Reliability and validity study of the Thai adaptation of the Maslach Burnout Inventory-Student Survey among preclinical medical students at a medical school in Thailand.

Burnout syndrome is characterized by emotional exhaustion, cynicism, and lack of professional efficacy. A considerable proportion of medical students experience burnout syndrome during their educational training. Therefore, this issue has become a major concern in the medical education community. The Maslach Burnout Inventory-Student Survey (MBI-SS) is the most widely used assessment of burnout syndrome among college students, including preclinical medical students. Therefore, our objective was to culturally modify and validate the MBI-SS in a Thai context for use with preclinical medical students. The MBI-SS comprises 16 items, including five items for emotional exhaustion, five items for cynicism, and six items for academic efficacy. Four hundred and twenty-six preclinical medical students participated in this study. We randomly divided the samples into two equivalent subsamples of 213 participants. The first subsample was used to calculate McDonald's omega coefficients to assess internal consistency and to perform exploratory factor analysis. McDonald's omega coefficients for exhaustion, cynicism, and academic efficacy were 0.877, 0.844, and 0.846, respectively. The scree plot from the unweighted least squares estimation and a direct oblimin rotation, supplemented with Horn's parallel analysis and the Hull method, revealed three major factors of the Thai MBI-SS. Due to the violation of the multivariate normality assumption in the second subsample, we performed a confirmatory factor analysis with the unweighted least squares with a mean and variance adjusted estimation approach. The results of the confirmatory factor analysis showed favorable goodness-of-fit indices. Data from 187 out of 426 participants (43.9%), who completed a second questionnaire, were utilized to evaluate test-retest reliability. The correlation coefficients for test-retest reliability with a three-week period between tests were 0.724, 0.760, and 0.769 for the exhaustion, cynicism, and academic efficacy domains, respectively (all p < 0.05). This indicates that the Thai MBI-SS is a valid and reliable instrument to assess burnout syndrome in our Thai preclinical medical student population.

Differences in Perspective Toward Organ Donation Between Second-Year and Final-Year Medical Students in a Thai Medical School.

Medical students, as prospective physicians, should develop a good attitude toward organ donation since physicians can positively affect the decision to donate organs. This study compared perspectives toward organ donation between Thai second-year and final-year (sixth-year) medical students, and explored changes that might occur during medical school training. Second-year and final-year medical students at the Faculty of Medicine Siriraj Hospital, Mahidol University, were invited to participate in the survey. The demographic data of the participants were collected and the attitudes toward organ donation were measured from the questionnaire. In total, 89 second-year and 60 final-year medical students voluntarily enrolled in the study. Nearly all the participating medical students supported organ donation and were willing to donate their organs after death. The majority of participants had a positive attitude toward organ donation in many perspectives, e.g., their beliefs, family issues, and donation procedure. There was a statistical difference between the proportion of second-year and final-year students who supported that a brain death condition is a true death (59.6% and 93.3%, respectively, p < 0.001) and who did not feel uncomfortable mentioning organ donation (82.0% and 96.7%, respectively, p = 0.007). In conclusion, there were significant differences in perspective between second-year and final-year students regarding brain death and discomfort perceived during organ donation-related situations. Experience gained during medical school could generate a more positive attitude toward organ donation. Therefore, medical schools play an essential role in nurturing a positive perspective toward organ donation in future physicians.

Student engagement in organising extracurricular activities: Does it matter to academic achievement?

This retrospective correlational study aimed to clarify the relationship between student engagement in organising extracurricular activities (ECAs) and academic achievement among pre-clerkship students. Data were from pre-clerkship students who enrolled during the 2012-2016 academic years at the Faculty of Medicine, Chulalongkorn University. Each cohort was followed for three consecutive years from the first to the third year of their 6-year program. The dependent variable was academic achievement, measured by grade point average (GPA). The independent variable was the level of involvement in organising ECAs, divided into breadth and intensity for each type of involvement. The results revealed that academic achievement had a linear correlation with the frequency of organising educational activities (r[1463] = 0.10; p < 0.001) and the frequency of organising community development and volunteering activities (r[1463] = -0.057; p = 0.030). Additionally, academic achievement had a curvilinear relationship with the frequency of organising recreational and miscellaneous activities, with a point of diminishing return at 1 activity per 3 following years. In summary, there were three relationships - positive linear, negative linear, and curvilinear - between academic achievement and student engagement in ECAs, based on the type of activity. Each should be supported in different ways to improve academic achievement.

Reliability and validity study of the Thai adaptation of the Copenhagen Burnout Inventory-Student Survey (CBI-SS) among preclinical medical students at the Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.

Burnout syndrome is a syndrome of emotional exhaustion, professional efficacy and cynicism. A significant proportion of medical students reported having burnout syndrome during their training in medical education. Several tools including the Copenhagen Burnout Inventory-Student Survey (CBI-SS) are considered to be a valid measurement of burnout syndrome in medical students. This study aimed to translate, culturally adapt, and validate the CBI-SS for assessing burnout syndrome among preclinical medical students in Thailand. This study was conducted during February to March 2019 at the Faculty of Medicine Siriraj Hospital, Mahidol University (Bangkok, Thailand), which is Thailand's largest and oldest medical school, and Thailand's largest national tertiary referral center. After receiving formal permission to do so from the copyright owner, the original English language version of the CBI-SS was translated to Thai language using an internationally recommended and accepted forward-backward translation protocol. The Thai version of the CBI-SS (Thai CBI-SS) comprises 25 items, including 6 items for personal burnout, 7 items for study-related burnout, 6 items for colleague-related burnout, and 6 items for teacher-related burnout. Standardized Cronbach's alpha coefficient was calculated to evaluate internal consistency reliability, and correlation coefficient was computed to determine test-retest reliability. A total of 414 preclinical medical students participated in this study. Due to sub-optimal factor weights (<0.50), items 6, 10 and 17 were excluded. The Cronbach's alpha coefficients of the 22-item Thai CBI-SS for personal, study-related, colleague-related, and teacher-related burnout were 0.898, 0.896, 0.910 and 0.900 respectively. The correlation coefficients for test-retest reliability after three weeks were 0.820, 0.870, 0.821, and 0.787 for personal, study-related, colleague-related, and teacher-related burnout, respectively. Maximum likelihood analysis with oblimin rotation indicated four main components, and confirmatory factor analysis revealed good fit indices of the Thai CBI-SS. Confirmatory factor analysis showed good fit indices of CBI-SS domains (χ2/df = 2.39; CFI = 0.957; GFI = 0.909; RMSEA = 0.058; TLI = 0.949; and NFI = 0.928). The convergent validity analysis using the Average Variance Extracted (AVE) and the Composite Reliability (CR) was adequate for all dimensions (personal: AVE = 0.626, CR = 0.893; study-related: AVE = 0.601, CR = 0.899; colleague-related: AVE = 0.677, CR = 0.913; teacher-related: AVE = 0.606, CR = 0.900). The HTMT values for all variables are in the range from 0.315 to 0.833, confirming the discriminant validity. The Thai CBI-SS was found to be a valid and reliable tool for evaluating burnout syndrome in preclinical medical students in Thailand.

Development of a New Scoring System To Accurately Estimate Learning Outcome Achievements via Single, Best-Answer, Multiple-Choice Questions for Preclinical Students in a Medical Microbiology Course.

During the preclinical years, single-best-answer multiple-choice questions (SBA-MCQs) are often used to test the higher-order cognitive processes of medical students (such as application and analysis) while simultaneously assessing lower-order processes (like knowledge and comprehension). Consequently, it can be difficult to pinpoint which learning outcome has been achieved or needs improvement. We developed a new scoring system for SBA-MCQs using a step-by-step methodology to evaluate each learning outcome independently. Enrolled in this study were third-year medical students (n = 316) who had registered in the basic microbiology course at the Faculty of Medicine, Siriraj Hospital, Mahidol University during the academic year 2017. A step-by-step SBA-MCQ with a new scoring system was created and used as a tool to evaluate the validity of the traditional SBA-MCQs that assess two separate outcomes simultaneously. The scores for the two methods, in percentages, were compared using two different questions (SBA-MCQ1 and SBA-MCQ2). SBA-MCQ1 tested the students' knowledge of the causative agent of a specific infectious disease and the basic characteristics of the microorganism, while SBA-MCQ2 tested their knowledge of the causative agent of a specific infectious disease and the pathogenic mechanism of the microorganism. The mean score obtained with the traditional SBA-MCQs was significantly lower than that obtained with the step-by-step SBA-MCQs (85.9% for the traditional approach versus 90.9% for step-by-step SBA-MCQ1; p < 0.001; and 81.5% for the traditional system versus 87.4% for step-by-step SBA-MCQ2; p < 0.001). Moreover, 65.8% and 87.8% of the students scored lower with the traditional SBA-MCQ1 and the traditional SBA-MCQ2, respectively, than with the corresponding sets of step-by-step SBA-MCQ questions. These results suggest that traditional SBA-MCQ scores need to be interpreted with caution because they have the potential to underestimate the learning achievement of students. Therefore, the step-by-step SBA-MCQ is preferable to the traditional SBA-MCQs and is recommended for use in examinations during the preclinical years.

Effects of Live Lecture Attendance on the Academic Achievement of Preclinical Medical Students.

BACKGROUND: Live lecture remains a ubiquitous form of knowledge delivery in preclinical medical education. However, voluntary live lecture attendance has markedly decreased at several medical schools. This case-control study examined the effect of live lecture attendance on academic achievement in selected basic science courses. METHODS: Cases (n = 174) were defined as students with below average examination scores, and controls (n = 198) were defined as students with above average examination scores. The exposure was absenteeism, which was defined as attending live lecture less than 75% of total live lecture sessions. Second-year and third-year students reported self-estimated frequency regarding live lecture attendance, and they estimated the time spent engaged in various behaviors during live lectures. RESULTS: Absenteeism was identified as a significant risk factor for having below average score in preclinical medical science courses with a 2.34-fold risk (95% confidence interval [CI]: 1.27-4.33). Distracting behavior more than 25% of live lecture time was a factor with non-significantly increased risk for having below average score (1.36-fold risk, 95% CI: 0.86-2.13). CONCLUSIONS: Absenteeism was compellingly associated with poorer examination performance among medical students in basic science medical courses. Preclinical medical students should be encouraged to attend live lectures as often as possible.

The efficacy of peer teaching for medical microbiology lectures.

This article was migrated. The article was marked as recommended. Background: A thorough understanding of infectious diseases is needed by medical professionals; therefore effective microbiological teaching is critical. Although faculty lectures are a convenient means of educating large groups of students, they may fail to engage students and convey an understanding of the subject. Therefore, we developed peer teaching methods based on game-based learning using a reality musical talent show format. Methods: A group of student representatives were trained to lecture to a class of 300 third-year medical students via a game show format over a 3-year period (2013-2015). Results: The students reported a higher level of understanding (3.6-4.2 vs 3.6-3.9 out of 5; p Conclusions: Peer teaching did improve the students' attitude towards learning and conferred teaching skills, but the learning activity needs adjustment to reduce the out-of-class preparation time.

Functional significance of conserved cysteines in the human organic cation transporter 2.

The significance of conserved cysteines in the human organic cation transporter 2 (hOCT2), namely the six cysteines in the long extracellular loop (loop cysteines) and C474 in transmembrane helix 11, was examined. Uptake of tetraethylammonium (TEA) and 1-methyl-4-phenypyridinium (MPP) into Chinese hamster ovary cells was stimulated >20-fold by hOCT2 expression. Both cell surface expression and transport activity were reduced considerably following mutation of individual loop cysteines (C51, C63, C89, C103, and C143), and the C89 and C103 mutants had reduced Michaelis constants (K(t)) for MPP. The loop cysteines were refractory to interaction with thiol-reactive biotinylation reagents, except after pretreatment of intact cells with dithiothreitol or following cell membrane solubilization. Reduction of disulfide bridge(s) did not affect transport, but labeling the resulting free thiols with maleimide-PEO(2)-biotin did. Mutation of C474 to an alanine or phenylalanine did not affect the K(t) value for MPP. In contrast, the K(t) value associated with TEA transport was reduced sevenfold in the C474A mutant, and the C474F mutant failed to transport TEA. This study shows that some but not all of the six extracellular loop cysteines exist within disulfide bridge(s). Each loop cysteine is important for plasma membrane targeting, and their mutation can influence substrate binding. The effect of C474 mutation on TEA transport suggests that it contributes to a TEA binding surface. Given that TEA and MPP are competitive inhibitors, the differential effects of C474 modification on TEA and MPP binding suggest that the binding surfaces for each are distinct, but overlapping in area.

Interaction of H+ with the extracellular and intracellular aspects of hMATE1.

Human multidrug and toxin extrusion 1 (hMATE1, SLC47A1) is a major candidate for being the molecular identity of organic cation/proton (OC/H(+)) exchange activity in the luminal membrane of renal proximal tubules. Although physiological function of hMATE1 supports luminal OC efflux, the kinetics of hMATE1-mediated OC transport have typically been characterized through measurement of uptake, i.e., the interaction between outward-facing hMATE1 and OCs. To examine kinetics of hMATE1-mediated transport in a more physiologically relevant direction, i.e., an interaction between inward-facing hMATE1 and cytoplasmic substrates, we measured the time course of hMATE1-mediated efflux of the prototypic MATE1 substrate, [(3)H]1-methyl-4-phenylpyridinium, under a variety of intra- and extracellular pH conditions, from Chinese hamster ovary cells that stably expressed the transporter. In this study, we showed that an IC(50)/K(i) for interaction between extracellular H(+) and outward-facing hMATE1 determined from conventional uptake experiments [12.9 ± 1.23 nM (pH 7.89); n = 9] and from the efflux protocol [14.7 ± 3.45 nM (pH 7.83); n = 3] was not significantly different (P = 0.6). Furthermore, kinetics of interaction between intracellular H(+) and inward-facing hMATE1 determined using the efflux protocol revealed an IC(50) for H(+) of 11.5 nM (pH 7.91), consistent with symmetrical interactions of H(+) with the inward-facing and outward-facing aspects of hMATE1.

Inorganic mercury interacts with cysteine residues (C451 and C474) of hOCT2 to reduce its transport activity.

Human organic cation transporter 2 (hOCT2) is essential for the renal tubular secretion of many toxic organic cations. Previously, of the cysteines (C437, C451, C470, and C474) that occur within transmembrane helices that comprise the hydrophilic cleft (proposed site of substrate binding), only C474 was accessible to maleimide-PEO(2)-biotin (hydrophilic thiol-reactive reagent), and covalent modification of this residue caused lower transport rates (Pelis RM, Zhang X, Dangprapai Y, Wright SH, J Biol Chem 281: 35272-35280, 2006). Thus it was hypothesized that the environmental contaminant Hg(2+) (as HgCl(2)) would interact with C474 to reduce hOCT2-mediated transport. Uptake of [(3)H]tetraethylammonium (TEA) into Chinese hamster ovary cells stably expressing hOCT2 was reduced in a concentration-dependent manner by HgCl(2), with an IC(50) of 3.9 +/- 0.11 microM. Treatment with 10 microM HgCl(2) caused a sixfold reduction in the maximal rate of TEA transport but did not alter the affinity of hOCT2 for TEA. To determine which cysteines interact with Hg(2+), a mutant with all four cleft cysteines converted to alanines (quadruple mutant), and four variants of this mutant, each with an individual cysteine restored, were created. The quadruple mutant was less sensitive to HgCl(2) than wild-type, whereas the C451- and C474-containing mutants were more sensitive than the quadruple mutant. Consistent with the HgCl(2) effect on transport, MTSEA-biotin only interacted with C451 and C474. These data indicate that C451 and C474 of hOCT2 reside in the aqueous milieu of the cleft and that interaction of Hg(2+) with these residues causes reduced TEA transport activity.

Cysteine accessibility in the hydrophilic cleft of human organic cation transporter 2.

Organic cation transporters (OCTs) are involved in the renal elimination of many cationic drugs and toxins. A hypothetical three-dimensional structure of OCT2 based on a homology model that used the Escherichia coli glycerol 3-phosphate transporter as a template has been described (Zhang, X., Shirahatti, N. V., Mahadevan, D., and Wright, S. H. (2005) J. Biol. Chem. 280, 34813-34822). To further define OCT structure, the accessibility to hydrophilic thiol-reactive reagents of the 13 cysteine residues contained in the human ortholog of OCT2 was examined. Maleimide-PEO2-biotin precipitated (surface biotinylation followed by Western blotting) and reduced tetraethylammonium transport by OCT2 expressed in Chinese hamster ovary cells, effects that were largely reversed by co-exposure to substrates and transport inhibitors, suggesting interaction with cysteines that are near to or part of a substrate-binding surface. Cysteines at amino acid position 437, 451, 470, and 474 were identified from the model as being located in transmembrane helices that participate in forming the hydrophilic cleft, the proposed region of substrate-protein interaction. To determine which residues are exposed to the solvent, a mutant with all four of these cysteines converted to alanine, along with four variants of this mutant each with an individual cysteine restored, were created. Maleimide-PEO2-biotin was only effective at precipitating and reducing transport by wild-type OCT2 and the mutant with cysteine 474 restored. Additionally, the smaller thiol-reactive reagent, methanethiosulfonate ethylsulfonate, reduced transport by wild-type OCT2 and the mutant with cysteine 474 restored. These data demonstrate that cysteine 474 of OCT2 is exposed to the aqueous milieu of the cleft and contributes to forming a pathway for organic cation transport.