Dujeepa D. Samarasekera & Matthew C.E. Gwee

Original Articles

Comparison of sleep, fatigue and burnout in Post-Graduate Year 1 (PGY1) residents and faculty members – A prospective cohort study

Mae Yue Tan, Jia Ming Low, Kay Choong See & Marion M Aw


Aim: We aimed to combine self-report measures with physiological measures (using a wrist actigraph) to compare and quantify the difference in activity levels, sleep, fatigue and professional quality of life between residents and faculty.

Methods: All year 1 post-graduate (PGY1) residents and faculty were invited to participate. Participants were required to wear a wrist actigraph for four months, and complete two validated surveys (i.e. Epworth Sleepiness Scale(ESS) and the Professional Quality of Life(ProQoL)) once each at the start and again at the end of the study.

Results: Forty-nine PGY1 residents and eleven faculty participated. Residents logged less sleep in a working day than faculty, with median (range) of 356 (114-630) minutes versus 393 (162-704) minutes (p=0.001). Residents had decreased sleep latency, with a shorter median time to fall asleep (6 versus 7 minutes) (p=0.001). Residents walked more, with median (range) daily steps of 10207.5 (280-26638) versus 8155 (481-31236) (p=0.001). At study start and end, residents (61.5%, 69.2%) and faculty (30%, 44.4%) both reported ESS>10, suggestive of excessive daytime sleepiness (p>0.05). Residents reported higher burnout scores compared to faculty; 34.9% versus 0% (p=0.024) and 23.1% versus 0% (p=0.304), and lower compassion satisfaction scores; 25.6 vs 0% (p=0.095), 37% versus 0% (p=0.039), for both time points.

Conclusion: Although faculty sleep more than PGY1 residents, they are similarly at risk of fatigue. However, faculty experience lower burnout and higher compassion satisfaction scores. Whilst lack of sleep and fatigue can contribute to burnout, faculty likely possess protective mechanisms, which residents have yet to acquire.

Keywords: Sleep; Activity; Fatigue; Burnout; Actigraph

Determinants of clarification research purpose in medical education research: A systematic review

Wee Shiong Lim, Kar Mun Tham, Fadzli Baharom Adzahar, Han Yee Neo, Wei Chin Wong & Charlotte Ringsted


Background: Medical education research should aspire to illuminate the field beyond description (“What was done?”) and justification (“Did it work?”) research purposes to clarification studies that address “Why or how did it work?” questions. We aim to determine the frequency of research purpose in both experimental and non-experimental studies, and ascertain the predictors of clarification purpose among medical education studies presented at the 2012 Asia Pacific Medical Education Conference (APMEC).

Methods: We conducted a systematic review of all eligible original research abstracts from APMEC 2012. Abstracts were classified as descriptive, justification or clarification using the framework of Cook 2008. We collected data on research approach (Ringsted et al., 2011), Kirkpatrick’s learner outcomes, statement of study aims, presentation category, study topic, professional group, and number of institutions involved. Significant variables from bivariate analysis were included in logistic regression analyses to ascertain the determinants of clarification studies.

Results: Our final sample comprised 186 abstracts. Description purpose was the most common (65.6%), followed by justification (21.5%) and clarification (12.9%). Clarification studies were more common in non-experimental than experimental studies (18.3% vs 7.5%). In multivariate analyses, the presence of a clear study aim (OR: 5.33, 95% CI 1.17-24.38) and non-descriptive research approach (OR: 4.70, 95% CI 1.50-14.71) but not higher Kirkpatrick’s outcome levels predicted clarification studies.

Conclusion: Only one-eighth of studies have a clarification research purpose. A clear study aim and non-descriptive research approach each confers a five-fold greater likelihood of a clarification purpose, and are potentially remediable areas to advance medical education research in the Asia-Pacific.

Keywords:      Research Purpose; Research Approach; Medical Education Research; Asia-Pacific

Implicit leadership theories and followership informs understanding of doctors’ professional identity formation: A new model

Judy McKimm, Claire Vogan & Hester Mannio


Aims: The process of becoming a professional is a lifelong, constantly mediated journey. Professionals work hard to maintain their professional and social identities which are enmeshed in strongly held beliefs relating to ‘selfhood’. The idea of implicit leadership theories (ILT) can be applied to professional identity formation (PIF) and development, including self-efficacy. Recent literature on followership suggests that leaders and followers co-create a dynamic relationship and we suggest this occurs commonly in the clinical setting. The aim of this paper is to describe a new model which utilises ILT and followership theory to inform our understanding of doctors’ PIF.

Methods: Following a literature review, we applied the core concepts of ILT and followership theories to theories underlying PIF by developing a mapping framework. We identified core themes, similarities and differences between the three perspectives and constructed a new model of PIF incorporating elements from ILT and followership. The model can be used to explain and inform understanding of medical practice and leadership situations.

Conclusion: The model offers insight into how concepts such as self-efficacy, prototypicality, implicit theories of self, power, authority and control and cultural competence result in PIF. Bringing together the theoretical frameworks of ILT and followership theory with PIF theories helps us understand and explain the unique dynamic of the clinical environment in a new light; prompting new ways of thinking about teams, interprofessional working, leadership and social identity in medicine. It also offers the potential for new ways of teaching, curriculum design, learning and assessment.

Keywords: Followership; Leadership; Professional Identity; Self Efficacy

Flipped Classroom Model for teaching and learning medical microbiology

Vindya Perera & Nelun de Silva


Flipped Classroom Model (FCM) is a method that was introduced to the educational system during the past decade which had shown substantial evidence of changing the traditional classroom learning to a more student centred learning environment. This method offers both students and the faculty, flexibility in teaching leaning activities that encourages a deeper approach to learning. This study was conducted to introduce FCM to undergraduates, to compare its effectiveness in learning clinical microbiology with lectures done in the traditional manner and to evaluate this system through student feedback. Power point presentations of 5 lectures were made accessible to students online and five lectures were done in a traditional manner. Freed lecture time was utilized to conduct discussions on clinical cases and problems. The effectiveness of this approach was determined by comparing the average marks students obtained for answers to questions covering the topics delivered by two methods. Questionnaires were given to students to evaluate their perceptions, effectiveness and experience of FCM versus traditional lectures for learning. Flipped classroom model was shown to be more effective than traditional lectures when the average marks in the final assessment were compared. More than 50% of students agreed on the benefits of FCM.  Majority suggested a combination of FCM and traditional lectures followed by small group discussions would be more beneficial. Newer models of teaching and learning such as FCM would enable teaching and learning in pre and para clinical subjects in a medical curriculum to be more students centred and encourage deep learning.

Keywords: Flipped Classroom Model; Medical Education; Microbiology

Short Communications

Medical and physiotherapy undergraduates’ perception on the importance of roles and qualities of a medical teacher

Akalanka P Hettihewa, Indika M Karunathilake & MNSK Perera


Introduction & Objectives: Faculty of Medicine, University of Colombo, Sri Lanka conducts MBBS and BSc physiotherapy degree programs following SPICES model where educators have to play diverse roles in order to fulfil their responsibilities. Looking at them from a student’s perspective will help understand what students perceive as important roles of educators and help the students understand the educators’ different capacities. An effective medical educator possesses a range of qualities. Looking at them from students’ point of view indicates what they expect from teachers as professionals.
Methods: Harden and Crosby (2000) paper on 12 roles of a medical teacher was the conceptual framework for this study. Based on previous literature a questionnaire was developed with 20 different roles and 15 qualities of an educator. Study followed an analytical cross-sectional design with participation of 188 physiotherapy and medical undergraduates.
Results: Study findings indicated that the students’ perception on importance of different roles of teachers had a close overlap with Harden’s 12 roles. Information provider as a lecturer in class room in clinical settings, in practical settings, developing learning materials for lectures, clinical educators etc. Importance of being an examiner and curriculum planner was rated relatively low by students. Students perceived good communication skills, professional skills, knowledge and respect for patients as most important qualities in an educator.
Conclusion: Findings will help educators understand what learners expect from them and help students understand the different capacities of educators.

Keywords: 12 Roles of a Medical Teacher; Ideal Medical Teacher; Student Perception; Survey

Letter to Editor

Brainstorming activity in class: How will you do it?

Siti Rohaiza Ahmad


I am an educator in a local university keen on exploring different types of teaching methods, including collaborative activity in class. I have explored several approaches of collaborative activity and here, I would like to reflect on my experience. First and foremost, as usual, I will prepare for a lecture that takes about 30 to 45 minutes depending on the topic. For most of my class, I like to integrate my teaching with interactive or collaborative activity such as a brainstorming activity. The aim of the brainstorming activity is to explore the student’s current level of understanding of certain topic and also an opportunity to explore their creativity and ideas. In order to facilitate a more effective brainstorming activity, before the class, I also provide the students with some reading exercises or learning questions. This will help the students prepare themselves with some prior knowledge before coming to the class. I have discovered that, such brainstorming activity encourages the students to do prior learning and will helps to facilitate a more effective and collaborative class discussion.