Malaysian Medical School Research Articles

An exploratory study on the challenges faced and coping strategies used by preclinical medical students during the COVID-19 crisis.

PurposeThe impact of the coronavirus disease 2019 crisis on medical education includes reduced clinical training, a significant loss of learning time and a probable decline in confidence of being a doctor. These recent changes will have significant effect on the well-being of medical students and interventional support needs to be given early. This study explores the challenges faced and coping strategies used by preclinical medical students during the crisis.MethodsA qualitative study involving 13 preclinical medical students was conducted between August and September 2020 at a medical school in Malaysia. An in-depth individual interview via Microsoft Teams (Microsoft Corp.) with semi-structured questions was conducted. The recorded interview data were thematically analyzed using the six phases of Braun and Clarke’s Thematic Analysis.ResultsThe challenges faced were identified under three themes: psychosocial impact of lockdown, significant lifestyle changes, and impact on professional progression. Meanwhile, four themes emerged in coping strategies that include behavioral strategies, re-appraisal of the uncertainties of situation, active coping mechanisms, and regulation of emotion with coping reserve. There are indications that personality traits determine strategies to cope with challenges faced during the crisis which may either lead to resilience building or experiencing burnout.ConclusionThe findings of the study highlighted the urgent need to develop early preventive and intervention strategies to address the mental health of medical students to mitigate stress and promote positive well-being in times of crisis.

Face Mask Usage During COVID-19 Pandemic: Prevalence and Associated Factors in a Malaysian Medical School

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a newly discovered coronavirus strain. Anxiety, anticipation, and lack of knowledge in the previous experience on severe acute respiratory syndrome (SARS) and influenza A virus subtype H1N1 (H1N1) pandemic have a substantial impact on significant public health behaviours including wearing face mask in public spaces. We investigate the prevalence of face mask usage and its associated factors during COVID-19 amongst students and staff of the Faculty of Medicine and Health Sciences (FMHS), Universiti Putra Malaysia (UPM). Using a cross-sectional study, 220 respondents participated in an electronic version of a self-administered questionnaire. Analyses were performed using the Chi-square test, IBM SPSS Statistics 25, with statistical significance at p<0.05. Out of the 220 respondents, 197 (89.5%) reported that they wore face masks all the time. Most of the respondents (90.3%) had a high level of precautionary measures against COVID-19, 89.6% selected the internet as their source of information and 90.9% had a good attitude level towards measures against COVID-19. There were significant associations between hygienic practices (p=0.001), source of information (internet) (p=0.025), and attitude towards COVID-19 (p=0.001) with face mask usage. This study demonstrated a high prevalence (89.5%) of face mask usage during the COVID-19 outbreak.

Mental health and self-determination profiles of the diverse population of medical students in Malaysia during the COVID-19 pandemic

IntroductionMedical schools throughout the world were forced to modify their programming during the COVID-19 pandemic. In Malaysia, virtual learning plans were implemented for non-clinical programming, while clinical posting modifications were designed to meet local SOPs. The prolonged enforcement of these modifications to undergraduate medical education will have affected student experiences, including well-being. Since these feelings can relate to perceived relatedness, autonomy, and competence, it is important to identify any potential factors that may lead to reduced intrinsic motivation in students. It is also important to consider how demographic features may contribute to student perspectives, which can be studied using the unique diversity represented by Malaysian students.MethodsA quantitative survey was distributed to Malaysian medical students to assess their overall wellbeing, autonomy in educational decision making, student experiences, and position on changes to graduation timing. Intrinsic components were identified using Principal Component Analysis and were aligned with the three needs for self-determination, namely relatedness, autonomy, and competence. Finally, trends in responses for participants from various sub-populations were assessed using ANOVA testing.ResultsResponses were collected from 442 students representing 23 accredited Malaysian medical schools. Upon validation and reliability testing, eight components were identified with themes relating to: mental health, social concerns, communication, timing of modifications, depth of learning, and student-centred learning. Of these, gender was related to mental health, student-centred learning, and delayed graduation, while stage was related to student-centred learning and delayed graduation in addition to concerns about depth of learning and timing of modifications. Interestingly, ethnicity was related to differences in opinions about delayed graduation and income was related to social concerns.ConclusionThe results of this study indicate that, while students were satisfied in general with the content and delivery of their programmes given the circumstances, there is evidence to suggest negative effects on emotional wellbeing and expression of student voice, due to the modifications that were made. Additionally, these feelings related to the three motivational needs, suggesting that students were experiencing a dampened motivational profile during the pandemic. Further, motivational profiles were distinct between student sub-groups, providing insight for developing appropriate and inclusive accommodations moving forward.

The Effectiveness of the Islamic Input in Medical Practice (IIMP) in Improving the Knowledge, Attitude and Practice among Medical Students in Malaysia. A 5-year Prospective Study

Introduction; In order to produce well-rounded medical doctors in the future, Islamic-based Medical schools in Malaysia and other parts of the world are implementing a special approach in their curricula. The main vision of these medical schools is instillation of Islamic values in their curricula. In International Islamic University of Malaysia (IIUM), a special curriculum namely Islamic Input in Medical Practice (IIMP) was introduced for this purpose. The importance of this study is to measure the effectiveness of this program on the aspects of knowledge, attitude and practice among our students. Materials & Methods: We follow up a total of 142 students for 5 years duration. The first assessment was done right at the enrolment to the medical program and the second assessment by using the similar questionnaire was done after 5 years upon completion of their course. Results: From a total number of students 145 from initial assessment, only a total of 102 medical students completed second time. The remaining number were excluded due to either incomplete forms and delay the academic progress due to failure of subjects. The mean different between pre and post shows a significant improvement in all 3 measured aspects (p<0.001 to 0.022). Conclusion: The 5-year evidence shows our IIUM program is effective to improve the knowledge, attitude and practice.

Barriers to effective research supervision in clinical specialist training: Experience from a medical school in Malaysia.

A compulsory research component is becoming increasingly common for clinical residents. However, integrating research into a busy clinical training schedule can be challenging. This study aimed to explore barriers to research supervision in specialist training programmes from the perspectives of clinical supervisors and trainees at a Malaysian university hospital. Qualitative interviews and focus group discussions were conducted (December 2016 to July 2017) with clinical supervisors (n=11) and clinical trainees (n=26) utilising a topic guide exploring institutional guidelines, research culture and supervisor-student roles. Interviews were transcribed verbatim and analysed thematically to identify barriers to research supervision. Supervisors and trainees from 11 out of 18 departments participated. Both clinical supervisors and trainees struggled to successfully integrate a compulsory research component into residency training. Among the reasons identified included a lack of supervisory access due to the nature of clinical rotations and placements, clashing training priorities (clinical vs research) that discouraged trainees and supervisors from engaging in research, poor research expertise and experience among clinical supervisors hampering high-quality supervision, and a frustrating lack of clear standards between the various parties involved in research guidance and examination. Both clinical supervisors and trainees struggled to successfully integrate a compulsory research component into residency training. This was not only an issue of resource limitation since questions regarding clinical priorities and unclear research standards emerged. Thus, institutional coordinators need to set clear standards and provide adequate training to make research meaningful and achievable for busy clinical supervisors and trainees.

Undergraduate Students’ Perception on Assessment Experience in a Malaysian Medical School: Comparison among Gender, Ethnicity and Phase of Study

INTRODUCTION: It is a well-known fact that assessment influences learning and study behaviour. Assessment affects what and how students learn, either positive or negative learning behaviour. This study was aimed to determine students’ perceived assessment experience and the comparison among different gender, ethnicity, and phase of the study. MATERIALS AND METHODS: This is a cross-sectional study. Assessment Experience Questionnaire (AEQ) version 3.3 was distributed to 324 undergraduate medical students of Universiti Putra Malaysia. The AEQ score among different gender, ethnicity, and phase of the study was compared using independent t-test and one-way ANOVA. RESULTS: Female students were found to develop a surface approach to learning, learn new things from the assessment, and be satisfied more with the teaching compared to males. Chinese students tended to put higher effort into learning compared to Malay. Clinical students valued more the feedback received and had clearer goals and expectations for their work than preclinical students. However, preclinical students tended to put a higher quantity of effort, learn wider coverage of syllabus and develop a surface approach of learning than clinical students. The respondents commented that feedback is lacking and suggested having more feedback sessions with their teachers after assessment. CONCLUSION: There were different assessment experiences and learning found among different gender, race, and phase of the study. These may affect their academic performance and are probably due to the curriculum setting. Understanding student assessment experience and its impact helps the faculty to improve the assessment structure for a conducive assessment environment and meaningful learning experience for the students.

Enablers and Barriers to Online Learning among Medical Students during COVID-19 Pandemic: An Explanatory Mixed-Method Study

As the coronavirus disease 2019 (COVID-19) trajectory remains unknown, online learning (OL) has replaced face-to-face teaching strategies in education institutions. Research and training focus on harnessing educators, but less is understood at the students’ ends. This study examines the OL readiness components, self-regulation, enablers, and barriers to OL at home among medical students during the COVID-19 pandemic through an explanatory mixed-method study. We conducted a cross-sectional study with 178 students and an in-depth interview with 10 students from a public medical school in Malaysia. We found that while all students owned at least one learning device, 22.5% of the students did not have a learning space at home. 21.9% students did not have Wi-Fi access, and 11.2% did not receive mobile broadband coverage at home. Despite these barriers, students had a suitable OL self-regulation level. Significantly higher self-regulation was observed among pre-clinical year students, students with higher grades, and students who had designated learning space at home. We found that high-immediacy and low-bandwidth applications such as WhatsApp and Telegram, and YouTube as the most accessible and easiest platforms to navigate in OL. Our qualitative findings yielded a conceptual model of OL enablers at learners, educators, and institution levels. This framework may serve as one of the guides in faculty development planning and policymaking, especially in promoting a more socially inclusive OL.

A Malaysian version of learning space preferences: a validation study.

ObjectivesThis study aimed to validate a Malaysian version of a revised learning space questionnaire, as well as to test the utility of the revised questionnaire as a tool to investigate learning space preferences in a Malaysian medical school. Methods This is a cross-sectional survey. A convenient sample of 310 preclinical students of a public medical school in Malaysia were invited to participate. Validation data were collected using a revised 40-item, 5-point Likert scale learning space questionnaire. The questionnaires were administered online via a student e-learning platform. Data analysis was conducted using IBM SPSS version 24. Exploratory factor analysis was conducted to examine the factor structure of the revised questionnaire to provide evidence for construct validity. To assess the internal consistency of the revised questionnaire, Cronbach's alpha coefficients (α) were computed across all the items as well as for items within each of the factor. ResultsA total of 223 (71.94%) preclinical students completed and returned the questionnaire. In the final analysis, exploratory factor analysis with principal axis factoring and an oblimin rotation identified a six-factor, 20-item factor solution. Reliability analysis reported good internal consistency for the revised questionnaire, with an overall Cronbach's alpha of 0.845, and Cronbach's alpha ranging from 0.800 to 0.925 for the six factors. Conclusions This study established evidence for the construct validity and internal consistency of the revised questionnaire. The revised questionnaire appears to have utility as an instrument to investigate learning space preferences in Malaysian medical schools.

Anatomy Education Environment Measurement Inventory (AEEMI): a cross-validation study in Malaysian medical schools

BackgroundThe Anatomy Education Environment Measurement Inventory (AEEMI) evaluates the perception of medical students of educational climates with regard to teaching and learning anatomy. The study aimed to cross-validate the AEEMI, which was previously studied in a public medical school, and proposed a valid universal model of AEEMI across public and private medical schools in Malaysia.MethodsThe initial 11-factor and 132-item AEEMI was distributed to 1930 pre-clinical and clinical year medical students from 11 medical schools in Malaysia. The study examined the construct validity of the AEEMI using exploratory and confirmatory factor analyses.ResultsThe best-fit model of AEEMI was achieved using 5 factors and 26 items (χ 2 = 3300.71 (df = 1680), P < 0.001, χ 2/df = 1.965, Root Mean Square of Error Approximation (RMSEA) = 0.018, Goodness-of-fit Index (GFI) = 0.929, Comparative Fit Index (CFI) = 0.962, Normed Fit Index (NFI) = 0.927, Tucker–Lewis Index (TLI) = 0.956) with Cronbach’s alpha values ranging from 0.621 to 0.927. Findings of the cross-validation across institutions and phases of medical training indicated that the AEEMI measures nearly the same constructs as the previously validated version with several modifications to the item placement within each factor.ConclusionsThese results confirmed that variability exists within factors of the anatomy education environment among institutions. Hence, with modifications to the internal structure, the proposed model of the AEEMI can be considered universally applicable in the Malaysian context and thus can be used as one of the tools for auditing and benchmarking the anatomy curriculum.

Medical students’ perception for online learning during covid-19 pandemic: A case study in a Malaysian private medical school

Medical students’ perception for online learning during covid-19 pandemic: A case study in a Malaysian private medical school

Evolution of bioethics education in the medical programme: a tale of two medical schools

Bioethics Education in the Anglo-European context developed since 1970 and was incorporated into the undergraduate and postgraduate education, residency training, and continuous education. In the Asia-Pacific region, bioethics education is less structured and often dependent on contextual constraints. This paper provides a cross-sectional analysis, describing institutional experiences in developing bioethics curriculum at two medical schools in Malaysia and Hong Kong. The medical programmes of the two institutions are distinctive in terms curriculum framework, teaching approach, and topic selection, and common challenges include implementation of bioethics courses, students’ resistance to bioethics, and limited teaching capacity, emerged as they evolve. The reported experiences revealed that there is room for improvement regarding how medical schools integrate bioethics education in regions where curriculum development remains at an early stage. At least, a bioethics education requires both top-down support from the faculty to improve teaching and educational quality, as well as from the bottom-up approach to empower students to raise awareness and concerns toward bioethics, and helps students developing reasoning through challenging issues.

Do medical student on-call reflective reports show their expressions of emotional intelligence? – a qualitative study

Introduction: In addition to cognitive intelligence, emotional intelligence (EI) is known to play a major role in producing better doctors. When medical students are exposed to critical incidents in the hospital, it can be emotionally disturbing and such occurrences may be captured in their reflective reports. A series of reflective reports written by third year medical students, soon after exposure to such incidents, in a private medical school in Malaysia, was analysed to determine whether one could capture expression of any of the 25 competencies, inclusive of several social skills or soft skills given in the framework of Mixed Model of EI by Daniel Goleman. Methods: A convenient sample of 148 reflective reports were analysed, using grounded theory approach and discourse analysis. Expression of emotions in these reports were thematically separated into different emotional competencies which were then matched with the framework of Mixed Model of EI. Results: Reflective writing manifesting all five major divisions emotional competencies in Goleman’s framework, namely; self-awareness, self-regulation, motivation, empathy, and social skills were found in many of the reports. Excerpts from of five different reflective reports (only the contextual component without the students’ reflection) manifesting each of these five major divisions of emotional competencies were given as triggers for focus group discussions and three out of the five showed close triangulation. Conclusion: Reflective reports seem to be useful to detect expression of EI. In addition, reflective reports seem to have a potential use as a tool to nurture EI in medical students.

Contribution of faculty developmental programmes to professional identity development of medical educators in Malaysia: A phenomenological study.

ObjectiveProfessional identity development (PID) of academicians is triggered by numerous elements, including faculty development programmes (FDP). The study aims at exploring how FDPs contribute to PID among junior medical educationists.MethodsA qualitative phenomenological study was carried out in six Malaysian public medical schools from 15th March to 15th April 2019. A total of 10 junior medical educationists participated in the study. A purposive sampling technique was utilised to select eligible participants. A series of semi-structured interviews was conducted to collect the data using a pre-determined interview protocol. The collected data were then analysed using open, axial, and selective coding methods assisted by ATLAS.ti software.ResultsThree themes (i.e. personal growth, professional growth, and self-reflective practice) and nine sub-themes (i.e. self-awareness, intention, internal satisfaction, career pathway, maintaining professional skills, acquiring new knowledge, identifying strengths and weaknesses, and areas for improvement) emerged from the data analysis.ConclusionThe study showed that PID could be developed through personal growth, professional growth, and self-reflective practice. Policymakers should focus on these characteristics during training sessions designed for the professional development of their medical faculty staff.

Supportive mentoring behaviours in a public medical school

PurposeThe purpose of this paper is to evaluate mentoring behaviours in a public medical school in Malaysia and examine factors associated with those mentoring behaviours. The study is important because effective mentoring promotes the personal and professional growth of mentees.Design/methodology/approachA cross-sectional study was conducted with a population of 632 medical students. The authors used the Mentor Behaviour Scale (MBS) to measure four domains of mentoring behaviour: mentoring relationship structure, engagement, autonomy support and competency support. The authors evaluated the scoring of these domains as high, moderate or low scores.FindingsA total of 508 (80.4 per cent) medical students in Years 2–5 participated in this study. Mentoring relationship structure, engagement and competency support were perceived as moderate scores, whereas autonomy support was perceived as a low score. Students in the early phases of study had better attitudes regarding mentoring behaviours. More frequent meetings and longer duration of meetings were significantly associated with better attitudes towards mentoring behaviour.Originality/valueThis paper evaluates contemporary mentoring behaviours in a Malaysian public medical school and contributes to non-western literature on mentoring. These behaviours were reflected in the four domains of the theory-based MBS.

Bioethics Education in the Medical Programme among Malaysian Medical Schools: Where Are We Now?

Introduction:A global trend in medical education is the inclusion of bioethics teaching in medical programme. The objective of this article is to describe the current state of bioethics education in the medical programme among Malaysian medical schools.Method:A national survey was conducted among Malaysian medical schools between January and March 2019. One representative from each medical school was invited to respond to the survey. Respondents were faculty members involved in teaching and assessment of bioethics in their medical schools, or/and in developing and coordinating bioethics curriculum. Descriptive statistics were reported.Findings:Out of 30 medical schools, 11 completed and returned the survey (overall response rate = 36.7%). Of these 11 schools, 6/10 (60%) were from public institutions while 5/20 (25%) were from private institutions. All except 1 school implemented a formal bioethics curriculum. A wide range of bioethics topics are currently taught in the medical programme. The majority involved in teaching bioethics were health care professionals (mainly clinicians), followed by lawyers. Lecture and attendance, respectively, are the most common teaching and assessment method. Major barriers to the implementation of bioethics education included limited qualified teaching staff (6/11 = 54.5%), no established curriculum to follow (5/11 = 45.5%), limited financial resources to hire qualified staff (4/11 = 36.4%), and no consensus among faculty members (4/11 = 36.4%).Conclusion:Bioethics education in Malaysia is relatively new and mostly limited by a shortage of scholars in bioethics. National support and institutional collaboration in providing bioethics training is the key to enhance the quality of bioethics education.

The Structural Framework, Implementation Strategies and Students’ Perception of Team- Based Learning in Undergraduate Medical Education of a Medical School in Malaysia

Abstract Background: Delivery and implementation strategies are key to curriculum success. There is growing evidence that team-based learning (TBL) is an effective way of interactive teaching. TBL is a method that uses learning teams to enhance student engagement and quality of learning. Individual accountability for out-of-class reading is followed by individual and group assessment. In-class application exercises, which is the hallmark of team-based learning promotes both learning and team development. TBL uses educational principles of transforming traditional content into application of knowledge and problem solving skills in an interactive learning environment. Objective: To know the structural framework and students’ perception about TBL in clinical setting of MBBS program in a Malaysian medical school. Method: A total of 120 students assigned to 22 small subgroups of 5-6 per group. TBL was delivered in three phases. In phase I students were assigned reading material. In phase II students were assessed for individual and group performance followed by a mini-lecture. In phase III, in-class application of learning activity was performed. Finally peer assessment evaluated contribution of peer in TBL. A TBL Classroom Evaluation Inventory (TBLCEI) was developed to probe student’s perception of TBL. In addition students were asked to provide their estimated grade in end of the posting assessment. Grades were categorized into excellent pass >85%, high pass 70–84%; average to good pass 50-69% and fail <50%. These grades were measured against students’ TBLCEI survey score using analysis of variance (ANOVA). Results were considered significant at p < 0.05. Result: Results of one-way analysis of TBLCEI scores differed significantly across four estimated end of posting achievers groups, F (3,116) = 52.279, p < 0.001. Bonferroni’s procedure of multiple comparisons indicated that mean value of TBLCEI score of High Pass significantly higher [70.90 (3.684)] than Good Pass [66.57 (3.625)], Pass [60.42 (3.583)] and Fail [57.67 (5.626)] at p < 0.001 Conclusion: It is concluded that medical students favourably liked teaching methods that useTBL as it increases students’ engagement in an outcome-based education. It also provided opportunities of frequent and immediate feedback with newly introduced IF-AT system, provided with partial credit in assessment.

Prevalence of Stress and Associated Stressors among Medical Students: A Comparative Study between a Private and Public Medical School in Malaysia

Stress among medical students has been well documented as a significant problem. The objective of this study is to compare the stress levels and its associated stressors between public and private university medical students. A cross-sectional study design was carried out using universal sampling in both University Sultan Zainal Abidin (UniSZA) (245) and UCSI University (315) medical students year 1–5, from 2015 till 2016. Data was collected using a self-administered questionnaire including sociodemography, Medical Student Stress Questionnaire and General Health Questionnaire. Data entry and analysis were done using SPSS version 20.0 software. The studies reported a mean age of 23.02 years (SD 1.78) and 21.8 years (SD 1.50) at UCSI University and UniSZA respectively. UCSI University had majority Chinese medical students (52.1%) while UniZSA had majority (66.5) Malay medical students. The stress prevalence was 42.2% and 33.1% among UCSI University and UniZSA medical students respectively. UCSI University had a higher mean stress score of 4.66 (SD 3.4) compared to UniZSA 2.91 (SD 2.98), which was statistically different (p<0.001). Both universities reported Academic and Group Activity related stressors as of high severity. Multiple logistic regression models showed that Academic Related Stressors (ARS), Social Related Stressors (SRS) and Group Activity Related Stressors (GARS) were significant predictors of stress levels among UCSI University medical students while Academic Related Stressors (ARS) and Interpersonal and Intrapersonal Related Stressors (IRS) were significant predictors of stress among UniSZA medical students. Private university students reported higher stress prevalence compared to the government university but both university students documented similar (Academic and Group Related) stressors as of high severity. Academic related stressors were reported by both universities to be significantly associated with stress. Review of the academic curriculum to reduce stress, student support groups and stress management programme-Medical Student Well-being Workshops, to inculcate good inter and intrapersonal cum teamwork skills are highly recommended.

Empathy among undergraduate medical students: A cross-sectional study in one Malaysian public medical school.

Background:Empathy is one of the cardinal components for physician–patient relationships, optimal outcomes in patient care, improved patient satisfaction, greater adherence to therapy, and lower malpractice liability. It is also considered an essential quality for health-care professionals to practice medicine. The aim of the present study was to assess the empathy level of medical students of Universiti Pertahanan Nasional Malaysia (UPNM) National Defense University of Malaysia, Kuala Lumpur, Malaysia.Methods:This was a cross-sectional study conducted in 2017 which recruited medical students of UPNM. The Empathy Quotient, a self-reported questionnaire, was utilized for data collection. The total empathy score of the questionnaire is 80.Results:Majority of the respondents were male (60.9%), year-V students (26.6%), Malay (70.5%), and cadet officer (69.6%). The overall mean score achieved by the respondents was 36.76 ± 9.18, and 74.4% of the respondents scored more than 30. The empathy scores of the students were significantly affected by the gender (t = 2.371; df = 205; P < 0.05), year of study (F = 2.553; df = 4/202; P < 0.05), and examination grades (F = 3.488; df = 2/204; P < 0.05). The findings showed that female students are more empathetic than their male counterparts. Further, the post hoc Tukey test analysis revealed that Year-V students are more empathetic than their junior counterparts and students who got highest grade are more empathetic.Conclusions:To improve the empathy level of the UPNM medical students, appropriate educational strategies and interventions should be designed and implemented in the curriculum to inculcate, maintain, and enhance empathy.

Validation of the Communication Skills Attitude Scale (CSAS) Questionnaire in a Cohort of Malaysian Medical Students

Introduction: The Communication Skills Attitude Scale (CSAS) assesses medical students’ attitudes towards learning communication skills and had been widely utilised all over the world. This questionnaire has 26 items framed within two subscales. This study aimed to examine the validity and reliability of the CSAS among medical students in Universiti Teknologi MARA (UiTM). Methods: This was a cross sectional questionnaire validation study among 171 first year medical students from UiTM. The CSAS had undergone content and face validation, followed by psychometric analysis using principal component analysis to assess construct validity. Internal consistency was evaluated using Cronbach alpha. Results: Factor analysis confirmed the original two-subscale structure of the CSAS (positive attitude scale, PAS and negative attitude scale, NAS). A total of 4 items were removed due to poor factor loading (1 item from PAS and 3 items from NAS). The final validated CSAS consisted of 22 items, 14 and 8 items for the PAS and NAS respectively. Cronbach alphas calculated were 0.862 for the PAS and 0.565 for the NAS. Conclusion: This study produced a validated and reliable CSAS to measure the attitude of UiTM medical students towards learning communication skills. Given the low internal reliability of the NAS in this study, future studies should include translating and validating the CSAS into the Malay language to improve its psychometric properties. Future studies should also include medical students from the three major ethnic groups and other medical schools in Malaysia to improve the generalisability of the CSAS.

Anatomy education environment measurement inventory: A valid tool to measure the anatomy learning environment

Students' perceptions of the education environment influence their learning. Ever since the major medical curriculum reform, anatomy education has undergone several changes in terms of its curriculum, teaching modalities, learning resources, and assessment methods. By measuring students' perceptions concerning anatomy education environment, valuable information can be obtained to facilitate improvements in teaching and learning. Hence, it is important to use a valid inventory that specifically measures attributes of the anatomy education environment. In this study, a new 11-factor, 132-items Anatomy Education Environment Measurement Inventory (AEEMI) was developed using Delphi technique and was validated in a Malaysian public medical school. The inventory was found to have satisfactory content evidence (scale-level content validity index [total] = 0.646); good response process evidence (scale-level face validity index [total] = 0.867); and acceptable to high internal consistency, with the Raykov composite reliability estimates of the six factors are in the range of 0.604-0.876. The best fit model of the AEEMI is achieved with six domains and 25 items (X2 = 415.67, P < 0.001, ChiSq/df = 1.63, RMSEA = 0.045, GFI = 0.905, CFI = 0.937, NFI = 0.854, TLI = 0.926). Hence, AEEMI was proven to have good psychometric properties, and thus could be used to measure the anatomy education environment in Malaysia. A concerted collaboration should be initiated toward developing a valid universal tool that, using the methods outlined in this study, measures the anatomy education environment across different institutions and countries. Anat Sci Educ 10: 423-432. © 2017 American Association of Anatomists.