Student Perspectives on E-Learning in a Malaysian Medical College One Year into the COVID-19 Pandemic: A Cross-Sectional Study

Background: During the coronavirus disease 2019 (COVID-19) pandemic, physical in-person classes in Newcastle University Medicine Malaysia (NUMed) were replaced with e-learning. Teaching in NUMed was being delivered online during COVID-19 pandemic for the last one and a half academic years (18 March 2020 – June 2021) due to the strict lockdowns and physical distancing measures in place, limited in-person sessions on campus, and disrupted hospital attachments. There was concern over the effectiveness and satisfaction with e-learning amongst our students, and how this affects their overall academic performance. Our study aims to explore students’ e-learning experiences and its perceived benefits and challenges during the pandemic. Methods: 285 students participated in this cross-sectional study using a convenience sampling method. Participants completed a self-administered online questionnaire via an email invitation between July 12th and August 12th, 2021 which comprised of sociodemographic characteristics and experiences with e-learning. The data was analysed using descriptive statistics and Spearman’s correlation tests were used to identify correlation between students’ e-learning experiences, the effects of e-learning, and academic performance. Results: Most students used laptops (n=275, 96.5%) for e-learning and owned at least two electronic devices (n=245, 86%). Over half of our students (n=148, 51.9%) reported their theoretical knowledge remains unchanged, while about three-quarters (n=213, 74.7%) perceived practical skills to have worsened. Students preferred paper-based exams (n=170, 59.6%) and objectively formatted online exams (n=193, 67.7%). Since transitioning to e-learning, the majority of students (n=207, 72.6%) reported difficulties studying online and were unsatisfied with their academic performance (n=166, 58.2%). Students preferred e-learning due to the lower risk of contracting COVID-19 (n=256, 89.8%), the convenience of online classes (n=244, 85.6%) and flexible schedules (n=219, 76.8%). However, the lack of patient contact (n=236, 82.8%), lecturer and peer interactions (n=234, 82.1%), and unreliable internet (n=201, 70.5%) made e-learning challenging. Students’ experiences were generally affected by multiple factors encompassing personal, lecturer, and environmental aspects. Conclusion: E-learning during the COVID-19 pandemic has negatively impacted students’ academic performance, particularly practical skills and performance satisfaction. Therefore, the university should look towards addressing e-learning constraints and providing adequate support to improve students’ educational experiences in the ongoing pandemic

Antimicrobial, antiviral and cytotoxic activities of selected marine organisms collected from the coastal areas of Malaysia

Many marine organisms have developed the capability of producing unique metabolites and thus are highly likely to contain anti-infective agents. This study was conducted to investigate extracts of three seaweeds (Caulerpa racemosa, Caulerpa sertularioides, Kappaphycus alvarezii), two soft corals (Lobophytum microlobulatum, Sarcophyton auritum) and a marine sponge (Spheciospongia vagabunda) collected from Malaysian coast for antibacterial, antifungal, antiviral and cytotoxic activities. The samples were subjected to sequential solvent extraction in order to obtain hexane, chloroform, ethyl acetate, ethanol, methanol and water extracts. The antibacterial and antifungal activities were studied using a colorimetric broth microdilution method. The hexane extract of L. microlobulatum had the strongest antibacterial activity and exhibited the lowest minimum inhibitory concentration (0.04 mg/mL) and minimum bactericidal concentration (0.08 mg/mL) against Staphylococcus aureus and Bacillus cereus, respectively. For antifungal activity, the lowest MIC and minimum fungicidal concentration values were produced by the hexane extract of S. auritum against the dimorphic yeast Cryptococcus neoformans, both with 0.04 mg/mL. None of the extracts were active against the filamentous fungus Aspergillus fumigatus. Only the hexane and ethanol extracts of L. microlobulatum and the ethyl acetate extract of S. auritum exhibited strong inhibition on the cytopathic effect induced by the Chikungunya virus (a re-emerging mosquito-borne virus) with 50% effective concentrations of 14.3 0.2, 124.3 1.9 and 176.6 9.7 µg/mL, respectively. Extracts from the two soft corals, L. microlobulatum and S. auritum possessed stronger antibacterial, antifungal and antiviral activities compared to the seaweeds and the sponge

Rapamycin pre-treatment abrogates Tumour Necrosis Factor-\u3b1 down-regulatory effects on LXR-\u3b1 and PXR mRNA expression via inhibition of c-Jun N-terminal kinase 1 activation in HepG2 cells

The Liver X Receptor (LXR) and Pregnane X Receptor (PXR) are members of the nuclear receptor superfamily. Previously, they have been classified as important regulators of lipid homeostasis. However, recent studies have shown that they may be implicated in anti-inflammatory responses as well. This study shows that Tumour Necrosis Factor-\u3b1 (TNF-\u3b1) treatment reduces both LXR-\u3b1 and PXR mRNA expression. However, pre-treatment with rapamycin, an mTOR inhibitor, followed by TNF-\u3b1 stimulation, significantly induces LXR-\u3b1 and PXR mRNA expression to ~17- and ~2-fold, respectively. This suggests that mTORC1, a multi-molecular complex of which mTOR is a member, may act as a negative regulator that inhibits the induction of LXR-\u3b1 and PXR as anti-inflammatory genes. It is also shown here that inhibition of JNK1 via the mTOR/Akt pathway coincides with the up-regulation of LXR-\u3b1 and PXR mRNA, after TNF-\u3b1 treatment. Together, these observations suggest that JNK1 possibly act downstream of mTORC1 as an LXR-\u3b1 and PXR inhibitor. From the results gleaned in this study, rapamycin (and its analogues) may be used to reduce acute inflammation by promoting the induction of LXR-\u3b1 and PXR as anti-inflammatory genes

A systematic scoping review of approaches to teaching and assessing empathy in medicine

10.1186/s12909-021-02697-6BMC Medical Education21129

Postgraduate ethics training programs: a systematic scoping review

BACKGROUND: Molding competent clinicians capable of applying ethics principles in their practice is a challenging task, compounded by wide variations in the teaching and assessment of ethics in the postgraduate setting. Despite these differences, ethics training programs should recognise that the transition from medical students to healthcare professionals entails a longitudinal process where ethics knowledge, skills and identity continue to build and deepen over time with clinical exposure. A systematic scoping review is proposed to analyse current postgraduate medical ethics training and assessment programs in peer-reviewed literature to guide the development of a local physician training curriculum. METHODS: With a constructivist perspective and relativist lens, this systematic scoping review on postgraduate medical ethics training and assessment will adopt the Systematic Evidence Based Approach (SEBA) to create a transparent and reproducible review. RESULTS: The first search involving the teaching of ethics yielded 7669 abstracts with 573 full text articles evaluated and 66 articles included. The second search involving the assessment of ethics identified 9919 abstracts with 333 full text articles reviewed and 29 articles included. The themes identified from the two searches were the goals and objectives, content, pedagogy, enabling and limiting factors of teaching ethics and assessment modalities used. Despite inherent disparities in ethics training programs, they provide a platform for learners to apply knowledge, translating it to skill and eventually becoming part of the identity of the learner. Illustrating the longitudinal nature of ethics training, the spiral curriculum seamlessly integrates and fortifies prevailing ethical knowledge acquired in medical school with the layering of new specialty, clinical and research specific content in professional practice. Various assessment methods are employed with special mention of portfolios as a longitudinal assessment modality that showcase the impact of ethics training on the development of professional identity formation (PIF). CONCLUSIONS: Our systematic scoping review has elicited key learning points in the teaching and assessment of ethics in the postgraduate setting. However, more research needs to be done on establishing Entrustable Professional Activities (EPA)s in ethics, with further exploration of the use of portfolios and key factors influencing its design, implementation and assessment of PIF and micro-credentialling in ethics practice. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12909-021-02644-5

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries