Background: House-officers and medical officers are at the forefront during medical emergencies in the ward and casualty which impose cognitive, communication, social and system challenges and yet, training in this area is commonly lacking. A workshop was conducted using simulation to provide training on some acute medical emergencies like cord prolapse, post- partum haemorrhage with collapse, poly-trauma and acute exacerbation of asthma. Objective: To determine the effectiveness of simulation in developing competency in managing selected clinical emergencies Methodology: There were 22 participants consisting of house-officers, junior medical officers and nursing clinical instructors. Only doctors were included in the study. Four medical emergencies were chosen viz.: Cord prolapse; post- partum haemorrhage with collapse; poly-trauma and acute exacerbation of asthma. The simulated sessions were conducted using high fidelity manikins and simulated patients. Simulated patients were trained and moulage was applied accordingly. The skills stations were on airway equipment and techniques of application, latest cardiac life support algorithm and hands on chest compression using manikins. Results: A 5 point Likert scale used to rate the sessions. The skills station had 65% (n=13) rating as excellent and 35% (n=7) good. The skills simulation was rated excellent by 75% (n=15) and good by 25% (n=5) of participants. Verbal feedback was that it was very refreshing, informative, and helpful in terms of improving their skills. Conclusion: The simulated skills training for the junior doctors was very well received and maybe beneficial for work preparedness and in the long run address patient safety
Education, Medical

Background: The teaching of trauma in medical schools faces many educational and logistic challenges. Issues on what to teach, how to teach, when to teach, who will teach and whether medical students with insufficient exposure to clinical medicine can benefit from a trauma course are unclear. Materials and Methods: A well-designed one day intensive trauma course concentrating on the primary survey was taught to semester seven and semester eight students by a multi-disciplinary team comprising of surgeons, anaesthetists, emergency physicians and trained medical officers. The course comprised of a pre-test of 30 multiple choice questions followed by three hours of lectures, three hours of skill stations and a post-test. The pre-test and posttest scores were analysed using the paired sample t-test and the independent t-test. Results: The pre- and post-test scores showed significant improvement for both semester seven and semester eight students. Semester seven students, who only had a sevenweek posting in Surgery had pre-test and post-test scores of only 4% less than semester eight students who had an additional six weeks in Orthopaedics and two weeks in Accident and Emergency postings. The use of a multidisciplinary team reduced the logistic burden of finding sufficient surgeons to teach trauma management. Conclusion: Trauma education can be taught to undergraduates by a multidisciplinary team as early as year three, in semester seven. However, the mean score of semester eight students is only at 66%, suggesting that a refresher course prior to graduation at semester ten will be useful.

The incidence of cancer in Malaysia is rising alarmingly and newly qualified doctors will be expected to be competent in the basic management of cancer patients. However, the opportunity to gain experience in oncology management will remain limited unless these students are stationed in an oncology unit which is solely dedicated to the treatment of such patients. Therefore, it is essential that undergraduate medical school training equips students with a sound knowledgebase, so that they can confidently manage basic oncological conditions appropriately. With the many private and local medical universities across the country, it is important that oncology training be standardized and reflective of the local resources available, and government health policies. As a result, having a standardized curriculum would help create a framework whereby competencies in cancer management would be accurately assessed.

ith recent medical advances and the availability of newer sophisticated technologies, critically ill patients tend to survive longer. 1 Thus, decisions to forgo life-sustaining medical treatment generate challenging issues that all doctors must face. 2 The aim of this pilot study was to assess attitudes towards end-of-life care in ICU which included futile therapy (withholding and withdrawing therapy) among final year medical students who had received the same degree of clinical exposure and training in medical school. The results revealed varying attitudes and views towards end-of-life care in ICU suggesting other factors such as religion, ethnicity and culture may influence decision making
Education, Medical

Introduction: Standard precautions in health care is the essence of medical practice encompassing the safety of patients and health care workers including medical students. Barriers to the proper use of personal protective equipment (PPE) exist across the world but identification of areas of weaknesses and appropriate remedies will reduce them. This study assesses knowledge and use of PPE among fourth year students after a period of educational interventions. Objective: To evaluate appropriate use, awareness and knowledge about PPE among fourth year students after interventions. Method: A cross- sectional study where forty year 4 students (Group B) were randomly observed and later asked to answer a questionnaire. Students had undergone interventions to improve PPE use, which included lectures and video sessions during each posting. Results were compared with a previous group (Group A). Chi-square test or Fisher’s exact test was used to analyse the data. Results: There was statistically significant improvement in the use of PPE like wearing and removing mask during invasive procedures (p < 0.001) and hand-washing before and after a non- invasive task (p < 0.001) . Comparison of Groups A and B on the results of the questionnaire for ‘Questions in which more than 10% students answered incorrectly’, showed that there was improvement in Group B in all the questions, some being statistically significant with p value=0.01. Conclusion: An overall improvement in the use of the PPE and knowledge was noted. Sometimes, students’ attitude and personality may be a challenge and these students may defy changes, but this can be overcome if the strategies are embedded in the curriculum and taught from as early as the first semester
Patient Safety ; Students, Medical

Background: At the International Medical University (IMU), a half day cardiac life support teaching session was provided to fourth year medical students which included training on the use of the defibrillator machine, how to handle cardiac or respiratory arrest and drugs used for resuscitation. A new CLS (cardiac life support) training session was introduced and increased to a oneday course where students were given practical training first, which included 5 stations (airway equipment, mega codes, drugs for resuscitation, defibrillator use and cardiac rhythm identification) , MCQ (multiple choice questions) test and a mega code (practical)assessment. Objective: To evaluate the students’ knowledge on cardiac resuscitation after a change in the delivery of the cardiac life support training (CLS). Methodology: Group I, consisted of 82 students taught using the traditional teaching and Group II consisted of 77 students taught using hands on simulation. The students in both groups had an online manual to read prior to the session, were given an identical written exam six months after the CLS training. Group II, however, had an online pre-test. Results: There was a statistical difference in the final mean marks between the two groups with group II scoring higher (67.3) than group 1 (62.1). No significant marks difference was noted between male and female students for both the cohorts. Conclusion: There is a significant difference in medical students’ knowledge when cardiac life support is taught using simulation. IMU has adopted the new teaching method with simulated training for the cardiac life support courses with plans to implement higher fidelity and technology to the existing simulated teaching in other areas of medicine.

Background: Healthcare providers must have the knowledge to carry out clinical procedures. Placing and maintaining intravenous (IV) infusion is one of them. To perform it, conceptual knowledge is an elementary requirement. Methods: This is a descriptive quantitative study using a self-administered questionnaire. Section A consists of four items detailing medical students’ socio-demographic data such as age, gender, ethnicity, and nationality. Section B includes 17 True/False items related to knowledge and understanding of peripheral intravenous cannulation (PIVC). Sixty-nine semester 6 medical students were recruited. The goal of the research was to determine their knowledge of PIVC and if there is an association between sociodemographic data and knowledge of PIVC. Results: All 100% (n=69) respondents were aware of self-introduction, clarification of patient’s identity, obtaining verbal consent, and hand hygiene importance. The majority (98.6%, n=68) had the knowledge to clean the insertion site before performing the procedure, aseptic technique maintenance, and gloves donning. More than half (53.6%; n=37) of respondents were not aware that an 18-gauge cannula was commonly used in adults for PIVC. Overall, findings showed 40.6% (n=28) of respondents have adequate knowledge about PIVC. There was a weak negative correlation indicating an association between socio-demographic variables and knowledge about PIVC (r = -.274, n=69, p<0.05). Conclusions The majority of semester 6 year 3 medical students in a private university in Seremban, Negeri Sembilan, had good knowledge of PIVC. Teaching strategies by nursing lecturers can be improved further, for example, role-playing which can increase students’ engagement and encourage critical thinking. This is to ensure that medical students are equipped with sufficient theoretical knowledge as it is important to produce doctors with great quality, confidence, and calibre.
Knowledge ; Students, Medical ; Perception ; Universities

Background: The spread of COVID-19 forced many countries including Malaysia to switch from on-campus learning to exclusively online learning. The modality of the synchronous session allows the learners to interact with the instructor and obtain instant feedback. The purpose of this study was to evaluate the effectiveness of synchronous simulation among medical students in clinical years in the absence of hospital-based clinical education. Methods: This was a prospective observational study involving 54 clinical year students, conducted in the simulation lab at International Medical University. Scenarios for each session were built around clinical skills targeting specific learning outcomes. The perception of the simulation session was evaluated using a 5-point Likert Scale. Synchronous debriefing followed each simulated session allowing active participation by all students. Focus group discussion was conducted among 6 students who volunteered representing online participants to obtain feedback on their learning experience. Results: The highest mean scores were obtained for the items referring to team communication (4.09±0.734), debriefing (4.06±0.811) and timetabling (3.92±1.007). Results from the focus group discussion revealed that: simulated sessions assisted in application of knowledge by observing their peers; the repetitive process of observing and performing was preferred over observing per se; observing the performance of peers from the same cohort was preferred, and critiques on technical logistics were reported. Conclusion The synchronous simulation sessions were well received by the students. It is believed that this will be a novel teaching modality to adopt even after the passing of the pandemic.
Students, Medical ; Education, Medical

Introduction: Cardiac resuscitation skills are a necessity for newly graduated doctors as they are first responders during a crisis. Despite undergraduate exposure, interns still struggle in an actual crisis. We evaluated final year medical students’ long-term retention of knowledge following cardiac life support training prior to exit from medical school to determine the need to revise and re-strategize. Methods: Thirty-seven final year medical students participated in a quasi-experimental research after a cardiac life support (CLS) course where results of their one best answer assessment-pretest, immediate posttest and 6 months posttest were analyzed. Results: A repeated measure ANOVA was conducted on mean test scores of 30-items one best answer (OBA) questions, measured as pre-test, immediate and 6 months posttests after the course. The result showed significant time effect, Wilks Lambda = 0.126, F (2,35) = 121.468, P = <.001. Follow up comparison indicated that each pairwise comparison difference was significant (p ≤ 0. 05). Both immediate and after 6 months post-course test scores were statistically better than the pretest scores suggesting that there was improvement in knowledge after the course despite the decay. Conclusion Our results showed that retention of knowledge as a short-term memory worked well immediately after the hands-on cardiac resuscitation course. However, though there was improved knowledge even after 6 months compared to before the course, there was decay in knowledge. There is a need to re-strategize to improve knowledge retention.
Knowledge ; Cardiopulmonary Resuscitation

Background: Side effects of intra-thecal (IT) morphine in lower caesarean section (LSCS) can be dangerous hence they are co-managed by the anesthesia pain team for a minimum of 24 hours. The aim of this study was to identify the side effects and consider the possibility of earlier discharge from the pain team to the parent team. Methods: A prospective observational study was conducted on 323 patients who received IT morphine for LSCS. An interviewer-centered questionnaire was used to obtain data on the side effects. Results: Side effects were experienced by 80% (n=259) of the patients, and none developed respiratory depression. Side effects occurred in first 6 hours in 94% (n=244) of the patients, 5% (n=13) within 6 to 12 hours and 1% (n=2) within 12 to 24 hours. Pruritus was the most common side effect (88%; n=227) and 93% (n=210) experienced it within the first 6 hours. Nausea and vomiting occurred in 54% (n=139) of the patients with side effects and 70% (n=97) of them experienced them within the first 6 hours. Kruskal-Wallis H test showed that Malays experienced more side effects, χ2(2) = 3.363, p = 0.004. No difference in pain scores was noted between races at 0-6 hours and 12-24 hours. However, Indians had higher scores at 6-12 hours (χ2(1) =4.31, p = 0.031). Conclusion The most common side effect was pruritus, then nausea and vomiting with no respiratory depression. Most occurred in the first 12 hours suggesting possibility of earlier discharge by the pain team to the parent team. However, further research is needed as guidelines suggest 24 hours, fearing respiratory depression. Side effects in Malays and increased pain perception among Indians need exploration.
Caesarean Section ; Drug-Related Side Effects and Adverse Reactions ; Send to: Racial Groups ; Respiratory Insufficiency