Abstract: Mentoring in academic medicine requires the trained mentor to commit time, purpose and dedication for the personal and professional development of three categories of protégés or mentees i.e. medical students, the clinician-trainee and the clinical-educator. Conventionally, assigned mentors monitor the progress of the first two categories of personnel as their career pathway is clearly defined. On the other hand the clinician–educator in academic medicine could be a scientist or a career clinician expected to contribute to medical education activities and research. The clinicianeducator has grown in complexity as he multitasks in providing clinical care, assists in delivering the medical curriculum and is expected to do research and publish. Although there is dearth of research in mentoring the clinician-educator, it is clear that mentored clinicaleducators are more productive by way of scientific publications. Trained mentors are expected to identify the needs of the mentee with regards to the level of his career development and his aptitude to move up the academic ladder, successfully nurturing the maturation process. Processes of mentoring in the clinical setting, attributes of the successful mentor and facilitating the mentee in overcoming challenges in academic medicine are discussed.

This is a cross sectional study conducted in July 2010 at the International Medical University, Seremban, Malaysia. The objective of this study was to ascertain the relationship between working memory capacity of final MBBS medical students using the digit span backward test and their academic achievement based on the total score at the modified essay questions (MEQ) which was the principal component of the theory examination. Seventy eight final year medical students were recruited, 41 (52.6%) were females and remaining 37 (47.4%) were males. Working memory capacity was measured by digit span backward test (DSBT) which ranged from 3 to 8 digits. The mean digit score was 6.6 ± 1.1 falling under the category of ‘above average’ score. There was no significant difference between working memory capacity and gender (p>0.05). There was no significant difference in the MEQ mean score and the different categories of working memory capacity (p>0.05). The DBST shows uniformity in working memory adequate to pass the modified essay questions. Medical students appear to use encoding and retrieval process in problem solving based on functionality and pattern recognition in tackling the problems in the MEQ.

Clinical research refers to any field of research involving human subjects. Clinicians as researchers are well placed in contributing to research as they have access to human subjects and are able to apply research results for better patient outcome. The need for clinician-scientists as a dedicated breed is hence implied. Clinical research has low priority in the agenda of academic clinicians for various reasons. Strategies to overcome such a malady include training in research methodology and creating a permissive environment for the conduct of research. The IMU has introduced several measures to enhance clinical research and has a vibrant postgraduate program. The BMedSc programme has seen an increase in MBBS students taking this degree. Research is part of the curriculum before the Semester 7 examinations. Clinicians have been increasingly seen to be involved in research. The enhancement of clinical research through encouraging formal clinical research training and development of the MBBS-PhD programs could further enhance clinical research at the IMU. Attention to logistic constraints, improvement in collaboration with the CRC-MOH and other agencies and the close working relationship with scientists will propel clinical research to higher levels.

Diabetes, Gestational

According to the Global status report on non-communicable diseases 2010, the prevalence of high blood sugars among adults exceeds 11 % in both males and females in Malaysia. This is the highest among ASEAN countries. This ties up closely with the prevalence of overweight adults in both sexes in the same report, again Malaysians rank highest among ASEAN countries. The burden of diabetes mellitus in Malaysia is estimated to be 12% of the population with a projected figure exceeding 15 % in 2020. 1 This enormous rise in both obesity and hyperglycaemia in adults is alarming and clear strategies to combat this noncommunicable disease is urgently warranted. One such strategy is to relook at the focussed approach of gestational diabetes mellitus (GDM) management currently in vogue in Malaysia, and suggest more effective preventive measures in view of information currently coming to light on both short and long term implications of GDM on both mother and offspring. Although information on actual prevalence of GDM in Malaysia is lacking, available crude data from hospital births obtained from the National Obstetric Register in 2010 involving 14 major government hospitals was 9.9% with Indians ranking highest followed by Malays and Chinese. Incidence of macrosomia in GDM mothers was double that of non-GDM mothers. A higher caesarean section rate with a threefold increase in shoulder dystocia was also recorded in those with GDM.
Diabetes Mellitus ; Diabetes, Gestational

Outcome and competency-based undergraduate and graduate medical education is the desired standard embraced by many medical educationists worldwide. Reflective capacity is an integral component of that strategy and reflective writing has shown tremendous potential as a delivery tool. But there are various challenges in the implementation of the initiative. Efficacy as a delivery tool, achievement of pedagogical outcomes, reliability issues, challenges in assessment outcomes/tools, and whether it can be taught and learnt, need to be addressed. Many questions are still not satisfactorily answered, and this review attempts to offer some perspective on the issues.

Avoiding the adverse neonatal effects of perinatal asphyxia has been one of the common indications for cesarean deliveries in current obstetric practice. Expeditious delivery is dependent on decision to perform cesarean delivery and time lines achieved. A decision-delivery interval of 30 minutes, a concept initiated by the American College of Obstetricians and Gynecologists has open to debate as controversy reins about neonatal outcome when this time interval is considered in isolation. Time lines alone are probably not the only criteria to be employed, and may contribute to errors in interpretation by professional regulatory bodies and the society at large. Procedures prior to decision making like trial of labour, fetal scalp sampling and readily available resources for instituting emergent cesarean delivery invariably need to be considered. Though decision to delivery time is an integral component of critical conduct intervals in the acutely compromised fetus, a more pragmatic approach needs to be taken considering potential and known logistical and obstetric factors in line with good obstetric practice.

Delay in childbearing, family history of type 2 diabetes mellitus and obesity in childbearing years increases a possibility of glucose intolerance or overt diabetes in pregnancy which may remain unrecognised unless an oral glucose tolerance test is done. The International Association of Diabetes and Pregnancy Study Group (IADPSG, 2010) recommended the detection and diagnosis of hyperglycaemic disorders in pregnancy at two stages of pregnancy, the first stage looking for ‘overt diabetes’ in early pregnancy based on risk factors like age, past history of gestational diabetes and obesity and the second stage where ‘gestational diabetes’ at 24-28 weeks with 75 g oral glucose tolerance test. Although the one step approach with 75 g of glucose offers operational convenience in diagnosing gestational diabetes, there are concerns raised by the National Institute of Health in the recent consensus statement, supporting the two step approach (50-g, 1-hour loading test screening 100-g, 3-hour oral glucose tolerance test) as the recommended approach for detecting gestational diabetes. Medical nutrition therapy (MNT) with well-designed meal plan and appropriate exercise achieves normoglycemia without inducing ketonemia and weight loss in most pregnant women with glucose intolerance. Rapidly acting insulin analogues, such as insulin lispro and aspart are safe in pregnancy and improve postprandial glycemic control in women with pre-gestational diabetes. The long acting analogues (Insulin detemir and glargine) though proven to be safe in pregnancy, do not confer added advantage if normoglycemia is achieved with intermediate insulin (NPH). Current evidence indicates the safe use of glyburide and metformin in the management of Type 2 diabetes and gestational diabetes as other options. However, it is prudent to communicate to the women that there is no data available on the long-term health of the offspring and the safety of these oral hypoglycemic drugs are limited to the prenatal period
Diabetes Mellitus

This paper attempts to utilise clinical scenarios where ethical issues are embedded and requires appropriate application of the steps of the framework mentioned. A step by step sequential approach is adopted to illustrate how the ‘ethical decision model ‘can be used to resolve ethical problems to arrive at a reasonable conclusion. The UNESCO ethical method of reasoning is used as the framework for decision making. Physicianeducators should be competent to use ethical decision models as well as best available scientific evidence to be able to arrive at the best decision for patient care as well as teach health professional trainees how reasonable treatment decisions can be made within the perimeter of medical law and social justice.
Obstetrics ; Education, Medical

Medical education of today continues to evolve to meet the challenges of the stakeholders. Medical professionals today are expected to play multiple roles besides being experts. Thus, the curriculum has to be developed in a manner that facilitates learners to achieve the intended goal of becoming a medical professional with multiple competencies. The understanding of learning theories will be helpful in designing and delivering the curriculum to meet the demands of producing a medical professional who would meet the CanMEDS model. This commentary explores and reflects on the learning theories of behaviorism, cognitivism and constructivism as they have evolved over time and the application of these learning theories in medical education, particularly in the context of medical education in Malaysia. The authors are convinced that these three theories are not mutually exclusive but should be operationalized contextually and throughout the different stages of learning in the MBBS curriculum. Understanding these theories and their application will enhance the learning experience of students.
Education, Medical