Clinical skills program as a laboratory method is a valuable adjunct to other forms of undergraduate medical training. This article describes the process of developing a core curriculum in clinical skills based on the Dundee model for a clinical skills centre. The School of Medical Sciences, in Universiti Sains Malaysia (USM) has been provided with a well equipped skills centre. However, the PBL curriculum in the undergraduate medical program in the school needs to be integrated with a clinical skills lab program. This is to counter the general feeling that the contribution of PBL is insignificant in terms of building clinical competency in an integrated system such as that used in USM compared to the traditional curricula of other medical teaching institutions in Malaysia. Integrating clinical skills laboratory training with the PBL curriculum will provide evidence of PBL as an effective and innovative method for teaching and learning in Malaysia.
skills ; Clinical ; curriculum aspects ; Malaysia ; Teaching aspects

The question vetting is an ongoing process that essentially is a teamwork represented by right combination of experts from within the teaching faculty. It is considered mandatory to maintain quality standard of any examination. Vetting sessions are not only used for screening of questions towards technical and language problems but vetting is also used to generate the content-related validity of assessment questions. The role of vetting committee has been emphasized in literature. However, implementation of question vetting in specially convened meetings is not without errors and problems are encountered if the faculty indulged in vetting does not adheres to an appropriately set vetting protocol. The objective of the study was to identify the percentage of errors to improve the quality of examination questions and to appraise the protocol of vetting at Faculty of Medicine, Universiti Sultan ZainalAbidin Percentage errors in current practice of question vetting were recorded and the need of adequately practiced vetting using a protocol was identified. A protocol based on different level of question evaluation was established. Two levels of vetting committee were identified with chairpersons and members selected from within the faculty. The role of committee members in vetting was established. However, a third level of vetting was exclusively practiced considering FM (UniSZA) a new medical school. Each level of vetting observed 10-30% changes suggested in originally structured questions by the experts with consensus of entire members of the vetting committee. This error was the initiative factor to subsequently design the formation of vetting committee with duly represented members. The vetting of question practiced with appropriate committees and prescribed guidelines was found important to improve the quality of items in assessment employed in second professional examination of MBBS program in Faculty of Medicine at Universit Sultan ZainalAbidin, Malaysia.

Multiple-choice question as one best answer (OBA) is considered as a more effective tool to test higher order thinking for its reliability and validity compared to objective test (multiple true and false) items. However, to determine quality of OBA questions it needs item analysis for difficulty index (PI) and discrimination index (DI) as well as distractor efficiency (DE) with functional distractor (FD) and non-functional distractor (NFD). However, any flaw in item structuring should not be allowed to affect students’ performance due to the error of measurement. Standard error of measurement (SEM) to calculate a band of score can be utilized to reduce the impact of error in assessment. Present study evaluates the quality of 30 items OBA administered in professional II examination to apply the corrective measures and produce quality items for the question bank. The mean (SD) of 30 items OBA = 61.11 (7.495) and the reliability (internal consistency) as Cronbach’s alpha = 0.447. Out of 30 OBA items 11(36.66%) with PI = 0.31-0.60 and 12 items (40.00%) with DI = ≥0.19 were placed in category to retain item in question bank, 6 items (20.00%) in category to revise items with DI ≤0.19 and remaining 12 items (40.00%) in category to discard items for either with a poor or with negative DI. Out of a total 120 distractors, the non-functional distractors (NFD) were 63 (52.5%) and functional distracters were 57 (47.5%). 28 items (93.33%) were found to contain 1- 4 NFD and only 2 (6.66%) items were without any NFD. Distracter efficiency (DE) result of 28 items with NDF and only 2 items without NDF showed 7 items each with 1 NFD (75% DE) and 4 NFD (0% DE), 10 items with 2 NFD (50% DE) and 4 items with 3 NFD (25% DE). Standard error of measurement (SEM) calculated for OBA has been ± 5.51 and considering the borderline cut-off point set at ≥45%, a band score within 1 SD (68%) is generated for OBA. The high frequency of difficult or easy items and moderate to poor discrimination suggest the need of items corrective measure. Increased number of NFD and low DE in this study indicates difficulty of teaching faculty in developing plausible distractors for OBA question. Standard error of measurement (SEM) should be utilized to calculate a band of score to make logical decision on pass or fail of borderline students.

Comparable selection methods based on interview as one of the selection criteria are used in many countries globally however; procedure of interview and its reliability has been of varying nature. A semi-structured interview procedure was developed by the Faculty of Medicine at Universiti Sultan ZainalAbidin to finally select the shortlisted candidates seeking to studying medicine in this institution as the new intake of 2015-2016 sessions of MBBS program. Multiple panels comprising of two members each to independently select the candidate held interview. Inter-ratter reliability of quality assessment was investigated. Current article investigates the inter-ratter reliability of interviewers in quality assessment of candidates seeking to join the Faculty of Medicine at Universiti Sultan ZainalAbidin, Malaysia. An observational study, conducted across all the candidates, who were shortlisted on merit for formal selection through interview procedure. Data reflecting candidates’ characteristics and qualities were collected as quantitative score. Inter-ratter reliability using intra class coefficient was calculated for interpretation. A moderate difference of mean (SD) among the interviewer varying from 37.61 (3.48) to 42.12 (0.60) was observed. The reliability of score varied between 0.50- 0.65, significant at p = < 0.05 with majority assessors. However, among the 4 panels of assessors’ intra-class correlation coefficient was between 0.70-0.0.90 (p = < 0.001). Assessment of candidates’ performance based on observation did not achieve the satisfactory level of intraclass correlation coefficient (ICC ≥ 0.70). However for higher discrepancy in inter-ratter scores in some cases, continuing faculty development program in interviewing skills and calibration workshops are recommended to improve the reliability and validity of quality selection through interview procedure in future.

Cysts ; complications ; pathology ; Epithelial Cells ; pathology ; Humans ; Male ; Middle Aged ; Recurrent Laryngeal Nerve Injuries ; Thyroid Diseases ; complications ; pathology ; Voice Disorders ; etiology

Tonsillectomy is performed for several indications, the two commonest in practice are infective (chronic tonsillitis) and obstructive symptoms such as sleep apnea. The objective of this study is to determine the necessity of routinely performed histopathological examination of fonsillectomy specimens. In this paper, a retrospective evaluation of 480 specimens from 241 patient who had undergone tonsillectomies in Hospital Universiti Sains Malaysia between January 2004 and October 2005 was done. It was found that 462 (96.25 %) were reactive lymphoid hyperplasia and 18 (3.75 %) were follicular hyperplasia. None of them were found to be malignant. The result of this study indicates that routine histopathological examination of tonsillectomy specimens are unnecessary and results only in added cost and a loss of man hours.
Tonsillectomy ; Retrospective Studies ; Malaysia ; Hospitals ; Carbon ion

To determine the characteristic presenting symptoms, otoscopic findings, audiological profiles and the intraoperative findings of children with chronic otitis media with effusion who required surgical intervention. A prospective cross sectional study was undertaken in the otorhinolaryngology clinic of USM Hospital (HUSM) involving 25 cases (50 ears) of children with chronic otitis media with effusion requiring surgical intervention from June 1999 to September 2001. Their ages ranged from 3 to 12 years old. The gender distribution included males at 72 % and females at 28 %. The presenting symptoms noted were hearing impairment (52%), otalgia (18%), ear block (16%) and tinnitus (14%). The otoscopic findings were fluid in the middle ear (40%), dullness (32%) and retraction of the tympanic membrane (28%). On audiometry, 24 ears had moderate deafness (48%), 16 ears had mild deafness (32%) while 4 ears had severe deafness (8%). With tympanometry, 42 ears out of the total 50 had a flat type B curve (84%) while 6 ears had type As curve (12%). During myringotomy, middle ear secretion was seen in 38 ears (76%) out of the 50 ears; 22 ears had mucoid secretion while 16 ears had serous secretion. Clinically, the commonest presenting symptom was hearing impairment (52%) while the most common otoscopic finding was fluid in the middle ear (40%). Audiologically, most patients had moderate conductive hearing loss (48%) and a type B curve (84%) on tympanometry. On myringotomy middle ear fluid was found in 76 % of the ears.
Disorder of middle ear ; Chronic ; Otitis Media ; Effusion, NOS ; Child

Tonsillectomy is performed for several indications, the two commonest in practice are infective ( chronic tonsillitis ) and obstructive symptoms such as sleep apnea. The objective of this study is to determine the necessity of routinely performed histopathological examination of specimens post-tonsillectomy . In this paper, a retrospective evaluation of 480 specimens from 241 patient who has undergone tonsillectomies in Hospital Universiti Sains Malaysia between January 2004 and October 2005 was done. It was found that 462 ( 96.25 % ) were reactive lymphoid hyperplasia and 18 ( 3.75 % ) were follicular hyperplasia. None of them were found malignant. The result of this study indicate that routine histopathological examination of tonsillectomy specimens are unnecessary and results only in added cost and a loss of man hours.

Nasopharyngeal carcinoma (NPC) is a non-lymphomatous, squamous cell carcinoma that occurs in the epithelial lining of the nasopharynx, an area that shows varying degrees of differentiation. Although relatively rare worldwide, NPC has substantial incidence and mortality in populations in Southeast Asia and in people with Southern Chinese ancestry. In Malaysia, NPC is a leading cancer type. In the clinic, NPC presents on a very wide spectrum. Therefore, a high degree of suspicion on the part of the clinician and an increased awareness by the patient is essential for the recognition of an early lesion. Early detection of the cancer is important as it affects the patient’s prognosis and the mode of treatment. Managing patients with NPC is very challenging as patients usually present late when the cancer is already in an advanced stage. Here, we review the challenges in the management of NPC.

Background: Warfarin is utilised for the treatment of thromboembolic disease. Its use demands a careful and continual monitoring given its narrow therapeutic index and potentially life-threatening complications. The aim of this study was to assess the extent of patients’ knowledge of their warfarin therapy. Methods: A total of 200 consecutive patients from a single community hospital completed an online survey questionnaire (www.eSurveysPro.com). Using the responses to the questionnaire, we recorded compliance to warfarin therapy, knowledge about drug interactions, adverse effects of warfarin therapy, complications, and resulting hospitalisation. Results: We recruited 200 patients, 55% (109/200) women and 45% (91/200) men, among which 88% were compliant with their daily medication. Of the 200 patients, 56% were unaware of any potential drug interactions, 58% were unaware of any adverse effects, 27% had experienced adverse effects, 12% had been hospitalised because of adverse effects (33% of which were due to bleeding), and 65% kept a personal record of their international normalised ratio. Conclusions: Despite the high level of compliance, patient knowledge of warfarin therapy was low. Given the potential drug interactions and complexities involved with warfarin therapy, it is of high importance that medical professionals educate their patients and make them aware of any impending signs of emergent medical complications.