Volume 8 2023, Number 3, July 2023

  • Global Perspectives

    Dental materials science curriculum in Malaysia: Time for transformation

    Galvin Sim Siang Lin1, Yook Shiang Ng2 & Chan Choong Foong3

    1Department of Dental Materials, Faculty of Dentistry, Asian Institute of Medicine, Science and Technology (AIMST) University, Malaysia; 2Conservative Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Malaysia; 3Medical Education and Research Development Unit (MERDU), Faculty of Medicine, Universiti Malaya, Malaysia

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    Abstract

    Introduction: Dental materials science is one of the core courses for Malaysian undergraduate dental programmes, which has been primarily taught through a series of didactic lectures during the preclinical phase. In accordance with the newly revised national competency statement, Malaysian dental education is moving toward competency-based education, hence a reformation of the dental materials science curriculum is warranted.

    Methods: Curriculum design including common teaching, learning and assessments methods for the Malaysian dental materials science were described and analysed. The common practices were reviewed and compared with latest national guidelines and literature.

    Results: There is yet an initiative to establish a national curriculum for dental materials science. The use of traditional teaching strategies for this course also needs to be revamped from a teacher-centred to a student-centred approach. Furthermore, faculty members are facing significant challenges because the revamp requires them to explore cutting-edge pedagogical methods and develop appropriate learning opportunities, environments, resources, and assessments. Several recommendations are proposed, such as mapping the existing dental materials science curriculum to identify gaps, incorporating more hands-on sessions, implementing an integrated curriculum, introducing various formative and summative assessments, as well as recruiting faculty members with different areas of educational expertise.

    Conclusion: It is hoped that this article offers a clearer pathway for Malaysian dental educators to pioneer new insight and transform the existing dental materials science curriculum.

  • Original Articles

    A randomised control trial study on the efficacy of high-fidelity simulation in enhancing knowledge

    Bikramjit Pal1, Aung Win Thein2, Sook Vui Chong3, Ava Gwak Mui Tay4, Htoo Htoo Kyaw Soe5 & Sudipta Pal6

    1Department of Surgery, Manipal University College Malaysia, Melaka, Malaysia; 2Department of Surgery, Manipal University College Malaysia, Melaka, Malaysia; 3Department of Medicine, Manipal University College Malaysia, Melaka, Malaysia; 4Department of Surgery, Manipal University College Malaysia, Melaka, Malaysia; 5Department of Community Medicine, Manipal University College Malaysia, Melaka, Malaysia; 6Department of Community Medicine, Manipal University College Malaysia, Melaka, Malaysia

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    Abstract

    Introduction: The practice of high-fidelity simulation-based medical education has become a popular small-group teaching modality across all spheres of clinical medicine. High-fidelity simulation (HFS) is now being increasingly used in the context of undergraduate medical education, but its superiority over traditional teaching methods is still not established. The main objective of this study was to analyse the effectiveness of HFS-based teaching over video-assisted lecture (VAL)-based teaching in the enhancement of knowledge for the management of tension pneumothorax among undergraduate medical students.

    Methods: A cohort of 111 final-year undergraduate medical students were randomised for this study. The efficacy of HFS-based teaching (intervention group) and VAL-based teaching (control group), on the acquisition of knowledge, was assessed by single-best answer multiple choice questions (MCQ) tests in the first and eighth week of their surgery posting. Mean and standard deviation (SD) for the total score of MCQ assessments were used as outcome measures. ANCOVA was used to determine the difference in post-test MCQ marks between groups. The intragroup comparison of the pre-test and post-test MCQ scores was done by using paired t-test. The P-value was set at 0.05.

    Results: The mean of post-test MCQ scores were significantly higher than the mean of pre-test MCQ scores in both groups. The mean pre-test and post-test MCQ scores in the intervention group were slightly more than those of the control group but not statistically significant.

    Conclusion: There was a statistically significant enhancement of knowledge in both groups but the difference in knowledge enhancement between the groups was insignificant.

    Keywords:           High-Fidelity Simulation, Video-Assisted Lecture, Simulation-Based Medical Education (SBME), Randomized Controlled Trial (RCT), Medical Education, Pre-test and Post-test Knowledge Assessments

  • Original Articles

    Learners’ report and perceptions concerning undergraduate paediatric endocrinology curriculum content and delivery across Southern Nigeria

    Iroro Enameguolo Yarhere1, Tudor Chinnah2 & Uche Chineze3

    1Department of Paediatrics, College of Health Sciences, University of Port Harcourt, Nigeria; 2Department of Anatomy, University of Exeter, United Kingdom; 3Department of Education and Curriculum studies, University of Port Harcourt, Nigeria

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    Abstract

    Introduction: This study aimed to compare the paediatric endocrinology curriculum across Southern Nigeria medical schools, using reports from learners. It also checked the learners’ perceptions about different learning patterns and competency in some expected core skills.

    Methods: This mixed (quantitative and qualitative) study was conducted with 7 medical schools in Southern Nigeria. A multi-staged randomized selection of schools and respondents, was adopted for a focus group discussion (FGD), and the information derived was used to develop a semi-structured questionnaire, which 314 doctors submitted. The FGD discussed rotation patterns, completion rates of topics and perceptions for some skills. These themes were included in the forms for general survey, and Likert scale was used to assess competency in skills. Data generated was analysed using statistical package for social sciences, SPSS 24, and p values < 0.05 were considered significant

    Results: Lectures and topics had various completion rates, 42.6% – 98%, highest being “diabetes mellitus”. Endocrinology rotation was completed by 58.6% of respondents, and 58 – 78 % perceived competency in growth measurement and charting. Significantly more learners, 46.6% who had staggered posting got correct matching of Tanner staging, versus learners who had block posting, 33.3%, p = 0.018.

    Conclusion: Respondents reported high variability in the implementation of the recommended guidelines for paediatric endocrinology curriculum between schools in Southern Nigeria. Variabilities were in the courses’ completion, learners’ skills exposure and how much hands-on were allowed in various skills acquisitions. This variability will hamper the core objectives of human capital development should the trend continue.

    Keywords:          Paediatric Endocrinology Curriculum, Perception, Compliance, Completion Rate, Learners

  • Original Articles

    Examiner training for the Malaysian anaesthesiology exit level assessment: Factors affecting the effectiveness of a faculty development intervention during the COVID-19 pandemic

    Noorjahan Haneem Md Hashim1, Shairil Rahayu Ruslan1, Ina Ismiarti Shariffuddin1, Woon Lai Lim1, Christina Phoay Lay Tan2 & Vinod Pallath3

    1Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, Malaysia; 2Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Malaysia; 3Medical Education Research & Development Unit, Dean’s Office, Faculty of Medicine, Universiti Malaya, Malaysia

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    Abstract

    Introduction: Examiner training is essential to ensure the trustworthiness of the examination process and results. The Anaesthesiology examiners’ training programme to standardise examination techniques and standards across seniority, subspecialty, and institutions was developed using McLean’s adaptation of Kern’s framework.

    Methods: The programme was delivered through an online platform due to pandemic constraints. Key focus areas were Performance Dimension Training (PDT), Form-of-Reference Training (FORT) and factors affecting validity. Training methods included interactive lectures, facilitated discussions and experiential learning sessions using the rubrics created for the viva examination. The programme effectiveness was measured using the Kirkpatrick model for programme evaluation.

    Results: Seven out of eleven participants rated the programme content as useful and relevant. Four participants showed improvement in the post-test, when compared to the pre-test. Five participants reported behavioural changes during the examination, either during the preparation or conduct of the examination.  Factors that contributed to this intervention’s effectiveness were identified through the MOAC (motivation, opportunities, abilities, and communality) model.

    Conclusion: Though not all examiners attended the training session, all were committed to a fairer and transparent examination and motivated to ensure ease of the process. The success of any faculty development programme must be defined and the factors affecting it must be identified to ensure engagement and sustainability of the programme.

    Keywords:           Medical Education, Health Profession Education, Examiner Training, Faculty Development, Assessment, MOAC Model, Programme Evaluation

  • Original Articles

    Blueprinting and auditing a postgraduate medical education programme – Lessons from COVID-19

    Rachel Jiayu Lee1*, Jeannie Jing Yi Yap1*, Abhiram Kanneganti1, Carly Yanlin Wu1, Grace Ming Fen Chan1, Citra Nurfarah Zaini Mattar1,2, Pearl Shuang Ye Tong1,2, Susan Jane Sinclair Logan1,2

    1Department of Obstetrics and Gynaecology, National University Hospital, Singapore; 2Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

    *Co-first authors

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    Abstract

    Introduction: Disruptions of the postgraduate (PG) teaching programmes by COVID-19 have encouraged a transition to virtual methods of content delivery. This provided an impetus to evaluate the coverage of key learning goals by a pre-existing PG didactic programme in an Obstetrics and Gynaecology Specialty Training Programme. We describe a three-phase audit methodology that was developed for this

    Methods: We performed a retrospective audit of the PG programme conducted by the Department of Obstetrics and Gynaecology at National University Hospital, Singapore between January and December 2019 utilising a ten-step Training Needs Analysis (TNA). Content of each session was reviewed and mapped against components of the 15 core Knowledge Areas (KA) of the Royal College of Obstetrics & Gynaecology membership (MRCOG) examination syllabus.

    Results: Out of 71 PG sessions, there was a 64.9% coverage of the MRCOG syllabus. Four out of the 15 KAs were inadequately covered, achieving less than 50% of knowledge requirements. More procedural KAs such as “Gynaecological Problems” and those related to labour were poorly (less than 30%) covered. Following the audit, these identified gaps were addressed with targeted strategies.

    Conclusion: Our audit demonstrated that our pre-pandemic PG programme poorly covered core educational objectives i.e. the MRCOG syllabus, and required a systematic realignment. The COVID-19 pandemic, while disruptive to our PG programme, created an opportunity to analyse our training needs and revamp our virtual PG programme.

    Keywords:        Medical Education; Residency; Postgraduate Education; Obstetrics and Gynaecology; Training Needs Analysis; COVID-19; Auditing Medical Education

  • Short Communications

    Gamification through collaborative learning in medical education

    Sasikala Devi Amirthalingam1, Shamala Ramasamy2 & Sharifah Sulaiha Hj Syed Aznal3

    1Department of Family Medicine, International Medical University, Kuala Lumpur, Malaysia; 2Department for Psychology, International Medical University, Kuala Lumpur, Malaysia; 3Department of Obstetrics and Gynaecology, International Medical University, Kuala Lumpur, Malaysia

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    Abstract

    Introduction: Introduction to Health Profession (IHP) was designed to teach first-year medical students the importance of self-directed learning, accountability, and teamwork in healthcare. Due to the COVID 19 pandemic, the course was delivered virtually, incorporating elements of gamification.

    Methods: Gamification features included collaborative teamwork to simulate and record the roleplay for assignments based on crisis management scenarios. The syllabus involves knowledge checks to promote self-directed learning and personal accountability as well as online questionnaires to identify personality traits followed by discussion. Games like Chinese whispers and charades were introduced to identify listening skills. Additional gamification features include progress mechanics for collecting badges upon successful completion of knowledge checks / assessments and completing collaborative teamwork activities.

    Results: Results from the descriptive study on the educational usefulness of the IHP module was found to be satisfactory. The feedback was encouraging as >95% of students gave positive feedback that the IHP activities enabled them to understand the value of teamwork, effective communication, professional behavior and enabled them to be resilient and adaptable. 92% agreed that the IHP activities helped to make connections and network with their peers during the pandemic

    Conclusion: Gamification of IHP course was successful in terms of practicality and usefulness in promoting communication, collaborative work, experiential learning, and teamwork. Students were empowered to take charge of their own learning of both content and development of interpersonal skills and teamwork through gamification. The isolation caused by the pandemic was alleviated by the networking that occurred during collaborative group activities.

    Keywords:           Gamification, Self-directed Learning, Collaborative Learning

  • Short Communications

    Connecting historical events to contemporary issues in bioethics and medical humanities teaching

    Olivia MY Ngan1,2, Jasmine YN Hui3 & Sihan Sun4

    1Medical Ethics and Humanities Unit, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, HKSAR; 2Centre for Medical Ethics and Law, Faculty of Law and LKS School of Medicine, The University of Hong Kong; 3Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; 4CUHK Centre for Bioethics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR

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    Abstract

    Introduction: Didactic pedagogy and passive learning in bioethics and medical humanities teaching are ineffective in engaging students and gauging learning interests. As a result, medical students are unaware of why and how bioethics and medical humanities relate to their learning and thus prioritising acquiring clinical knowledge in their medical education.

    Methods: This project involves a teacher-student collaboration to develop a teaching approach, which bridges historical events and contemporary issues, acknowledging how ethics and humanities are interwoven in clinical and everyday life. The objectives are to (1) highlight landmark historical events in bioethics and medical humanities and (2) recognise the evolving nature of values and social norms that inform current practice.

    Results: The three activities include the use of historical narratives, annual newsletter publications, and social media to augment didactic classroom teaching and learning. Video narratives of landmark events in bioethics were developed to strengthen historical knowledge and encourage self-reflection. The newsletter invited students to write about any topic in bioethics and medical humanities and enabled them to experience a peer-review process. It allowed students to critically appraise everyday issues. Social media engagement via Instagram offered a flexible and informal medium to diversify the traditional bioethics content taught in the classroom. The advantages and obstacles of each element are discussed.

    Conclusion: A holistic approach using historical narratives, newsletters, and social media engages students’ learning and allows students to become conscious of how past events shape the present.

    Keywords:          Bioethics, Medical Ethics, Medical Humanities, Education, History, Curriculum Development, Social Media, Student as Partner, Newsletter

  • Short Communications

    Minor tweaks to tutorial presentation improved students’ perceptions of our mass tutorial

    Seow Chong Lee & Foong May Yeong

    Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

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    Abstract

    Introduction: In the first weeks of medical school, students learn fundamental cell biology in a series of lectures taught by five lecturers, followed by a mass tutorial session.  In this exploratory study, we examined students’ perceptions of the mass tutorial session over two academic years to find out if they viewed the tutorials differently after minor tweaks were introduced.

    Methods: Reflective questions were posted to the undergraduate Year 1 Medical students at the end of each mass tutorial session in 2019 and 2020. Content analysis was conducted on students’ anonymous responses, using each response as the unit of analysis. The responses were categorised under the learning objectives, with responses coded under multiple categories where appropriate. The distribution of the counts from responses in 2019 and 2020 was compared, and the tutorial slides used over the two years were reviewed in conjunction with students’ perceptions to identify changes.

    Results:  In 2019, we collected 122 responses which coded into 127 unique counts, while in 2020, 119 responses coded into 143 unique counts. Compared to 2019, we noted increases in the percentage of counts under “Link concepts” and “Apply knowledge”, with concomitant decreases in percentage of counts in “Recall contents”. We also found that the 2020 tutorial contained additional slides, including a summary slide and lecture slides in their explanations of answers to the tutorial questions.  

    Conclusion: Minor tweaks in the tutorial presentation could improve students’ perceptions of our mass tutorials.

    Keywords:          Mass Tutorials, Students’ Reflections, Apply Knowledge, Link Concepts, Minor Tweaks

  • Short Communications

    An online medical course during the COVID-19 pandemic: A mixed methods analysis

    Maria Isabel Atienza & Noel Atienza

    San Beda University College of Medicine, Philippines

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    Abstract

    Introduction: An evaluation of the online medical course was conducted to assess student readiness, engagement, and satisfaction at the San Beda University College of Medicine in Manila during the COVID-19 pandemic.

    Methodology: A convergent mixed methods approach was done with a quantitative online survey and a qualitative thematic analysis of focus group discussions (FGD) with medical students. A total of 440 students participated in the survey while 20 students participated in the FGDs.

    Results: The medical students were sufficiently equipped with computers and internet connections that allowed them to access the online medical course from their homes. The 5 themes identified during the study that were relevant to education were: Student readiness for online learning, Learning Management System (LMS) and internet connectivity, teaching and learning activities, the value of engagements, and teaching effectiveness of the faculty. The combined quantitative and qualitative analysis revealed vital issues that affect student learning. This included the need for students to interact with fellow students and to be engaged with their faculty. The issues that affect teaching included the need for continuing faculty training and management skills in delivering the full online course.

    Conclusion: The success of online education rests heavily on the interactions of the students, the teachers, and the knowledge. Student interactions, managerial and skills training for the faculty, and providing students with a mix of synchronous and asynchronous activities are the most effective means to ensure the effective delivery of online medical courses.

    Keywords:       Medical Curricular Revision, Formative Evaluation, Student Engagement, Synchronous and Asynchronous Online Learning, Cognitive Overload

  • Personal view

    Expanding social contribution of medical schools: One perspective from a regional medical university in Japan

    Sachiko Kasamo, Satoshi Ozeki, Hiroyasu Inoue & Seiji Matsumoto

    Institutional Research Office, Asahikawa Medical University, Japan

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    I. INTRODUCTION

    There is growing interest in social responsibility around the world in order to accomplish a sustainable society. Indeed, modern universities cannot be ivory towers unrelated to society. It would not be an overstatement to say that without interaction and contribution to society, the university’s survival and development are unlikely.

    It is frequently said that the university fulfils three different missions: education, research, and social contribution. J. A. Perkins, the eminent theoretician of higher education in the 1960s, proposed there are three aspects of knowledge that must be understood as they have their institutional reflections in the university’s three missions (Perkins, 2016). For knowledge itself to have significant power, there must be communication and interaction between the newly acquired knowledge, its transmission, and its application. The above concept began in the United States and has since been widely adopted as three major missions in many universities worldwide. Despite these three missions, however, depending on the university’s expertise and readiness, and the resources and support received from external organisations and individuals, the university may be more active on some missions and less active on others.

  • Case Study

    Medical student impressions of general surgery clinical clerkships conducted during the COVID-19 pandemic

    Hiroshi Kawahira1, Yoshitaka Maeda1, Yoshihiko Suzuki1, Yuji Kaneda1, Yoshikazu Asada2, Yasushi Matsuyama2, Alan Kawarai Lefor3 & Naohiro Sata3

    1Medical Simulation Center, Jichi Medical University, Japan; 2Medical Education Center, Jichi Medical University, Japan; 3Department of Surgery, Jichi Medical University, Japan

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    I. INTRODUCTION

    The ongoing COVID-19 pandemic has a significant impact on medical education, forcing changes in the curriculum (Rose, 2020). Since the COVID-19 pandemic began, governments and authorities in many countries have imposed online learning on medical students and in many institutions, medical students were not permitted to participate in in-person clinical clerkships or other practical training at university hospitals (Mian & Khan, 2020). Although the surgical clerkship is an important contributing factor to nurture student interest in a surgical career (Khan & Mian, 2020), medical students were excluded from the operating room due to lack of personal protective equipment, and participation in ward duties and training facilities were restricted (Calhoun, et al., 2020).

    The purpose of this study is to analyse how the lack of in-person surgical experience and ward duties (online clerkship), among the most important components of a surgical clerkship, affected student interest in a career in surgery. The impact on student perceptions of surgery comparing online learning and onsite clinical clerkship (typical in-person clerkship) was assessed by comparing student satisfaction with the surgical clerkship, changes in interest in a career in surgery, and changes in the image of surgery at the beginning and end of rotations for online and onsite training groups.

  • Letter to Editor

    Poetry in medicine – Another adjunct to improving Emotional Intelligence?

    David Mathew

    Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore

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    Dear Editor,

    I read with great interest the article entitled “The associates of Emotional Intelligence in medical students: A systematic review” (Edussuriya et al., 2022) in your journal published in October 2022. The association of Emotional Intelligence (EI) with wellbeing cannot be underestimated, especially with the plethora of positive effects it has on mental health and academic performance. In fact, I think this can be extended beyond students, to all healthcare professionals.

  • Letter to Editor

    Insufficient undergraduate education for medication safety: A student’s perspective

    Hirofumi Kanazawa1 & Ikuo Shimizu2,3

    1Shinshu University School of Medicine, Matsumoto, Japan; 2Safety Management Office, Shinshu University Hospital, Matsumoto, Japan; 3Department of Medical Education, Chiba University Graduate School of Medicine, Chiba, Japan

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    Medication errors are one of the most serious problems in healthcare, and their occurrence is due to a wide variety of causes. While almost all drug-related medical errors are potentially avoidable, the main obstacles are primarily health system vulnerabilities and human error. To remove those obstacles, the World Health Organization (WHO) suggested providing more education (World Health Organization, 2017), specifically by participating in medical care. Graduation competencies in many countries, which include activities about medication and patient safety, are consistent with the statement. In addition, it is known that more prescribing errors occur in the first postgraduate year. Learning about prescriptions during medical studentships must be enhanced.

  • Multimedia Article

    A review of development approaches for Artificial Intelligence chatbots in medical education

    Christopher See1*, Cynthia Sin Nga Lam2* & Yalsin Yik Sum Li2

    1School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; 2Hospital Authority, Hong Kong

    *Authors contributed equally

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