Developing professional identity among undergraduate medical students in a competency-based curriculum: Educators' perspective.

Professional identity formation (PIF) refers to the possession and exhibition of the conduct of a medical professional. It's an external representation of a medical personnel's feelings, beliefs, experiences, and values that influence the provision of holistic patient care. Apart from training medical students to be competent and skilled physicians, one of the goals of today's medical education must be to encourage them to achieve professional identity formation. Many medical schools across the globe have made this explicit during the clinical years of study, but we believe that professional identity formation starts as early as day one of medical school. So, for educators, apart from delivering basic science subject content during early years of study, the creation of learning opportunities and pedagogic space in the curriculum to enhance competencies of PIF becomes mandatory. This competency-based educational approach will help medical students transform and reconsider their own values and beliefs by relating to the behaviors that are expected by the profession, colleagues, and patients when they graduate as medical doctors. In this paper, we discuss how a competency-based curriculum should provide opportunities for students to interact and communicate effectively with patients and colleagues, to self-reflect on their own personal identity before creating a professional identity that is unique to the profession, to make the right judgment and confidently practice medicine in a business-based healthcare system.

Prevalence and Associated Factors of the Severity of Depression, Anxiety and Stress Among Low-Income Community-Dwelling Adults in Kuala Lumpur, Malaysia.

Growing prevalence of mental illnesses and the role they play in the global disease burden is an emerging public health issue. The prevalence of depression and anxiety is on the rise in Malaysia. Low-income urban communities are among the key affected populations with regards to mental health problems. This cross-sectional study was aimed to determine the prevalence and severity of depression, anxiety and stress, and their associated factors among adults in the low-income community of Kuala Lumpur, Malaysia. A total of 248 participants aged 18-60 years old were recruited. Data were collected via face-to-face interviews using the Depression, Anxiety and Stress Scale-21 Items (DASS-21). Chi-squared test was used to examine the association between the variables. Multiple ordinal regression model was introduced to identify the predictors of depression, anxiety and stress. The proportions of participants with depression, anxiety and stress were 24.2% (95% CI: 19.6-30.4), 36.3% (95% CI: 29.9-43.0), and 20.6% (95% CI: 15.4-26.5), respectively. There was a statistically significant association of ethnicity (p = 0.002) and age (p = 0.014) with the severity of depression, ethnicity (p = 0.001) and age (p = 0.024) with the severity of anxiety, and ethnicity (p < 0.001) and marital status (p = 0.006) with the severity of stress. In a multivariable analysis, only non-Malay ethnicity was an independent predictor of the severity of depression [OR = 2.43, 95% CI (1.25, 4.72), p = 0.009], anxiety [OR = 2.55, 95% CI (1.41, 4.62), p = 0.002] and stress [OR = 4.28, 95% CI (2.06, 8.89), p = <0.001]. Mental health interventions should target low-income communities to address social inequalities of mental health within economically disadvantaged populations.

Income and obesity in an urban poor community: a cross-sectional study.

Background: Recent studies have shown that higher income is associated with a higher risk for subsequent obesity in low- and middle-income countries, while in high-income countries there is a reversal of the association - higher-income individuals have a lower risk of obesity. The concept of being able to afford to overeat is no longer a predictor of obesity in developed countries. In Malaysia, a trend has been observed that the prevalence of obesity increases with an increase in income among the low-income (B40) group. This trend, however, was not further investigated. Therefore, this study was performed to investigate the association of income and other sociodemographic factors with obesity among residents within the B40 income group in an urban community.  Methods: This cross-sectional study used a systematic sampling technique to recruit participants residing in a Program Perumahan Rakyat (PPR), Kuala Lumpur, Malaysia. The sociodemographic characteristics were investigated through face-to-face interviews. Weight and height were measured, and body mass index (BMI) was calculated and coded as underweight, normal, overweight and obese according to the cut-off points for the Asian population. A chi-squared test was used to compare the prevalence of obesity in this study with the national prevalence. A generalized linear model was introduced to identify BMI predictors. Results: Among the 341 participants, 25 (7.3%) were underweight, 94 (27.6%) had normal weight, 87 (25.5%) were overweight, and 135 (39.6%) were obese. The proportion of obese adults (45.8%) was significantly higher than the national prevalence of 30.6% (p<0.001). Among all the tested variables, only income was significantly associated with BMI (p=0.046). Conclusion: The proportion of obesity in this urban poor community was higher compared with the national average. BMI increased as the average monthly household income decreased.

Whole-grain consumption and its determinants in Malaysian medical students: A cross-sectional study.

BACKGROUND: Whole-grain consumption is associated with several health benefits. Little is known, however, about whole-grain consumption patterns in medical students in Malaysia. OBJECTIVES: The study was conducted to assess whole-grain intake pattern and factors influencing intake among Malaysian medical students. METHODS: A cross-sectional study investigating whole-grain intake among 151 medical students in a private medical university in Malaysia was conducted from January to June 2018. A self-administered questionnaire was used to assess sociodemographic variables, the whole-grain intake pattern and the knowledge and attitudes toward whole-grain intake. Data were analyzed using IBM SPSS software. Chi-square test and multivariable logistic regression were used. RESULTS: The prevalence of reported whole-grain intake in the past 3 months was 51%. Chinese ethnicity, readiness to adhere to Malaysian food pyramid, and self-preparation of food, and eating at home were significantly associated with whole-grain consumption. However, the primary determinants of food choice such as education, knowledge, and affordability did not seem to influence whole-grain consumption. Whole-grain consumption is relatively low among Malaysian medical students. Cultural background and self-belief influence this practice despite being from the medical fraternity. CONCLUSIONS: Efforts are needed to bridge the knowledge-practice gap by assessing the barriers to whole-grain consumption to design effective initiatives to promote an increase in whole-grain consumption.

Case-based Learning: Our Experience in Clinical Pharmacology Teaching.

Majority of junior doctors struggle to apply the knowledge of pharmacology to prescribing drugs. A paradigm shift in teaching of clinical pharmacology is the need of the hour in medical curriculum. One of the ways to enhance the teaching of clinical pharmacology is to develop and conduct case-based learning for MBBS students instead of didactic lecturing. Case-based learning session can bridge the gap between theory and practice. Case-based learning provides hands-on training in a classroom setting. We tried to develop and conduct case-based learning for year two medical students and evaluated their response via the Dundee Ready Education Environment Measure questionnaire. Majority of our students enjoyed learning clinical pharmacology through case-based learning. Case-based learning also provided students the opportunity to embrace the principles of problem solving, critical thinking, and lifelong learning. It helped students to amalgamate the concept of development of P drug list with rationale prescribing habits. Majority of our students also agreed that they understood the content of the subject taught in the session.

Low Awareness of Osteoporosis among Women Attending an Urban Health Centre in Mumbai, Western India

Osteoporosis is a global health problem both in the developed and developing countries. Patient education forms an important part in the management of osteoporosis. The objective of this study was to evaluate knowledge about osteoporosis and its correlates among women aged ≥ 40 years attending an urban health centre in India and to identify their sources of information on osteoporosis. Knowledge about osteoporosis was assessed using the Osteoporosis Questionnaire (OPQ) in 243 women over 40 years of age, attending an urban health centre in the city of Mumbai located in the state of Maharashtra in western India. This exploratory cross-sectional study was conducted over a period of eight months. The OPQ analysis was performed using SPSS for Windows Version 13.0. The scores were expressed as mean ± SD (Standard Deviation). The one sample-t test was used to study the differences in the mean scores between socio-demographic variables. The mean total OPQ score was 0.91 (SD ± 5; range -9 to 10; maximum possible score 20). There was a significant difference in the total OPQ scores by the level of education and family history of osteoporosis (p<0.05). The main sources of information identified were television/radio (55%), family and friends (23%), newspapers (22%) and doctors (20%). The study reveals lack of knowledge about osteoporosis in the present sample, and the need for increased involvement of doctors in educating patients about osteoporosis.

Prevalence Of Exclusive Breast Feeding And Its Correlates In An Urban Slum In Western India

Background: The World Health Organization recommends the practice of exclusive breastfeeding of infants for the first 6 months after birth. The objective of present study was to estimate the prevalence and the factors influencing exclusive breastfeeding. The perceptions of mothers about breastfeeding in an urban slum area of Western India were also enquired. Methods: This cross sectional study was conducted over six months amongst 200 mothers of children in the age group of 6 – 12 months attending the growth and development clinic in one of the urban health centres. Data was collected using a pre-tested, structured questionnaire on breastfeeding practices. Factors related to exclusive breastfeeding were analysed using bivariate and multivariate analysis. Results: Prevalence of exclusive breastfeeding reported by the participants was 61.5%. Having a male child, maternal age < 30 years, level of education of mother, parity, receiving infant feeding advice, initiation of breastfeeding within one hour of birth and administration of colostrum to the baby were associated with exclusive breastfeeding (p<0.001). Multivariate logistic regression analysis revealed that male sex (adjusted odd ratios: 20.03), primiparity (0.19), home delivery (0.32), receiving infant feeding advice (5.90), initiation of breastfeeding within one hour of birth (0.26) and giving colostrum to the baby (2.56) were independently associated with exclusive breastfeeding. Prelacteal feeds were given by almost 35% of mothers. Conclusion: Prevalence of exclusive breastfeeding was higher than the national figures. However, practices like discarding the colostrum, giving prelacteal feeds, early/late weaning and use of formula feeds are still widely prevalent and need to be addressed.