Motivation, study habits, and expectations of medical students in Singapore.

OBJECTIVES: To determine the motivation and incentives in education, learning experience and teaching techniques, and expectations about future careers among medical students from a multi-ethnic Asian country. METHODS: Pre-validated questionnaire-based survey with stratified random sampling among medical students. The questionnaire combined qualitative responses with semi-quantitative measures of available alternatives. RESULTS: The response rate was 83.1%. The most important factor for pursuing university study was 'prospect of finding an interesting challenging job' (rank 1-75%). Family made a significant contribution in decision making. Given the chance, a majority (67.2%) of respondents would prefer to study overseas. The main deterring factors were cost (67.7%), distance from home (28%), and local opportunity for post-graduation (23.4%). Despite their inclination of study overseas, the majority (73.9%) of the respondents indicated they were either very satisfied or satisfied with their current choice of university study. Only 20% of students were comfortable in asking questions in classroom as asking questions was deemed 'too risky' and 'unnecessary to get better grades'. Students adopted strategies related to assessment and competition to monitor their study. Senior students reported university education as less relevant to their future careers as compared to junior students (p = 0.002). CONCLUSIONS: Students' learning behaviour is determined by complex factors such as educational incentives, learning support, assessment and competition. Among several external factors, family, job prospects and expectations about the future play a critical role in education.

A multi-institutional survey on faculty development needs, priorities and preferences in medical education in an Asian medical school.

BACKGROUND: Faculty development in medical education is crucial for maintaining academic vitality. The authors conducted a needs assessment survey in Singapore to determine the educational needs and priorities of clinical faculty. METHODS: This study implemented a questionnaire-based, anonymous, multi-institutional survey with stratified random sampling. Each question was anchored with two statements on a 9-point scale. Respondents were asked to determine their current knowledge and the knowledge they would need in future. RESULTS: The response rate was 81.9%. Overall, the participants' current knowledge was rated either "modest" (scale 4-6) or "substantial" (scale 7-9), irrespective of teaching experience. Participants reported higher knowledge in areas related to teaching and modest knowledge in educational concepts and assessment. They reported a need for higher knowledge in most areas to function well as a teacher. CONCLUSION: The need for faculty development is universal and independent of teaching experience in this group. Teaching faculty from the institutes studied understood the need for improved knowledge in pedagogical knowledge.

Optical immunoassay for snake venom detection.

A sensitive and specific optical immunoassay (OIA) has been developed for snake venom detection. The assay is based on the principle of detection of physical changes in thickness of molecular thin film resulting from specific binding events on an optical silicon chip (SILAS-I, ThermoBioStar, Colorado, USA). The reflection of white light through the thin film results in destructive interference of a particular wavelength of the light from gold to purple-blue depending on the thickness of the thin film formed or the amount of venom in the test sample. A prototype test kit for the simultaneous identification of species and semi-quantitative detection of venoms from four medically important snakes of South Vietnam (Trimeresurus albolabris, Calloselasma rhodostoma, Naja kaouthia and Ophiophagus hannah) has been developed. The kit can detect venom analytes in blood, plasma, urine, wound exudates, blister fluid or tissue homogenates. The efficacy of the test kit in snakebite diagnosis has been demonstrated in experimental envenomations and sample analytes taken from snakebite victims in South Vietnam. This rapid snake venom detection kit based on OIA technique is potentially applicable in the clinics as well as in the field.

Immunogenicity of venoms from four common snakes in the South of Vietnam and development of ELISA kit for venom detection.

The antigenicity and antigenic relationship between venoms of four common snakes in the South of Vietnam-Trimeresurus popeorum, Calloselasma rhodostoma, Naja naja and Ophiophagus hannah-were studied. Most of venom components expressed antigenicity and produced high titre antivenoms. The venoms share common components and antivenoms cross-reacted along them. Furthermore, cross-reactions were observed among non-common antigens, indicating that they share common epitopes. Hence, using single component as immunogen for species diagnosis of snakebites can reduce cross-reaction, perhaps may not be totally specific. A three-step affinity purification protocol was set up for preparation of species-specific antivenom antibodies. The steps involved affinity chromatography of IgG from hyper-immunized rabbit sera with protein A columns, immuno-affinity chromatography of monovalent antivenom antibodies with respective homologous venom columns, and immuno-absorption of cross-species reacting antibody molecules with heterologous venom columns. The antibodies were then used for construction of an enzyme-linked immunosorbent assay (ELISA) test kit. The kit can differentiate among the four common snake venoms in various types of samples with the detection limit of 0.2-1.6 ng/ml, depending on the type of samples and species of the snake. The efficacy of this kit for snake venom detection was successfully demonstrated in experimental envenomation in rats. Preliminary evaluation with 140 samples taken from 88 human snakebite victims in Vietnam showed that the kit could detect venom in human samples and would be a very useful tool for fast identification of snakebites in clinics.

A new avidin-biotin optical immunoassay for the detection of beta-bungarotoxin and application in diagnosis of experimental snake envenomation.

A highly sensitive avidin-biotin optical immunoassay (AB-OIA) has been developed for the detection of beta-bungarotoxin (beta-BuTx), a neurotoxin from the venom of Bungarus multicinctus, in whole blood, plasma, and urine. Affinity purified rabbit IgG anti-beta-BuTx antibody was immobilized on an optically active silicon surface (SILIAS wafer). The test sample was incubated and the antigen-antibody reaction was monitored by the addition of a biotinylated monoclonal antibody (mAb 15) specific to the toxin, avidin-horseradish peroxidase (HRP) and tetramethylbenzidine substrate. The silicon assay surface technology enables us to directly visualize a physical change in the optical thickness of the antibody thin film. The change in thickness is due to the specific capture of the toxin on the surface and when the substrate is added, the binding event is amplified, which then alters the reflected light path and a change in colour is visualized. The assay could detect beta-BuTx levels as low as 16 pg/ml in sample buffer and 100 pg/ml in whole blood or plasma. The AB-OIA is simple, requires only 40 microl of biological fluid and can be performed without specialized equipment. The efficacy of the test for detection of beta-BuTx in blood or plasma obtained from mice during experimental envenomation with B. multicinctus venom was demonstrated. The AB-OIA was also used to quantitate the postmortem level of beta-BuTx in various organs such as brain, liver, and kidney, as well as the tissue at the site of injection. Development of a simple, rapid snake toxin detection kit based on AB-OIA technique potentially applicable in the clinics as well as in the field is discussed.