Validation of Metacognitive Awareness Inventory in Academic Stage of Undergraduate Medical Education

Medical students are expected to improve critical thinking, clinical reasoning and problem solving skills. These cognitive attributes need to be supported with metacognitive skills. Students with better metacognitive ability will be able to synergize their learning with self-reflection strategies to achieve learning target. One of the tools to assess students’ metacognitive skills is Metacognition Awareness Inventory (MAI). This study is aimed to validate Indonesian MAI in the academic stage of undergraduate medical education and was done on May-June 2014 at faculty of medicine Universitas Malahayati Bandar Lampung. This study used cross-sectional design consisted of 3 stages: language adaptation, pilot study and validation study. Validation study involved 1200 medical students. Factor analysis was conducted to identify factors of MAI. Language adaptation and pilot study produced Indonesian MAI which contains the same number of items. There were 757 MAI questionnaires eligible for analysis. Extraction of the 51-item MAI using principal component analysis (PCA) produced 5 factors which were cognitive preparation, supervision, management, strategy and evaluation. The Cronbach alpha value for the whole Indonesian MAI was 0.904. Indonesian MAI complies to construct validity criteria, specifically content validity and internal consistency. MAI is useful as an instrument to assess metacognitive ability in the academic stage of undergraduate medical education

Antibiotic stewardship knowledge and belief differences among healthcare professionals in hospitals: A survey study

Background:Collaborative practice in healthcare has been recommended to improve the quality of antimicrobialstewardship interventions, a behavioral change in antimicrobial use. Insufficient knowledge regarding antibioticresistance, the fear of complications from infections, and how providers perceive antibiotic use and resistance arelikely to influence prescribing behavior. This study's objective was to identify the knowledge and belief healthcareprofessionals' differences about antibiotic stewardship.Methods:This cross-sectional survey study of three hospitals in the East Java province, Indonesia utilized a 43-item questionnaire to assess antimicrobial stewardship knowledge and belief. There were 12 knowledge ques-tions (total possible score: 12) and 31 belief questions (total possible score: 155). The Kuder Richardson 20 (KR-20) and Cronbach alpha values of the questionnaire were 0.54 and 0.92, respectively.Results:Out of the 257 respondents, 19% (48/257) had a low scores of knowledge, and 39% (101/257) had lowscores on belief about antibiotic stewardship (101/257). Most midwives had a low scores on knowledge (25/61)and low scores on belief (46/61). Respondents with high scores on belief were 17% (10/59) physicians, 15% (4/27) pharmacists, 8% (5/65) nurses, and 3% (2/61) midwives.Conclusion:Among healthcare professionals, knowledge and belief differences concerning antibiotic stewardshipvary widely. These differences will affect their capability, behavior, and contribution to the healthcare teamcollaboration and performance. Further studies are needed to evaluate the correlation between the level of inter-professional collaboration and the quality of the antibiotic stewardship implementation

Discordance to ASHP Therapeutic Guidelines Increases the Risk of Surgical Site Infection

Clean surgery without contamination does not require prophylactic antibiotics, but there are high-risk surgical procedures that may cause infection and/or involve vital organs such as the heart, brain, and lungs, and these indeed require the use of antibiotics. This study aimed to deter- mine the quantity of antibiotic use based on the defined daily dose (DDD) per 100 bed days and the quality of antibiotic use based on the percentage of concordance with The American Society of Health-System Pharmacists (ASHP) therapeutic guidelines (i.e., route of administration, time of ad- ministration, selection, dose, and duration). This includes the profiles of surgical site infection (SSI) in surgical patients from January through June 2019. The study subjects were 487 surgical patients from two hospitals who met the inclusion criteria. There were 322 patients out of 487 patients who had a clean surgical procedure. Ceftriaxone (J01DD04) was the most used antibiotic, with a total DDD/100 bed days value in hospitals A and B, respectively: pre-surgery: 14.71, 77.65, during sur- gery: 22.57, 87.31, and postsurgery: 38.34, 93.65. In addition, 35% of antibiotics were given more than 120 min before incision. The lowest concordance to ASHP therapeutic guideline in hospital A (17.6%) and B (1.9%) was antibiotic selection. Two patients experienced SSI with bacterial growths of Proteus spp., Staphylococcus aureus, Staphylococcus epidermidis, and Escherichia coli. The usage of prophylactic antibiotics for surgical procedures was high and varied between hospitals. Hospital B had significantly lower concordance to antibiotic therapeutic guidelines, resulting to a higher infec- tion rate, compared with hospital A. ASHP adherence components were then further investigated, after which antibiotic dosing interval and injection time was found to be a significant predictor for positive bacterial growth based on logit–logistic regression. Further interventions and strategies to implement antibiotic stewardship is needed to improve antibiotic prescriptions and their use

Understanding the nature of medical students reflection on learning and how it relates to feedback: an exploratory study

© 2013 Dr. Diantha SoemantriWhile there is a theoretical basis for the relationship between reflection on learning and feedback, there are still very few studies that provide empirical data about their relationship. To frame the study, a reflection on learning model was developed based on thorough theoretical and conceptual analysis. The analysis demonstrated that for students to be able to reflect on learning they need to have adequate internal motivation and self-efficacy, along with the appropriate level of cognitive and metacognitive skills and also proper feedback-seeking behaviour. Two separate studies were carried out to explore each of the two components and suggest best practice in feedback provision and a standardized way of measuring reflection on learning. This approach should advance our understanding of the nature of medical students’ reflection on learning and how it relates to feedback. Using the reflection on learning framework, the first study was conducted to determine the most appropriate instrument to measure medical students’ reflection the learning. Study one described the adaptation of the Motivated Strategies for Learning Questionnaire (MSLQ) to suit medical students learning context. The MSLQ was obtained through a systematic review of existing literature and was considered to be the most suitable instrument to measure reflection on learning. It has undergone expert panel review, pilot testing and a validation study with two groups of medical students to further establish its suitability. The findings in study one revealed that the modified MSLQ consisted of four factors: self-orientation, critical thinking, self-regulation and feedback seeking. These factors were compatible with the reflection on learning model developed as the conceptual framework in the present study. Using the modified MSLQ medical students reported only moderate reflective learning ability. Study two investigated the current process of feedback provision to medical students in the Mini Clinical Evaluation Exercise (Mini-CEX) setting. Five perspectives were pursued in order to understand how feedback was delivered and received: 1) non-participant observation of Mini-CEX, 2) analysis of Mini-CEX assessment forms, 3) structured interviews with medical students, 4) obtaining students’ perceptions of Mini-CEX feedback provision through questionnaire, and also 5) structured interviews with clinical teachers. The exploration of the feedback process in the Mini-CEX setting indicated that the feedback process was viewed as a one-way communication where students were unlikely to reflect on their learning experiences. The focus of the process was on teachers who transmitted information, whereas students’ roles and responses in receiving feedback received less attention. These approaches were not conducive for the development of reflective learning ability. The important implication of these findings is that both teachers and students need training in reflective learning practice. Both parties need to understand the concept of reflective learning in which feedback is one of the influencing factors on reflective learning. Teachers need to be trained to deliver feedback within a two-way communication process to help students develop their reflective learning ability

Validation of Metacognitive Awareness Inventory in Academic Stage of Undergraduate Medical Education

Medical students are expected to improve critical thinking, clinical reasoning and problem solving skills. These cognitive attributes need to be supported with metacognitive skills. Students with better metacognitive ability will be able to synergize their learning with self-reflection strategies to achieve learning target. One of the tools to assess students’ metacognitive skills is Metacognition Awareness Inventory (MAI). This study is aimed to validate Indonesian MAI in the academic stage of undergraduate medical education and was done on May-June 2014 at faculty of medicine Universitas Malahayati Bandar Lampung. This study used cross-sectional design consisted of 3 stages: language adaptation, pilot study and validation study. Validation study involved 1200 medical students. Factor analysis was conducted to identify factors of MAI. Language adaptation and pilot study produced Indonesian MAI which contains the same number of items. There were 757 MAI questionnaires eligible for analysis. Extraction of the 51-item MAI using principal component analysis (PCA) produced 5 factors which were cognitive preparation, supervision, management, strategy and evaluation. The Cronbach alpha value for the whole Indonesian MAI was 0.904. Indonesian MAI complies to construct validity criteria, specifically content validity and internal consistency. MAI is useful as an instrument to assess metacognitive ability in the academic stage of undergraduate medical education

Health Profession Education Students’ Satisfaction toward Online Courses during the COVID-19 Pandemic

Background: Given the extensive use of e-learning, especially during the COVID-19 pandemic, a validated instrument is deemed important for continuous evaluation. This study aimed to measure health profession education students’ satisfaction toward the e-learning process within all health sciences cluster (HSC) courses, following further validation of the satisfaction scale for the e-learning process. Methods: A cross-sectional study using an exploratory factor analysis (EFA) was conducted to validate the 29-item Indonesian version of the satisfaction scale for the e-learning process. That the validated tool was used to measure 2,471 students’ satisfaction toward the e-learning process. Results: The EFA resulted in 19 items divided into three subscales: the teaching process (5 items), the instructional content (4 items), and the interaction and evaluation (10 items). The scores of students’ satisfaction toward the e-learning process are at 84–94% of the possible maximum score of the whole instrument or each subscale. Conclusions: The Indonesian version of the satisfaction scale for the e-learning process serves as a valid tool to measure students’ satisfaction toward e-learning. Current students have relatively good perceptions toward e-learning used in all HSC courses, including the interaction domain, which is an important aspect in an e-learning system. Strategies are warranted to maintain and further improve the e-learning process

Measuring medical students' reflection on their learning: modification and validation of the motivated strategies for learning questionnaire (MSLQ)

Background: Reflection on learning is an essential component of effective learning. Deconstructing the components of reflection on learning using a self-regulated learning (SRL) framework, allows the assessment of students' ability to reflect on their learning. The aim of this study was to validate an instrument to measure medical students' reflection on their learning. Methods: A systematic search was conducted to identify the most suitable instrument to measure students' reflection on their learning based on the theoretical framework of SRL. The search identified the Motivated Strategies for Learning Questionnaire (MSLQ) which contained five subscales: internal goal orientation, self-efficacy, critical thinking, metacognitive/self-regulation, help seeking and peer learning. Using the original MSLQ as the foundation, we carried out three phases of a research program to develop a useful set of items: an expert panel's review of items, a substantial pilot study, and a factor analysis of ratings of a modified set of items by preclinical and final year medical students. Results: The factor analysis of the Modified MSLQ extracted four subscales with reasonable internal consistency: self-orientation, critical thinking, self-regulation and feedback-seeking. Each subscale correlates highly with the Modified MSLQ score, with modest inter-correlations between the subscales suggesting that they are measuring different components of the total score. Conclusion: Medical students and their educators need to be able to monitor their learning in their complex academic and clinical environments. The Modified MSLQ provides a means of investigating and tracking individual medical students' reflections on their learning

Feedback Process in The Mini Clinical Evaluation Exercise (Mini-CEX): an Exploratory Study

 In the midst of clinical environment unpredictability, feedback helps students to make the most out of clinical learning opportunities. Mini clinical evaluation exercise (Mini-CEX) is considered to be appropriate for providing feedback to students. This study aims to explore the feedback process within the Mini-CEX at a large Australian medical school. Between year 2011-2012, 23 Mini-CEX sessions, involved 18 final year medical students, were observed, followed by 15-minutes structured interviews. 7 experienced clinical teachers were also interviewed. A questionnaire administered to 274 final year medical students to seek their views on feedback provided in the Mini-CEX. Most feedback has complied with the characteristics of constructive feedback, however the amount of feedback decreased as the quality level of feedback increased. These findings matched students’ perceptions recorded on the questionnaire. The themes derived from the interviews showed that for feedback to be useful, each of feedback process components (feedback provider, types of feedback, feedback recipient and action plans following feedback) need to be attended to. Both tutors and students need to focus on the process of incorporating feedback to inform students’ learning, not only on the feedback characteristics. One of the means to achieve this is by providing reflective feedback where students are considered as active recipients. Keywords: feedback, Mini-CEX, clinical, assessment, learning.     Proses Umpan Balik pada Mini Clinical Evaluation Exercise (Mini-CEX): Studi Eksplorasi   Abstrak Di tengah ketidakpastian lingkungan klinis, umpan balik membantu mahasiswa memaknai kesempatan belajar di tatanan klinis. Mini clinical evaluation exercise (Mini-CEX) cocok untuk memberikan umpan balik kepada mahasiswa. Studi ini bertujuan untuk mengeksplorasi proses umpan balik pada Mini-CEX di sebuah fakultas kedokteran besar di Australia. Antara tahun 2011-2012, 23 sesi Mini-CEX, melibatkan 18 mahasiswa kedokteran tahap akhir, diobservasi dan dilanjutkan wawancara terstruktur selama 15 menit. 7 dosen klinik berpengalaman juga diwawancara. Kuesioner diberikan kepada 274 mahasiswa kedokteran tahap akhir untuk mengetahui pandangan mereka terhadap umpan balik yang diberikan dalam Mini-CEX. Sebagian besar umpan balik telah memenuhi karakteristik umpan balik konstruktif, namun jumlah umpan balik menurun seiring dengan meningkatnya level kualitas umpan balik. Hal tersebut juga ditemukan dalam persepsi mahasiswa yang tercatat sebagai hasil kuesioner. Tema yang diidentifikasi dari wawancara memperlihatkan bahwa agar umpan balik bermanfaat, setiap komponen dari proses umpan balik (pemberi umpan balik, tipe umpan balik, penerima umpan balik, rencana aksi setelah umpan balik) perlu diperhatikan. Baik dosen maupun mahasiswa harus fokus pada proses untuk memastikan bahwa umpan balik dimanfaatkan dalam pembelajaran, tidak hanya pada karakteristik umpan balik semata. Salah satu cara untuk mencapai hal tersebut adalah dengan memberikan umpan balik reflektif yaitu mahasiswa diperlakukan sebagai penerima aktif. Kata kunci: umpan balik, Mini-CEX, klinik, asesmen, pembelajaran.&nbsp