Md Anwarul Majumder | University of Bradford (original) (raw)

Papers by Md Anwarul Majumder

South East Asia Journal of Public Health, 2013

South East Asia Journal of Public Health, 2013

not available DOI: http://dx.doi.org/10.3329/seajph.v2i2.15961 South East Asia J Public Health | ... more not available DOI: http://dx.doi.org/10.3329/seajph.v2i2.15961 South East Asia J Public Health | Jul-Dec 2012 | Vol 2 Issue 2 | 80-84

Advances in Medical Education and Practice

Rural and Remote Health, 2019

Introduction: Community orientation in medical education, which prepares medical students to beco... more Introduction: Community orientation in medical education, which
prepares medical students to become more effective practitioners,
is now a global movement. Many medical schools around the
world have adopted the concept as the main curricular framework
in order to align learning programs with the needs of the
community and the learner. Despite many changes over the past
few decades, many improvements are still needed in medical
education in Bangladesh. This study investigated medical students’
perceptions of the community-based learning experiences
incorporated into the Bachelor of Medicine, Bachelor of Surgery
(MBBS) degree at Uttara Adhunik Medical College, Dhaka (UAMC),
Bangladesh.
Methods: A total of 135 students from three undergraduate year
levels of the MBBS degree at UAMC, Dhaka, Bangladesh,
undertook study tours (community-based teaching, CBT) as a part
of a community medicine course and visited a medical college, two
rural health centres and a meteorology centre in the Cox’s Bazar
district, 400 km from Dhaka city. A questionnaire was used to
assess the perceptions of students regarding the administration,
organisation and learning experiences of the study tours. Students
were required to write reports, present their findings and answer
questions in their examinations related to the study tours and CBT.
Results: The majority of the students agreed or strongly agreed
that the tour was a worthwhile (93%) and enjoyable (95%) learning
experience that helped them to understand rural health issues
(91%). More than half of the students reported that the study tours
increased their awareness about common rural health problems
(54%) and provided a wider exposure to medicine (61%). Only 41%
of students reported that the study tour increased their interest in
undertake training in a rural area. A substantial number of students
also expressed their concerns about the planning, length,
resources, finance and organisation of the study tours.
Conclusions: Overall, the study tours had a positive effect,
enhancing students’ awareness and understanding of common
rural health problems. As study tours failed to increase the
motivation of the students (approximately 60%) to work in rural
areas, CBT in the medical curriculum should be reviewed and
implemented using effective and evidence-based models to
promote interest among medical students to work in rural and
underserved or unserved areas

The rapid development of new drugs, therapies, and devices has created a dramatic increase in the... more The rapid development of new drugs, therapies, and devices has created a dramatic increase in the number of clinical research studies that highlights the need for greater participation in research by physicians as well as patients. Furthermore, the potential of clinical research is unlikely to be reached without greater participation of physicians in research. Physicians face a variety of barriers with regard to participation in clinical research. These barriers are system- or organization-related as well as research- and physician-related. To encourage physician participation, appropriate organizational and operational infrastructures are needed in health care institutes to support research planning and management. All physicians should receive education and training in the fundamentals of research design and methodology, which need to be incorporated into undergraduate medical education and postgraduate training curricula and then reinforced through continuing medical education. Medical schools need to analyze current practices of teaching–learning and research, and reflect upon possible changes needed to develop a ‘student-focused teaching–learning and research culture’. This article examines the barriers to and benefits of physician participation in clinical research as well as interventions needed to increase their participation, including the specific role of undergraduate medical education. The main challenge is the unwillingness of many physicians and patients to participate in clinical trials. Barriers to participation include lack of time, lack of resources, trial-specific issues, communication difficulties, conflicts between the role of clinician and scientist, inadequate research experience and training for physicians, lack of rewards and recognition for physicians, and sometimes a scientifically uninteresting research question, among others. Strategies to encourage physician participation in clinical research include financial and nonfinancial incentives, adequate training, research questions that are in line with physician interests and have clear potential to improve patient care, and regular feedback. Finally, encouraging research culture and fostering the development of inquiry and research-based learning among medical students is now a high priority in order to develop more and better clinician-researchers.

Introduction: Information regarding career choices of medical students is important to plan human... more Introduction: Information regarding career choices of medical students is important to plan human resources for health, design need-based educational programs, and ensure equitable and quality health care services in a country.
Aim: The aim of the study is to identify career choices, nature of career, intended practice locations, and reasons for career choices of Bangladesh medical students.
Method: First-, third-, and fifth-year students of Bangladesh Medical College and Uttara Adhunik Medical College completed a self-report questionnaire on career choices, nature of career, intended practice locations, and reasons for career choices. The students were requested to choose three long-term choices from the given specialties.
Results: A total of 132 students responded (46 males and 86 females) and response rate was 75%. The popular choices (first choice) among males and females were medical specialty, surgical specialty, obstetrics and gynecology, and general practice. For first, second, and third choices altogether, male students chose surgical specialties and female students preferred medical specialties. The leading reasons for selecting a specialty were personal interest and wide job opportunity. More than 67% of respondents wanted to join private services and about 90% chose major cities as practice locations. About 43% of respondents expressed willingness to practice medicine in Bangladesh, whereas 51% of total respondents wanted to practice abroad.
Discussion: Majority of students intended to specialize in established clinical specialties and subsequently practice in major cities, and more than half wanted to immigrate to other countries. Basic medical subjects and service-oriented (lifestyle-related) and preventive/social medical specialties were found to be less attractive. If this pattern continues, Bangladesh will suffer a chronic shortage of health personnel in certain specialties and in rural areas.
Conclusions: Reorientation of health care and medical education is needed along with policy settings to attract doctors to the scarcity and high-priority disciplines so that imbalances encountered would be minimal in future.

Learning disabilities (LDs) represent the largest group of disabilities in higher education (HE) ... more Learning disabilities (LDs) represent the largest group of disabilities in higher education (HE) institutes, including medical schools, and the numbers are continuing to rise. The worrying concern is that two-thirds to half of these students with LDs remain undiagnosed when they start their undergraduate education and may even graduate without having their disabilities diagnosed. These students struggle with their academic abilities, receive poor grades and, as a result, develop lower perceptions of their intellectual abilities than do those students without LDs. All these ultimately hamper their professional practice, employment, and career progression. Appropriate and adequate educational policies, provisions, and practices help students to progress satisfactorily. In Asian countries, public and professional awareness about LDs is low, supportive provisions are limited, legislations are inadequate, data are scarce, and equal-opportunity/widening-participation policies are not implemented effectively in the HE sector. This article discusses the issues related to LDs in medical education and draws policy, provision, and practice implications to identify, assess, and support students with LDs in medical schools, particularly in an Asian context.

Arterial stiffness has been used to demonstrate vasculopathy in adults with diabetes but studies ... more Arterial stiffness has been used to demonstrate vasculopathy in adults with diabetes but studies on arterial stiffness in offspring of diabetic patients are scarce, and no study has been reported in the offspring of parents with impaired glucose tolerance (IGT). In this study arterial stiffness in normoglycaemic offspring (n=30) of parents with type 2 diabetes, normoglycaemic offspring (n=30) of IGT parents and 30 age and sex-matched normoglycaemic offspring of normoglycaemic parents was investigated. Arterial stiffness was assessed by pulse wave velocity (PWV) and augmentation index (AI) using SphygmoCor. Significantly higher PWV was noted in
offspring of type 2 diabetes than in offspring of normoglycaemic parents (6.94±0.9 vs. 6.33±0.7 m/s, p=0.010). Offspring of type 2 diabetes parents also demonstrated significantly higher PWV than IGT offspring (6.94±0.9 vs. 6.43±1.1, p=0.021). Significantly higher AI was observed in offspring of type 2 diabetes and IGT parents than progeny of normoglycaemic parents (105.62±14.2 vs. 96.42±7.7, p=0.001; 104.98±11.1 vs. 96.42±7.7%, p=0.004, espectively). The study demonstrated that normoglycaemic offspring of newly diagnosed, never treated type 2 diabetes and IGT parents had increased arterial stiffness. Such increases in arterial stiffness revealed early manifestations of preclinical vasculopathy and potentially increased risk for development of macrovascular diseases in the normoglycaemic offspring.
Br J Diabetes Vasc Dis 2009;9: 65–68.

Lecture handouts are widely used instructional tools. Handouts supplement rather than substitute ... more Lecture handouts are widely used instructional tools. Handouts supplement rather than substitute students’ regular reading. It is now a common practice to supply PowerPoint handouts and publish lecture handouts on the web for students’ access. A study was conducted among the first year medical students (n=142) of School of Medical Sciences (SMS), Universiti Sains Malaysia (USM) in order to determine their perceptions and expectations with regards to lecture handouts provided to them. The majority of the students reported that they read the lecture handouts as a reference and found them useful as a guide for future learning. More than half (68%) of the students expressed dissatisfaction with the overall presentation format of the handouts which is mainly technology-related i.e. PowerPoint and photocopying. This study indicated that students’ expectations and experiences were positive towards the use of handouts. They used handouts as a means of supplementing rather than substituting their learning. Much care is needed when educators supply computer-based handouts, as this study shows a number of limitations when students use them. Medical schools should consider publishing
web-based handouts with online and other facilities to make it interesting and effective.
Key words : Lecture; Handout; Medical education, Malaysia

Most medical schools, especially in South-East Asia, currently are experiencing difficulties in p... more Most medical schools, especially in South-East Asia, currently are experiencing difficulties in providing the right quality and quantity of educational experiences as the curricula have failed to respond to the needs of the community and country. The pedagogic shift from traditional approach to a need-based approach requires a fundamental change of the roles and commitments of educators, planners and policymakers. Teachers of health professional education in the region are to be well-informed of the trends and innovations and utilize these to increase relevance and quality of education to produce competent human resources for the region. The purpose of this paper is twofold: (i) to discuss innovative strategies and emerging trends, which have been successfully adopted by educators around the world for the reorientation of medical education to overcome existing traditions of educational planning, review and development and (ii) to highlight their implications and importance to initiate need-based reforms of medical training in South-East Asia.

We disagree with the very notion of the author1 and others2 to consider health care as a business... more We disagree with the very notion of the author1 and others2 to consider health care as a business i.e. “medical tourism industry”. We, with others in the profession3, also feel that health care must be different from other industries, such as real estate business or IT industry, because it deals with something that seems to transcend monetary value – life itself.

In recent years, several changes have taken place in Asian countries, mainly in India, Singapore and Thailand, which transformed health care more into business. Many believe that the process is severely detrimental to the societal structure of the Asian countries. The profit motive and good patient care is fundamentally incompatible. This is true for India and other developing nations where there is a shortage of physicians, supportive staff, equipment, resources, and facilities, and moreover, majority of the people have poor access to health care services1. A number of Indian doctors pay short visits to Bangladesh to offer their extraordinary expertise (!). For making good business, they are attracting people by giving ads to the local newspapers and appointing ‘middle-men’ to “go fishing for patients”. Private hospitals and clinics are being established and renowned doctors are also opening their chambers in the border towns like Maldah and Bahrampur to hunt Bangladeshi patients4. Such type of medical tourism will only do harm5.

The encouragement of medical tourism by the governments will mean that hospital care is no longer solely a charitable proposition, and many astute entrepreneurs will start providing hospital care on a for-profit basis not only for the foreign patients, but also for their own people. Ironically, most of the so-called “five-star hospitals” in India are not owned and managed by doctors.2 And these owners took the challenge as a “business proposition” – equating this humanitarian service with dollars! It’s nothing but ‘a wolf in sheep’s clothing’.

We have to remember that health is a basic human right and that everyone is entitled to access to health care, regardless of his or her ability to pay.

Reference:
1. Mudur G. Hospitals in India woo foreign patients. BMJ 2004; 328:1338.
2. Dey S. Software? We can earn $20bn from medical tourism, The Economic Times Online, 3 Oct, 2003. Available from URL: http://economictimes.indiatimes.com/articleshow/msid-214698,prtpage-1.cms? Accessed 8 June, 2004.
3. Relman AS. The health care industry: where is it taking us? N Engl J Med 1991: 325:854-859.
4. Wadood N. Patients to India from Rajshahi rising: 35,000 medical visitors spend Tk 100cr a year. New Age, 4 Nov 2003. Available from URL: http://www.newagebd.com/nov1st03/041103/front.html. Accessed 8 June, 2004.
5. Bishop RA & Litch JA. Medical tourism can do harm. BMJ 2000; 320:1017.

This article addresses the roles, issues, approaches, rationale, pitfalls, priorities and balance... more This article addresses the roles, issues, approaches, rationale, pitfalls, priorities and balance of research in medical education, particularly its "disarray" status in Asia. Research in medical education has influenced education in many ways. Most importantly, it provides legitimate evidences to stakeholders on which to make educational decisions. It also has a wider social impact on teaching practice and subsequent clinical practice. However, in Asia, medical educational research has not substantially influenced educational policy and medical practices. Moreover, it fails to receive comparable attention as in developed countries. A number of constraints that have hampered the development of educational research in Asia are identified: low socio-economic condition of the region; cultural and religious values and beliefs of the people; lack of congruence between the mission and vision of medical schools; leadership crisis; lack of financial resources; inadequate exposure to medical educational research in undergraduate training; lack of collaboration and commitment; and unforeseeable short-term outcome of medical education. The article concludes with some specific recommendations to strengthen research and to create a research culture in the region, including active leadership and commitment of the institutes/organisations, careful assessment and strategic settings of the priorities of medical educational research, establishment of a regional centre for medical education research, availability of financial resources, wider dissemination of research findings, collaboration with the developed countries and initiative to publish regional-based medical education journals, including electronic journals. Appropriate research environment and culture will enable stakeholders to obtain evidence-based information from educational research to increase the relevance, quality, cost-effectiveness and equity of medical education and practice in Asia.

Problem-based learning (PBL) is gradually becoming popular in medical schools in Asian countries.... more Problem-based learning (PBL) is gradually becoming popular in medical schools in Asian countries. It is an integrated, student-centered educational approach, which uses problems (triggers) as the key units for stimulating and structuring relevant student learning. Such learning is largely dependent on the quality of the problems and the areas tested in PBL. Aligning PBL activities with subsequent student assessment often proves to be difficult, because it is different from the assessment conducted in the traditional curriculum. A study was conducted to analyze the PBL problems and examination questions used in the School of Medical Sciences, Universiti Sains Malaysia (USM) to examine the demographic characteristics of the people featured and the level of acuity of case scenarios presented.

‘Problems’ (triggers) are the heart of problem-based learning (PBL) and controlling the quality, ... more ‘Problems’ (triggers) are the heart of problem-based learning (PBL) and controlling the quality, structure, complexity and fidelity of problems is important. The School of Medical Sciences, Universiti Sains Malaysia (USM) has pioneered an integrated problem-based curriculum since its inception in 1979. A study was conducted to analyse PBL problems (n ¼ 51) and examination questions (MEQs: 95, OSCEs: 169) to investigate their demographic and pedagogical characteristics.

Most medical schools around the world have been adopted problem-based learning (PBL) as their mai... more Most medical schools around the world have been adopted problem-based learning (PBL) as their main teaching-learning strategy. PBL is an instructional strategy in which learner-centered method is utilised and ‘problems’ are used as the focus of learning in small groups. PBL has disadvantages as well as advantages. However, such method is found to be more effective than learning based on established disciplines in the traditional curriculum. Undergraduate medical curriculum of Bangladesh is to be reviewed to incorporate PBL to overcome some of the potential difficulties of medical education.

By virtue of technological innovations and advances in diagnosis and treatment of common conditio... more By virtue of technological innovations and advances in diagnosis and treatment of common conditions, such as cardiovascular disease and cancer, development of effective immunizations and control of many infectious diseases and steady declines in infant mortality, medical science and public health have made great strides in achieving reductions in morbidity and mortality. Yet, despite these accomplishments and advances, the health burden imposed by unhealthful behaviors (such as improper diet, sedentary lifestyle, and use and abuse of tobacco and alcohol) as well as by preventable illnesses, injuries, and disability remains substantial, especially in Asians countries. Accordingly, patients, physicians, other health care professionals, and the public have increasingly recognized the importance of effective strategies for health promotion, health protection, and risk reduction as being essential to protect, promote, and improve the health of all. This paper seeks to highlight the health promotion/education and risk management/education endeavours adopted by the Asian countries to promote healthy lifestyles, combat communicable diseases, confront non-communicable diseases, sustain healthy environment and strengthen health care system.

Quality of medical education, performance of medical students and graduates and provision of effe... more Quality of medical education, performance of medical students and graduates and provision of effective health care are interrelated. We always concerned about physicians performance and the care they render to the people, but hardly we talk about the quality of medical education in the country and if talk so we do not really mean it. One of the main reasons is, medical education is always given low priority in the political agenda of the government. Notable exceptions are the establishment of Centre for Medical Education (CME) in the early 1980s and initiation of the Further Improvement of Medical Colleges (FIMC) Project in the early 1990s. Last decade can be considered as the “golden age” of medical education in Bangladesh. FIMC Project undertook a number of important reforms in the arena of medical education in Bangladesh in collaboration with international agencies - none of the South-East Asian countries have the chances to undergo such experiences. But it is unfortunate that we failed to consolidate and sustain the achievements of FIMC and other projects. At present, none of the projects’ activities are fully practiced, implemented or reviewed.

In the recent years, educational institutions around the world have been increasingly confronted ... more In the recent years, educational institutions around the world have been increasingly confronted with the challenge of making their curricula relevant to the needs of the time. Medical education in Bangladesh has also experienced many changes and challenges. The government has taken initiatives to bring reform in medical education over the last two decades through the UNDP-funded Project1, the FIMC Project2 and the Health and Population Sector Program (HPSP)3. The outcome is not frustrating, rather encouraging, as an "educational environment for change" has been established in the arena of medical education of Bangladesh. The positive aspects are: (i) growing realisation among stakeholders to review existing curriculum4-5; (ii) availability of a sufficiently large “critical mass” of trained teachers in medical education6; (iii) availability of resources, expertise, procedures and guidelines which were left behind by the FIMC Project4-5; (iv) presence of an organisational and operational framework of the Quality Assurance Scheme, both nationally and locally in the medical colleges4; and (v) commitment to improve the medical education in the current Health and Population Sector Program (HPSP)3. Since its development, 1988-curriculum has been criticised by several authorities as it is not strongly oriented towards community health needs and advocated urgent interventions for its revision and improvement1-4, 7-15. This paper discusses the progresses, pitfalls and perspectives of medical education in Bangladesh and put forward recommendations for its improvement.

South East Asia Journal of Public Health, 2013

Advances in Medical Education and Practice

Rural and Remote Health, 2019

We have to remember that health is a basic human right and that everyone is entitled to access to health care, regardless of his or her ability to pay.