South-East Asian Journal of Medical Education

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Integration in Medical Colleges; Can Role of Basic Sciences be Minimized.
(South East Asia Regional Association for Medical Education., 2014-12) Iqbal, K; Rahim, A
Efficacy of Multimedia Set on Acquisition Clinical Skills, Views of Medical Students in UMS.
(South East Asia Regional Association for Medical Education., 2014-12) Sefein, M F; Naing, D K S; D‟Souza, U J A
Undergraduate training in Ear, Nose and Throat (ENT) surgery is often challenged by the short posting and limited patient contact. Multimedia is an useful tool in medical education to enhance clinical skills training. However, there is limited research on the development of such tools. We describe the development of an innovative multimedia set, where Mayer‘s principles for designing multimedia were followed in preparing an interactive CD-ROM. The developed set integrated basic sciences and clinical applications. The views of a sample of fourth year medical students and general practitioners were explored about the usefulness of this developed multimedia in facilitating the acquisition of clinical skills. The instructor led the live demonstration for the clinical examination. Then, students interacted with the multimedia set in a ratio of 4 students to 1 computer. Immediately afterwards, they practiced the technique of clinical examination of the nose. End of the session feedback revealed that most of the students found the innovative set had simplified the difficult techniques and rated it very good to excellent. Shortcomings in producing a perfect media tool are related to unavailability of media professionals in the institute. However, the prototype product was found effective in acquisition clinical skills and enhancing cognitive outcome. The continuous development of multimedia materials will improve the skills of the crew and the quality of the multimedia product.
Communication Skills Appropriate to Context: Our Approach to Meeting the Training Needs of Interns.
(South East Asia Regional Association for Medical Education., 2014-12) Rahim, A A; Govindaraj, G M; Thekkekara, R J; Anitha, P M; Laila, K V
Objectives: To identify the core competency areas for teaching and training interns in communication skills followed by evaluating effectiveness of the training subjectively, based on student perception. Methods: At the outset we identified five key areas where doctors faced difficulty in communication in their routine clinical practice. This was followed by a two day training programme to 160 interns consisting of videos, hand-outs, lectures and role plays with emphasis on deliberate practice of skills. At the end of the training, Intern‘s perception about the effectiveness of the programme and their selfperceived improvement in skills were assessed. Results: The core competency areas listed by the doctors were: breaking bad news; dealing with a parent resistant to immunisation; communicating with the distressed patient and irritated bystander in casualty, explaining risks and procedures; and dealing with a patient with psychosomatic complaints. Interns responses to the training methodology based on the core competencies were overwhelming with 91% rating the training as effective. Role play was the most appreciated learning technique. Increased self-perceived immediate improvement in Communication skills was reported by 85% of Interns. Conclusions: This exercise has helped us identify the key areas to be focused in communication skills training for interns in our setting, as well as design appropriate teaching learning methods to achieve the objectives. A systematic approach in developing a teaching-learning methodology stressing on the content and process of communication skills training relevant to the local context using a mix of experiential problem based and didactic methods should be stressed while framing a communication skill curriculum.
Learning to be the Patients’ Advocates: Evaluation of an Evidence-Based Communication Skills Course.
(South East Asia Regional Association for Medical Education., 2014-12) Susilo, Astrid Pratidina; Claramita, Mora; Dalen, Jan van; Scherpbier, Albert
Introduction: A communication skills course to prepare nurses for their roles as patient advocates in the informed consent process was developed based on evidence from education and healthcare research, mostly from Western literature, tailored with evidence from the local context in South-East Asia. This study aimed to evaluate the course and to investigate factors influencing the application of the skills in the real setting. Methods: This was a mixed method study. Subjects were 32 participants who were ‗champions‘ (opinion leaders) at their home institutions. We used a questionnaire to measure the participants‘ reactions, pre/post/follow-up test to measure knowledge, and Focus Group Discussions (FGDs) to investigate the transfer and impact of the course. Results: Participants perceived the course to be helpful for learning. The post test showed increased knowledge and the follow up test indicated retention. FGDs showed participants‘ approaches to apply the skills in the informed consent process and different areas of practice. Factors influencing implementation were similar to previous studies. Conclusions: Despite strong contextual factors, a well-designed course underpinned with evidence can contribute to the desired improvement. Application of evidence from Western literature in South- East Asia should be tailored to the local context. A thorough needs assessment is necessary to explore the context.
Survey of Factors that Influence Doctors’ Selection of Anaesthesiology as Professional Specialty and Opinion Regarding Being Anaesthesiologists.
(South East Asia Regional Association for Medical Education., 2014-12) Charuluxananan, S; Chatrkaw, P; Rodanant, O; Tuchinda, L; Somboonwiboon W, L
Objectives: The aims of the present study were to survey reasons regarding choosing Anaesthesiology as professional specialty and evaluate perception regarding being anaesthesiologists. Methods: This cross sectional, multi-institutional study anonymously surveyed first year Anaesthesiology residents in resident training centres in Bangkok who came for the first inter-hospital lectures at Department of Anaesthesiology, Faculty of Medicine, Chulalongkorn University in July, 2012. A structured questionnaire comprising of demographic data, reasons for choosing anaesthesiology, and attitude regarding anaesthesiologists was filled in and returned before beginning of lectures. Results: All 50 anaesthesia residents who attended the inter-hospital lectures responded; 40 residents (80%) were female. By selecting three preferred choices, the respondents stated reasons for choosing Anaesthesiology were as follows: 1) Responsibility of patient on case by case basis 38 (76%); 2) Impression of anaesthesiologist as a role model 17 (34%); 3) Career characteristic of both knowledge and skill 16 (32%); 4) Limited number of patients under responsibility 15 (30%); 5) Not too frequent communication 14 (28%). In the respondents‘ view point, disadvantages of being anaesthesiologist were high chance of being legally sued (74%) and contact with blood and/or body fluids (60%). Characteristics of good anaesthesiologists were identified as the ability to make decisions during critical events (86%), high responsibility (62%), ability to obtain patients‘ data for adjusting of anaesthesia care (46%) and knowledge of own limitations and capacity (46%). Conclusion: Career characteristics favouring controllable lifestyle such as responsibility of patients on case by case basis, identification of the anaesthesiologist as a role model and professional ability of both knowledge and skills were features that residents found most attractive.
The Correlation between Written and Practical Assessments of Communication Skills among the First Year Medical Students.
(South East Asia Regional Association for Medical Education., 2014-12) Sari, S M; Rahayu, G R; Prabandari, Y
Background: Communication is a core clinical skill that is essential for clinical competence. Practical assessments, such as Objective Structured Clinical Examinations (OSCEs) commonly assess communication skills among undergraduates; however organizing an OSCE is an expensive and complex process. Faculty of Medicine Unjani University uses essay format tests in communication skills assessments of the first year communication block. The evidence of written assessment in communication skills is still very limited. Objective: To study the correlation between written and practical assessments of communication skills among the first year medical students; to study the validity and reliability of written assessments to assess communication skills. Methods: A cross sectional study was conducted among the first year students in the Faculty of Medicine, Unjani University. At the end of the communication block, students faced a written assessment comprised of Modified Essay Questions (MEQ) and a practical assessment in one station with a simulated patient where the performance at the station was videotaped. There were two examiners for each assessment. Result: Kappa coefficient for inter-rater reliability of MEQ was 0.707 and practical assessment was 0.735. The correlation coefficient between written and practical assessments from the two examiners ranged between 0.063 – 0.127, n=120, p>0.01. On the item level, correlation coefficient in building initial rapport was -0,067, identifying the reason(s) for consultation was 0.030 and gathering information was 0.107. This result showed a low concurrent validity of the written test in assessing communication skills. Conclusion: Written assessments cannot predict the students‘ communication skills competence. Written assessments have a high reliability, nevertheless they have a low validity to assess communication skills.
Evaluation of Small Group Discussion as a Teaching- Learning Method in Biochemistry for First Year MBBS Students: A Pilot Study.
(South East Asia Regional Association for Medical Education., 2014-12) Wilma, D S C R; Suresh, D R; Chandrakala, M V
Background: Significance of Small Group Discussion as a teaching learning method is yet to be explored in teaching Biochemistry for medical students in India. Hence, this experimental pilot study was undertaken to assess the effectiveness of small group discussion for first year MBBS students in learning Biochemistry. Materials and Methods: A voluntary group of 40 first year MBBS students were chosen randomly for the study comprising of both high achievers and low achievers. Study was conducted on a particular day for five consecutive weeks. In each session, small group discussion study pattern included a pretest followed by group discussion then by a post-test. Participants‘ feedback was obtained after completion of the study. Statistical comparisons were done on each PAIR (pre-test and post-test) of Mean scores obtained and Pearson‘s correlation co-efficient were calculated for each pair. Statistical significance was obtained at p<0.05. Results: Mean post-test scores were increased compared to mean pre-test scores in each PAIR and the increase was statistically significant. Significant positive correlations were observed between pretest scores and post-test scores in all PAIRS. Majority of the study group felt that small group discussion method will enhance their learning and memory. Conclusion: This pilot study emphasizes that small group teaching is an effective teaching learning method to develop the student‘s critical thinking and problem-solving skills. However, larger studies at several medical colleges for a longer duration have to be undertaken before arriving at a conclusion.
Models of Physiotherapy Clinical Education in South-West Nigeria.
(South East Asia Regional Association for Medical Education., 2014-12) Odole, A C; Oladoyinbo, O T
Background: Clinical education is an essential component of physiotherapy education programs worldwide. Different models of providing clinical education exist all over the world. It appears that there is no published literature on the models of clinical education used in the training of physiotherapy undergraduates in Nigeria. Aim: The study investigated the models of physiotherapy clinical education in South West Nigeria. Methods: Seventy four (45 males, 29 females) physiotherapy educators participated in this crosssectional population-based survey. They were recruited from the three university institutions in South- West Nigeria that run physiotherapy programs and their associated teaching hospitals. A selfdeveloped, validated questionnaire was used to solicit information on the models of clinical education being used in undergraduate physiotherapy training in South Western Nigeria. Data was analysed using descriptive statistics of mean, standard deviation and percentages. Results: Participants were aged 38±7 years. 53 (71%) participants had postgraduate qualifications. 22 (29.7%) participants reported that they had received formal training in clinical education prior to this study. Over half of the participants (40, 54.1%) reported the shared responsibility model (both clinician and lecturer based) to be the most commonly used model of clinical education. The least reported (8.1%) model was the designated clinical educator model (clinician based). Conclusion: It can be concluded from this study that the most commonly reported model of clinical education is the shared responsibility model (both clinician and lecturer based). The development of a standardized model of physiotherapy clinical education is recommended. Training programmes should be organized for physiotherapy educators on clinical education.
Development and Assessment of an Online Computer- Assisted Instruction Method.
(South East Asia Regional Association for Medical Education., 2014-12) Vichitvejpaisal, P; Panjamawat, T; Varasunun, P; Apidechakul, P; Kraiprasit, K; Chainchop, P
Objectives: The purposes of this study were to develop an online computer-assisted instruction method and assess its efficiency in terms of propriety, feasibility, accuracy and utility standards. Method: The sample consisted of third-year medical students and critical care nurses, who volunteered to join the study. Research tools included online activities and student assessments, open-ended questionnaires and students' record profiles. Data was analysed using the percentage, mean, standard deviation, correlation coefficient and t-test. Results: A total of 83 out of 116 third-year medical students (71.55%) and 35 out of 56 critical care nurses (62.50%) registered through the website, and completed the learning courseware. Results of the system efficiency assessment through the tests and open-ended questionnaires showed that it was highly appropriate for use in communicating for learning; it was also found that the system was highly feasible in stimulating learners to continuously plan for self-directed learning and for system accuracy. It appeared that the system had objectivity, construct validity, concurrent validity, and internal reliability; and for system utility, it was found that learners gained high learning achievement and growth scores. Online record profiles revealed that 63 medical students and 35 nurses appreciated the significance of the developed online learning system as fair to full. Conclusion: The online computer-assisted instruction method was highly efficient. Through selfdirected learning, the students were stimulated to apply problem-solving strategies, individual help seeking strategies, and self-regulation, as well as develop critical thinking with discretion for selfassessment and continue learning with a sense of self-actualization and self-esteem.
Towards Better Understanding of Medical Students: Learning Styles of Preclinical and Clinical Medical Students.
(South East Asia Regional Association for Medical Education., 2014-12) Khalil, Marwa M; Ahmed, Mohamed Galal Al Din; Gawish, Shefaa M
Introduction: Medical students represent a broad spectrum of diversity that presents a challenge for instructors to meet their educational needs. Four sensory modalities of learning have been described: visual, auditory, read-write, and kinaesthetic (VARK). In order to strengthen students' non preferred learning styles, their preferred styles must be identified. This study aims at understanding the learning styles of medical students in order to develop appropriate learning approaches. Materials and methods: The English version of the VARK questionnaire was distributed to preclinical and clinical students. Students were classified into Uni-, Bi-, Tri- or Quadri-modal. Results: There were statistically significant differences between preclinical and clinical students in the means of different VARK styles. The Quadri-modal preference (VARK) was the most preferred followed by Kinaesthetic. The most common in bimodal was Auditory-Kinaesthetic while in tri-modal Auditory-Read-Kinaesthetic and Visual-Auditory-Kinaesthetic. There were statistically significant differences between Preclinical and Clinical students in (Visual-Read) preference and (Auditory-Read-Kinaesthetic) and (Visual-Auditory-Kinaesthetic) preferences. Conclusion: A hypothesis that medical students had higher preference for Kinaesthetic learning compared to average students, was confirmed in this study. Further studies are recommended to investigate the correlation between different learning styles and performance of students in different types of exams.
Learning Style Preferences: A Comparison between Students of an Indian and a Malaysian Medical School.
(South East Asia Regional Association for Medical Education., 2014-12) Heethal, J P; Sahana, G N; Ghosh, S; Chitra, G
Background: Students have different levels of motivation, attitudes about teaching-learning and responses to specific environments. The more the instructors understand the differences, better the chance they have of meeting the diverse learning needs of all their students. This study aims to analyze the learning preferences among students of an Indian and a Malaysian medical school. Methods: The study was conducted among the 2nd year medical students from an Indian medical school (group 1, n=91) and a Malaysian medical school (group 2, n=100). After obtaining informed consent, the students were instructed to fill ―the index of learning styles questionnaire‖ by Felder and Solomon. The questionnaire assesses preferences on four dimensions: processing (active/reflective), perception (sensing/intuitive), input (visual/verbal) and understanding (sequential/global). The data obtained was analyzed using descriptive statistics. Results: In group 1, 56 students were female and 35 male, and in group 2, 61 were female and 39 male. In both groups we found that active learners were common in processing, sensing learners in perception, visual in input and sequential in understanding. The comparison in the learning style between both groups revealed that active learners were more in group 2 (64%), reflective in group 1 (42%), sensing in group 2 (64%), intuitive in group 2 (37%), verbal in group 2 (26%), visual in group 1 (80%), sequential in group 2 (68%) and global in group 1(42%). Conclusion: It is recommended that educators take learning style preferences of medical students into consideration so that teaching-learning methods are designed to suit the learning styles of all or most of the students.
Setting an Agenda for Collaborative Research in Medical Education in Indonesia.
(South East Asia Regional Association for Medical Education., 2014-12) Widyahening, Indah Suci; Muthmainah; Yulistini; Laksmi, Purwita Wijaya; Simadibrata, Marcellus
Introduction: Collaborative research in medical education has been proposed as part of the education collaboration activities among three medical faculties (Universitas Indonesia, Universitas Sebelas Maret and Universitas Andalas) under ―Development of Medical Education and Research Centres and Two University Hospitals Project in Indonesia‖. This paper describes the development of medical education research priorities among three medical schools with consideration of different resources and capabilities in the three settings. Methods: A two-day working group meeting held in October 2011 was attended by representatives of the three medical schools and the Directorate of Higher Education of the Indonesian Ministry of Education and Culture. Participants were divided into two groups to develop a list of research areas and topic priorities. A rating system was employed to select the most prioritized topics among those listed. Each participant was then asked to score each topic according to pre-determined criteria. Results: The first five research priorities in medical education were (1) learning environment, (2) Evidence Based Practice (EBP) in medical education, (3) medical education and patient safety, (4) students assessment in clinical stage, and (5) involvement of residents in clinical teaching. Conclusion: Through a listing and scoring process, collaborative research priorities for three medical schools have been established. The research priorities were set considering the availability of resources in the three medical schools and also other factors (national importance, contribution toward academic hospital development and collaboration program).
Compulsory Rural Service – A Step Towards Achieving Universal Health Coverage.
(South East Asia Regional Association for Medical Education., 2014-12) Sangale, S; Sankhe, L; Rajguru, C; Zodpey, S
Universal Health Coverage is being adopted on a larger dimension globally. One of the important components for effective implementation of Universal Health Coverage is adequately trained human resources at every level of healthcare. The production and retention of trained human resources is a huge on-going challenge. Several state governments in India have devised a strategy of compulsory rural posting for undergraduates and postgraduates from government institutes, ensuring the availability of medical professionals in rural and tribal areas. The present study was planned with the objective of assessing the understanding of postgraduate and super speciality course students regarding the compulsory rural posting against a financial bond, and evaluate the factors influencing the completion of the bond. The aim was to provide suggestions to improve the compliance towards compulsory rural posting. The study revealed that increased duration of the medical course due to inclusion of bond, career pathway being unclear, lack of incentives in the form of increased salary or extra marks during postgraduate admission, effect on pursuing higher studies, social and personal life were major deterrents in completion of the compulsory rural posting. We also propose measures such as educational reforms, policy level reforms and consideration of social issues so as to make the implementation of this strategy a successful model in taking Universal Health Coverage forward.
The Importance of Teaching and Assessing Communication Skills in Medical Education.
(2014-12) Karunathilake, Indika
Kaleidoscope: Bridging the visual gaps between terminologies and their implications in Investigative Medicine.
(South East Asia Regional Association for Medical Education., 2014-06) Akhilesh, Meenakshi; Shaik, Imam; Bradley, Philip M
Student-Led Seminars as a teaching-learning method- effectiveness of a modified format.
(South East Asia Regional Association for Medical Education., 2014-06) Gomathi, Kadayam Guruswami; Shaafie, Ishtiyaq Ahmed; Venkatramana, Manda
Background and objectives: Student-led seminars (SLS) are being used as a teaching-learning method for undergraduate medical students in the Gulf Medical University, Ajman. Student feedback, however, ranked SLS as a poor teaching-learning method. Objectives were to assess effectiveness of a modified format for student-led seminars in the undergraduate medical curriculum. Methods: SLS was modified into a presentation followed by a quiz, to make it more interactive and student centred. The new format was implemented midway in the academic year. Student perceptions regarding SLS sessions were surveyed using an anonymous questionnaire and scored using a likert-like scale. Statistical significance (p < 0.05) was tested using the Wilcoxon signed ranked test using the SPSS19 software. Results: The new format was reported to be significantly more interesting, interactive, fun and made them feel more like a team. High number of students reported ―gained new knowledge‖, ―enjoyed learning through seminars‖, ―learnt new things from my colleagues in the seminar group‖ and ―enjoyed working with my colleagues for my seminar‖. Scores for ―improvement in communication skills‖, ―learnt to make a formal scientific presentation‖ and ―gained self-confidence after presenting the seminar‖ were also high. Conclusions: Since the main use of SLS as a teaching-learning method in Gulf Medical University, Ajman is to inculcate self-learning, peer-learning, teamwork and communication skills, the new format is significantly better at achieving the outcomes.
Effectiveness of Small Group Discussion Sessions in Teaching Biochemistry for Undergraduate Medical Students.
(South East Asia Regional Association for Medical Education., 2014-06) Hadimani, Chetana P
Background: Group discussions are at the centre of medical education as students learn more efficiently by small group discussions. Small group discussion (SGD) session as an instructional method is included in the curriculum of USM-KLE International medical program. The purpose of this paper is to depict student‘s perceptions in learning biochemistry through SGD, aimed at continuous medical educational development and will also be useful in other medical curriculum. Methods: The study was conducted for first year undergraduate medical students of USM-KLE International medical program. An anonymous questionnaire was given to the group to elicit their perceptions about SGD. Forty students participated. The responses were obtained on a Likert scale to indicate their degree of agreement with the statements in the questionnaire. Results: Analysis showed that 62.5% students strongly agreed that by virtue of the SGD sessions understanding of the subject was better. 55% students strongly agreed that SGD facilitated active learning. However, 37.5% students strongly agreed that SGD sessions facilitated promoting clinical reasoning and communication skills. 65% students strongly agreed that SGD sessions enabled them to correlate biochemical concepts in context of a medical problem. Conclusion: In order to overcome the limitations of only lectures in a basic science subject, inclusion of an active teaching-learning SGD session facilitated students in better understanding of the subject, ability to apply biochemical principles to clinical cases and development of communication skills.
A Lecture in Medical Physiology- PowerPoint versus Chalkboard.
(South East Asia Regional Association for Medical Education., 2014-06) Prabhu, Rekha; Pai, Kirtana M; Prabhu, Girish; Shrilatha
Background and objectives: Various teaching methodologies have been utilized in medical education, chalk board once was a staple of classrooms, but PowerPoints are now standard in most medical schools. Objectives were a) to understand the student perspective on the use of different teaching modes in Medical Physiology b) to rate the effectiveness of lectures by different modes of teaching. Method: A lecture in physiology was delivered to two batches of First year of Bachelor of Medicine and Bachelor of surgery (I MBBS) students. For one batch of students the lecture was delivered using PowerPoint, for the second batch of students, the same content was taught using a chalk board. A multiple choice question examination was conducted before (Pre-test) and after (Post-test) delivering the lecture. The students were given a questionnaire to choose between the chalkboard (CB) or PowerPoint (PPT) method for the various attributes. Results: It was observed that students scored better in the post-test examination, and no significant difference in score was seen between PowerPoint or chalkboard. According to the students, the attributes ―clarity of words‖ (67%), ―stress on important points‖ (52%) and ―summarizations‖ (80%) were best dealt with PowerPoint and chalk board based lectures gave better ―clarity of concepts‖ (71%), ―learning to draw diagrams‖ (67%), ―better understanding of the subject‖ (59%), ―easier note taking‖ (55%). The preferred method for delivering lectures was CB (51%). Conclusion: Lectures could be improved by utilizing a combination of both chalkboard and PowerPoint, as they each have their own advantages.
Which Model is the Best Predictor of Learning Achievement: Raw Score, Relative Growth or Knowledge Retention Score.
(South East Asia Regional Association for Medical Education., 2014-06) Vichitvejpaisal, Phongthara; Panjamawat, Tippawan; Varasunun, Pinda
Objective: To verify the student learning performance using the raw score, relative growth score and knowledge retention score. Methods: Thirty-two nurse anesthetist students in academic years 2011-12, Faculty of Medicine, Siriraj Hospital, Mahidol University, volunteered to participate. After pretest, they studied the designated subject via a website. After 3 weeks, the system was locked and students underwent the post-test. The final1 and final2 test were held in a classroom without prior notice. The post and final1 test as well as the final1 and final2 test took place exactly 4 weeks apart. The difference scores between pre and post-test, pre and final1 test, as well as pre and final2 test were calculated for relative growth score G1, G2 and G3 respectively. Thus the differences between G1 and G2 as well as G1 and G3 were determined as knowledge retention score R1 and R2 respectively. Results: The post, final1 and final2 test scores were significantly higher than the pretest one significantly. However, the post, final1 and final2 test scores showed no statistical difference. Though G2 and G3 appeared to decrease as compared to G1, they were not significant. The R2 showed higher than R1 without significant difference; however, they showed a strong correlation to each other (r = .69) Conclusion: The knowledge retention score was the best prediction on academic gains.
Blended Learning in Emergency Medicine: Implementing the E-Learning component.
(South East Asia Regional Association for Medical Education., 2014-06) Lateet, Fatimah
Blended learning (BL) refers to the combination of approaches to learning and teaching using a variety of delivery modes. It is playing an increasingly prominent role in medical education. Its strategy includes the combination of traditional face to face learning with e-learning, multimedia videos, online discussions and computer-based assessments. This paper discusses the steps undertaken in implementing an e-learning model through the utilization of a Blackboard system. The phases involved in the implementation include: 1) Training and Familiarisation: introductory learning session with hands-on trial and explanation of the system and its capabilities; 2) Deepening Understanding: formal training with real time trials and demonstration, as well as more complex problem handling; 3) Feedback: trainees and supervisors present and share experience of using the system and how to improve/ enhance it; 4) Assimilation and integration: final stage where knowledge and skills learnt are blended into clinical applications in daily practice. In combining e-learning with other forms of learning under the umbrella of BL, there could be a notable shift from a teacher-oriented model to an active learner- centred one. The whole process emphasizes active learning, with collaboration between learners and supervisors, for the eventual delivery of best clinical care to patients.

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