The impact of good assessment in medical education depends on how appropriately the tools measure the clinical performance and how reliable, valid and feasible they are to achieve the logical decision. The traditional methods of clinical examination using long and short cases and orals are often argued for its subjectivity, low reliability and inadequate context specificity. Oral test though comparatively more valid due to its face-to-face questions are considered less reliable for problems of unstandardized questions, inconsistent marking and lack of sufficient testing time. Development of an “objective structured clinical examination” (OSCE) was sought as a solution to these problems. But the fragmented representation of the context in a number of stations in OSCE makes it less authentic for an integrated judgment of performance. Yet another method to thought of, was the workplace-based assessment (WPBA) but it takes a snapshot as a predefined attribute of a more complex integrated assessment such as long case. However due to the problem of feasibility it is less likely that high stakes examination as summative assessment will ever be able to attain workplace-based assessment such as Mini-CEX and DOPS. A TOACS (task oriented assessment of clinical skills) format currently used in high stakes fellowship examination in one of the center and claimed to have more active role for examiners was analyzed and compared with OSCE. Author however, did not find a difference except the difference of acronyms of the two formats. Both have multiple, fragmented static or interactive stations of 5-10 minutes duration with or without examiners, patients or exhibits and a marking scheme comprising of checklist or global rating. In the backdrop of this context a new assessment format named the ‘task integrated objective structured clinical examination” or TIOSCE modified from OSCE is currently developed in School of Medical Sciences (SMS) at USM. However, it is a different version of OSCE in which though the principle concept is the same as that of an OSCE, the continuum of clinical skill’s work up of the same patient’s is followed through to test multiple short attributes of clinical competences. As it retains most of the favorable features, TIOSCE also addresses some of the odds features of OSCE.
Introduction: This study explores the health status of injured workers in return to work (RTW) programs based on their ability and capacity. Injured workers were diagnosed with work-related musculoskeletal disorders. The findings will help not only the service provider plan a specific strategy but also allow stakeholders to review their role in the RTW program.
Methods: 102 participants were chosen from a national RTW program, and categorized into three groups based on different phases of the RTW program: off-work (n=30, 29.4%), work re-entry (n=44, 43.1%) and maintenance (n=28, 27.5%). Self-report questionnaires identified demographic data, health surveillance via SF-36 and perceived physical and psychological workload by 10-point numerical scales. Analysis of variance (ANOVA) and Kruskal-Wallis Test was employed to examine the differences in three phases of the RTW program. Paired t-test analyzed the differences of related samples of physical and psychological workload before and after injuries.
Results: The domains of health status are below the average compared to the norm-based population. Mental health component summary is better than physical health. At the domain level, there are significant differences among injured workers, specifically in the three RTW program phases. The SF-36 domains are: role-physical, vitality, bodily-pain, general health, and mental health (p ! 0.049). In contrast, non-significant differences were found in physical and social functioning, and role of emotion status. Moreover, their self-perceived physical and psychological work-load significantly worsened after injuries (p ! 0.020).
Conclusions: The case manager-coordinated RTW program provided further opportunities to improve injured workers’ health status when looking at their differences for different phases of RTW. Other health professionals like occupational therapists, ergonomists and psychologists should become involved in the RTW program. Specific guidelines and regulations have to be implemented to ensure full participation with all parties in the workplace.
Low back pain (LBP) is a major medical and social problem associated with disability and work absenteeism. Since the effect on unawareness on back care among hospital staff may affect the smooth running of the services to the public and patients, it is the objective of this study to identified the awareness of back care among nurses so that preventive measures can be taken. About 80 nurses working in the outpatient clinic was survey using self addressed questionnaires which were adapted from Zutphen Physical Activity Questionnaire at Queen Elizabeth Hospital, Kota Kinabalu. Demographic analysis demonstrated that among the eighty nurses that responded, 37.5% (n=30) are Malays, 25% (n=25) Chinese and 37.5% (n=30) ( to include other Sabahan tribes). Their age group varies between 23 to 55 years of age. A total of 72 nurses, both agreed (45%,n=36) and strongly agreed (45%,n=36) that understanding good postures is important to prevent LBP. They felt strongly (55%, n=44) about the importance of correct lifting techniques, and having a well-designed workplace (50%,n=40). Regarding factors that cause LBP, 55% (n=44) of them strongly agreed that good lifting technique can prevent LBP while 56 (70%) agreed that prolong sitting doing computer work can cause LBP. About 60% (n=48) also agreed that LBP can cause stress and that 45% (n=36) of them strongly agreed that being overweight than average can worsen LBP. However, 40% (n=32) provide a neutral answer to whether height have any influence on LBP while 50% (n=40) agreed that weak back muscles can worsen the backache further. However, 45% (n=36) agreed that games that involved back movement have high risks and 55% (n=44) agreed that swimming helps to strengthen back muscle. The environmental factors addresses issues of footwear and soft mattress where 60%(n=48) agreed while 15%(n=12) strongly agreed that good footware and appropriate use of soft mattresses 60% (n=48) can prevent LBP. This study have demonstrated that the nurses that participated had a clear understanding and knowledge on back care even though a wider study need to be carried out to ensure validity of study finding.
Study site:outpatient clinic, Queen Elizabeth Hospital, Kota Kinabalu
Stress in the work place is a global major risk factor to worker’s health, which triggers the workers to be poorly motivated and less productive. Objectives: The objective of the study was to determine the prevalence of job stress and its associated factors among Universiti Putra Malaysia staff. Methods: This is a cross sectional study involving 511 academic and non-academic staff of Universiti Putra Malaysia in Serdang. Probability proportionate to size was used for calculating the required sample size. Results: The overall prevalence of stress was 21.7% (21.0% among male and 23.0% among female). The variables found to be significantly associated with stress were: Job demand, coworker support, depression, anxiety, focus and venting of emotion and self-blame (p
Acoustics issues such as noise in the workplace remains one of the most prevalence occupational hazard especially in
the manufacturing industry with heavy machineries. Increasing mechanization in all industries and most trades has
since proliferated the noise problem. In Malaysia, much has been studied and is known about the auditory effects of
noise. However less attention has been given to the non-auditory effects of noise such as annoyance, stress, and work
performance, and concern about such effects is a relatively recent phenomenon. In view of this, this study aims to
determine the level of noise from different type of machines and tools in a manufacturing plant and also the effects
of noise to the employees. A structured questionnaire was used to assess the effects of noise on the workers and
sound level meter was used to measure the noise level at selected work areas. The results of this study showed that
nearly all the identified work areas exceeded the action level of 85 dB(A) and four of these areas noise levels’ are
more than 90 dB(A) which is the permissible exposure limit according to the Factories and Machinery (Noise
Exposure) Regulations 1989. For the questionnaire, it was found that annoyance topped the noise effects list with
51.4%, followed by stress with 40.0%, hearing deterioration (14.3%) and job performance deterioration (2.9%). As a
conclusion, noise control or preventive measures are suggested in order to minimize the health risks from noise
exposure.
Background: Level of comfort in working environment can contribute to increase level of health, emotion during working, level of safety, quality and productivity of work. A study of physical factors (heat, noise and lighting) is important to determine the level of comfort during working. This study was carried out to study those physical factors upon comfort level during working among Casting Shop workers in a car manufacturing factory.
Methods: Instruments for the physical monitoring including Questemp°36 Thermal Environment Monitor, Sound Level Meter and Lux Meter were used at seven measured areas. The information about the level of comfort during working was collected using questionnaires among 65 respondents by random sampling method.
Results: Measured data showed there were four measured areas which Wet Bulb Globe Temperature indoor (WBGTi) value are above the standard limit recommended by ACGIH, three measured areas recorded noise level above the standard limit recommended by Factories and Machineries (Noise Exposure) 1989, while there was no measured area recorded lighting reading below the standard limit recommended by MS ISO 8995:2005. Result from questionnaire found that the majority of the workers did not feel comfortable towards the heat and noise level in their workplace while most of the respondents felt comfortable towards lighting level in their workplace. Mean of WBGTi reading and lighting reading have a significant difference (p
Introduction: Exposure to excessive noise is the major avoidable cause of permanent hearing impairment. Sawmill is one of the workplaces where workers are exposed to hazardous noise level. This study was conducted to determine the reliability and validity of noise-induced hearing loss questionnaire among sawmill workers. Materials and Methods: This cross sectional study was conducted in March 2007 among 35 consented sawmill workers. A total of 40 items; 10 items for knowledge (8 areas), 20 items for attitude (7 areas) and 10 items for practice (2 areas) were assessed. Statistical analysis for reliability analysis was test by internal consistency and construct validity by exploratory factor analysis using principal components and Varimax rotation method. Results: Cronbach’s alpha coeffi cients were acceptable for attitude (0.90) and practice
(0.75). However, it was low for knowledge (0.67). Exploratory factor analysis showed three meaningful exploratory factors that could explain the three dimensions in the questionnaire. Conclusion: The results of the validation study suggested that the noise-induced hearing loss questionnaire is reliable and valid tool for assessing knowledge, attitude and practice among sawmill workers.
This two-phase study examined the prevalence of depressive disorders among married working women in a sub-urban area in Malaysia. The Malay version of the General Health Questionnaire-12 (GHQ-12) was used for initial screening. Using multistage cluster sampling, there were 700 subjects from 25 workplaces that were approached, of which 307 filled out GHQ-12 in the initial phase. The prevalence of psychological distress (GHQ 2/3 cut off) is 22.8% (n=70, 95% CI 18.1-27.5). In the second phase, all 49 consenting patients who were screened positive for severe psychological distress (GHQ 3/4 cut off point) were telephone-interviewed by a trained psychiatrist with the Malay version of Mini International Neuropsychiatric Interview (M.I.N.I) to diagnose depressive disorders. The prevalence of depressive disorders was 5.5% (n=17, 95% CI 3.5-7.5). The prevalence of depressive disorders is comparable to those found in the working population worldwide.
Background: In order to achieve the desired performance of graduates a number of traditional evaluation exercises have been practiced to assess their competence as medical students. Many of these assessments are done in a controlled environment and mostly reflect on tests of competence than performance. Mini-CEX or direct observed procedural skills (DOPS) are the real performance-based assessment of clinical skills. Increased opportunity for observation and just-in-time feedback from the role model superiors produce a positive educational impact on students learning. This also provides trainees with formative assessment to monitor their learning objectives. However, to implement assessment strategies with Mini-CEX or DOPS needs to develop institution’s clear policy for a different teaching and learning culture of workplace based assessment. It also needs to develop user friendly rating form, checklist, elaboration of clinical competence and its attributes and procedural guidelines for practice. A precise role of these tools in the assessment of postgraduate program must be established before practicing them to evaluate and monitor trainee’s progress.
Objective: To determine DOPS for its acceptability and feasibility as a method of formative assessment of clinical skills in postgraduate program of Otolaryngology and Head-Neck Surgery.
Method: A total of 25 trainees were assessed for DOPS by 8 supervisors in this 12-weeks pilot study. A faculty development program for faculty members and trainees was run for DOPS. Trainees were advised to undertake at least one DOPS encounter out of 42 shortlisted procedures. Assessors were asked to mark trainees by completing a rating form using a checklist developed for each procedure. Trainees and assessors were asked to endorse their opinion on feasibility and acceptance of DOPS for practice of formative assessment in future. Data was analyzed to determine feasibility and acceptability of DOPS in assessment program. Result: Faculty development and trainees orientation in DOPS were found satisfactory for its acceptance and feasible for its practice. Trainees were mostly assessed in outpatient clinical setting. Majority reported higher rating of satisfaction by assessors and trainees. Among clinical skills higher rating was received in procedural skills performed by the senior trainees. Conclusion: DOPS was found feasible for practice of formative assessment of trainees in postgraduate program of Otolaryngology and Head-Neck Surgery in School of Medical Sciences (SMS) at Universiti Sains Malaysia (USM). It was well accepted by the trainees to help monitor their quality of procedural skills as self-directed learning.
Employee satnfaction surveys can provide the information needed to improved levek of productivity, job and loyalty. Management can identify the factors of job issues and provide solutions to improve the working environment. A cross sectional descriptive study on employee satisfaction among a health care district office’s staff was conducted in Perak in March - April 2006. A total of 19 staff were randomly picked and interviewed in the data collection process. Almost all understand the objectives of the administration unit (94%) and were satisfied with the management leadership’s style (78%- l 00%) . Majority agreed that their relationship with immediate superior and within the group was harmonious and professional (89%) and they preferred an open problem solving method in handling conflict (72 %). The most common type of incentive rewarded by the administration to express gratitude to their staff was certificate (56%); bonus and medal (33%); and informal gesture (28%). Majority (83%) were also satisfied by the method used to disseminate the information in their units. Majority agreed that the working environment in the administration unit were conducive (72%), their ideas were equally considered during decision making sessions (89%) and training opportunities were similarly given to them by the management (72%). This study revealed that employee satisfaction was determined by several factors such as management leadership's style, opportunity to contribute skills and idea; reward and incentive; and conducive king environment.
Objective: To assess the prevalence of iron deficiency, anaemia and iron deficiency anaemia (IDA) in women aged 20-40 years and its association with iron intake. Methods: A total of 388 women were recruited from universities and work sites in Kuala Lumpur and its suburbs. The subjects comprised 135 Malays, 130 Chinese and 123 Indians. Dietary intake was estimated using a single 24-hour food recall and a semi-quantitative food frequency questionnaire. Haemoglobin (Hb), haematocrit (hct), mean corpuscular volume (MCV) and serum ferritin were determined. Results: The prevalence of anaemia (Hb
Occupational stress exists in all professions, but the nursing profession appears to experience more stress at work compared to other health care workers. Stressful conditions at the workplace may cause the high turnover and burnout among nurses. This study objective was to determine the level of stress and its associated factors among in-patient ward nurses. A cross sectional study using the stratified random sampling method was carried out among 114 staff nurses from 5 different departments in a public hospital in Kuala Lumpur. Respondents were requested to complete a single set of validated and self-administered questionnaire, the Depression, Anxiety, Stress Scale (DASS) . Data was analysed using SPSS 17. In general, the prevalence of stress at the department of Medicine was found to be higher compared to other departments studied. There was also a statistical significant relationship between the prevalence of stress and types of department (p 0.05). In conclusion, stress had no significant association with sociodemographic factors (age, marital status and financial status) and working environment except for type of department nurses work in. There might be some other possible confounders that have a bigger potential in becoming stressors compared to those independent variables in this study.
A cross sectional study on work stress prevalence was carried out among 185 executives and managers in the head quarter of an international tobacco company. The aim of the study was to identify work stress prevalence in this company and work stressors that were associated with stress experienced by the workers. A questionnaire based on the Personal Stress Inventory by O'Donell (1984) was used. Data collected from participants included sociodemography factors, symptoms of stress and work stressors related to organizational policy, organizational structure, organizational process, and work environment. The study showed that the prevalence of stress among executives was 68.1% and managers were 67.9%. There was no significant difference in the level of stress between the executives and the managers in the company. The sociodemographic factors that were significantly associated with stress were salary, number of children and personal factors. The significant stressors in the workplace were lack of job recognition, over focusing on quality of work, heavy workload and long working hours.
Heat stress is considered to be the sum of heat generated in the body (metabolic heat) plus the heat gained from the environment (environmental heat) minus the heat lost from the body to the environment. The consequences of heat stress can caused heat disorder such as heat stroke, heat syncope, heat exhaustion, heat cramps and other heat related diseases. The objective of this study was to compare the pattern of heat stress in each section. A crosssectional study was carried out in two sections (Paintshop A and Bodyshop B) in a selected automotive assembly plant in Selangor to monitor the environmental heat stress. The environmental heat monitoring was done on 89 March 2005. Heat stress monitor (Model: QUESTemp o 34 Thermal Environment Monitor, Quest Technologies, USA) was used to record the pattern of heat exposure in the workplace over a period of eight hours. Heat parameters such as dry temperature, wet temperature, globe temperature and relative humidity were measured. Wet Bulb Globe Temperature index (WBGT) and workload evaluation were used to compare both sections. Heat parameters such as timeweighted average wet bulb globe temperature for indoor setting (TWAWBGT indoor ), dry temperature (DB), natural wet bulb temperature (WB), globe temperature (GB) in Paintshop A were higher than those in Bodyshop B. The relative humidity in Paintshop A was hotdry compared to Bodyshop B which is hotwarm. Paintshop A was considered a hot area compared to Bodyshop B which is normal. Workers in both sections were not faced with heat stress problems because they were worked under acceptable condition according to American Conference of Governmental Industrial Hygienists standard. Both sections in the automotive assembly plant exhibited acceptable working condition for workers in a tropical environment.
The working environment of intensive care unit (ICU) nurses is a constant source of stress. Researchers have described ICU as a stressful environment because of the complex nature of patients’ health problems requiring an extensive use of very sophisticated technology. This study aimed to identify the prevalence of stress among staff nurses working in ICU, Hospital Universiti Kebangsaan Malaysia (HUKM), factors influencing stress and to explore the symptoms of stress experienced. This descriptive study was conducted on 67 staff nurses working in ICU, HUKM. Data was collected using self-administered questionnaires. The questionnaires included sections on socio-demographic data, factors influencing stress and symptoms of stress experienced. Data was analyzed using frequency and percentage. The Chi square test was used to examine the relationship between socio-demographic data and factors influencing stress. Findings indicated that stress symptoms were experienced by 100 per cent (n =67) of staff nurses Knowledge, working experience, critically ill patients, and environmental factors were one of the many factors contributing to the stress experienced by the ICU nurses in HUKM. Nurses working in ICU, HUKM are found to have a high level of stress. Recommendations like encouraging ICU nurses to take up post basic ICU courses and increasing the nurses quota can reduce the prevalence of stress among ICU nurses. Hospital management has an important role to play in reducing the stress levels of nurses working in ICU as stress has an effect on job performance and quality of nursing care.
Although stress among nursing staff is common, adopting effective coping styles helps in minimizing the problem. The objectives of this study were to compare stress level among ursing staff working in the above disciplines, to identify common coping style used and to determine the relationship between stress and coping styles. This cross-sectional study involved 106 nursing staff who were universally sampled from psychiatric wards and emergency departments in two public hospitals in the Klang Valley. Self-rated questionnaires i.e. Stress Arousal Checklist (SACL) and Coping inventory for Stressful Situations (CISS) were used to assess stress levels and coping styles respectively. There was insignificant difference in terms of stress level between the two nursing staffs. Stress dimension of SACL between the psychiatry (6.53 + 3.18, p=0.372) and emergency (6.02 + 2.67, p=0.372) nursing staffs were insignificant. Arousal dimension of SACL was also insignificant between psychiatry (8.60 + 1.70, p=0.372) and emergency (9.19 + 1.61, p=0.07) nursing staff. Task coping was the most commonly used coping styles among the psychiatry (55.36 + 9.85) and emergency (57.73 + 9.87) nursing staff in this study. Stress dimension of SACL showed weak significant relationship with task coping (r=-0.313, p=0.001) and emotion coping (r=0.292, p=0.001). Arousal dimension of SACL was also found to have weak significant relationship with task coping (r=0.271, p=0.003) and emotion coping (r=-0.251, p=0.005). While nursing was found to be a stressful profession, a significant relationship between stress and coping styles allows intervention to enable better adaptation to the stressful working environment.
Lately, increasing workplace violence is a problem that requires serious attention by the management of the healthcare sector. This study was carried out to examine workplace violence experienced by nurses in the Universiti Kebangsaan Malaysia Medical Centre. It aimed to identify the category of nursing staff who formed the highest number of victims, the perpetrators and the common types of workplace violence. This was a descriptive cross-sectional study carried out over a three month period on 55 nurses who had participated voluntarily in this study. The demographic data and data on the violent incident were collected by using a 21-item questionnaire. The reliability and validity with Cronbach’s alpha was 0.872. Information on the most common types of violence, victims and the perpetrators was also collected. The study revealed that workplace violence among the nursing staff was 3.7% with an average of 1.2% being abused per month and one nurse being abused every other day. The study also revealed that the staff nurses were the most common victims and the perpetrators were mainly the patients (40.6%) and the patients’ relatives (37.5%). The most common forms of violence were verbal abuse (31.9%) and verbal threat (23.7%). Physical violence was experienced by 44.4% of the victims. These results suggest that workplace violence is a serious problem which should be addressed in order to create a safe environment for the nurses.
Geographically, Malaysia is situated in the equatorial region, thus having a climate of hot and humid throughout the
year. Effect of heat stress and physical work load at construction industry need to be investigated because of the high number of
accidents. Thus, perception of physical workload and heat stress by the construction workers in Malaysia needed to be investigated
and documented. The aim of this paper is to establish a set of questionnaires containing the item generation regarding on physical
workload and the heat stress perception of construction workers. Physical workload factors such as fatigue, risks, concentration,
work rhythm, responsibility, satisfaction, and autonomy are inserted as the items in assessing the physical workload. While heat
stress are assessed using heat risk factors such as temperature, humidity, heat radiation, air movement, workload, clothing and
acclimatisation. A questionnaire has been developed resulted from various reviewing of literatures on physical workload and heat
stress and better suited to the Malaysia working environment.
Traumatic rupture of the popliteus tendon is a rare type of knee injury. Most reported cases had occurred in athletes or following high impact trauma. We report a case of a 23-year-old male with an isolated complete popliteus tendon rupture that was diagnosed arthroscopically. The patient worked as a general labourer in a sawmill. He fell at his workplace and presented with acute painful fixed flexion of the right knee. Initially he was suspected to have a meniscus tear. Diagnostic arthroscopy of the knee was carried out; and diagnosis of popliteal tendon rupture was established. The patient was subsequently managed conservatively by arthroscopic debridement. He was allowed to mobilize the knee as tolerated after the surgery. He was well with a full knee range of movement and was able to walk normally at six weeks after surgery. This article highlights the possibility of complete popliteus tendon rupture following a minor occupational injury in a previously normal knee.
One of the major problems causing medication errors is ineffective
communication between patients and health personnel. This paper discusses
the communication issues in the healthcare environment and how
medication errors can be avoided through effective communication. An
internet-based search was conducted to locate relevant articles published
between 2004 and 2017. Only articles that touch upon communication and
health-related issues were selected. Online sources such as PubMed,
ScienceDirect, and Google Scholar were utilized. The importance of good
communication practices for effective health and improved patient safety in
hospital settings has been highlighted. It is evident from this review that
poor communication most frequent causes adverse effects, delay in
treatment, medication errors, and wrong-site surgery. The major
communication issues in healthcare environment include language barriers,
the medium of communication, physical setting, and social setting.
Healthcare workers tend to use technical language in the workplace because
they consider the tone of communication to be always professional. It has
been established that knowledge on professional-patient communication is
essential and valuable in improving therapeutic outcomes. Patients need
knowledge and support in order to be able and motivated to undergo
medicine therapy. Health practitioners need to take responsibility for
demanding and creating an environment where high-quality healthcare
counselling is routinely practiced. To promote safe and effective practice in hospitals and avoid medication errors, clinicians should adhere to teamwork
and effective communication with the patients. There is a need for designing
strategies such as effective communication and teamwork amongst
healthcare professionals, which can consequently influence the quality of
healthcare services and patient outcomes.