Tharin Phenwan
University of Dundee, School of Nursing and Health Sciences, Faculty Member
- A PhD student, lecturer and family medicine doctor. Research interests are dementia, Palliative care, Advance Care Planning (ACP) and medical education.edit
Doing research with People with Dementia (PwD) can be challenging given that disease symptoms of anxiety, forgetfulness, and fluctuating mental capacity can make recruitment and data collection difficult. Once COVID-19 made face-to-face... more
Doing research with People with Dementia (PwD) can be challenging given that disease symptoms of anxiety, forgetfulness, and fluctuating mental capacity can make recruitment and data collection difficult. Once COVID-19 made face-to-face data collection impractical, using internet-based methods became an alternative option to continue with research. However, data collection with PwD over the internet requires strategies to observe, support, and enable them to engage with research, especially with qualitative approaches. Nine articles were selected via a decade rapid scoping review (undertaken March-June 2020) to identify qualitative online methods used with PwD and associated challenges. Methods used were online interviews, clinical assessment/telemedicine, and textual analysis from blogs, forum posts, and Tweets created by PwD. Practical challenges identified: the researchers’ limited ability to manage the physical and social environment. Technical challenges identified: the need for a high degree of technical support for participants prior and during data collection. Ethical challenges identified, negotiating confidentiality, obtaining valid informed consent, and ensuring data security. Implicit findings found related to how researchers perceived and treated online data retrieved from the internet and how the challenges mentioned in the included articles did not link to dementia symptoms.
Research Interests:
Background: This article demonstrates the innovative practice of using a card game to teach participants about Advance Care Planning (ACP) and palliative care in Thailand via Zoom during the COVID-19 pandemic. Aims: To assess the... more
Background: This article demonstrates the innovative practice of using a card game to teach participants about Advance Care Planning (ACP) and palliative care in Thailand via Zoom during the COVID-19 pandemic.
Aims: To assess the feasibility of using online workshops to conduct sensitive topics of palliative care and death and dying.
Methods: The interactive online workshops were conducted after imposition of the COVID-19 restriction and national lockdown in Thailand between March and September 2020. The sessions were conducted via Zoom meetings and Facebook secret group. Trained facilitators plus one IT team member hosted each workshop. Participants were given an anonymous post-course evaluation with open-ended written feedback form. Content analysed was used.
Results
Eleven sessions were conducted. 103 participants joined the online classes. Participants gave an overwhelmingly positive of the workshops, emphasising on: (i) convenient; (ii) social connectedness during the lockdown; (iii) bichronous element of the activities.
Aims: To assess the feasibility of using online workshops to conduct sensitive topics of palliative care and death and dying.
Methods: The interactive online workshops were conducted after imposition of the COVID-19 restriction and national lockdown in Thailand between March and September 2020. The sessions were conducted via Zoom meetings and Facebook secret group. Trained facilitators plus one IT team member hosted each workshop. Participants were given an anonymous post-course evaluation with open-ended written feedback form. Content analysed was used.
Results
Eleven sessions were conducted. 103 participants joined the online classes. Participants gave an overwhelmingly positive of the workshops, emphasising on: (i) convenient; (ii) social connectedness during the lockdown; (iii) bichronous element of the activities.
Research Interests:
Purpose of the review: To identify and assess factors that affect the decisions to initiate advance care planning (ACP) amongst people living with dementia (PwD).MethodsA narrative review was conducted. A keyword search of Medline,... more
Purpose of the review:
To identify and assess factors that affect the decisions to initiate advance care planning (ACP) amongst people living with dementia (PwD).MethodsA narrative review was conducted. A keyword search of Medline, CINAHL PsycINFO, and Web of Sciences databases produced 22,234 articles. Four reviewers independently applying inclusion/exclusion criteria resulted in 39 articles. Discrepancies were settled in discussions.
Results:
Twenty-eight primary studies and eleven review articles remained. Narrative analysis generated five categories of facilitating and inhibitory factors: people with dementia, family orientation, healthcare professionals (HCP), systemic and contextual factors, and time factors. Key facilitators of ACP initiation were (i) healthcare settings with supportive policies and guidelines, (ii) family members and HCPs who have a supportive relationship with PwD, and (iii) HCPs who received ACP education. Key inhibitors were: (i) lack of knowledge about the dementia trajectory in stakeholders, (ii) lack of ACP knowledge, and (iii) unclear timing to initiate an ACP.
Conclusion:
This review highlighted the main challenges associated with optimal ACP initiation with PwD. To encourage effective ACP initiation with PwD, succinct policies and guidelines for clinical commissioners are needed. ACP also needs to be discussed with family members in an informal, iterative manner. More research is required on initiation timing given the disease trajectory and changing family dynamics.
To identify and assess factors that affect the decisions to initiate advance care planning (ACP) amongst people living with dementia (PwD).MethodsA narrative review was conducted. A keyword search of Medline, CINAHL PsycINFO, and Web of Sciences databases produced 22,234 articles. Four reviewers independently applying inclusion/exclusion criteria resulted in 39 articles. Discrepancies were settled in discussions.
Results:
Twenty-eight primary studies and eleven review articles remained. Narrative analysis generated five categories of facilitating and inhibitory factors: people with dementia, family orientation, healthcare professionals (HCP), systemic and contextual factors, and time factors. Key facilitators of ACP initiation were (i) healthcare settings with supportive policies and guidelines, (ii) family members and HCPs who have a supportive relationship with PwD, and (iii) HCPs who received ACP education. Key inhibitors were: (i) lack of knowledge about the dementia trajectory in stakeholders, (ii) lack of ACP knowledge, and (iii) unclear timing to initiate an ACP.
Conclusion:
This review highlighted the main challenges associated with optimal ACP initiation with PwD. To encourage effective ACP initiation with PwD, succinct policies and guidelines for clinical commissioners are needed. ACP also needs to be discussed with family members in an informal, iterative manner. More research is required on initiation timing given the disease trajectory and changing family dynamics.
Research Interests:
Introduction: Advance Care Planning (ACP) is an agreement of preferred care between patients, family, and the health care team should the patient become incapacitated. However, ACP uptake and awareness is still low in Thailand. The Life... more
Introduction: Advance Care Planning (ACP) is an agreement of preferred care between patients, family, and the health care team should the patient become incapacitated. However, ACP uptake and awareness is still low in Thailand. The Life Unlocking Card Game is an intervention that was conceived to use gamified element to raise ACP awareness. This study aims to assess the feasibility of the Life Unlocking Card Game as a tool to raise death and ACP awareness in Thais. Methods: A retrospective feasibility study using a convenient sampling method. Twenty-seven card game sessions were held during January 2014 and December 2016 with 342 participants. We performed content analysis using an investigator triangulation method. Results: Five themes emerged; 1) Death is closer than I thought, 2) the need to contemplate my own life, 3) learning through others' experiences, 4) spending more time with my loved ones, 5) the importance of Advance Care Planning.
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Advance Directive (AD) is a medical agreement to ensure that patients' autonomy is respected. In Thailand, there has been Health Act Legislation to promote the use of a living will, a form of AD, since 2007. However, there is no... more
Advance Directive (AD) is a medical agreement to ensure that patients' autonomy is respected. In Thailand, there has been Health Act Legislation to promote the use of a living will, a form of AD, since 2007. However, there is no assessment of its practicability yet. The objective of this study was to explore perceptions and attitudes to living wills by women who were diagnosed with cancer. We conducted semi-structured interviews using a purposive sampling method. Fifteen patients at the gynaecologic oncology clinic from January 2014 to April 2015 joined the study. Participants were instructed to read the living will document designed by the Thai National Health Security Office (NHSO) and asked about 3 aspects; awareness of and attitude towards living wills, comprehension of the document, and decision-making. Final codes were analysed using investigator and data triangulation methods along with content analysis. All participants were in the early stages of cancer. Five women were diagnosed with breast cancer, 7 with cervical cancer, and 3 with ovarian cancer. None of them had heard of living wills before. Three themes emerged; 1) Participants felt overwhelmingly positive about the idea of making an AD with a living will. 2) The document was too complicated for participants. 3) Past experiences about death and terminal illness played a major role in decision-making regarding AD. In conclusion, larger scale assessment of AD in Thailand is recommended. Living wills may be useful tools for making AD in women with cancer but they need to be simplified.
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Context: Spirituality is the essence of a human being. Patients who have good spiritual well-being (SWB) will also have better quality of life. However, health-care providers usually under-assess this aspect due to lack of practical... more
Context: Spirituality is the essence of a human being. Patients who have good spiritual well-being (SWB) will also have better quality of
life. However, health-care providers usually under-assess this aspect due to lack of practical guideline. In Thailand, the validated survey came
from a different cultural background and was heavily based on Buddhism approach.
Aims: The aim of the study is to assess the meaning of spirituality and SWB in Thai breast cancer patients in Southern Thailand where people have more diverse cultural and religious background.
Settings and Design: Descriptive qualitative phenomenology design. Subjects and Methods: In‑depth interview with stratifed purposive
sampling method. The interviews took place in the oncology outpatient unit department and participants’ home. Inclusion criteria were being
diagnosed with breast cancer, age over 18 years old, able to communicate in Thai, has a Palliative Performance Scale more than 50, and was not diagnosed with any psychological disorder.
Statistical Analysis Used: Descriptive statistic.
Results: From October 2016 to February 2018, 16 women joined the study. Three themes emerged with fve subthemes: (1) feeling life worthwhile, (2) sense of belonging in the community, and (3) feeling connected to the nature.
Conclusions: For Thai women, who have breast cancer, their spirituality focuses on family, mainly their children. They also have better SWB if they have good family relationship, social support, or feeling connected with nature or higher being in a religious or nonreligious way. Future survey design needs to be broader in a secular view and on another perspective rather than the religious approach.
life. However, health-care providers usually under-assess this aspect due to lack of practical guideline. In Thailand, the validated survey came
from a different cultural background and was heavily based on Buddhism approach.
Aims: The aim of the study is to assess the meaning of spirituality and SWB in Thai breast cancer patients in Southern Thailand where people have more diverse cultural and religious background.
Settings and Design: Descriptive qualitative phenomenology design. Subjects and Methods: In‑depth interview with stratifed purposive
sampling method. The interviews took place in the oncology outpatient unit department and participants’ home. Inclusion criteria were being
diagnosed with breast cancer, age over 18 years old, able to communicate in Thai, has a Palliative Performance Scale more than 50, and was not diagnosed with any psychological disorder.
Statistical Analysis Used: Descriptive statistic.
Results: From October 2016 to February 2018, 16 women joined the study. Three themes emerged with fve subthemes: (1) feeling life worthwhile, (2) sense of belonging in the community, and (3) feeling connected to the nature.
Conclusions: For Thai women, who have breast cancer, their spirituality focuses on family, mainly their children. They also have better SWB if they have good family relationship, social support, or feeling connected with nature or higher being in a religious or nonreligious way. Future survey design needs to be broader in a secular view and on another perspective rather than the religious approach.
Research Interests:
Introduction: Advance Care Planning (ACP) is a part of comprehensive palliative care but there are challeges for its implementation. In Thailand, undergraduate medical curriculum also has not implemented palliative care and ACP as a core... more
Introduction: Advance Care Planning (ACP) is a part of comprehensive palliative care but there are challeges for its implementation. In Thailand, undergraduate medical curriculum also has not implemented palliative care and ACP as a core teaching topic for the medical students yet. Life Unlocking Card Game is an end-of-life conversation card game that aims to bridge this gap.
Objective: To assess second year medical students’ attitude of death by using Life Unlocking Card Game and its effectiveness to teach about death and dying.
Methods: Non-equivalent quasi-experimental design with convenience sampling method. All (48) of second year medical students participated in an end-of-life conversation game (8 games in total with one facilitator within each group). After that, each group formed an after-game focus group interview. Seven students also joined individual semi-structured interviews. We used content analysis approach along with investigator triangulation and methodological triangulation methods for the qualitative analysis.
Results: Participants (n = 48) were second-year preclinical medical students. 26 of them were male (54.2%), 22 were female (45.8%), with the mean age of 20 years (SD 0.6). Five primary themes regarding the card game emerged: 1) Safe space to disclose personal issues 2) Seeing the world through different views 3) Surprise elements 4) Death distant closure 5) Changed behaviour.
Conclusions: Life Unlocking Card Game proves to be an effective tool to teach death and dying issues and also ACP in second year medical students. Further study in clinical year students or postgraduate students are recommended.
Objective: To assess second year medical students’ attitude of death by using Life Unlocking Card Game and its effectiveness to teach about death and dying.
Methods: Non-equivalent quasi-experimental design with convenience sampling method. All (48) of second year medical students participated in an end-of-life conversation game (8 games in total with one facilitator within each group). After that, each group formed an after-game focus group interview. Seven students also joined individual semi-structured interviews. We used content analysis approach along with investigator triangulation and methodological triangulation methods for the qualitative analysis.
Results: Participants (n = 48) were second-year preclinical medical students. 26 of them were male (54.2%), 22 were female (45.8%), with the mean age of 20 years (SD 0.6). Five primary themes regarding the card game emerged: 1) Safe space to disclose personal issues 2) Seeing the world through different views 3) Surprise elements 4) Death distant closure 5) Changed behaviour.
Conclusions: Life Unlocking Card Game proves to be an effective tool to teach death and dying issues and also ACP in second year medical students. Further study in clinical year students or postgraduate students are recommended.
Research Interests:
การแจ้งข่าวร้ายแก่ผู้ป่วย เป็นกระบวนการทางการแพทย์ที่สำคัญอย่างหนึ่ง หากแพทย์ไม่สามารถแจ้งข่าวได้อย่างเหมาะสม จะส่งผลต่อความสัมพันธ์ระหว่างผู้ป่วยและแพทย์ คุณภาพชีวิตของผู้ป่วย รวมไปถึงความร่วมมือในการรักษาในอนาคตได้ บทความนี้... more
การแจ้งข่าวร้ายแก่ผู้ป่วย เป็นกระบวนการทางการแพทย์ที่สำคัญอย่างหนึ่ง หากแพทย์ไม่สามารถแจ้งข่าวได้อย่างเหมาะสม จะส่งผลต่อความสัมพันธ์ระหว่างผู้ป่วยและแพทย์ คุณภาพชีวิตของผู้ป่วย รวมไปถึงความร่วมมือในการรักษาในอนาคตได้ บทความนี้ ได้อธิบายถึงความสำคัญของการแจ้งข่าวร้าย ปัจจัยที่ทำให้การแจ้งข่าวร้ายสำเร็จ ปัจจัยที่ทำให้การแจ้งข่าวร้ายของแพทย์ยังขาดประสิทธิภาพ ตัวอย่างของการแจ้งข่าวร้าย รวมถึงข้อเสนอแนะและกระบวนการในการแจ้งข่าวร้ายแก่ผู้ป่วย
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Background: Total pain is a concept that approaches pain holistically: physically, psychologically, socially, and spiritually. Any individual may experience pain in each domain at a different level. This is the case report of an... more
Background: Total pain is a concept that approaches pain holistically: physically, psychologically, socially, and spiritually. Any individual may experience pain in each domain at a different level. This is the case report of an adolescent who suffered from total pain and how his healthcare team and peers helped to relieve it.
Case presentation: A 15-years-old Thai male was diagnosed with recurrent T-cell lymphoma and readmitted to hospital. He was admitted to an adult ward and suffered from pain due to his disease and from the fear of being alienated. As a result, he had an existential crisis. His parents felt unsure whether they or the patient should make the medical decisions and advance care plan.
Conclusions: This case report emphasises the importance of total pain assessment in the relief of total pain in an adolescent whose needs are different from both children and adults. It also highlights the role of medical decision-making in adolescents and the importance of the social support of peers in the alleviation of pain.
Case presentation: A 15-years-old Thai male was diagnosed with recurrent T-cell lymphoma and readmitted to hospital. He was admitted to an adult ward and suffered from pain due to his disease and from the fear of being alienated. As a result, he had an existential crisis. His parents felt unsure whether they or the patient should make the medical decisions and advance care plan.
Conclusions: This case report emphasises the importance of total pain assessment in the relief of total pain in an adolescent whose needs are different from both children and adults. It also highlights the role of medical decision-making in adolescents and the importance of the social support of peers in the alleviation of pain.
Research Interests:
Background: Reflective practice (RP) plays a crucial role in encouraging learners to think critically and consciously about their performances. Providing constructive feedback can further enhance RP. But non-Western learners might face... more
Background: Reflective practice (RP) plays a crucial role in encouraging learners to think critically and consciously about their performances. Providing constructive feedback can further enhance RP. But non-Western learners might face different learning barriers compared to learners in the West, where RP originated. Methods: In this retrospective study, we assessed RP and feedback performances on Thai medical students' patient history-taking skills. We applied RP and peer feedback, along with feedback from the instructors, during the history-taking sessions of the ten-week introduction course for fourth-year medical students. Twelve history-taking sessions were used for the analysis. Two instructors assessed students' reflective performance and categorised them into one of the six stages of Gibbs' reflective cycle; their feedback performances were analysed using Pendleton's model. We investigated the correlations between students' overall grade point average (GPAX) and patient history-taking scores on the Objective Structured Clinical Examination (OSCE). Students' opinions of the RP teaching method were also collected. Results: All (n = 48) students participated in our study. The students' mean age was 21.2 ± 0.5 years. The majority of the students were female (64.6%). The data indicated that 33 and 4% of the participants were categorised into the evaluation stage and action plan stage of Gibbs' reflective cycle, respectively. In addition, 22 and 15% of the participants were able to state what their peers did well and suggest how peers could improve their skills, respectively. All students passed the minimum passing level of four history-taking OSCE stations. Participants agreed that RP was a useful tool (mean 9.0, SD 0.1), which enhanced their thought processes (mean 8.4, SD 0.2) and future performances (mean 8.2, SD 0.2). However, there was no correlation between the students' highest Gibbs' reflection levels and their history-taking OSCE scores.
Research Interests:
Mind maps (MM), is a learning method assisting learners in the visualisation of relationships betweentheoretical concepts. Studies also showed enhancement of data retention, overall comprehension, and creativity inMM users. Thus, MM has... more
Mind maps (MM), is a learning method assisting learners in the visualisation of relationships betweentheoretical concepts. Studies also showed enhancement of data retention, overall comprehension, and creativity inMM users. Thus, MM has been implemented in many medical schools to facilitate medical students’ learningexperiences. Nevertheless, retained mind mapping skills and its effect on the learning outcomes in long-term followupremain unknown.
Methods: A concurrent mixed-methods design with convenient sampling method. All (48) second-year medicalstudents joined a three-day MM workshop. One year later, we surveyed the students who still use MM and thosewho did not. Mind Map Assessment Rubric (MMAR) and Grade Point Average (GPA) were compared between twogroups. Content analysis with data triangulation method was used to explore their preferences and MM skills. Results: We achieved a 100% response rate. 39 (81.2%) of participants were female. The mean age of participantswas 20.6 years (SD = 0.5). 37 students still use MM (77.1%). With MMAR, participants in MM group scored 28.9higher than participants in MM-free group significantly (p = 0.01). There were no differences in the median GPAs toboth groups. However, there was a significant correlation between using MM in learning and the second trimester(year1) (r=0.29, p<0.05). Majority of participants in MM groups stated the advantages of using MM as a toolhelping those organising data and their thought process. On the contrary, students in MM-free group declared thedisadvantages of MM as a time-consuming and missing data from lectures.
Conclusions: Without revision in MM, participants’ skills deteriorated immensely. There was a non-statisticallysignificant trend toward increased learning outcomes with MM group. Further studies to examine whether morefrequent MM use or workshop revision can boost their learning outcomes or not is recommended.
Methods: A concurrent mixed-methods design with convenient sampling method. All (48) second-year medicalstudents joined a three-day MM workshop. One year later, we surveyed the students who still use MM and thosewho did not. Mind Map Assessment Rubric (MMAR) and Grade Point Average (GPA) were compared between twogroups. Content analysis with data triangulation method was used to explore their preferences and MM skills. Results: We achieved a 100% response rate. 39 (81.2%) of participants were female. The mean age of participantswas 20.6 years (SD = 0.5). 37 students still use MM (77.1%). With MMAR, participants in MM group scored 28.9higher than participants in MM-free group significantly (p = 0.01). There were no differences in the median GPAs toboth groups. However, there was a significant correlation between using MM in learning and the second trimester(year1) (r=0.29, p<0.05). Majority of participants in MM groups stated the advantages of using MM as a toolhelping those organising data and their thought process. On the contrary, students in MM-free group declared thedisadvantages of MM as a time-consuming and missing data from lectures.
Conclusions: Without revision in MM, participants’ skills deteriorated immensely. There was a non-statisticallysignificant trend toward increased learning outcomes with MM group. Further studies to examine whether morefrequent MM use or workshop revision can boost their learning outcomes or not is recommended.
Research Interests:
Background: Problem-based learning (PBL) was used in basic and clinical sciences learning in an integrated approach. Despite its implementation into medical curricula around the world over four decades ago, group dynamic issues in PBL are... more
Background: Problem-based learning (PBL) was used in basic and clinical sciences learning in an integrated approach. Despite its implementation into medical curricula around the world over four decades ago, group dynamic issues in PBL are still abundant. To date, there is no publication addressing the difficulties in PBL for Thai medical students.
Objective: To explore difficulties in PBL and suggest solutions at the School of Medicine, Walailak University.
Methods: A sequential explanatory mixed method was employed using the triangulation method to get the information from students, facilitators, and a medical curriculum expert. Anonymous online survey data from students emphasised barriers to PBL and respondents’ suggestions. Content analysis was performed on written feedback from facilitators. Finally, a researcher performed a semi-structured interview with a medical curriculum expert. Data were collected throughout the academic year 2016.
Results: A total of 83 (86.5%) medical students responded to the survey, 58 students (69.9%) reported no difficulties in their learning process; 25 students (30.1%) disclosed challenges in learning. Facilitators’ feedback was collected from a total of 23 PBL sessions. Factors affecting the PBL process included facilitators’ characteristics, course organisation, and learning environment. Favourable characteristics for facilitators included thinking process support (28.7%), appropriate and constructive feedback (27.9%), listening skills (24.3%), safe environment (14.0%), and being concise (5.1%).
Conclusions: Three major factors contributing to PBL difficulties among Thai medical students were facilitator’s quality, course organisation, and learning environment. Hence these factors should be optimized to allow students to achieve the best learning process and outcome.
Objective: To explore difficulties in PBL and suggest solutions at the School of Medicine, Walailak University.
Methods: A sequential explanatory mixed method was employed using the triangulation method to get the information from students, facilitators, and a medical curriculum expert. Anonymous online survey data from students emphasised barriers to PBL and respondents’ suggestions. Content analysis was performed on written feedback from facilitators. Finally, a researcher performed a semi-structured interview with a medical curriculum expert. Data were collected throughout the academic year 2016.
Results: A total of 83 (86.5%) medical students responded to the survey, 58 students (69.9%) reported no difficulties in their learning process; 25 students (30.1%) disclosed challenges in learning. Facilitators’ feedback was collected from a total of 23 PBL sessions. Factors affecting the PBL process included facilitators’ characteristics, course organisation, and learning environment. Favourable characteristics for facilitators included thinking process support (28.7%), appropriate and constructive feedback (27.9%), listening skills (24.3%), safe environment (14.0%), and being concise (5.1%).
Conclusions: Three major factors contributing to PBL difficulties among Thai medical students were facilitator’s quality, course organisation, and learning environment. Hence these factors should be optimized to allow students to achieve the best learning process and outcome.
Research Interests:
Background and Objective: Owning to self-assessment limitations, reflective practice and feedback is one of the methods help improving self-assessment accuracy. So far, there is little evidence in its practicability in Thai medical... more
Background and Objective: Owning to self-assessment limitations, reflective practice and feedback is one of the methods help improving self-assessment accuracy. So far, there is little evidence in its practicability in Thai medical students. The aims of this study were (1) to investigate the effectiveness of the reflective practice and feedback on improving self-assessment accuracy and learning outcomes in medical students at Walailak University; (2) to explore participants’ perspectives on the reflective practice and feedback. Methods: This prospective uncontrolled study was conducted in the academic year 2017 at Walailak University. Third-year students voluntarily enrolled into the study. Surveys were contributed before the two examinations that consisted of one-hundred multiple choice questions. Reflective practice and feedback session was held after the first examination. Baseline characteristics, self-estimated scores, declared strengths and weaknesses, and actual scores were used for data analysis. Results: We had 38 volunteers (77.6%) with male predominance (57.9%) in participants. The mean age was 20.6 ± 0.6 years. After the reflective practice and feedback, the difference between the median of self-estimation score and the median of actual score decreased significantly (p < 0.05). The actual scores increased by 20.7 percent (95%CI 15.3-26.0) significantly (p < 0.001). Majority of participants (57.9%) agreed that the reflective practice and feedback was helpful. Conclusions: Reflective practice and feedback improve self-assessment accuracy and learning outcome in Thai medical students. Further work needs to be carried out to investigate whether the results are transferable to other Thai medical schools or not.
Research Interests:
A pretest for the medical competency assessment test for national license step I was divided into 3 parts. The scores, categorized by learning subjects, were notified individually at the end of each part. The purposes of this study were... more
A pretest for the medical competency assessment test for national license step I was divided into 3 parts. The scores, categorized by learning subjects, were notified individually at the end of each part.
The purposes of this study were (1) to investigate the effectiveness of a
self-directed learning model in order to gain higher scores; (2) to explore
factors affecting their scores.
The study was a mixed methods research. In quantitative part, all third-year medical students were included into the study. Mean, standard deviation,
percentage and non-parametric test were used for data analysis. For the qualitative part, 10 students with high GPAX were selected with purposive sampling method. Focus group interviews and semi-structured interviews were performed. We used investigator and methodological triangulation methods with content analysis to analyse final codes.
The findings were as follow: (1) there was a 19.3% (95%CI 13.6-25.1)
increased in the 2nd test mean percentage scores compared with the 1st test mean percentage scores. And there was a 26.2% (95%CI 18.9-33.5) increased in the 3rd test mean percentage scores compared with the 1st test mean percentage scores. The study suggested that scores notification helped
students recognize their weak points in a self-directed learning process. The
pretest project let them feel as staying in a virtual examination room and
stimulate them for better preparedness. In addition, a regular-type learning
style was most mentioned in students with high GPAX.
The purposes of this study were (1) to investigate the effectiveness of a
self-directed learning model in order to gain higher scores; (2) to explore
factors affecting their scores.
The study was a mixed methods research. In quantitative part, all third-year medical students were included into the study. Mean, standard deviation,
percentage and non-parametric test were used for data analysis. For the qualitative part, 10 students with high GPAX were selected with purposive sampling method. Focus group interviews and semi-structured interviews were performed. We used investigator and methodological triangulation methods with content analysis to analyse final codes.
The findings were as follow: (1) there was a 19.3% (95%CI 13.6-25.1)
increased in the 2nd test mean percentage scores compared with the 1st test mean percentage scores. And there was a 26.2% (95%CI 18.9-33.5) increased in the 3rd test mean percentage scores compared with the 1st test mean percentage scores. The study suggested that scores notification helped
students recognize their weak points in a self-directed learning process. The
pretest project let them feel as staying in a virtual examination room and
stimulate them for better preparedness. In addition, a regular-type learning
style was most mentioned in students with high GPAX.
Research Interests:
Introduction: In-house comprehensive examinations for preclinical students from various Thai medical schools were provided. However, their quality has never been evaluated with a score correlation with NLE as the gold standard. This study... more
Introduction: In-house comprehensive examinations for preclinical students from various Thai medical schools were provided. However, their quality has never been evaluated with a score correlation with NLE as the gold standard. This study aimed to assess the correlation of the scores as determined by three different comprehensive examinations and national license examination 1 (NLE step I) and to identify the positive learning strategies.
Method: A mixed methods sequential explanatory study was done to investigate the performances amongst four tests and to identify the potential factors affecting those scores using semi-structured interviews and focus groups with content analysis.
Result: All (n = 48) third-year medical students participated in our study. The majority were females (64.6%). Significantly positive correlations of NLE scores were: test A scores (r = 0.86), test B scores (r = 0.85), and WU test scores (r = 0.78). The highest accuracy index (AI = 0.87) was the WU test, where sensitivity, specificity were 20.0% and 97.1%, respectively. The WU test revealed that it was most helpful in preparing them for the NLE. Students who passed the exam used three study strategies; group study, tutorial sessions, and review by themselves.
Discussion and Conclusion: There were strong positive correlations between three different in-house developed comprehensive examinations and NLE. The WU test showed the highest accuracy index to predict the NLE result. Regular review of lessons was emphasized as a cornerstone.
Method: A mixed methods sequential explanatory study was done to investigate the performances amongst four tests and to identify the potential factors affecting those scores using semi-structured interviews and focus groups with content analysis.
Result: All (n = 48) third-year medical students participated in our study. The majority were females (64.6%). Significantly positive correlations of NLE scores were: test A scores (r = 0.86), test B scores (r = 0.85), and WU test scores (r = 0.78). The highest accuracy index (AI = 0.87) was the WU test, where sensitivity, specificity were 20.0% and 97.1%, respectively. The WU test revealed that it was most helpful in preparing them for the NLE. Students who passed the exam used three study strategies; group study, tutorial sessions, and review by themselves.
Discussion and Conclusion: There were strong positive correlations between three different in-house developed comprehensive examinations and NLE. The WU test showed the highest accuracy index to predict the NLE result. Regular review of lessons was emphasized as a cornerstone.
Research Interests:
A small group learning for evidence-based medicine in pre-clinical medical students: EBM in pre-clinical medical students
Research Interests:
Objective: To evaluate the quality of life (QoL) amongst Thai nasopharyngeal cancer patients (NCP) and identify associated factors with QoL. Methods: This study was based on secondary data from a cross-sectional study that aimed to... more
Objective: To evaluate the quality of life (QoL) amongst Thai nasopharyngeal cancer patients (NCP) and identify associated factors with QoL. Methods: This study was based on secondary data from a cross-sectional study that aimed to develop the Thai version of functional assessment of cancer therapy with nasopharyngeal cancer subscale demographic data, clinical information of participants, and Functional Assessment of Cancer Therapy with Nasopharyngeal cancer subscale (FACT-NP) were utilized. Data were analyzed using Student's t-test, rank-sum test, variance analysis, and the Kruskal-Wallis test. Multiple linear regression with the stepwise model was used to determine multiple variable analysis. Statistical significance was defined at p-value < 0.05. Results: Two hundred and thirty NCP were included in the study with a mean age of 50.3±12.4 years. According to our findings, 68.3% were male, 81.7% were married or living with a partner, and 86.1% were Buddhism had the Eastern Cooperative Oncology Group (ECOG) performance status between 0-2 (95.2 %). The employment status, education level, economic status, ECOG, stage , and disease status significantly influenced patients' QoL. Patients who had active treatment and received prophylactic percutaneous gastrostomy were also impacted by the FACT-NP score. In the multivariate analysis, employment status, ECOG, and disease status were shown to be significant factors that were associated with their QOL in the final model. Conclusion: Employment status was a socioeconomic factor that led to positive QOL amongst NCP.
Research Interests:
Objective: To understand the transition of changed body image after the diagnosis and surgery in women with breast cancer. Methods: Semi-structured interview and focus group with narrative approach. Thematic analysis was performed using... more
Objective:
To understand the transition of changed body image after the diagnosis and surgery in women with breast cancer.
Methods:
Semi-structured interview and focus group with narrative approach. Thematic analysis was performed using methodological and investigator triangulation methods.
Results:
Participants’ body image transformation was categorized into three phases: (1) the moment of diagnosis and changed self, (2) transition and recovery, and (3) normalization.
Conclusion:
The truth-telling process of breast cancer diagnosis and the freedom to choose their treatment options have a profound impact on body image transformation of women with breast cancer. Family support, social construction, and social support could help women with breast cancer pass through these transitional process faster, while inappropriate truth-telling by their surgeons and not having any choice in their treatment options will delay the transitional process.
To understand the transition of changed body image after the diagnosis and surgery in women with breast cancer.
Methods:
Semi-structured interview and focus group with narrative approach. Thematic analysis was performed using methodological and investigator triangulation methods.
Results:
Participants’ body image transformation was categorized into three phases: (1) the moment of diagnosis and changed self, (2) transition and recovery, and (3) normalization.
Conclusion:
The truth-telling process of breast cancer diagnosis and the freedom to choose their treatment options have a profound impact on body image transformation of women with breast cancer. Family support, social construction, and social support could help women with breast cancer pass through these transitional process faster, while inappropriate truth-telling by their surgeons and not having any choice in their treatment options will delay the transitional process.
Research Interests:
Background: To explore factors that influence quality of life (QOL) in patients receiving breast conserving therapy (BCT). Materials and Methods: In this sequential mixed methods study, 118 women from Songklanagarind Hospital were... more
Background: To explore factors that influence quality of life (QOL) in patients receiving breast conserving therapy (BCT).
Materials and Methods: In this sequential mixed methods study, 118 women from Songklanagarind Hospital were included. We used participants' characteristics, Body Image Scale (BIS), and Functional Assessment of Cancer Therapy with the Breast Cancer Subscale (FACT-B) for analysis. The BIS transformed into presence of body image disturbance (BID). Factors that influenced QOL were determined by stepwise multiple linear regression. Forty-one participants were selected for qualitative analysis. Our female researcher performed the semi-structured interviews with questions based on the symbolic interaction theory. Final codes were analysed using thematic analysis along with investigator triangulation methods.
Results: Ninety percent had early stage breast cancer with post-completed BCT, for an average of 2.7 years. The median BIS score and FACT-B score were 2 (IQR=10) and 130 (IQR=39). In the regression analysis, an age of more than 50 years and BID were significant factors. As for the value of conserved breasts, two themes emerged: a conserved breast is an essential part of a participant's life and also the representation of her womanhood; the importance of a breast is related to age.
Conclusions: Body image influenced QOL in post BCT participants. The conserved breasts also lead to positive and better impact on their body image as an essential part of their life.
Materials and Methods: In this sequential mixed methods study, 118 women from Songklanagarind Hospital were included. We used participants' characteristics, Body Image Scale (BIS), and Functional Assessment of Cancer Therapy with the Breast Cancer Subscale (FACT-B) for analysis. The BIS transformed into presence of body image disturbance (BID). Factors that influenced QOL were determined by stepwise multiple linear regression. Forty-one participants were selected for qualitative analysis. Our female researcher performed the semi-structured interviews with questions based on the symbolic interaction theory. Final codes were analysed using thematic analysis along with investigator triangulation methods.
Results: Ninety percent had early stage breast cancer with post-completed BCT, for an average of 2.7 years. The median BIS score and FACT-B score were 2 (IQR=10) and 130 (IQR=39). In the regression analysis, an age of more than 50 years and BID were significant factors. As for the value of conserved breasts, two themes emerged: a conserved breast is an essential part of a participant's life and also the representation of her womanhood; the importance of a breast is related to age.
Conclusions: Body image influenced QOL in post BCT participants. The conserved breasts also lead to positive and better impact on their body image as an essential part of their life.
Research Interests:
Advance Care Planning (ACP) is an agreement of preferred care between patients, family, and the health care team that is utilised should the patient become incapacitated. ACP uptake and awareness is still low in Thailand due to the lack... more
Advance Care Planning (ACP) is an agreement of preferred care between patients, family, and the health care team that is utilised should the patient become incapacitated. ACP uptake and awareness is still low in Thailand due to the lack of practical tool to initiate ACP and cultural barriers to see death as a taboo and sensitive subject. The Life Unlocking Card Game is an intervention uses the gamified element to raise ACP awareness. This study explored the experience of the Life Unlocking Card Game as a tool to raise death and ACP awareness in Thailand.
Research Interests:
Doing research with People with Dementia (PwD) can be challenging given that disease symptoms of anxiety, forgetfulness, and fluctuating mental capacity can make recruitment and data collection difficult. Once COVID-19 made face-to-face... more
Doing research with People with Dementia (PwD) can be challenging given that disease symptoms of anxiety, forgetfulness, and fluctuating mental capacity can make recruitment and data collection difficult. Once COVID-19 made face-to-face data collection impractical, using internet-based methods became an alternative option to continue with research. However, data collection with PwD over the internet requires strategies to observe, support, and enable them to engage with research, especially with qualitative approaches. Nine articles were selected via a decade rapid scoping review (undertaken March-June 2020) to identify qualitative online methods used with PwD and associated challenges. Methods used were online interviews, clinical assessment/telemedicine, and textual analysis from blogs, forum posts, and Tweets created by PwD. Practical challenges identified: the researchers’ limited ability to manage the physical and social environment. Technical challenges identified: the need fo...
Research Interests: Technology, Gerontology, Social Statistics, Dementia, Internet research methods, and 12 moreInternet research, Qualitative Research, Medicine, Inclusive Research, Online Research Methods, Dementia Care, The qualitative report, Social and Behavioral Sciences, Scoping review, Online research, Rapid review, and Medicine and Health
BackgroundReflective practice (RP) plays a crucial role in encouraging learners to think critically and consciously about their performances. Providing constructive feedback can further enhance RP. But non-Western learners might face... more
BackgroundReflective practice (RP) plays a crucial role in encouraging learners to think critically and consciously about their performances. Providing constructive feedback can further enhance RP. But non-Western learners might face different learning barriers compared to learners in the West, where RP originated.MethodsIn this retrospective study, we assessed RP and feedback performances on Thai medical students’ patient history-taking skills. We applied RP and peer feedback, along with feedback from the instructors, during the history-taking sessions of the ten-week introduction course for fourth-year medical students. Twelve history-taking sessions were used for the analysis. Two instructors assessed students’ reflective performance and categorised them into one of the six stages of Gibbs’ reflective cycle; their feedback performances were analysed using Pendleton’s model. We investigated the correlations between students’ overall grade point average (GPAX) and patient history-t...
Research Interests:
To estimate the prevalence of dementia among Thai elderly in the upper Southern region of Thailand, we performed a cross-sectional screening of all Thai older people from 2 areas of Nakhon Si Thammarat province: Tambon Baan Thungchon, Tha... more
To estimate the prevalence of dementia among Thai elderly in the upper Southern region of Thailand, we performed a cross-sectional screening of all Thai older people from 2 areas of Nakhon Si Thammarat province: Tambon Baan Thungchon, Tha Sala district, and Moo 6 and 7 from Sichon district, from December 2016 to November 2017. Trained health volunteers identified the participants in their communities and collected data including age, gender, comorbidities, Timed Up and Go Test (TUGT) results, and Montreal Cognitive Assessment (MoCA) scores. Our sample comprised 773 participants, of which 605 (78.3 %) were from Baan Thungchon area, while 168 were from Moo 6 and Moo 7 of Sichon district. The majority of participants were female (431, 55.7 %). The mean age of the participants was 79 ± 9.1 years, with a minimum age of 60, and a maximum age of 95. Their comorbidities were hypertension (42.9 %), type II diabetic mellitus (33.2 %), dyslipidemia (37.5 %), and osteoarthritis of the knees (35...
Research Interests:
Objectives: To study factors associated with Attention Deficit/Hyperactivity Disorders in school aged children of Sichon Hospital Method: The study was the cross-sectional analytic study conducted by the questionnaires as Self... more
Objectives: To study factors associated with Attention Deficit/Hyperactivity Disorders in school aged children of Sichon Hospital Method: The study was the cross-sectional analytic study conducted by the questionnaires as Self administered questionnaire. The participants of this research are 6-12 years of age, who were diagnosed ADHD and used services in Sichon Hospital .Other groups were children whose ages are between 6-12 years. These children used service in Sichon Hospital.Sample groups were 87 people by Simple Random sampling. The questionnaires were analyzed by using the frequency and finding the relationship of factors associated with Attention Deficit/Hyperactivity Disorders in school aged by using the statistic of Chi-square univariate analysis odds ratio in the level of statistical signficance as p-value < 0.05. Results: The factors associated with ADHD in school aged children of Sichon hospital were male having risk more 2.7 times than female. Children who were punish...
Introduction: In-house comprehensive examinations for preclinical students from various Thai medical schools were provided. However, their quality has never been evaluated with a score correlation with NLE as the gold standard. This study... more
Introduction: In-house comprehensive examinations for preclinical students from various Thai medical schools were provided. However, their quality has never been evaluated with a score correlation with NLE as the gold standard. This study aimed to assess the correlation of the scores as determined by three different comprehensive examinations and national license examination 1 (NLE step I) and to identify the positive learning strategies. Method: A mixed methods sequential explanatory study was done to investigate the performances amongst four tests and to identify the potential factors affecting those scores using semistructured interviews and focus groups with content analysis. Result: All (n = 48) third-year medical students participated in our study. The majority were females (64.6%). Significantly positive correlations of NLE scores were: test A scores (r = 0.86), test B scores (r = 0.85), and WU test scores (r = 0.78). The highest accuracy index (AI = 0.87) was the WU test, wh...
Research Interests:
Objective: To understand the transition of changed body image after the diagnosis and surgery in women with breast cancer. Methods: Semi-structured interview and focus group with narrative approach. Thematic analysis was performed using... more
Objective: To understand the transition of changed body image after the diagnosis and surgery in women with breast cancer. Methods: Semi-structured interview and focus group with narrative approach. Thematic analysis was performed using methodological and investigator triangulation methods. Results: Participants’ body image transformation was categorized into three phases: (1) the moment of diagnosis and changed self, (2) transition and recovery, and (3) normalization. Conclusion: The truth-telling process of breast cancer diagnosis and the freedom to choose their treatment options have a profound impact on body image transformation of women with breast cancer. Family support, social construction, and social support could help women with breast cancer pass through these transitional process faster, while inappropriate truth-telling by their surgeons and not having any choice in their treatment options will delay the transitional process.
Research Interests:
Research Interests:
To estimate the prevalence of dementia among Thai elderly in the upper Southern region of Thailand, we performed a cross-sectional screening of all Thai older people from 2 areas of Nakhon Si Thammarat province: Tambon Baan Thungchon, Tha... more
To estimate the prevalence of dementia among Thai elderly in the upper Southern region of Thailand, we performed a cross-sectional screening of all Thai older people from 2 areas of Nakhon Si Thammarat province: Tambon Baan Thungchon, Tha Sala district, and Moo 6 and 7 from Sichon district, from December 2016 to November 2017. Trained health volunteers identified the participants in their communities and collected data including age, gender, comorbidities, Timed Up and Go Test (TUGT) results, and Montreal Cognitive Assessment (MoCA) scores. Our sample comprised 773 participants, of which 605 (78.3 %) were from Baan Thungchon area, while 168 were from Moo 6 and Moo 7 of Sichon district. The majority of participants were female (431, 55.7 %). The mean age of the participants was 79 ± 9.1 years, with a minimum age of 60, and a maximum age of 95. Their comorbidities were hypertension (42.9 %), type II diabetic mellitus (33.2 %), dyslipidemia (37.5 %), and osteoarthritis of the knees (35.8 %). 35.1 % of them also had positive TUGT. Sixty-seven participants (8.7 %) scored 7 or lower in the Abbreviated Mental Test (AMT). Five participants (7.5 %) had a positive screening for dementia.
Research Interests:
Objectives: To study factors associated with Attention Deficit/Hyperactivity Disorders in school-aged children of Sichon Hospital