fertility rate from 6.3 in 1960 to 3.3 in 2010 has been another important factor. To achieve the 2015 Millennium Development Goals (MDG) to further reduce maternal deaths by 50%, more needs to be done especially to identify maternal deaths that are missed by omission or misclassification and also to capture the late maternal deaths.
In the developing world, clinical knowledge management in primary care has a long way to go. Clinical decision support systems, despite its promise to revolutionise healthcare, is slow in its implementation due to the lack of financial investment in information technology. Point-of-care resources, such as comprehensive electronic textbooks delivered via the web or mobile devices, have yet to be fully utilised by the healthcare organisation or individual clinicians. Increasing amount of applicable knowledge of good quality (e.g. clinical practice guidelines and other pre-appraised resources) are now available via the internet. The policy makers and clinicians need to be more informed about the potential benefits and
limitations of these new tools and resources and make the necessary budgetary provision and learn how best to harness them for patient care.
Nurse education is undergoing a process of transition. Nurses worldwide are working towards
achievement of higher levels of education and training through an improved education system. Current trends and innovations in nursing education are emerging to prepare more nurses and to deliver education to students across geographical boundaries while taking into
consideration their work and family responsibilities. The current trends and innovations in nursing education range from full time face-to-face interactions to distance education programmes. Teaching approaches such as blended learning, online or e-Learning have provided nurses with an avenue for continuing education for development and progression in their career pathways. Every nurse aspires to reach her highest potential. While the current trends and innovations in nursing education provides the flexibility for nurses to continue learning and upgrade their professional qualifications, there are issues to be considered in catering to the needs of the bottom billion nurses. An exploration of related issues will include views from different perspectives, such as that of the institution/provider, instructor/facilitator and student/learner involved in the development and implementation of the related education programmes.
It is estimated that more than 1.1 billion adults and 115 million children worldwide are overweight. In Malaysia, the second and third National Health and Morbidity Surveys in 1996 and 2006 respectively reported a three-fold increase in obesity prevalence among adults, surging from 4.4% to 14% over the 10-year period. Evidence of rising childhood obesity has also emerged. The aim of this article is to gather evidence from food availability data for an insight into population shifts in dietary patterns that may help explain the rising obesity in this country. The nutrition transition was delineated in conjunction with the epidemiologic transition in order to explain the convergence of dietary practices, and the high prevalence of obesity and diet-related non-communicable diseases worldwide. The Food Balance Sheets for Malaysia from 1967 to 2007 were used to provide estimates and trends for the availability of foods and calories. Evidence is generated that indicate at least two major upward shifts in the dietary patterns in Malaysia in the past 4 decades.
These shifts have led to the rising availability of calories from animal products, and from sugar and sweeteners. These major dietary shifts, together with increased sedentariness, constitute core public health challenges faced in addressing the country’s obesity and noncommunicable diseases (NCD) conundrum.
Chinese medicine is one of the most famous traditional medicines in the world with a glorious and long written history of at least 2000 years. Recently, acupuncture and the use of other herbal medicine are being gradually accepted globally. In 2011,the International Medical University (IMU) started the Chinese Medicine programme which is the first of its kind in a western medicine university in Malaysia.The author introduced the background of Chinese medicine and the curriculum of the Chinese Medicine programme established in IMU, analyzed the situation regarding the quality of lectures given by internal and
external lecturers in this programme and also discussed on ways to integrate western and traditional medicine in IMU or in Malaysia. The launching of Chinese medicine in IMU is a great step in the development of IMU and also an important step in the development of medical education in Malaysia or even in South-east Asia.
IMU is one of 17 institutions of higher learning conducting the Bachelor of Pharmacy course
in Malaysia. The White paper on pharmacy student professionalism by the Task Force of the American Pharmaceutical Association Academy of Students of Pharmacy together with the American Association of Colleges of Pharmacy Council of Deans mentioned10 essential traits of a professional, recommending their early development. Since the beginning of theIMU Bachelor of Pharmacy (BPharm) (Hons) course in July 2004 on Registration Day, IMU has adopted the concept of developing professionalism in the pharmacy student from the very first day of university, by having the White Coat Ceremony where the entire class takes the Pledge of Professionalism (adapted from the Task Force) against the “Code of Conduct for Pharmacists and Bodies Corporate” by the Pharmacy Board of Malaysia in the presence of the Senior Director of the Pharmaceutical Services Division of the Ministry of
Health, Malaysia and the President of the Malaysian Pharmaceutical Society (MPS). Throughout their 4 years in IMU, the pharmacy students are exposed to various aspects of professionalism in different subjects in their curriculum. On 23rd April 2012, when the fifth cohort of BPharm students received their final examination results, “Pharmacy Professional Day” was launched. The graduating students took the Oath of a Pharmacist (adapted from the American Association of Colleges of Pharmacy’s Oath with slight amendment). Talks by alumni and speakers from MPS aimed to facilitate the transition of the new graduate to working life as a pharmacist.