User experience (UX) and usability in completing a MOOC on emergency medicine core content course (iEM/Lecturio): A case study

Posted Posted in Articles, Original Article

Authors: Fatin Aqilah Binti Ishak, Jia Shen Goh, Grace Devadason, Ke Wei Hiew, Dhaniya A/P Subramaniam, Yan Ren Hong, Sivalingam Nalliah


This study evaluates a Massive Open Online Course (MOOC) on Emergency Medicine designed by iEM Education Project and Lecturio, using a validated checklist to assess its usability and user experience. The MOOC received a high score for cognitive connection (>4/5), in four components including interactivity, content and resources, media use, and instructional assessment. However, for learner guidance and support, the score was 2.75/5, indicating that the course did not provide clear instructions on how learners can get support or feedback from teachers when encountering problems in the course. For affective and functional connections, all components received a high overall mean score of more than 4/5. The course was impactful to the users who were in their early clinical years, as they were actively engaged and were motivated to complete the course. However, improvements should be made to better stimulate learning by improving learner feedback and providing space for collaborative learning online.

Evaluation of MOOC applying the heuristics of usability and user experience identifies specific components of online learning course apart from rating the severity of acceptance or violation of instructional design principles. The information derived from usability and user experience studies can improve design and delivery of online courses.

Keywords: Usability, user experience (UX), instructional technology, Emergency Medicine, e-Learning, MOOCs.

Citations: IeJSME 2023 Vol 17(3): 26-43


Awareness and acceptance of Pre-exposure Prophylaxis (PrEP) for HIV among undergraduate students in a private medical university in Malaysia

Posted Posted in Original Article

Authors: Kwee Choy Koh, Nur Illiana Mohamad Zaki, Priyanka Ravindharan, Sarah Nur Hanin Shamsuddin, Yi Ling Teh.


Background: Pre-exposure prophylaxis (PrEP) is an evidence-based strategy recommended for at-risk populations for prevention of HIV transmission. However, the level of PrEP awareness and acceptance among Malaysian undergraduate students is currently unknown.

Objectives: To assess the sexual activities, sexual behaviors, risk perception, awareness, and acceptance of PrEP of medical compared to non-medical students in a private medical university.

Method: Demographic data, sexuality, sexual activity and behaviors, source of HIV knowledge, self- perceived risk of HIV, awareness and acceptance of PrEP were collected using an online anonymous survey among medical and non-medical students at a private medical university. Descriptive, comparative and regression analyses were performed where applicable. A p-value < 0.05 was considered statistically significant.

Results: A total of 369 (187 medical, 182 non-medical) students responded. The median age was 22 with female:male ratio of 2:1. Eighty-one (22%) were sexually active of which 54% used condoms inconsistently, 58% had condomless sex in the preceding six months and 35% had casual or transactional sex. Despite this, 33 perceived themselves to be at low risk of HIV. Most learned about HIV from their coursework. PrEP awareness was 40% versus 20% while PrEP acceptance was 69% versus 67%, between medical and non-medical students, respectively.

Conclusion: Awareness of PrEP among medical students was low and even lower among non-medical students. PrEP acceptance was fair after viewing an introductory video on PrEP. PrEP must be included in the course curriculum. Studies to identify reasons for PrEP-hesitancy should be conducted to help guide policies and initiatives toward promoting PrEP as an additional tool in HIV prevention.

Keywords: Preexposure prophylaxis, Malaysia, HIV, acceptance, awareness.

Citations: IeJSME 2023 17 (2): 10-17


Prevalence of cyberbullying and its effects on studies, personal life and mental health of medical students in a private medical university in Malaysia

Posted Posted in Original Article

Authors: Wei Sean Kang, Sherry Soo Jin Lee, Alissa Sonia Ali Munawar, Saleema Sakul, Gardiya Weligamage Ruvimi Kaushadhi, Kwee Choy Koh.


Introduction: Cyberbullying is the use of information and communication technologies to support deliberate, repeated, and hostile behaviour by an individual or group to harm others. Cyberbullying may negatively affect the studies, personal lives and mental health of victims who are students. We report on the prevalence of cyberbullying and its effects on personal lives, studies, and mental health among medical students.

Methods: A self-administered online questionnaire was used to collect demographic data, determine the prevalence of cyberbullying, and its effects on personal lives, studies and mental health of medical students. Student-t test was used for comparison of means, and logistic analysis was used to identify predictors of being cyberbullied.

Results: 40 out of 261 study participants reported being cyberbullied in the preceding 6 months (prevalence: 15.3%). Cyberbullying did not negatively affect the studies and personal lives of victims. Most victims reported none or minimal-to-mild depression. Malay ethnicity was a predictor of being cyberbullied. Female students were 5-times more likely to be cyberbullied because of their lifestyle compared to males.

Conclusion: The prevalence of cyberbullying among medical students in this study was relatively low compared to reports from other universities. Cyberbullying had little to no effect on the studies, personal life, and mental health of medical students in our study. Malay ethnicity was a significant predictor to being cyberbullied. Females were more likely to be cyberbullied for their lifestyle. Support systems, awareness of good internet etiquette, and promotion of early help-seeking behaviour, especially targeted at identified vulnerable groups, should be put in place to check the practice of cyberbullying.

Keywords: cyberbullying, Malaysia, medical students, personal life, mental health

Citations: IeJSME 2023 17 (2): 18-26


Quality evaluation of child feeding related websites on complementary feeding in Malaysia

Posted Posted in Original Article

Authors: Zi Jie Lim, Kanimolli Arasu, Seong Ting Chen


Introduction: The internet is widely used by parents to access child feeding related information. The accuracy and reliability of information available online remain uncertain. The objective of this study was to evaluate the quality of child feeding related websites on complementary feeding for children aged 6-24 months in Malaysia.

Methods: A cross-sectional study was conducted between December 2021 to April 2022 to evaluate complementary feeding-related websites in the Bahasa Malaysia (BM) language. The key terms were entered into Google Chrome and the first 30 websites were screened. Websites that could not be accessed due to broken links, duplicated websites and not freely accessible websites were excluded from the study. The quality was evaluated using Health-Related Websites Evaluation Form to appraise content, accuracy, author, currency, audience, navigation, external links, and structure of the web-based information. The website was rated as excellent (at least 90% of the total possible score), adequate (75 90%) and poor content (<75%).

Results: Twenty-one websites out of 1006 websites screened were selected for evaluation. 81% of the websites were rated as excellent while 19% were with adequate quality. Websites with excellent quality ratings had higher scores for currency (p=0.039) and navigation (p=0.039) as compared to adequate quality websites.

Conclusions: This study highlighted that complementary feeding practices websites in the BM language were generally of good quality. The accuracy, currency and content of these websites can be further improved by including the resources developed by dietitians to optimise child feeding practices for optimal growth and development of children between 6–24 months.

Keywords: Child feeding information, evaluation, internet, quality, websites

Citations: IeJSME 2023 17 (2): 27-33


Synchronous Clinical Simulation: An Effective Teaching Modality in Medical Education During COVID-19 and Beyond

Posted Posted in Original Article

Authors: Thiruselvi Subramaniam, Mohammad Arshad Ikram, Shamala Ramasamy.


Background: The spread of COVID-19 forced many countries including Malaysia to switch from on-campus learning to exclusively online learning. The modality of the synchronous session allows the learners to interact with the instructor and obtain instant feedback. The purpose of this study was to evaluate the effectiveness of synchronous simulation among medical students in clinical years in the absence of hospital-based clinical education.

Methods: This was a prospective observational study involving 54 clinical year students, conducted in the simulation lab at International Medical University. Scenarios for each session were built around clinical skills targeting specific learning outcomes. The perception of the simulation session was evaluated using a 5-point Likert Scale. Synchronous debriefing followed each simulated session allowing active participation by all students. Focus group discussion was conducted among 6 students who volunteered representing online participants to obtain feedback on their learning experience.

Results: The highest mean scores were obtained for the items referring to team communication (4.09±0.734), debriefing (4.06±0.811) and timetabling (3.92±1.007). Results from the focus group discussion revealed that: simulated sessions assisted in application of knowledge by observing their peers; the repetitive process of observing and performing was preferred over observing per se; observing the performance of peers from the same cohort was preferred, and critiques on technical logistics were reported.

Conclusion: The synchronous simulation sessions were well received by the students. It is believed that this will be a novel teaching modality to adopt even after the passing of the pandemic.

Keywords: Clinical teaching, medical student, medical education, simulation, synchronous, teaching modality.

Citations: IeJSME 2023 17 (1): 02-08


A Cross-Sectional Study on the Knowledge, Attitude and Practice of Hand Hygiene among Adults in the Chowrasta Market, Penang

Posted Posted in Original Article

Authors: Woan Ching Chang, Elvina Yuh Harn Lau, Yi Xuan Goh, Yen Wen Tan.


Background: The community plays a crucial role in practising effective hand hygiene to prevent disease transmission. Several studies conducted on hand hygiene practices among healthcare practitioners show positive outcomes in decreasing disease transmission particularly during the COVID-19 pandemic. However, studies related to hand hygiene among adults in the local communities are scant.

Aim:  This study aimed to determine 1) the level of knowledge, attitude, and practice of hand hygiene, and 2) the relationship between demographic factors and hand hygiene practice among adults in a local community in Penang.

Methods: This was a cross-sectional quantitative survey combined with direct observation of hand hygiene practice. A self-administered questionnaire on knowledge and attitude towards hand hygiene, and an observational checklist of hand hygiene practice were adapted to measure the variables studied. Non-random quota sampling technique was used to recruit the required 398 sample size.

Results: The study found that the level of knowledge using an internationally commonly used 12 item questionnaire was good. Attitude towards hand hygiene measured on another 7 item questionnaire was also good. A majority of the participants (73.9%) had a good level of hand hygiene practice. No significant relationship was found between age, gender, level of education, and hand hygiene practice.

Conclusion: Local health authorities are urged to continue to emphasise to the public on the importance of hand hygiene to reduce disease transmission in the community. Further studies are recommended to explore the possible barriers that hinder people from adopting good hand hygiene practice.

Keywords: adults, attitude, hand hygiene, knowledge, practice

Citations: IeJSME 2023 17 (1): 09-18


Descriptive analysis of international deportations caused by irresponsible traveller behaviour

Posted Posted in Original Article

Authors: Ryan M Mangan, Gerard T Flaherty.


Background: The COVID-19 pandemic focused public attention on the importance of responsible
tourism. The purpose of this study was to characterise irresponsible tourist behaviour leading to deportation from the destination country.

Methods: A web-based search of media reports relating to deportations of tourists was conducted.

Results: The most common reasons for deportation were related to indecent exposure or physical damage to sacred monuments and violations of COVID-19-related national public health rules. Other incidents resulted from social media posts and breach of environmental regulations.

Conclusions: The results of this study may inform future research efforts and targeted public awareness campaigns.

Keywords: responsible travel; deportation; COVID-19; cultural sensitivity; sustainable travel

Citations: IeJSME 2022 16 (3): 07-11


Comparison of altmetrics with conventional bibliometrics in the surgical literature

Posted Posted in Original Article

Authors: Shashank R Thyarala, Gerard T Flaherty.


Background: The impact of a research publication has traditionally been quantified by its citation count. Newer bibliometric indices such as Altmetric Attention Score (AAS) and article page views are emerging as supplementary measures to quantify the academic influence of research.

Objective: The aim of the current study was to interrogate the relationship between novel and traditional bibliometric indices for research published in a leading surgical journal and evaluate the role
of these newer indices in measuring the impact of surgical research.

Methods: All articles published in JAMA Surgery between 1 January 2019 and 1 September 2021 were
examined. The literature database PubMed was used to identify all articles published within the specified time period. Cumulative citation count (Web of Science), AAS and article page views were retrieved from the journal website. Statistical analysis using the Spearman rank correlation coefficient (r) was performed on Minitab 19.

Results: A total of 1,071 articles were retrieved for further analysis. The correlation (95% CI) between ranks for all articles was 0.635 (0.594-0.673) for AAS and citation scores, 0.680 (0.642-0.714) for citations and article page views, and 0.813 (0.788-0.835) for AAS and article page views.

Conclusions: We demonstrated a strong correlation between citations and AAS for articles published in a leading surgical journal. The inter-year correlation between 2019 and 2021 was similar, suggesting that AAS could be predictive of future citations. AAS may be useful in evaluating the wider societal impact of the surgical literature and could serve to promote greater public engagement in surgical research.

Keywords: Altmetrics; Bibliometrics; Surgical Research; Citations; Social Media; Citations.

Citations: IEJSME 2022 16 (2): 6-8


Impact of cardiac life support training on retention of knowledge measured by pretest, immediate posttest, and 6-months posttest

Posted Posted in Original Article

Authors: Thiruselvi Subramaniam, Shahid Hassan, Ann Jee Tan, Siti Ramlah Abdul Rahman, Jun Siang Tay.


Introduction: Cardiac resuscitation skills are a necessity for newly graduated doctors as they are first responders during a crisis. Despite undergraduate exposure, interns still struggle in an actual crisis. We evaluated final year medical students’ long-term retention of knowledge following cardiac life support
training prior to exit from medical school to determine the need to revise and re-strategize.

Methods: Thirty-seven final year medical students participated in a quasi-experimental research after a cardiac life support (CLS) course where results of their one best answer assessment-pretest, immediate posttest and 6 months posttest were analyzed.

Results: A repeated measure ANOVA was conducted on mean test scores of 30-items one best answer (OBA) questions, measured as pre-test, immediate and 6 months posttests after the course. The result showed significant time effect, Wilks Lambda = 0.126, F (2,35) = 121.468, P = <.001. Follow up comparison indicated that each pairwise comparison difference was significant (p ≤ 0. 05). Both immediate and after 6 months post-course test scores were statistically better than the pretest scores suggesting that there was improvement in knowledge after the course despite the decay.

Conclusion: Our results showed that retention of knowledge as a short-term memory worked well immediately after the hands-on cardiac resuscitation course. However, though there was improved knowledge even after 6 months compared to before the course, there was decay in knowledge. There is a need to re-strategize to improve knowledge retention.

Keywords: Long term retention, knowledge, cardiac resuscitation, strategy, simulation.

Citations: IeJSME 2022 16 (2): 28-35


A structured lifestyle intervention combined with mobile health application to reduce chronic disease risk among employees at a university workplace

Posted Posted in Original Article

Authors: Ching Li Lee, Harvinder Kaur, Gilcharan Singh, Winnie Siew Swee Chee


Introduction: This pilot study assessed the impact of a structured lifestyle intervention combined with mobile health application on chronic disease risk in a healthcare-based university.

Methods: A total of 24 overweight/obese university employees participated in a 12-week intervention that included group nutrition education and exercise sessions, a structured low-calorie meal plan, meal replacements, and a mobile health application.

Results: A pre- and post-intervention analysis showed that the participants had weight loss (p < 0.001), a reduction in blood triglyceride (p = 0.010), and a reduction in systolic blood pressure (p < 0.001). There was an increase in the proportion of participants who achieved their clinical targets for systolic blood pressure from 16.7% at baseline to 58.3% after the intervention (p = 0.004). A focus group discussion demonstrated good acceptability of the intervention that was driven by the use of practical nutrition knowledge gained from the group education sessions and structured meal plans, and timely feedback on eating behaviour from use of the mobile heath application.

Conclusion: A structured lifestyle intervention combined with mobile health application supports significant clinical improvements including weight loss and reductions in blood triglyceride and blood pressure.

Keywords: Chronic diesease, Mobile health, Obesity, Structured lifestyle intervention, Workplace wellness

Citations: IeJSME 2022 16 (1): 3-15