Intake Interview Procedure For The Selection Of Undergraduate Students In Malaysian Medical Schools: Inter-Ratter Reliability Of Quality Assessment

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.

Item Analysis, Reliability Statistics And Standard Error Of Measurement To Improve The Quality And Impact Of Multiple Choice Questions In Undergraduate Medical Education In Faculty Of Medicine At Unisza

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.

Structured Vetting Procedure Of Examination Questions In Medical Education In Faculty Of Medicine At Universiti Sultan Zainal Abidin Malaysia

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.

Lymphangioma circumscriptum of buttock mimicking lupus vulgaris and responding with anti-tubercular chemotherapy

Lymphangioma circumscriptum [LC] is a form of lymphangioma involving skin and subcutaneous tissue. Circumscriptum as its name suggests, is a well-circumscribed small lesion but it has a rare extensive variety also. LC may resemble other entities such as metastatic carcinoma of skin, lymphangiectasis, syringocystadenoma papilliferum, lupus vulgaris, actinomycosis etc. It is a difficult condition to treat. Different modalities of treatment such as surgical excision, laser, sclerotherapy, radiofrequency coagulation are used to treat this condition. We report here clinical presentation mimicking lupus vulgaris and responding with anti-tubercular [ATT] chemotherapy

Radiographic evaluation of enlarged adenoids in children with chronic adenoiditis

To evaluate the use of soft tissue neck x-ray in the assessment of enlarged adenoids in children with chronic adenoiditis. Tertiary referral centre of Malaysia. Prospective study. We performed a soft tissue neck x-ray [lateral view] for adenoids in children with chronic adenoiditis admitted for adenoidectomy under general anaesthesia. Only those children whose parents /guardian agreed for imaging were included. The enlarged adenoids were graded from 1+ to 4+ where 1+ is the normal adenoids with normal nasopharyngeal airway and 4+ is massive enlargement of adenoids with totally occluded nasopharyngeal airway. RESULTS: Fifty children were accrued from June 1999 to September 2001. The ages of the children were from 3-12 years old. All of them had adenoidectomy successfully without any complications. The soft tissue neck x-ray showed 8% of the patients have 1+, 38% have 2+, 42% have 3+ and 12% have 4+ adenoids enlargement. Lateral soft tissue neck x-ray is a good method to demonstrate adenoids enlargement in children with chronic adenoiditis and convenient for the busy otorhinolaryngologists. It may help to determine that the symptoms are due to adenoids enlargement and exclude other causes

Generalized eruptive syringoma

Syringoma is a benign adnexal neoplasm formed by well-differentiated ductal elements. The name syringoma is derived from Greek word Syrinx which means pipe or tube. Most commonly, syringomas are skin-colored or yellowish, small dermal rounded or flat papules ranging from 1- 3mm in diameter in the lower lid and upper part of the cheek. Eruptive syringoma is clinically distinct, uncommon variant of syringomas. Since the initial description by Darier and Jaquet in 1887, less than 100 cases have been reported to date. A case of 18 year old female with a 5 year history of eruptive syringoma is presented

Prevalence of various components of metabolic syndrome in our younger population

Metabolic Syndrome prevalence all over the world is increasing. Assessment at an early age regarding the presence of these is imperative to early prevention and treatment. This study was conducted to evaluate prevalence of the various components of metabolic syndrome in our adolescent population. A total of 193 young adolescents between ages 17 to 25 years were taken, 106 males and 87 females. Record of each subject's personal, socioeconomic, educational, dietary and family histories was taken. Anthropometric and laboratory investigations done were: waist circumference, hip circumference, height, weight, waist hip ratio, body mass index, and blood pressure. Laboratory investigations performed after an overnight fasting of 12 hours were: Plasma glucose levels. Lipid profile including total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides, and Uric acid levels. Data on all variables required to define the metabolic syndrome according to National Cholesterol Education Program Adult Treatment Panel III [NCEP ATP III] criteria was recorded. Waist hip ratio was increased in 23.8%. Obesity was seen in 34.7%, 29% were overweight, and 5.7% were frankly obese. Blood pressure measurements showed upper normal ranges; in 23.8% subjects high systolic and in 15% subjects high diastolic values were observed. Fasting plasma glucose was high in 4.7%. Fasting serum lipid profile: cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides: 20.2% fasting serum cholesterol of more than 191 mg/dl, HDL-cholesterol being less than 40 mg/dl in 87.6%. 23.3% had LDL-cholesterol more than 200 mg/dl. Fasting serum triglycerides more than 185 mg/dl seen in 12.5%. Serum uric acid raised in 3.6%. WHR, BMI, Fasting plasma glucose, HDL-c and TG were sensitive indicators of metabolic syndrome. Serum HDL-cholesterol was the most prevalent abnormality followed by obesity. Metabolic syndrome is much prevalent in Pakistani adolescents and can be diagnosed using simple and economical investigations

Outcome of neck dissections in a rural tertiary University Hospital in Malaysia

To determine the outcome of neck dissection among our head and neck cancer patients in the setting of a rural Universitiy Sains Malaysia Hospital. Neck dissection procedures were reviewed from 2004 to 2008. The medical folders of each patient were traced and the data collected includes diagnosis, type of operative procedure and outcome on follow-up. A total of fourteen patients had undergone neck dissection as a combined procedure with the'primary tumor surgical removal. There were five radical neck and one modified type two radical neck dissections. The rest were eight selective neck dissections [three anterior and five supraomohyoid]. Twelve patients underwent unilateral neck dissections and two patients underwent bilateral neck dissections. The average duration of hospital stay was seventeen days, the longest stay was two months and the shortest stay was four days. One patient died secondary to complication of the primary tumor and one had to undergo exploration due to chylous leak post operation. Neck dissection is a surgical procedure to control neck lymph nodes metastasis from primary carcinoma of the head and neck. The extent of the cervical nodes involvement determines the type of neck dissections and their outcomes

Challenges in the Management of Nasopharyngeal Carcinoma: A Review

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.

Critical appraisal and the surgical technique of maxillary swing approach for advance stage juvenile nasopharyngeal angiofibroma

Unsuspected tumor extension in an occult anatomical region of nasopharynx with overwhelming surgical hazard and unpredictable outcome of surgical extirpation has made juvenile nasopharyngeal angiofibroma a unique experience for operating surgeons. This is more true for those advance tumors invading the skull base. No ideal surgical technique has been described to totally ablate these tumors, however, key to success in controlling the recurrence is the selection of surgical approach, which is tailored to the individual need and tumor staging. A variety of anterior and lateral skull base approaches have been described for advance stage III and IV nasopharyngeal angiofibroma. Maxillary swing approach was employed in five cases of juvenile angiofibroma in the present study, which, aims at evaluation of operative procedure in adolescents with respect to adequacy of exposure, peroperative difficulties, postoperative complications and the outcome in minimizing the rate of recurrences with this procedure. A total of 30 cases of JNA were done through various surgical procedures, inclusive of 5 maxillary swing approaches. The outcome was compared after meticulous follow up to identify any residual tumor or recurrences during next three years. The result showed that the procedures done through other surgical approaches in 30 cases required further surgical management for recurrences in 5 cases compared to 1 case in maxillary swing group. Most of these cases were re-explored through a transpalatal approach

The routine histopathological examination of tonsillectomy specimens at Hospital Universiti Sains Malaysia- Retrospective study and its implication

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.

Clinical and audiological profiles in children with chronic otitis media with effusion requiring surgical intervention

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.

How to develop a core curriculum in clinical skills for undergraduate medical teaching in the School of Medical Sciences at Universiti Sains Malaysia?

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.

The routine histopathological examination of tonsillectomy specimens at Hospital Universiti Sains Malaysia – A retrospective study and its implication

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.

Appraisal of clinical profile and management of juvenile nasopharyngeal angiofibroma in Malaysia

Juvenile nasopharyngeal angiofibroma (JNA) is a benign but locally invasive tumour. Patients are usually in their adolescent age and present with epistaxis and nasal blockage. Diagnosis is based on clinical evaluation and the C.T. scan findings. Pre-operative superselective embolisation (SSE) and surgical excision is the treatment of choice. The outpatient clinic of ORL-HNS hospital of University Science Malaysia received 25 referrals, all male, majority between 9-13 years of age and few adolescents. Clinically the patients were consistent with symptoms of recurrent epistaxis and nasal blockage. They reported from October 1998 to October 2001 from within the state of Kelantan and the nearby states of Pahang, Kedah and Terenganu. Diagnosis was mostly made on typical radiological findings and the tumours were classified accordingly into four stages. SSE and surgical excision was carried out in all cases. Regular follow-up helped us to identify early recurrences which were treated with salvage surgery or radiotherapy in one case with extensive intracranial extension. A retrospective review of presenting features, diagnostic difficulties, surgical approaches and its outcome is presented. Maxillary swing procedure performed in three cases as a new surgical option in the management of JNA is also discussed.

Conventional biopsy to EBV amplification kit in quick diagnosis of nasopharyngeal carcinoma

The conventional diagnostic method by nasopharyngeal biopsies and fine needle aspiration of neck lumps have high rate of false negatives. Serological test for EBV antibody titre is also less helpful due to low sensitivity and specificity. EBV DNA in tumor cells detected by polymerase chain reaction [PCR] has been shown to be more reliable and able to detect the cancer before it develops clinically. The author and his team in University Sciences Malaysia has successfully conducted a study to evaluate the validity and reliability of detecting EBV genes in fine needle aspirates and biopsy tissue in NPC by PCR. EBV products EBNA, and EBNA, and LMP, [generally implicated in oncogenesis] together with Beta-actin gene were analyzed with adequate sample in this study for the first time in Southeast Asia. This was a step forward towards the ultimate diagnosis of NPC which otherwise may lead to an advance disease with regional metastasis adversely affecting the prognosis due to delay in diagnosis. This and a few similar studies have given new hope towards the accurate diagnosis of NPC which has inherent pitfalls in detection by conventional methods based on histopathology. This is an Editorial

role of endoscopic surgery in the management of juvenile nasopharyngeal angiofibroma

Endoscopic sinonasal surgery [ESNS] as an adjuvant to transpalatal approach cum lateral rhinotomy in grade II juvenile angiofibroma [JNA] is experienced in two cases. Superselective embolization provided the optimal use of this approach. Intraoperative ESNS is found immensely helpful in identifying the residual tags and site of origin of JNA. Eventually this may also be helpful in reducing the recurrence usually seen with all other surgical approaches. Two cases of JNA were dealt in our department during May 1999 and April 2000

displaced laryngeal FB

A 35 year old man inhaled a F.B. [air gun pellet] which could not be located endoscopically. Repeated radiological examinations continued to reveal the F.B. in the neck. Tomograms showed the F.B. within the confines of thyroid cartilagenous frame work. Repeated endoscopic and microlaryngeal approaches failed, thus Laryngfissure was used to remove the F.B. from soft tissues of the Larynx with much difficulty

Free field distraction test of hearing for assessment of deafness in hearing and speech impaired children

This is a retrospective study of 216 patients with hearing and speech impairment between 1982-1991. Free field hearing test has been found a useful convenient and simple investigation in the assessment of deaf children. Beside determining the degree of hearing loss an effort was also made in this study to establish the possible causative factors of deafness primarily based on history. On assessment 62 children were found to have normal hearing but had speech impairment. Among 154 deaf patients, 65 had mild to moderate loss, 63 were profoundly deaf where as 26 had shown total hearing loss. There were more who acquired the deafness than those who were born congenitally deaf. It is emphasized to employ this test in routine otological practice to establish the handicaps at an early age to achieve better rehabilitation results, rather than depriving patients of assessment and diagnosis for want of advanced and audiological test