International Medical University Research Articles

The implementation of problem-based learning in collaborative groups in a chiropractic program in Malaysia.

Purpose:Problem-based learning (PBL) is usually conducted in small-group learning sessions with approximately eight students per facilitator. In this study, we implemented a modified version of PBL involving collaborative groups in an undergraduate chiropractic program and assessed its pedagogical effectiveness.Methods:This study was conducted at the International Medical University, Kuala Lumpur, Malaysia, and involved the 2012 chiropractic student cohort. Six PBL cases were provided to chiropractic students, consisting of three PBL cases for which learning resources were provided and another three PBL cases for which learning resources were not provided. Group discussions were not continuously supervised, since only one facilitator was present. The students’ perceptions of PBL in collaborative groups were assessed with a questionnaire that was divided into three domains: motivation, cognitive skills, and perceived pressure to work.Results:Thirty of the 31 students (97%) participated in the study. PBL in collaborative groups was significantly associated with positive responses regarding students’ motivation, cognitive skills, and perceived pressure to work (P<0.05). The students felt that PBL with learning resources increased motivation and cognitive skills (P<0.001).Conclusion:The new PBL implementation described in this study does not require additional instructors or any additional funding. When implemented in a classroom setting, it has pedagogical benefits equivalent to those of small-group sessions. Our findings also suggest that students rely significantly on available learning resources.

Dental esthetic impact of malocclusion and orthodontic treatment need based on self-perception among university students

AimsThe objectives of this study were to assess the self-perceived esthetic orthodontic treatment need, to determine esthetic impact of malocclusion and investigate the effect of factors including gender and courses to the need of orthodontic treatment among university students. MethodsA random study of 275 subjects among 18–25 year old university students from International Medical University (IMU) were evaluated using 2 scales; the Aesthetic Component of Index of Orthodontic Treatment Need (AC) and Oral Aesthetic Subjective Impact Scale (OASIS) and one direct question. ResultsThe data were analyzed to evaluate the subjective orthodontic treatment need, aesthetic impact of malocclusion, and perceived orthodontic treatment need.In the study, 55.7% of the students experienced negative perception and 44.3% have positive self-perception. Female perceived more negative perception (AC-OASIS) as compared to male, 35.3% and 20.4% respectively. The Mann–Whitney U Test was used to compare the total AC-OASIS score between males and females showed positive significance, p=0.05. The comparison between dentistry and non-dentistry students shows no significant difference in perception, p>0.05. ConclusionThere was no difference in the level of orthodontic treatment need among students from different courses, but impact of malocclusion was higher in females compared to males.

The relationship between learning preferences (styles and approaches) and learning outcomes among pre-clinical undergraduate medical students.

BackgroundLearning styles and approaches of individual undergraduate medical students vary considerably and as a consequence, their learning needs also differ from one student to another. This study was conducted to identify different learning styles and approaches of pre-clinical, undergraduate medical students and also to determine the relationships of learning preferences with performances in the summative examinations.MethodsA cross-sectional study was conducted among randomly selected 419 pre-clinical, undergraduate medical students of the International Medical University (IMU) in Kuala Lumpur. The number of students from Year 2 was 217 while that from Year 3 was 202. The Visual, Auditory, Read/Write, Kinesthetic (VARK) and the Approaches and Study Skills Inventory for Students (ASSIST) questionnaires were used for data collection.ResultsThis study revealed that 343 students (81.9%) had unimodal learning style, while the remaining 76 (18.1%) used a multimodal learning style. Among the unimodal learners, a majority (30.1%) were of Kinesthetic (K) type. Among the middle and high achievers in summative examinations, a majority had unimodal (Kinaesthetic) learning style (30.5%) and were also strategic/deep learners (79.4%). However, the learning styles and approaches did not contribute significantly towards the learning outcomes in summative examinations.ConclusionsA majority of the students in this study had Unimodal (Kinesthetic) learning style. The learning preferences (styles and approaches) did not contribute significantly to the learning outcomes. Future work to re-assess the viability of these learning preferences (styles and approaches) after the incorporation of teaching-learning instructions tailored specifically to the students will be beneficial to help medical teachers in facilitating students to become more capable learners.

A pilot study to explore if reading fictional works of medical writers can be used as a formative assessment tool in the learning of Humanism and Bioethics: A narrative report

In a pilot study conducted to explore if reading fictional works of medical writers could be used as a tool to formatively assess learning of Humanism and Bioethics, a medical student in her elective rotation at International Medical University (IMU) was assigned to read a story-book relating to daily life and suffering authored by a medical-writer, and subsequently write a reflective narrative report which was assessed with guided reflection by her mentor. It was perceived that reading of fictional works of medical writers during medical students’ leisure time may prove to be a worthwhile and enjoyable way for students to learn higher levels of clinical competence, in the realm of humanism and bioethics. From the student’s report in this pilot study it was evident that she had gained experiential learning in three areas, namely, self-reflection and self-awareness, empathy, and ethical reasoning skills. Although Bioethics and Professionalism delivered through formal face to face teaching in classrooms and the clinical setting is taught in all ten semesters of the medical program, reading fiction of medical writers as an innovative tool to formatively assess the learning of Humanism and Bioethics could be explored further from the observations noted in this pilot study.

Flipped Classroom with Poll Everywhere: Engaging Students with Active Learning in Large Group Settings

Large group teaching has always been the most popular way of teaching from past decades. It is one of the most convenient and economical ways to transfer knowledge from the content expert to the learner. Educationists have always raised concerns about active learning in this method. The use of variety of methods would be included in classroom teaching and active learning should be encouraged. The objective of this study was to investigate the impact of implementing flipped classroom with the Poll Everywhere tool on student engagement in large group teaching for active learning by students. Blended method of active learning using flipped classroom with the use of Poll Everywhere tool has been widely accepted by learners in large group teaching. Poll Everywhere tool is useful to get immediate feedback from learners which will help the teacher to focus more on the difficulty level of learners. As per the feedback given by learners during large group teaching in classroom, teaching strategies can be amended to spend more time on those areas which needs to be addressed within a time limit of lecture. Study was conducted on the undergraduate students of the second year (semester 4) from Biomedical Science Program at International Medical University, Kuala Lumpur, Malaysia, between January to June 2014. Flipped classroom was introduced to same cohort of learners who were used to attend traditional class of learning for large group of teaching. Learners were well informed in advance with prior information of teaching learning material in elearning portal of university. Students were grouped in small groups and given some questions which were answered by using the Poll Everywhere tool in smart phones. Teacher centered learning will be changed into student centered learning and focused more on difficulty area of concepts. Combination of Poll Everywhere tool with flipped classroom was well accepted by students though needs lots of planning by teacher and high speed internet in university for effective learning method.

Knowledge and practice of medical students of the usage of personal protective equipment: A comparison of two cohorts of students at the International Medical University

Knowledge and practice of medical students of the usage of personal protective equipment: A comparison of two cohorts of students at the International Medical University

Cloning and expression of Pteropine Orthoreovirus sigma C protein in bacterial cells

Introduction: Pteropine Orthoreovirus (PRV) was first cloned in 2011 to represent a collective of orthoreoviruses isolated from bat species of the genus Pteropus . Humans, especially infants or children, infected with Mammalian Orthoreovirus (MRV), a genetically closely related ‘ relative’ to PRV, commonly present with mild upper respiratory tract illness or enteritis. However, this does not hold true for PRV, as acute respiratory syndrome is commonly seen in patients infected with PRV. Objectives: The focus of this study was to clone the sigma C gene in two vectors (pMal-C5X and pMal-P5X) and express it in different bacterial cells (ER2523 and BL21). However, the targeted receptor will be identified in a future study. Materials and methods: The sigma C gene of PRV1K (Kampar virus), PRV2P (Pulau virus) and PRV3M (Melaka virus) were amplified and cloned into (pMal-C5X and pMal-P5X) vectors. Colony polymerase chain reaction (PCR) was preformed to screen for positive clones prior to being expressed in BL21 and ER2523 bacteria. Periplasmic and total lysis extraction was performed on both bacterial cells prior to separation by SDS-PAGE (sodium dodecyl sulphate polyacrylamide gel electrophoresis) and visualization with Coomassie Blue stain. Results: The PCR of sigma C gene for three different viruses, namely Pulau, Melaka and Kampar, were performed. PCR of Pulau and Kampar viruses were successful but Melaka virus was unsuccessful because it did not reach the desired band and was excluded. The protein receptors were confirmed by a restriction enzyme reaction. Conclusions: Sigma C of PRV2P was expressed in bacterial cells without any lethal effect on the bacteria. The protein will be purified and targeted receptor identified in a future study. Acknowledgements: We would like to acknowledge our University and our Dean, Dr Khalid Al Qumaizy, for giving us this great opportunity, and we acknowledge Dr Keeny Voon from International Medical University of Malaysia for helping us conduct this research.

Quality of Root Canals Performed by the Inaugural Class of Dental Students at Libyan International Medical University.

Objective. The purpose of this study was to radiographically evaluate technical quality of root canal fillings performed by dental undergraduates at Libyan International Medical University in Libya. Methods. Root canal cases were treated at university dental clinic from the fall of 2012 to the fall of 2013 by the fourth and fifth year dental students. Students used step-back preparation and cold lateral compaction in the treatment. Radiographs were reviewed over a two-year period from initial procedure to final restoration. Radiographs were evaluated for adequacy or inadequacy by length, density, and taper. Length inadequacy was classified as short or overextended. Overall quality was considered “adequate” based on all three variables. Chi-square tested differences between teeth groupings and adequacy classification. Significant p value results were adjusted by Bonferroni correction. Results. Adequate length of root canal fillings were observed in roughly half of all samples (48.6%). Density was adequate in 75.8% of the samples. Taper was observed as adequate in 68.8%. Higher quality was evident in anterior teeth (plus premolars) versus molars (65.6% versus 43.3%, resp.; p < 0.04). Conclusion. Overall quality of endodontic treatment performed by undergraduate dental students was adequate in 53.9% of the cases. Significant opportunity exists to improve the quality of root canals provided by dental students.

Antibiotics self-medication among medical and nonmedical students at two prominent Universities in Benghazi City, Libya.

Background:Trivial use of antibiotics is a major reason for the spread of antibiotics resistance. The aim behind undertaking this investigation was to study the prevalence antibiotics self-medication among university students in Benghazi city.Methods:A questionnaire-based cross-sectional, survey was conducted at both Libyan International Medical University and Benghazi University. A total of 665 copies of questionnaires was distributed. A total of 363 forms were completed and returned (response rate 55%). Remaining responses were either with no antibiotics use history within the past 1 year or were provided incomplete.Results:Among the respondents, 45% were males and 55% females. Males practiced self-medication more compared to females. Approximately, 43% and 46% from medical and nonmedical students, respectively, were antibiotics self-medicated. A total of 153 students (42%) out of total respondents administered antibiotics for symptoms related to respiratory problems, among which 74 students (48%) took antibiotics based on doctor's prescription. Among the respondents, 94 students (27%) who had antibiotics, were covered under medical insurance, and 19 (29%) of the medically insured students had antibiotics without doctor's prescription. About 14% of students did not complete their antibiotics course. Of these, 57% were medical students, and 43% were nonmedical students. The rate of self-medication among higher classes was more as compared to lower classes. About 58% of students overdosed the antibiotic, while 15% had antibiotics for <3 days, for treatment of ailments such as acne, toothache, diarrhea, earache, and tonsillitis. About 75% of students purchased the antibiotics in consultation with a pharmacist.Conclusion:Self-medication is a frequent problem among university students in Benghazi city. There is a need for an immediate intervention to address this malpractice among both students and medical practitioners.

Substrate zymography of snake venom components depicting the activity of matrix metalloprotease

Introduction: Matrix metalloproteases (MMPs) are a group of endopeptidases belonging to a superfamily of zinc protease enzymes that have the potential to degrade the extracellular matrix (ECM). The loss of its activity could lead to very serious alterations in the human body, causing several conditions such as arthritis and aneurisms. Previous studies indicate that snake venom contains snake venom metalloprotease (SVMP), which might possess similar activity to MMPs. In these experiments, it was shown that Malaysian cobra SVMP is capable of gelatinolytic activity, which was demonstrated using gelatine as substrate in sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) (zymography). Objectives: To investigate the activity of Malaysian cobra SVMP using zymography. Materials and methods: Protein was extracted from cobra snake venom using fast protein liquid chromatography then, after purification, the fractions were collected and run on SDS-PAGE to visualize the protein of interest, which was then desalted and concentrated using dialysis and ready to be used for zymography to demonstrate the activity of SVMP. Results: In the detection of the SVMP on SDS-PAGE, the molecular weight was observed around 55kDa. A possible dimer was also seen at 110kDa. Gelatinase activity of SVMP was clearly revealed on the gelatine gel that was used in zymography. Conclusions: Having found the gelatinolytic activity of SVMP the future direction of this protein can be tested against the tumour environment to see the potential use of SVMP’ s. Acknowledgements: Al-Imam Muhammad ibn Saud Islamic University for their support, International Medical University for using their laboratories, and Dr Fabian Davamani for supervising this project.

Comparison and Agreement among Various Case Definitions of Periodontitis: A Secondary Data Analysis

Background and aims. A plethora of definitions has been used for periodontitis for epidemiological studies. The aim of this cross-sectional study was to assess the impact of different case definitions on the prevalence of periodontitis and to find the level of agreement among them. Materials and methods. Periodontal records of 300 subjects were randomly selected from the database of Oral Health Center, International Medical University. The prevalence of periodontitis was determined using six different case definitions of I, II, III, IV, Va and Vb previously used in various studies. The definition Va proposed by CDC Periodontal Disease Surveillance Workgroup was adopted as the gold standard to calculate sensitivity and specificity. Results. There were large variations in the prevalence of periodontitis based on different definitions, ranging from 28% to 76.7%. There was good agreement between definitions III and Vb (0.901) and definitions II and III (0.713). Definition II had the highest agreement with the gold standard (Va) among all the definitions. Excluding definition I, all had a high specificity to the gold standard. Conclusion. The prevalence of periodontitis is greatly influenced by the choice of the case definition. Prevalence rates with definition II could be more accurate if the true prevalence is determined by definition Va.

Neuroprotective role of antioxidant and pyranocarboxylic acid derivative against AlCl3 induced Alzheimer’s disease in rats

Neuroprotective role of antioxidant and pyranocarboxylic acid derivative against AlCl3 induced Alzheimer’s disease in rats Sarabjeet Singh, Ramandeep Singh, Ajay S. Kushwah, Gaurav Gupta Pharmacology and Toxicology Research Laboratory, ASBASJS Memorial College of Pharmacy Bela, Ropar (Punjab)-140 111, India Department of Pharmacy, Himachal Institute of Pharmacy, Paonta Sahib, Himachal Pradesh, India Department of Life Sciences, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia Journal of Coastal Life Medicine 2014; 2(7): 571-578

Assessors for communication skills: SPs or healthcare professionals?

Introduction: The complexity of modern medicine creates more challenges for teaching and assessment of communication skills in undergraduate medical programme. This research was conducted to study the level of communication skills among undergraduate medical students and to determine the difference between simulated patients and clinical instructors’ assessment of communication skills.Methods: This comparative study was conducted for three months at the Clinical Skills and Simulation Centre of the International Medical University in Malaysia. The modified Calgary-Cambridge checklist was used to assess the communication skills of 50 first year and 50 second year medical students (five-minutes pre-recorded interview videos on the scenario of sore throat). These videos were reviewed and scored by simulated patients (SPs), communication skills instructors (CSIs) and non-communication skills instructors (non-CSIs).Results: Better performance was observed among the undergraduate medical students, who had formal training in communication skills with a significant difference in overall scores detected among the first and second year medical students (p = 0.0008). A non-significant difference existed between the scores of SPs and CSIs for Year 1 (p = 0.151).Conclusions: The SPs could be trained and involved in assessment of communication skills. Formal training in communication skills is necessary in the undergraduate medical programme.

Formulation and delivery of itraconazole to the brain using a nanolipid carrier system.

The objectives of this study were to develop and characterize itraconazole (ITZ)-loaded nanostructured lipid carriers (NLCs) and to study their potential for drug delivery into the brain. Precirol® ATO 5 and Transcutol® HP were selected as the lipid phase, and Tween® 80 and Solutol® HS15 as surfactants. The ITZ-NLCs were prepared by a hot and high-pressure homogenization method. The entrapment efficiency for the best formulation batch was analyzed using high-performance liquid chromatography and was found to be 70.5%±0.6%. The average size, zeta potential, and polydispersity index for the ITZ-NLCs used for animal studies were found to be 313.7±15.3 nm, −18.7±0.30 mV, and 0.562±0.070, respectively. Transmission electron microscopy confirmed that ITZ-NLCs were spherical in shape, with a size of less than 200 nm. Differential scanning calorimetry and X-ray diffractometry analysis showed that ITZ was encapsulated in the lipid matrix and present in the amorphous form. The in vitro release study showed that ITZ-NLCs achieved a sustained release, with cumulative release of 80.6%±5.3% up to 24 hours. An in vivo study showed that ITZ-NLCs could increase the ITZ concentration in the brain by almost twofold. These results suggest that ITZ-NLCs can be exploited as nanocarriers to achieve sustained release and brain-targeted delivery.

Blood supply of anterior longitudinal ligament: an approach to understand diffuse idiopathic skeletal hyperostosis (543.3)

Diffuse idiopathic skeletal hyperostosis (DISH) or Forestier’s disease is a common entity among elderly and is characterized by ossification of the anterior longitudinal ligament (ALL) of the spine and various extraspinal ligaments.The pathogenesis of abnormal bone growth in DISH is not fully understood. In an attempt to figure out an anatomical explanation of the etiology of such a debilitating disease, the present study investigated the role of blood supply of the ALL.In cadavers of the anatomy lab in Libyan International Medical University, fine dissection of vessels supplying ALL was performed in the vicinity of azygos, hemiazygos veins and descending thoracic aorta; starting from the level T5 till T12 vertebrae. The current work elucidated that the blood vessels supplying ALL ran in ascending manner ranging from oblique to nearly vertical in direction.The present study demonstrated that poor blood supply reaching certain regions of the spine caused by antigravity‐directed blood vessels supplying ALL, may lead to ischemic changes caused by hypoperfusion and thereby ossification of ALL leading to DISH disease. The current results open a new era of investigation of the probable etiology of this disease.Grant Funding Source: Supported by the Libyan International Medical University

Medical students' perceptions regarding the impact of mobile medical applications on their clinical practice

Kwee Choy Koh, MMed, MBBS, Jun Kit Wan, Sivasanggari Selvanathan, Chithralekha Vivekananda, Gan Yi Lee, Chun Tau Ng Senior lecturer, Department of Medicine, International Medical University, Seremban, Negeri Sembilan, Malaysia, and consultant infectious disease physician, Hospital Tuanku Ja’afar, Seremban, Negeri Sembilan, Malaysia; 3rd year undergraduate medical student, International Medical University, Seremban, Negeri Sembilan, Malaysia Corresponding Author: kweechoy_koh@imu.edu.my

Comprehensive Implementation of the International Caries Detection and Assessment System (ICDAS) in a Dental School and University Oral Health Centre: A Stepwise Framework

ICDAS (the International Caries Detection and Assessment System) is a new approach to the detection and classification of dental caries, starting with the stage showing the earliest visual changes. Methodology: This article describes the implementation of the ICDAS at the School of Dentistry, International Medical University, and Kuala Lumpur, Malaysia in a step-by-step systematically planned process. Beginning with the setting up of a Task Force in 2011 for the evaluation and preparation of the training resources and the running of exploratory training exercises, it finally culminated in carrying out training workshops for the entire staff and students. After the internal processes had been completed, an international expert (KE) was invited to evaluate the process and conduct another workshop using the resources developed within the University, including a reference set of carious teeth. The overall time taken was one and a half years. Conclusions: The implementation of the ICDAS has been comprehensively set into motion within the context of our local curriculum and oral healthcare delivery arrangements. However, this will be an ongoing process with further quality assurance measures being required clinically together with the continuing training of new staff. Sharing this ‘framework’ of the ICDAS implementation process should considerably ease the path and reduce the time period of future implementations by other dental teaching institutions.

Clinical Audit Teaching in Record–Keeping for Dental Undergraduates at International Medical University, Kuala Lumpur, Malaysia

This study investigated the impact of clinical audit training on record-keeping behavior of dental students and students' perceptions of the clinical audit training. The training was delivered to Year 4 and Year 5 undergraduates at the School of Dentistry, International Medical University, Kuala Lumpur, Malaysia. It included a practical audit exercise on patient records. The results were presented by the undergraduates, and guidelines were framed from the recommendations proposed. Following this, an audit of Year 4 and Year 5 students' patient records before and after the audit training was carried out. A total of 100 records were audited against a predetermined set of criteria by two examiners. An email survey of the students was also conducted to explore their views of the audit training. Results showed statistically significant improvements in record-keeping following audit training. Responses to the email survey were analyzed qualitatively. Respondents reported that the audit training helped them to identify deficiencies in their record-keeping practice, increased their knowledge in record-keeping, and improved their record-keeping skills. Improvements in clinical audit teaching were also proposed.

Does simulated training improve medical students’ knowledge on cardiac life support? A study comparing simulated versus traditional teaching at the International Medical University

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.

Dental Malocclusion among University Students and Its Effect on Self-esteem: A Cross-sectional Study

ABSTRACT Introduction Studies on prevalence of malocclusion and self-esteem among young adults are sparse in Malaysia. The objectives of this study were to highlight the type of Angle's malocclusion most commonly prevalent in young adults of International Medical University (IMU) of age 18 to 25 years as well as to assess the social impact of malocclusion in them. Another objective was to identify the young adults’ satisfaction level with the appearance of the teeth and self-perceived orthodontic treatment needs using a questionnaire and to correlate groups of malocclusion with self-esteem. Materials and methods All 142 subjects were randomly selected from the name list of different cohorts of students in IMU. Study information was provided to the subjects along with the consent form and two questionnaires about global self-esteem (GSE) and social impact of malocclusion. Intraoral clinical examination was performed using disposable mouth mirror, probe and metal ruler in presence of artificial illumination. Angle's molar relation and other occlusal characteristics were recorded. Results Angle's class I malocclusion was most prevalent (48.6%), followed by class III (26.8%), class II (16.2%) and normal occlusion (8.5%). Analysis of variance Anova test showed no significant association between Angle's malocclusion and GSE with mean self-esteem score of 14.1, 15.5 and 13.8 for class I, II and III malocclusion respectively. Conclusion The satisfaction with the teeth appearance (0.026) and social impact of malocclusion (0.004) had significant association. How to cite this article Sheikh A, Mathew T, Siew TB. Dental Malocclusion among University Students and Its Effect on Selfesteem: A Cross-sectional Study. World J Dent 2014;5(4):204-208.