Online formative assessments: exploring their educational value

Introduction: online formative assessments [OFA's] have been increasingly recognised in medical education as resources that promote self-directed learning. Formative assessments are used to support the self-directed learning of students. Online formative assessments have been identified to be less time consuming with automated feedback. This pilot study aimed to determine whether participation and performance in online formative assessments [OFA's] had measurable effects on learning and evaluate the students' experience of using the OFA's in the department of Obstetrics and Gynaecology

Methods: this is a cross-sectional study conducted among fourth year medical students [n=92] during their seven week postings in Obstetrics and Gynaecology. Five sets of online formative assessments in the format of one best answers [OBA], Objective structured practical examination [OSPE] and Short answer question [SAQ] with feedback were delivered over five weeks through the online portal. The mean scores of the end of posting summative exam [EOP] of those who participated in the assessments [OFA users] and of those who did not [non-OFA users] were compared, using Students t-test. The frequency of tool usage was analysed and satisfaction surveys were utilized at the end of the course by survey questionnaire using the five point Likert scale

Results: the mean scores of the students in end of posting summative examination marks for students who had participated in the online formative assessment [OFA users] and for those who had not [non OFA users] showed no significant difference in all the three components OBA, SAQ and OSPE [p=0.902, 0.633, 0.248]. Majority of the students perceived that OFAs fulfilled the stated aims and objectives and so they would persuade their peers to participate in the OFAs

Conclusions: online formative assessments are perceived as tools that promote self-directed learning, improved knowledge and tailor learning for individual learning needs and style

Neuroendocrine carcinoma of the cervix: Review of classification and current developments in diagnosis and management

Neuroendocrine carcinoma of the female reproductive tract are a heterogeneous group of rare neoplasms posing both diagnostic and therapeutic challenges. The recent classification by WHO includes neuroendocrine carcinomas (NECs) and neuroendocrine tumours (NETs). NECs are the poorly differentiated small cell carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC), while well-differentiated NETs include typical carcinoids (TC) and atypical carcinoids (AC). Majority of these tumours have an aggressive clinical course and published data is supportive of multi-modal therapeutic strategies. Etoposide/platinum based chemotherapy is commonly advocated. Histopathological categorisation and diagnosis are paramount to guide therapy. Well-differentiated carcinoid and atypical carcinoid tumours should be managed similar to gastroenteropancreatic neuroendocrine tumours. This review discusses the current classification, clinicpathologic characteristics and advances in the diagnostic evaluation and the treatment options of neuroendocrine carcinoma of the cervix.

Mother’s mental preparedness for pregnancy : The affecting factors and its effect on birth outcomes

Background: Increased maternal anxiety level has been reported to have detrimental effects on the physical outcome of pregnancies such as not achieving vaginal births. This study thus aims to determine the level and factors affecting mental preparedness among mothers with normal pregnancies and its correlation with birth outcomes. Methods: Three hundred healthy mothers above 37 weeks of gestation in the early stage of labour were assessed for their level of mental preparation before birth process and outcomes after births which include general feeling (euphoria), ability to withstand labour pain and bonding with the new born. The successfulness of vaginal birth and other data on factors affecting mental preparation were also collected. Results: The level of mental preparedness was found good in 78% of the mothers, mainly determined by their socioeconomic status, family support and personal ability to adjust to changes. Age (p= 0.048), parity (0.00) and income (0.01) were found to influence mental preparedness significantly. Race, occupation, education level and marital status are however not significantly related. Poor mental preparedness is associated with greater pain during labour. A correlation analysis also found a positive relationship between the level of mental preparation and mental outcomes following birth in these mothers but it did not significantly influence the mode of delivery. Conclusion: Mental preparation before birth seems to have an effect on mental outcomes of mothers following birth process. It is vital that mothers of the younger age group with no previous obstetric experience be given more attention in preparing them mentally before they face the painful birth process.

Assessment Effects Of Maintenance Therapy On Quality Of Life Of Opiate Abusers

Objective: This study was conducted to assess the effects of Methadone Maintenance Therapy (MMT) and buprenorphine-naloxone Maintenance Therapy (BNX) on the Quality of life (QoL) of opiate abusers. Methods: The QoL status of opioid-dependent patients was assessed using the WHOQOL-BREF questionnaire. It is a cross-sectional study involving a total of 108 patients who received MMT or BNX therapy in Malaysia from May 2011 to September 2011. Results: A statistically significant difference in the overall QoL and psychological aspect among patients on MMT was observed. On the contrary, the scores of overall QoL and quality of social relationship for BNX group were higher in patients with lower dosage. Conclusion: The comparison between patients on high dose MMT and high dose BNX exhibited significant difference in the overall QoL especially in psychological, social relationship and environment domains, with the high dose MMT group having better mean score.

Biochemical evaluation of the supporting structure of pelvic organs in selected numbers of premenopausal and postmenopausal Malaysian women.

Context: Pelvic organ prolapse (POP) is associated with menopause and changes in the proteins of the pelvic supporting system, but there is scant data on the precise alterations in Malaysian women. Aim: The aim of this study is to determine the differences in the extracellular matrices (ECM) of uterosacral ligaments in premenopausal and postmenopausal Malaysian women with or without POP. Settings and Design: The observational study was conducted for 9 months in three general hospitals involving 30 women who underwent hysterectomies for various indications except for carcinoma of pelvic organs. Materials and Methods: Three groups were identified: Premenopausal women (Group 1), postmenopausal women without POP (Group 2), and postmenopausal women with POP (Group 3). Age, duration of menopause, body mass index (BMI), parity, and vaginal deliveries were documented. Only 21 samples of the uterosacral ligaments were stained immunohistochemically for collagen I and III, matrix metalloproteinases (MMPs) 1 and 2, elastin, and tenascin. Statistical Analysis Used: Image J software analysis was utilized for quantification, while non-parametric statistics (Kruskal-Wallis with post-hoc Dunns Multiple Comparison test) was used for result analysis. Results: The profile parameters were not significantly different except for mean age and duration of menopause in Group 3. Samples from Group 2 showed lower expression of almost all proteins except MMP1 and tenascin (higher) as compared to Group 1. The changes appeared to be exaggerated in Group 3, though statistically insignificant. Conclusion: A significant difference in the expression of ECM was apparent in postmenopausal subjects as compared to premenopausal ( P = 0.05), compromising the uterosacral ligament tensile strength. The findings are proven similar as those changes in women from other studies.

Risk factors of peripheral venous catheterization thrombophlebitis

Background: Peripheral venous catheterisation is indispensable in modern practise of medicine. The indications of venous access should be weighed against the risk of complications, the commonest being thrombophlebitis. Thrombophlebitis causes patient discomfort and the need for new catheter insertion and risk of developing further widespread infections. Methodology: This observational study was conducted on adult patients admitted to the surgical and medical ward of a tertiary hospital in Negeri Sembilan Malaysia in 2011. Four researchers visited patients daily and examined for signs of thrombophlebitis; warmth, erythema, swelling, tenderness or a palpable venous cord. Risks factors that were studied in this research were patient/s age and gender, duration of catheterization, use of catheter for infusion, size of catheter, site of catheter insertion and types of infusate. Thrombophlebitis was graded using a scale adapted from Bhandari et al. (1979). Results: In total, 428 patients were recruited with an incidence rate of thrombophlebitis of 35.2%. Among those who developed thrombophlebitis, 65% had mild thrombophlebitis, 19% moderate and 8% severe thrombophlebitis. Results showed that female patients had a significant increased risk of developing thrombophlebitis. Also risk increased significantly with increased duration of catheterization and usage of the catheter for infusion. The age of a patient, types of infusate use, size of catheter and site of catheter insertion did not significantly influence the development of thrombophlebitis. Conclusion: The study showed that risk of developing thrombophlebitis is significantly increased among female patients, and also with increased duration of catheterization and use of the peripheral venous catheter for infusion. We recommended elective replacement of catheter every 72 hours and daily examination of catheters for signs of thrombophlebitis by a healthcare personnel.

Task-Based Learning: Student’s Perception Of Their Skill In Participating In Small Group Discussions

Task-based learning (TBL) has been accepted as an effective tool in teaching and learning activities in most medical schools. Many studies have looked at competencies and learning outcomes essential for undergraduates. Among the essential competencies are interpersonal skills and the ability to engage in a group discussion which this study has focused on. The evidence supporting higher interpersonal skills is however limited because many relevant competencies are hard to measure and require long observational periods. Objective To determine students’ self-perceived value of TBL in enhancing their interpersonal skills during the clinical phase. Material and Methods All students’ (semesters 6-10) in the clinical school of International Medical University (IMU) were invited to participate in this cross-sectional study done in December 2007 utilising a self-administered questionnaire with a 5-point Likert scale. It assessed the students’ perception on TBL sessions conducted during their clinical attachments in the various disciplines. Mean-scores, standard deviations, and confidence interval were used. Results Response rate was 62%. The results indicated that students were favorable in their opinion on TBL as a suitable forum for active communication and participation in group discussion. The results also show that both male and female students’ have similar perception. As for the comparison according to semesters, this showed that students’ maturity does not influence their perception as well. Conclusion In conclusion, the study has shown positive students’ perception on the effect of TBL on acquired skills such as interpersonal communication. Our findings are consistent with many earlier studies which show students’ perception of the method of learning as important factor in the enhancement of their interpersonal skills which is fundamental to clinical practice. Further research is necessary; long-term and larger scale observational studies would undoubtedly be optimal to minimise response bias.