Shahid Hassan - Academia.edu (original) (raw)

Papers by Shahid Hassan

Research paper thumbnail of Revisiting TiOSCE (Task Integrated Objective Structured Clinical Examination) for Remote Assessment in COVID-19 Pandemic

In the backdrop of OSCE known for a valid but fragmented test of clinical competency, a new asses... more In the backdrop of OSCE known for a valid but fragmented test of clinical competency, a new assessment format named the, “Task--‐integrated Objective Structured Clinical Examination (TiOSCE)” was developed by the author in 2012. However, author had no idea then that the TiOSCE will provide a readily available tool to remotely assess students’ performance in a crisis like COVID-‐19 in which a face--‐to--‐face delivery of OSCE may not be possible. TiOSCE at the time of its invention was aimed to introduce integrated OSCE with multiple sub--‐stations and simulated patient (SP) using authentic case scenario to respond to OSCE being segmented tests of clinical competency. Present work is a reproduction of the same TiOSCE in terms of principles, rationale, protocol, logistics and the outcome with add--‐in concepts of remote exam for its implementation in COVID--‐19 crisis. Aiming to revist TiOSCE is to find its utility of remotely managed assessment in a crisis like COVID. TiOSCE with rem...

Research paper thumbnail of Research in teaching: what it means to an academic physician

Education in Medicine Journal, 2013

Research paper thumbnail of Online Small Group Clinical Be(side) Teaching (BeST) Using Authentic Scenario with Hypothetico-deductive Approach and Gagne Instructional Model

Education in Medicine Journal

Online training is intended to provide a solution to on-campus teaching and learning, this is not... more Online training is intended to provide a solution to on-campus teaching and learning, this is not always the case. The important factor in designing online learning sessions should be consider, how to prevent students from getting frustrated with increasingly high workload. The basic principle to ensure this is to divide a session into several chunks that help students being engaged and motivated. One should think of putting up something, which is collaborative, interactive, dynamic and full of fun. Bedside Teaching (BST) of a clinical environment converted to an online delivery however, achieving learning outcome, is difficult to imagine. In the current scenario of COVID-19 pandemic, it is wise to consider educational pedagogy to design and develop teaching and learning method rather than focusing on using technology for online delivery. Teachers can be guided by the nine steps of Gagne's Instructions Model that authors have explored and named Be(Side) Teaching (BeST) as a traditional BST. The method is a systematic process for instructional classes in which each step addresses a form of communication that help learning process online. On completing each step learners are likely to be engaged that may help them to retain and transfer information for longer retention with a contextualised Kolb experiential learning cycle at the end. Authors adapted clinical reasoning in a problem-solving learning method using small group (6-8 students) guided by a supervisor. The learning experience design worked well in supervisor's experience.

Research paper thumbnail of Evaluation of immediate impact of Faculty Development Programme using a pretest–post-test study design format

Innovation and Education, 2021

Background Workshops are the most common models to enhance knowledge and skills in a specific sub... more Background Workshops are the most common models to enhance knowledge and skills in a specific subject area with an intent to explore, solve a problem and/or innovate new things. The most important aspect of a workshop is the transfer of knowledge in a safe learning environment as a faculty development activity (FDA). At International Medical University (IMU), Malaysia’s first private medical university which was established in 1992, Faculty Development Programmes (FDPs) are run throughout the year in order to enhance the knowledge and skills in teaching and assessment. In order to sustain this faculty development, IMU has a dedicated medical education unit called the IMU Centre of Education (ICE) with dedicated staff and respected faculty developers who are academic role models to the faculty of the institution. However, FDA are collaboratively run by ICE and IMU Centre for lifelong learning (ICL). Objectives To determine the immediate impact of faculty development workshops for hea...

Research paper thumbnail of Fine-needle aspiration in the preoperative assessment of parotid tumours

International Medical Journal, 2011

Research paper thumbnail of Item analysis, reliability statistics and standard error of measurement to improve the quality and impact of multiple choice questions in undergraduate medical education in Faculty of Medicine at UniSZA

Malaysian Journal of Public Health Medicine, 2016

Research paper thumbnail of Assessment for “Fit to Practice” Graduates: OTTAWA-ICME Conference 2018

Education in Medicine Journal, 2018

Research paper thumbnail of Students’ Perceptions about the Immediate Feedback Assessment Technique (IF-AT) in Team- Based Learning

Education in Medicine Journal, 2018

Immediate feedback assessment technique (IF-AT) are self-scoring answer sheets, based on the conc... more Immediate feedback assessment technique (IF-AT) are self-scoring answer sheets, based on the concepts of immediate feedback for choosing the correct answer in multiple choice questions (MCQs) during group readiness assurance tests (GRATs) in team-based learning (TBL). IF-AT scratch card system rewards a student with partial credit for proximate knowledge. This technique motivates students to pursue learning with just-in-time feedback and gives them the opportunity for collaborative learning and analytic reasoning among group members. A rubric for partial credit is decided pre-hand depending upon the number of options used in MCQs. In this study, we assessed students' perception about immediate feedback assessment technique before and after the training. To determine students' perception of the IF-AT scratch card system in instruction and assessment. Students perceptions about the IF-AT system has been explored using a 25-item questionnaire administered to 60 students assigned randomly to control and training groups using pre-test and post-test analysis. Paired-sample t-test and independent-sample t-test statistics were employed and the data was analysed. Descriptive statistics observed for mean (SD) was found greater in trained group = 58.48 (4.87) vs. control group = 66.43 (5.81) with t-statistics significant at p = < 0.001. A significant difference in mean (SD) of pre-test minus post-test scores (5.16) of control and trained group = 5.37 (4.85) and 10.53 (8.36) respectively was also found with independent t-test analysis. It was found highly significant with t =-2.92, p < 0.05 and the effect size of 78.1%, established by Cohen's d criteria. The IF-AT system provides an individualised and instantaneous instruction as feedback in an assessment, which is marked with collaborative learning as in team-based learning. The IF-AT system promotes analytic reasoning with problem solving skills through partial credit for proximate knowledge. Students' perceive the concept of immediate feedback and partial credit for proximate knowledge as the most important features of the IF-AT scratch card system.

Research paper thumbnail of Use of Item Analysis to Improve the Quality of Single Best Answer Multiple Choice Question in Summative Assessment of Undergraduate Medical Students in Malaysia

Education in Medicine Journal, 2017

Research paper thumbnail of Combined use of maxillomandibular swing approach and neurosurgical ultrasonic aspirator in the management of extensive clival chordoma: A case report

Journal of Medical Case Reports, 2008

Introduction: Chordoma is a rare malignant tumour with an incidence of metastasis of less than 10... more Introduction: Chordoma is a rare malignant tumour with an incidence of metastasis of less than 10 percent. Usually arising from clivus its posterior extension may involve the brainstem before presenting as nasal mass and obstruction. Surgery is the main mode of treatment with adjuvant radiotherapy. However surgery is rarely possible for a large intracranial lesion. Case presentation: We report the case of an adolescent patient with a chordoma extending posteriorly to the brainstem and anteriorly to the nasopharynx and managed by the combination of resection using a maxillomandibular swing approach and the use of a neurosurgical ultrasonic aspirator. Conclusion: Maxillomandibular swing approach provides good access for large nasopharyngeal tumour extending brainstem area.

Research paper thumbnail of Assessment for Learning

Encyclopedia of Child Behavior and Development, 2011

Research paper thumbnail of The Structural Framework, Implementation Strategies and Students’ Perception of Team- Based Learning in Undergraduate Medical Education of a Medical School in Malaysia

Education in Medicine Journal

Delivery and implementation strategies are key to curriculum success. There is growing evidence t... more Delivery and implementation strategies are key to curriculum success. There is growing evidence that team-based learning (TBL) is an effective way of interactive teaching. TBL is a method that uses learning teams to enhance student engagement and quality of learning. Individual accountability for out-of-class reading is followed by individual and group assessment. In-class application exercises, which is the hallmark of team-based learning promotes both learning and team development. TBL uses educational principles of transforming traditional content into application of knowledge and problem solving skills in an interactive learning environment. To experience the structural framework and to determine the students' perception about TBL in clinical setting of MBBS program in a Malaysian medical school. A total of 120 students assigned to 22 small subgroups of 5-6 per group underwent a number of TBL sessions delivered in three phases. In Phase I, students were assigned reading material. In Phase II, students were assessed through One Best Answer (OBA) items for individual and group readiness assessment test as individual readiness assessment test (IRAT) and group readiness assurance test (GRAT) respectively followed by a mini-lecture. In Phase III, in-class application of learning activity was performed. Finally, peer assessment evaluated the contribution of peer in TBL. A TBL Classroom Evaluation Inventory (TBLCEI) developed to probe student's perception of TBL, comprised of 40 items composite scale with Cronbach's alpha at 0.881. In addition, students were asked to provide their estimated grade in end of the posting assessment. Grades were categorised into excellent pass >85%, high pass 70%-84%; average to good pass 50%-69% and fail <50%. These grades were measured against students' TBLCEI survey score using analysis of variance (ANOVA). Results were considered significant at p < 0.05. Results of one-way analysis of TBLCEI scores differed significantly across four estimated end of posting achievers groups, F (3,116) = 52.279, p < 0.001. Bonferroni's procedure of multiple comparisons indicated that mean value of TBLCEI score of excellent pass significantly higher [70.90 (3.684)] than high pass [66.57 (3.625)], average to good pass [60.42 (3.583)] and fail [57.67 (5.626)] at p < 0.001. It is concluded that medical students favourably liked TBL for interactive learning irrespective of their grades. A positive response for TBL from students is encouraging to consider

Research paper thumbnail of Evaluation of preoperative Technetium99m (99mTc) Pertechnetate Scintigraphy in patients with thyroid Mass

The Internet Journal of Head and Neck Surgery

Introduction: Preoperative thyroid scintigraphy has traditionally been regarded as the gold stand... more Introduction: Preoperative thyroid scintigraphy has traditionally been regarded as the gold standard for the investigation of the solitary thyroid nodule. It determines the activity of the lesion in relation to the adjacent structures.Objective: The aim of this study was to evaluate the accuracy of preoperative thyroid scintigraphy, in terms of sensitivity and specificity, in detecting malignant lesion.Materials and methods: This was a retrospective observational study, conducted at Hospital Universiti Sains Malaysia. We identified the patients who were operated between 2000 and 2005. Patients with thyroid mass, who had thyroid scintigraphy as part of the preoperative assessment, were recruited in this study.Results: 33 patients were recruited. The sensitivity of thyroid scan in our study population was 81.8 % and the specificity was 22.7 %.Conclusion: The specificity of thyroid scintigraphy was low and this technique should not be done as a routine test in every patient with thyroid nodule.

Research paper thumbnail of A Rare Cause of Vocal Cord Palsy due to Small Thyroid Nodule

The Internet Journal of Head and Neck Surgery

Thyroid lesion is strongly associated with recurrent laryngeal nerve palsy. It is because of the ... more Thyroid lesion is strongly associated with recurrent laryngeal nerve palsy. It is because of the close anatomical relationship between the gland on the trachea and the nerve which lies in the tracheoesophageal groove. The recurrent laryngeal nerve can be affected either from the thyroid disease itself or as the complication of thyroidectomy. However, benign thyroid lesion rarely causes recurrent laryngeal nerve palsy. We report a case of a small thyroid nodule causing unilateral vocal cord palsy. After lobectomy, the voice improved but due to the compensation mechanism of the opposite side. As the nerve was found to be atrophic intraoperatively, recovery should be allowed if it is going to take place, in a long period of time.

Research paper thumbnail of Assessment of First-Year Students’ Metacognitive Ability in Faculty of Medicine, Universiti Sultan Zainal Abidin (UniSZA): Toward Curriculum Development

Education in Medicine Journal, 2017

Introduction: Metacognition is the awareness of knowledge how one learns in addition to what one ... more Introduction: Metacognition is the awareness of knowledge how one learns in addition to what one learns and to understand how a task will be performed. Metacognitive skill as self-assessment is recognised as an important contributor to the development of critical capacity, reflective attitude and autonomous lifelong learning. Accurate, self-assessment of knowledge and skills is essential for students to maintain and improve through self-directed learning. Objective: The objective of this study was to explore, how well students' evaluate their own level of understanding for lectures to reflect their metacognitive skill that can be used in educational strategy to promote students' personal and professional growth. Methods: To assess the metacognition of the students, a questionnaire based on three items was designed. All 60 (17 male and 43 female) preclinical, first-year medical students were included in this study. The metacognition as planning, monitoring and evaluating the lecture was judged through students' response on 33 lectures in terms of understanding of knowledge, clearing of misconceptions and presenting of a well prepared material respectively in the field of haematology and parasitology. Metacognition as reflected in the lecture understanding level (LUL) score, lectures preparation level (LPL) score and students question level (SQL) score was estimated for its correlation with student' achievement score in pre-clinical phase of MBBS program. Results: The data was analysed for correlation between metacognition and overall students' achievement scores and a statistically significant correlation between LUL and multiple true false (MTF) of 268 (p = .039), LPL and MTF of .282 (p = .029) as well as between SQL and MTF of .360 (p = .005) was compared to poor correlation between LUL, LPL and SQL and the other three assessment tools (short essay questions [SEQ], problem-based questions [PBQ] and objectively structured practical examination [OSPE]) was found. Conclusion: The significant correlation of students' metacognition and their achievement score in classroom setting with MTF and poor correlation with SEQ, PBQ and OSPE is attributed to multiple factors discussed in this study, imperative to students' personal and professional growth.

Research paper thumbnail of Challenges in the management of nasopharyngeal carcinoma: a review

Malaysian Journal of Medical Sciences, Oct 1, 2009

Nasopharyngeal carcinoma (NPC) is a non-lymphomatous, squamous cell carcinoma that occurs in the ... more Nasopharyngeal carcinoma (NPC) is a non-lymphomatous, squamous cell carcinoma that occurs in the epithelial lining of the nasopharynx, an area that shows varying degrees of differentiation. Although relatively rare worldwide, NPC has substantial incidence and mortality in populations in Southeast Asia and in people with Southern Chinese ancestry. In Malaysia, NPC is a leading cancer type. In the clinic, NPC presents on a very wide spectrum. Therefore, a high degree of suspicion on the part of the clinician and an increased awareness by the patient is essential for the recognition of an early lesion. Early detection of the cancer is important as it affects the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s prognosis and the mode of treatment. Managing patients with NPC is very challenging as patients usually present late when the cancer is already in an advanced stage. Here, we review the challenges in the management of NPC.

Research paper thumbnail of Clinical and Audiological Profiles in Children with Chronic Otitis Media with Effusion Requiring Surgical Intervention

The Malaysian Journal of Medical Sciences Mjms, Jul 1, 2007

To determine the characteristic presenting symptoms, otoscopic findings, audiological profiles an... more To determine the characteristic presenting symptoms, otoscopic findings, audiological profiles and the intraoperative findings of children with chronic otitis media with effusion who required surgical intervention. A prospective cross sectional study was undertaken in the otorhinolaryngology clinic of USM Hospital (HUSM) involving 25 cases (50 ears) of children with chronic otitis media with effusion requiring surgical intervention from June 1999 to September 2001. Their ages ranged from 3 to 12 years old. The gender distribution included males at 72 % and females at 28 %. The presenting symptoms noted were hearing impairment (52%), otalgia (18%), ear block (16%) and tinnitus (14%). The otoscopic findings were fluid in the middle ear (40%), dullness (32%) and retraction of the tympanic membrane (28%). On audiometry, 24 ears had moderate deafness (48%), 16 ears had mild deafness (32%) while 4 ears had severe deafness (8%). With tympanometry, 42 ears out of the total 50 had a flat type B curve (84%) while 6 ears had type As curve (12%). During myringotomy, middle ear secretion was seen in 38 ears (76%) out of the 50 ears; 22 ears had mucoid secretion while 16 ears had serous secretion. Clinically, the commonest presenting symptom was hearing impairment (52%) while the most common otoscopic finding was fluid in the middle ear (40%). Audiologically, most patients had moderate conductive hearing loss (48%) and a type B curve (84%) on tympanometry. On myringotomy middle ear fluid was found in 76 % of the ears.

Research paper thumbnail of Mature cystic teratoma: unusual presentation as anterior neck swelling

Singapore medical journal

The unusual presentation of a mature mediastinal cystic teratoma as an anterior neck swelling in ... more The unusual presentation of a mature mediastinal cystic teratoma as an anterior neck swelling in a 29-year-old Malay woman is reported.

Research paper thumbnail of Underlay myringoplasty: Comparison of human amniotic membrane to temporalis fascia graft

The Medical journal of Malaysia

Human amniotic membrane as a homograft material was compared to temporalis fascia to close tympan... more Human amniotic membrane as a homograft material was compared to temporalis fascia to close tympanic membrane perforations in 50 patients with chronic otitis media. Human amniotic membrane was used in 20 patients while temporalis fascia was used in the remaining 30. Anatomical closure of the perforation and reduction of the air-bone gap was measured. The graft uptake showed a 65% success rate for the amniotic membrane and 56.7% for the temporalis fascia at 3 months post-operatively. Significant closure of air-bone gap was observed in the human amniotic group. These results indicate comparable outcomes between human amniotic membrane and the temporalis fascia graft.

Research paper thumbnail of How to develop a core curriculum in clinical skills for undergraduate medical teaching in the school of medical sciences at universiti sains malaysia?

Malaysian Journal of Medical Sciences

Clinical skills program as a laboratory method is a valuable adjunct to other forms of undergradu... more Clinical skills program as a laboratory method is a valuable adjunct to other forms of undergraduate medical training. This article describes the process of developing a core curriculum in clinical skills based on the Dundee model for a clinical skills centre. The School of Medical Sciences, in Universiti Sains Malaysia (USM) has been provided with a well equipped skills centre. However, the PBL curriculum in the undergraduate medical program in the school needs to be integrated with a clinical skills lab program. This is to counter the general feeling that the contribution of PBL is insignificant in terms of building clinical competency in an integrated system such as that used in USM compared to the traditional curriculi of other medical teaching institutions in Malaysia. Integrating clinical skills laboratory training with the PBL curriculum will provide evidence of PBL as an effective and innovative method for teaching and learning in Malaysia.

Research paper thumbnail of Revisiting TiOSCE (Task Integrated Objective Structured Clinical Examination) for Remote Assessment in COVID-19 Pandemic

In the backdrop of OSCE known for a valid but fragmented test of clinical competency, a new asses... more In the backdrop of OSCE known for a valid but fragmented test of clinical competency, a new assessment format named the, “Task--‐integrated Objective Structured Clinical Examination (TiOSCE)” was developed by the author in 2012. However, author had no idea then that the TiOSCE will provide a readily available tool to remotely assess students’ performance in a crisis like COVID-‐19 in which a face--‐to--‐face delivery of OSCE may not be possible. TiOSCE at the time of its invention was aimed to introduce integrated OSCE with multiple sub--‐stations and simulated patient (SP) using authentic case scenario to respond to OSCE being segmented tests of clinical competency. Present work is a reproduction of the same TiOSCE in terms of principles, rationale, protocol, logistics and the outcome with add--‐in concepts of remote exam for its implementation in COVID--‐19 crisis. Aiming to revist TiOSCE is to find its utility of remotely managed assessment in a crisis like COVID. TiOSCE with rem...

Research paper thumbnail of Research in teaching: what it means to an academic physician

Education in Medicine Journal, 2013

Research paper thumbnail of Online Small Group Clinical Be(side) Teaching (BeST) Using Authentic Scenario with Hypothetico-deductive Approach and Gagne Instructional Model

Education in Medicine Journal

Online training is intended to provide a solution to on-campus teaching and learning, this is not... more Online training is intended to provide a solution to on-campus teaching and learning, this is not always the case. The important factor in designing online learning sessions should be consider, how to prevent students from getting frustrated with increasingly high workload. The basic principle to ensure this is to divide a session into several chunks that help students being engaged and motivated. One should think of putting up something, which is collaborative, interactive, dynamic and full of fun. Bedside Teaching (BST) of a clinical environment converted to an online delivery however, achieving learning outcome, is difficult to imagine. In the current scenario of COVID-19 pandemic, it is wise to consider educational pedagogy to design and develop teaching and learning method rather than focusing on using technology for online delivery. Teachers can be guided by the nine steps of Gagne's Instructions Model that authors have explored and named Be(Side) Teaching (BeST) as a traditional BST. The method is a systematic process for instructional classes in which each step addresses a form of communication that help learning process online. On completing each step learners are likely to be engaged that may help them to retain and transfer information for longer retention with a contextualised Kolb experiential learning cycle at the end. Authors adapted clinical reasoning in a problem-solving learning method using small group (6-8 students) guided by a supervisor. The learning experience design worked well in supervisor's experience.

Research paper thumbnail of Evaluation of immediate impact of Faculty Development Programme using a pretest–post-test study design format

Innovation and Education, 2021

Background Workshops are the most common models to enhance knowledge and skills in a specific sub... more Background Workshops are the most common models to enhance knowledge and skills in a specific subject area with an intent to explore, solve a problem and/or innovate new things. The most important aspect of a workshop is the transfer of knowledge in a safe learning environment as a faculty development activity (FDA). At International Medical University (IMU), Malaysia’s first private medical university which was established in 1992, Faculty Development Programmes (FDPs) are run throughout the year in order to enhance the knowledge and skills in teaching and assessment. In order to sustain this faculty development, IMU has a dedicated medical education unit called the IMU Centre of Education (ICE) with dedicated staff and respected faculty developers who are academic role models to the faculty of the institution. However, FDA are collaboratively run by ICE and IMU Centre for lifelong learning (ICL). Objectives To determine the immediate impact of faculty development workshops for hea...

Research paper thumbnail of Fine-needle aspiration in the preoperative assessment of parotid tumours

International Medical Journal, 2011

Research paper thumbnail of Item analysis, reliability statistics and standard error of measurement to improve the quality and impact of multiple choice questions in undergraduate medical education in Faculty of Medicine at UniSZA

Malaysian Journal of Public Health Medicine, 2016

Research paper thumbnail of Assessment for “Fit to Practice” Graduates: OTTAWA-ICME Conference 2018

Education in Medicine Journal, 2018

Research paper thumbnail of Students’ Perceptions about the Immediate Feedback Assessment Technique (IF-AT) in Team- Based Learning

Education in Medicine Journal, 2018

Immediate feedback assessment technique (IF-AT) are self-scoring answer sheets, based on the conc... more Immediate feedback assessment technique (IF-AT) are self-scoring answer sheets, based on the concepts of immediate feedback for choosing the correct answer in multiple choice questions (MCQs) during group readiness assurance tests (GRATs) in team-based learning (TBL). IF-AT scratch card system rewards a student with partial credit for proximate knowledge. This technique motivates students to pursue learning with just-in-time feedback and gives them the opportunity for collaborative learning and analytic reasoning among group members. A rubric for partial credit is decided pre-hand depending upon the number of options used in MCQs. In this study, we assessed students' perception about immediate feedback assessment technique before and after the training. To determine students' perception of the IF-AT scratch card system in instruction and assessment. Students perceptions about the IF-AT system has been explored using a 25-item questionnaire administered to 60 students assigned randomly to control and training groups using pre-test and post-test analysis. Paired-sample t-test and independent-sample t-test statistics were employed and the data was analysed. Descriptive statistics observed for mean (SD) was found greater in trained group = 58.48 (4.87) vs. control group = 66.43 (5.81) with t-statistics significant at p = < 0.001. A significant difference in mean (SD) of pre-test minus post-test scores (5.16) of control and trained group = 5.37 (4.85) and 10.53 (8.36) respectively was also found with independent t-test analysis. It was found highly significant with t =-2.92, p < 0.05 and the effect size of 78.1%, established by Cohen's d criteria. The IF-AT system provides an individualised and instantaneous instruction as feedback in an assessment, which is marked with collaborative learning as in team-based learning. The IF-AT system promotes analytic reasoning with problem solving skills through partial credit for proximate knowledge. Students' perceive the concept of immediate feedback and partial credit for proximate knowledge as the most important features of the IF-AT scratch card system.

Research paper thumbnail of Use of Item Analysis to Improve the Quality of Single Best Answer Multiple Choice Question in Summative Assessment of Undergraduate Medical Students in Malaysia

Education in Medicine Journal, 2017

Research paper thumbnail of Combined use of maxillomandibular swing approach and neurosurgical ultrasonic aspirator in the management of extensive clival chordoma: A case report

Journal of Medical Case Reports, 2008

Introduction: Chordoma is a rare malignant tumour with an incidence of metastasis of less than 10... more Introduction: Chordoma is a rare malignant tumour with an incidence of metastasis of less than 10 percent. Usually arising from clivus its posterior extension may involve the brainstem before presenting as nasal mass and obstruction. Surgery is the main mode of treatment with adjuvant radiotherapy. However surgery is rarely possible for a large intracranial lesion. Case presentation: We report the case of an adolescent patient with a chordoma extending posteriorly to the brainstem and anteriorly to the nasopharynx and managed by the combination of resection using a maxillomandibular swing approach and the use of a neurosurgical ultrasonic aspirator. Conclusion: Maxillomandibular swing approach provides good access for large nasopharyngeal tumour extending brainstem area.

Research paper thumbnail of Assessment for Learning

Encyclopedia of Child Behavior and Development, 2011

Research paper thumbnail of The Structural Framework, Implementation Strategies and Students’ Perception of Team- Based Learning in Undergraduate Medical Education of a Medical School in Malaysia

Education in Medicine Journal

Delivery and implementation strategies are key to curriculum success. There is growing evidence t... more Delivery and implementation strategies are key to curriculum success. There is growing evidence that team-based learning (TBL) is an effective way of interactive teaching. TBL is a method that uses learning teams to enhance student engagement and quality of learning. Individual accountability for out-of-class reading is followed by individual and group assessment. In-class application exercises, which is the hallmark of team-based learning promotes both learning and team development. TBL uses educational principles of transforming traditional content into application of knowledge and problem solving skills in an interactive learning environment. To experience the structural framework and to determine the students' perception about TBL in clinical setting of MBBS program in a Malaysian medical school. A total of 120 students assigned to 22 small subgroups of 5-6 per group underwent a number of TBL sessions delivered in three phases. In Phase I, students were assigned reading material. In Phase II, students were assessed through One Best Answer (OBA) items for individual and group readiness assessment test as individual readiness assessment test (IRAT) and group readiness assurance test (GRAT) respectively followed by a mini-lecture. In Phase III, in-class application of learning activity was performed. Finally, peer assessment evaluated the contribution of peer in TBL. A TBL Classroom Evaluation Inventory (TBLCEI) developed to probe student's perception of TBL, comprised of 40 items composite scale with Cronbach's alpha at 0.881. In addition, students were asked to provide their estimated grade in end of the posting assessment. Grades were categorised into excellent pass >85%, high pass 70%-84%; average to good pass 50%-69% and fail <50%. These grades were measured against students' TBLCEI survey score using analysis of variance (ANOVA). Results were considered significant at p < 0.05. Results of one-way analysis of TBLCEI scores differed significantly across four estimated end of posting achievers groups, F (3,116) = 52.279, p < 0.001. Bonferroni's procedure of multiple comparisons indicated that mean value of TBLCEI score of excellent pass significantly higher [70.90 (3.684)] than high pass [66.57 (3.625)], average to good pass [60.42 (3.583)] and fail [57.67 (5.626)] at p < 0.001. It is concluded that medical students favourably liked TBL for interactive learning irrespective of their grades. A positive response for TBL from students is encouraging to consider

Research paper thumbnail of Evaluation of preoperative Technetium99m (99mTc) Pertechnetate Scintigraphy in patients with thyroid Mass

The Internet Journal of Head and Neck Surgery

Introduction: Preoperative thyroid scintigraphy has traditionally been regarded as the gold stand... more Introduction: Preoperative thyroid scintigraphy has traditionally been regarded as the gold standard for the investigation of the solitary thyroid nodule. It determines the activity of the lesion in relation to the adjacent structures.Objective: The aim of this study was to evaluate the accuracy of preoperative thyroid scintigraphy, in terms of sensitivity and specificity, in detecting malignant lesion.Materials and methods: This was a retrospective observational study, conducted at Hospital Universiti Sains Malaysia. We identified the patients who were operated between 2000 and 2005. Patients with thyroid mass, who had thyroid scintigraphy as part of the preoperative assessment, were recruited in this study.Results: 33 patients were recruited. The sensitivity of thyroid scan in our study population was 81.8 % and the specificity was 22.7 %.Conclusion: The specificity of thyroid scintigraphy was low and this technique should not be done as a routine test in every patient with thyroid nodule.

Research paper thumbnail of A Rare Cause of Vocal Cord Palsy due to Small Thyroid Nodule

The Internet Journal of Head and Neck Surgery

Thyroid lesion is strongly associated with recurrent laryngeal nerve palsy. It is because of the ... more Thyroid lesion is strongly associated with recurrent laryngeal nerve palsy. It is because of the close anatomical relationship between the gland on the trachea and the nerve which lies in the tracheoesophageal groove. The recurrent laryngeal nerve can be affected either from the thyroid disease itself or as the complication of thyroidectomy. However, benign thyroid lesion rarely causes recurrent laryngeal nerve palsy. We report a case of a small thyroid nodule causing unilateral vocal cord palsy. After lobectomy, the voice improved but due to the compensation mechanism of the opposite side. As the nerve was found to be atrophic intraoperatively, recovery should be allowed if it is going to take place, in a long period of time.

Research paper thumbnail of Assessment of First-Year Students’ Metacognitive Ability in Faculty of Medicine, Universiti Sultan Zainal Abidin (UniSZA): Toward Curriculum Development

Education in Medicine Journal, 2017

Introduction: Metacognition is the awareness of knowledge how one learns in addition to what one ... more Introduction: Metacognition is the awareness of knowledge how one learns in addition to what one learns and to understand how a task will be performed. Metacognitive skill as self-assessment is recognised as an important contributor to the development of critical capacity, reflective attitude and autonomous lifelong learning. Accurate, self-assessment of knowledge and skills is essential for students to maintain and improve through self-directed learning. Objective: The objective of this study was to explore, how well students' evaluate their own level of understanding for lectures to reflect their metacognitive skill that can be used in educational strategy to promote students' personal and professional growth. Methods: To assess the metacognition of the students, a questionnaire based on three items was designed. All 60 (17 male and 43 female) preclinical, first-year medical students were included in this study. The metacognition as planning, monitoring and evaluating the lecture was judged through students' response on 33 lectures in terms of understanding of knowledge, clearing of misconceptions and presenting of a well prepared material respectively in the field of haematology and parasitology. Metacognition as reflected in the lecture understanding level (LUL) score, lectures preparation level (LPL) score and students question level (SQL) score was estimated for its correlation with student' achievement score in pre-clinical phase of MBBS program. Results: The data was analysed for correlation between metacognition and overall students' achievement scores and a statistically significant correlation between LUL and multiple true false (MTF) of 268 (p = .039), LPL and MTF of .282 (p = .029) as well as between SQL and MTF of .360 (p = .005) was compared to poor correlation between LUL, LPL and SQL and the other three assessment tools (short essay questions [SEQ], problem-based questions [PBQ] and objectively structured practical examination [OSPE]) was found. Conclusion: The significant correlation of students' metacognition and their achievement score in classroom setting with MTF and poor correlation with SEQ, PBQ and OSPE is attributed to multiple factors discussed in this study, imperative to students' personal and professional growth.

Research paper thumbnail of Challenges in the management of nasopharyngeal carcinoma: a review

Malaysian Journal of Medical Sciences, Oct 1, 2009

Nasopharyngeal carcinoma (NPC) is a non-lymphomatous, squamous cell carcinoma that occurs in the ... more Nasopharyngeal carcinoma (NPC) is a non-lymphomatous, squamous cell carcinoma that occurs in the epithelial lining of the nasopharynx, an area that shows varying degrees of differentiation. Although relatively rare worldwide, NPC has substantial incidence and mortality in populations in Southeast Asia and in people with Southern Chinese ancestry. In Malaysia, NPC is a leading cancer type. In the clinic, NPC presents on a very wide spectrum. Therefore, a high degree of suspicion on the part of the clinician and an increased awareness by the patient is essential for the recognition of an early lesion. Early detection of the cancer is important as it affects the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s prognosis and the mode of treatment. Managing patients with NPC is very challenging as patients usually present late when the cancer is already in an advanced stage. Here, we review the challenges in the management of NPC.

Research paper thumbnail of Clinical and Audiological Profiles in Children with Chronic Otitis Media with Effusion Requiring Surgical Intervention

The Malaysian Journal of Medical Sciences Mjms, Jul 1, 2007

To determine the characteristic presenting symptoms, otoscopic findings, audiological profiles an... more To determine the characteristic presenting symptoms, otoscopic findings, audiological profiles and the intraoperative findings of children with chronic otitis media with effusion who required surgical intervention. A prospective cross sectional study was undertaken in the otorhinolaryngology clinic of USM Hospital (HUSM) involving 25 cases (50 ears) of children with chronic otitis media with effusion requiring surgical intervention from June 1999 to September 2001. Their ages ranged from 3 to 12 years old. The gender distribution included males at 72 % and females at 28 %. The presenting symptoms noted were hearing impairment (52%), otalgia (18%), ear block (16%) and tinnitus (14%). The otoscopic findings were fluid in the middle ear (40%), dullness (32%) and retraction of the tympanic membrane (28%). On audiometry, 24 ears had moderate deafness (48%), 16 ears had mild deafness (32%) while 4 ears had severe deafness (8%). With tympanometry, 42 ears out of the total 50 had a flat type B curve (84%) while 6 ears had type As curve (12%). During myringotomy, middle ear secretion was seen in 38 ears (76%) out of the 50 ears; 22 ears had mucoid secretion while 16 ears had serous secretion. Clinically, the commonest presenting symptom was hearing impairment (52%) while the most common otoscopic finding was fluid in the middle ear (40%). Audiologically, most patients had moderate conductive hearing loss (48%) and a type B curve (84%) on tympanometry. On myringotomy middle ear fluid was found in 76 % of the ears.

Research paper thumbnail of Mature cystic teratoma: unusual presentation as anterior neck swelling

Singapore medical journal

The unusual presentation of a mature mediastinal cystic teratoma as an anterior neck swelling in ... more The unusual presentation of a mature mediastinal cystic teratoma as an anterior neck swelling in a 29-year-old Malay woman is reported.

Research paper thumbnail of Underlay myringoplasty: Comparison of human amniotic membrane to temporalis fascia graft

The Medical journal of Malaysia

Human amniotic membrane as a homograft material was compared to temporalis fascia to close tympan... more Human amniotic membrane as a homograft material was compared to temporalis fascia to close tympanic membrane perforations in 50 patients with chronic otitis media. Human amniotic membrane was used in 20 patients while temporalis fascia was used in the remaining 30. Anatomical closure of the perforation and reduction of the air-bone gap was measured. The graft uptake showed a 65% success rate for the amniotic membrane and 56.7% for the temporalis fascia at 3 months post-operatively. Significant closure of air-bone gap was observed in the human amniotic group. These results indicate comparable outcomes between human amniotic membrane and the temporalis fascia graft.

Research paper thumbnail of How to develop a core curriculum in clinical skills for undergraduate medical teaching in the school of medical sciences at universiti sains malaysia?

Malaysian Journal of Medical Sciences

Clinical skills program as a laboratory method is a valuable adjunct to other forms of undergradu... more Clinical skills program as a laboratory method is a valuable adjunct to other forms of undergraduate medical training. This article describes the process of developing a core curriculum in clinical skills based on the Dundee model for a clinical skills centre. The School of Medical Sciences, in Universiti Sains Malaysia (USM) has been provided with a well equipped skills centre. However, the PBL curriculum in the undergraduate medical program in the school needs to be integrated with a clinical skills lab program. This is to counter the general feeling that the contribution of PBL is insignificant in terms of building clinical competency in an integrated system such as that used in USM compared to the traditional curriculi of other medical teaching institutions in Malaysia. Integrating clinical skills laboratory training with the PBL curriculum will provide evidence of PBL as an effective and innovative method for teaching and learning in Malaysia.