One hundred and twenty-eight medical students who had experienced a traditional-style preclinical curriculum completed three self-report questionnaires. Using factor analysis of students' responses this study explores interactions between study orientation, preferences for different kinds of learning environment, and evaluations of the physiology course. Such interactions can provide insight into the reasons why students fail to adopt effective learning strategies. Although many students had the intention to understand, they did not adopt a deep approach. Achievement motivation was strong, test anxiety high, and the course was perceived to be competitive. The meaning orientation merged with the achieving orientation; students were thus performance rather than task oriented. These students perceived the course to have been challenging, as did students within the reproducing orientation and who had 'surface' preferences. Students within the non-academic orientation had difficulty coping with the course. The findings suggest that conventional teaching and assessment methods are preventing students from developing appropriate criteria and internal standards for evaluating performance. An illusion of comprehension may prevent students from seeing the need to adopt more effective learning strategies and cause 'good' students with the ability to adopt a deep approach to abort the pursuit of deep understanding. Students' preferences and evaluations of teaching and assessment indicate that students within the different learning orientations have different educational needs. The implications for instruction and evaluation are discussed.
This study investigates the reasons for entry to medicine and the career perspectives of phase III medical students of the Universiti Sains Malaysia (USM). The majority of the students were Malays from low socio-economic backgrounds who entered medical school after completing a 2-year matriculation course. An interest in medicine and helping people were the two main stated reasons for entry to medical school. A group of students wishing to work in private practice was identified. In comparison to the rest of the study body, students in the group were: not well prepared to enter medical school; dissatisfied with the course; and subject to family influences. A desire for monetary gain motivated their choice of medicine as a career. Overall, 13% of the students wished to change career because they were dissatisfied with their experience of medicine as undergraduates. The study did not find a significant difference in career intentions between female and male medical students. However, women were less likely to seek entrance into private practice or pursue formal postgraduate education. The choice of surgery as a career was confined to men. About 90% of the students had already decided on their future specialty. Four well-established specialties were their most popular choices. The gender of the students had no significant influences of the decision to continue into postgraduate education. The proportion of female students who wished to marry doctors was significantly higher than for male students.
This study deals with personality variables of medical students in relation to their academic success in the preclinical stage. One hundred and one students completed the 16PF Questionnaire at the beginning of their medical course and the scores were analysed in relation to their marks obtained at the end of the 2-year preclinical stage. This study shows that the 16PF Questionnaire can be a useful instrument for identifying personality variables in candidates who are likely to have academic problems and those who are likely to do well in the preclinical stage of a medical course. Students of urban origin and the eldest in the family performed better in their preclinical years. Performance was not related to sex, ethnic group, family size of entrance qualification into medicine. Personality variables of being enthusiastic, venturesome, self-opinionated, imaginative, experimenting, resourceful and driven correlate positively with performance, whereas being self-assured has negative correlation. Problem students were more reserved, emotionally less stable and more apprehensive than non-problem students.
The competence of general practitioners (GPs) in diagnosing anxiety neurosis was assessed using standardized patients (SPs) unknown to the doctors. Out of a computer-generated random sample of 100 general practitioners in Kuala Lumpur, 42 volunteered to participate in the study. The results showed that the GPs can be divided into three groups: group A made the correct diagnosis and informed the SPs about their condition (11.9%); group B prescribed tranquillizers and did not inform the SPs of the actual diagnosis but instead said that they were either normal or were suffering from some stress (28.6%); and group C made various diagnoses of physical disorder or did not detect any abnormality at all (59.5%). Thus about 40% of the doctors considered an emotion-related disorder and only 12% of the doctors were confident enough to make and inform the patient of the actual diagnosis. Group A significantly (P < 0.001) asked higher numbers of relevant questions in the signs and symptoms section of the history than the other two groups. No differences between the three groups were observed in the other two sections of history-taking (personality, family, social and precipitating factors), in the general and specific physical examination and interpersonal skills. Generally, with the exception of the interpersonal skills section, the doctors performed less than 40% of the expected tasks in every section. The study highlighted the lack of competence in making a definite diagnosis of anxiety disorder. Among those who apparently made the diagnosis (group B) or made the diagnosis with certainty (group A), there was no demonstration of appropriate treatment behaviour with respect to pharmacological intervention.(ABSTRACT TRUNCATED AT 250 WORDS)
The knowledge and clinical and minor surgical skills acquired by 257 medical students in three universities in Sri Lanka and Malaysia were assessed by a questionnaire after they had completed their training period in ophthalmology. This study showed that many medical students graduating from these universities lacked the basic clinical and minor surgical skills essential for a doctor practising in a community in south-east Asia. The responses also indicated that teaching by consultants in all three universities was inadequate and due to these inadequacies the students requested that the duration of their training period be doubled. Ophthalmology is an important component of clinical practice and proper education in this subject is important. An urgent revision of the aims and objectives of the curriculum in ophthalmology is essential to place greater emphasis on this important and much neglected subject, for which very little curricular time is allotted.
Required learning of the basic medical sciences based on five clinical problems was compiled by teachers and subsequently derived as 'learning needs' by students during the problem-solving process. These lists of topics were compared in terms of number of lecture-hours and when these were taught in the traditional curriculum. The findings indicate that learning from problems is not entirely free-rein and can be largely determined by teachers; topics taught earlier in the course appeared more frequently than latter topics and there was a tremendous overlap of topics in both the traditional and problem-based list. Regardless of whether lectures have been given or not, students recalled facts better if they had encountered the related clinical problem. This study also reveals that problem-based learning can be as efficient as lectures in content coverage and concludes that the lecture method be retained provided the topics are selective and are derived and sequenced appropriately with clinical problems. Problem-solving should be adopted as a teaching strategy.
Changing social demands made it necessary for the Medical Faculty of the University of Malaya to accommodate students with a wider range of academic experience than before. However, teachers sought to achieve comparable academic standards to those in the West by striving to maintain a close resemblance to the Western model of medical education in other respects. As a result teachers failed to adapt their teaching methods, assessment techniques and curriculum design to meet the educational needs of the students, thus compromising academic standards. Many students lack basic academic skills and do not know how to learn effectively. In order to help students overcome their learning difficulties innovative teaching was required during the first year at university, designed to foster the joint development of knowledge and basic skills. In the case of less well-prepared students who lack self-confidence, a caring and supportive learning environment is crucial to the achievement of meaningful learning. Lecturers needed to become facilitators of learning rather than transmitters of knowledge. However, teachers' objective to retain international recognition of the degree, which presumably reflected the importance of teaching, was not operationalized in terms of its incentive structure such that teachers were constrained not to try to fill the new roles demanded of them. It was assumed that academic distinction accrued through scientific research was essential for the achievement of academic excellence. However, under the prevailing circumstances the two aims were mutually exclusive and incompatible and teaching quality deteriorated.
It has been suggested that the 'ideal' measure of reliability of an examination is obtained by test and retest using the one examination on the same group of students. However, because of practical and theoretical arguments, most reported reliabilities for multiple choice examinations in medicine are actually measures of internal consistency. While attempting to minimize the effects of potential interfering factors, we have undertaken a study of true test-retest reliability of multiple true-false type multiple choice questions in preclinical medical subjects. From three end-of-term examinations, 363 items (106 of 449 from term 1, 150 of 499 from term 2, and 107 of 492 from term 3) were repeated in the final examination (out of 999 total items). Between test and retest, there was little overall decrease in the percentage of items answered correctly and a decrease of only 3.4 in the percentage score after correction for guessing. However, there was an inverse relation between test-retest interval and decrease in performance. Between test and retest, performance decreased significantly on 33 items and increased significantly on 11 items. Test-retest correlation coefficients were 0.70 to 0.78 for items from the separate terms and 0.885 for all items that were retested. Thus, overall, these items had a very high degree of reliability, approximately the 0.9 which has been specified as the requirement for being able to distinguish between individuals.
The suitability of physiology topics taught in the first-year dental curriculum needs to be investigated in the light of the view of the present generation of clinical and preclinical teachers, and students. This was studied in the University of Malaya in order to propose a rational physiology curriculum with proper identification of priority topics. Oral physiology, blood and the cardiovascular system were found to be the most relevant for dental students. Among the systems, high and low priority topics were identified and their relative importance is discussed.
The belief that it is unwise to alter the initial response to a multiple choice question is questioned. Among 39 380 MCQ responses, there were 1818 changes (4.62%) of which 21.9% were correct to incorrect responses, 46.3% incorrect to correct responses and 31.8% incorrect to incorrect. This effect was very much more marked among the better students, incorrect to correct changes accounting for 61% of the responses in the upper group, 42% in the middle group and 34% in the lower group.
A cross-sectional national survey was conducted amongst a random sample of medical practitioners registered in 1988 with the Malaysian Medical Council with the purpose of determining their educational needs with regards to continuing medical education (CME). A 91.0% response rate was obtained. It was found that more than 70% wanted a programme that would provide them with new practical skills and new knowledge or advances in specific fields. About 2/3 also wanted their intellectual skills in problem-solving to be further developed. Reinforcement of communication skills appears to be of secondary importance. They would also like a programme of CME to help them monitor and improve their diagnostic accuracy, investigative habits, prescribing pattern, skills in interpreting diagnostic tests and management of common illnesses. As for content areas it was found that the problems they have least confidence in managing come mainly from the disciplines of psychiatry, obstetrics and gynaecology, and emergency and critical care. More than 90% preferred self-learning methods with some group-type activities. Based on these needs it was recommended that a programme of CME be developed with orientation towards a practice-based setting, self-directed learning, utilizing problem-solving approaches and focusing on the major content areas identified. In addition, activities such as small-group discussions, clinical rounds and journal clubs should be encouraged to develop into local network group activities to supplement the self-learning and present lectures and talks.
This paper describes the analysis of the written professional examinations administered at the Medical School, Universiti Kebangsaan Malaysia (UKM), during the academic year 1979-80. It is a product of a collaborative activity involving medical teachers and two short-term consultants of the World Health Organization. The examination papers were analysed in order to identify content areas disproportionately emphasized in the examinations; to determine the quality and appropriateness of the examination items used; and to review the extent of continuity and integration across departments and courses. This paper is intended to introduce an approach to curriculum review which is based on analysis of the examination system. The procedures and sample outcomes are described and the implications for curriculum development and evaluation are discussed.
The multidiscipline laboratories (MDLs) of University of Malaya are a significant feature in the Faculty of Medicine. They provide facilities for a number of activities within the teaching curriculum. This is in contrast to the departmental type of laboratories. Being the first in the eastern hemisphere, they are gaining popularity among new medical schools in this part of the world. Since a number of visitors testify to a continued interest in the multidiscipline laboratories, an attempt is made to discuss our experience with these facilities in relation to tthe design, uses, organisation, staff requirement, student usage and space problems.
The tracer concept was applied to evaluate the delivery of family health care and the training of family health workers. A retrospective evaluation permitted linking the products of care to process, input and context, by isolating and analysing potential factors contributing to a limited number of representative concerns. Contributory learning deficiencies identified in health workers, one input to health care as well as a product of training, enabled the evaluation of training programmes to be focused on related segments of the courses. The latter were evaluated through a pathway analysis which followed the same deficiency model as the evaluation of health care. Links were thus established between the traditionally compartmentalized training and service sectors in health.
A random survey of 400 doctors was carried out over a period of 3 months to determine the factors that would facilitate or inhibit the participation of doctors in continuing medical education (CME) in Malaysia. Regular participation in CME was defined as participation in any activity (self-directed reading or attending organized activities) at least once a month during the past year. It was found that 78% of doctors regularly participated in CME. Working in a hospital environment and being members of the Malaysian Medical Association and at least one specialty organization appeared to be important facilitatory factors in CME participation. These doctors also read the local medical journals regularly and subscribed to other journals. In addition, they were more likely to possess postgraduate qualifications and would have teaching, research, diagnostic or clinical responsibilities as major components of their work. They were more likely to practise in the big cities and would tend to be active in at least one voluntary or social organization. If they were in the Government sector, they were more likely to work in the Universities or in the Hospital Division of the Ministry of Health. The 22% who were less likely to participate in CME were general practitioners in the private sector. They worked long hours with day, evening and/or night shifts every day. If the doctors were in the Government sector, they were more likely to be in the Health Division, working in administration and public health, or they were in the armed forces and other organizations such as local councils. They worked in the smaller towns or in the districts.(ABSTRACT TRUNCATED AT 250 WORDS)
In the government hospitals of Malaysia quality assurance activities have been introduced since 1985. Local clinicians and other health care workers had been stimulated by the Ministry of Health to pursue these activities, but they found themselves untrained and ill-prepared for the job. With the help of the World Health Organization a programme of training courses has been set up and conducted, most recently, in February 1989. A model for teaching quality assurance was developed, geared towards the needs of the Malaysian clinicians and taking into account the recent progress made in the development of quality assurance approaches worldwide. Moreover, quality assurance results from one Malaysian hospital were used, thus increasing the relevance of the teaching. Results show that Malaysian clinicians have appreciated the training and have relaxed in their attitude towards quality assurance and the government's involvement in it. During the various courses pitfalls have been identified in the teaching of modern quality assurance in health care for audiences from developing and newly industrialized countries.