|Year : 2018 | Volume
| Issue : 1 | Page : 3-18
Assessment of academic/non-academic factors and extracurricular activities influencing performance of medical students of faculty of medicine, Universiti Sultan Zainal Abidin, Malaysia
Mainul Haque1, Nor Azlina A Rahman2, Md. Anwarul Azim Majumder3, Nor Iza A Rahman4, Seraj Zohurul Haque5, Zainal Zulkifli4, Halyna Lugova1, Rabiu Muazu Musa6, Ahmed Ghazi Alattraqchi4
1 Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional (National Defence University of ), Kem Sungai Besi, 57000 Kuala Lumpur, Malaysia
2 Department of Biomedical Science, Kulliyyah of Allied Health Sciences, IIUM Kuantan Campus, Malaysia
3 Faculty of Medical Sciences, The University of the , Cave Hill Campus, Barbados, West Indies
4 Faculty of Medicine, Medical Campus, Universiti Sultan Zainal Abidin, Jalan Sultan Mahmud, 20400 Kuala Terengganu, Terengganu, Malaysia
5 Year-V Medical Student, School of Medicine, University of Dundee, Mackenzie Building, Ninewells Hospital & Medical School, Kirsty Semple Way, Dundee DD2 4BF, United Kingdom
6 Faculty of Applied Social Sciences, Universiti Sultan Zainal Abidin, 21300, Terengganu, Malaysia
|Date of Web Publication||5-Jan-2018|
Prof. Mainul Haque
Unit of Pharmacology, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kem Sungai Besi, Kuala Lumpur 57000
Source of Support: None, Conflict of Interest: None
Background: Physical and mental comfort is known to have a crucial influence on health and performance amongst medical students. Very often, medical students suffer from poor quality of life (QOL) related to the work-life balance due to the lack of sleep, nutritional and dietary disorders and low physical activity, resulting in a negative impact on their academic performance. This study aims to determine the potential academic/non-academic factors and extra-curricular activities influencing the performance of medical students in Universiti Sultan Zainal Abidin (UniSZA). Materials and Methods: This was a cross-sectional study conducted on medical students at the Faculty of Medicine, UniSZA, Terengganu, Malaysia. A sample size of 300 respondents were recruited from Year I to V medical students. The questionnaire was adopted, modified and validated from a similar study in Saudi Arabia. Results: Majority of the students enjoy medical education are self-motivated, have a good command of English, non-smokers and have a sufficient sleep. Conclusion: University medical students possess good QOL within the optimum educational environment.
Keywords: Academic performance, academic/non-academic factors, extracurricular, influencing, Malaysia, medical students
|How to cite this article:|
Haque M, Rahman NA, Majumder MA, Rahman NA, Haque SZ, Zulkifli Z, Lugova H, Musa RM, Alattraqchi AG. Assessment of academic/non-academic factors and extracurricular activities influencing performance of medical students of faculty of medicine, Universiti Sultan Zainal Abidin, Malaysia. Adv Hum Biol 2018;8:3-18
|How to cite this URL:|
Haque M, Rahman NA, Majumder MA, Rahman NA, Haque SZ, Zulkifli Z, Lugova H, Musa RM, Alattraqchi AG. Assessment of academic/non-academic factors and extracurricular activities influencing performance of medical students of faculty of medicine, Universiti Sultan Zainal Abidin, Malaysia. Adv Hum Biol [serial online] 2018 [cited 2022 Aug 15];8:3-18. Available from: https://www.aihbonline.com/text.asp?2018/8/1/3/222244
| Introduction|| |
Medical education has been recognised as being completely different from many other university programmes as it creates an environment in which students experience tremendous psychological stress which often diminishes their quality of life (QOL).,,,,,,, The World Health Organisation has defined QOL as ‘the individual's perception of his position in life, within the context of culture and system of values wherein the individual lives and in relation to his objectives, expectations, standards and concerns’. A study used WHO QOL-BREF (WHOQOL-BREF) instrument and found that academic achievement of preclinical students was positively correlated with their QOL. The WHOQOL-BREF instruments were developed collaboratively in several centres worldwide, have been widely field-tested and translated into many languages. However, it was claimed that the WHO defined QOL but did not actually create the demarcation of a minimum level of QOL, considering age, gender, occupation and culture. A number of studies in Malaysia reported that medical students were stressed, especially because of academic reasons.,,, It was also reported that on average 30%–49% of the medical students experienced stress during their academic life., Overburden in the academic curriculum usually led to poor sleep quality, nutritional and dietary disorders, low physical activity, and a negative impact on students' academic performance and start experimenting with drugs (e.g., addiction to substances such as khat chewing, cigarette, smoking and alcohol drinking) and engaging in other high-risk behaviours.,,,
Extra-curricular, socio-economic and other academic/non-academic factors also influence academic performance of the students. One study conducted on the students of high school revealed that playing sports, viewing television and contributing in community service improves academic performance while playing a musical device deters academic performance. Another study found financial difficulties, employment, political affiliation and unavailability of lecturers to students were found to be negatively related to academic achievement. Multiple studies reported that students from higher socio-economic status lead to the higher academic performance of students and vice versa.,, Nevertheless, it was also reported that high and average socio-economic level affects the performance more than the lower level. Again, it was thought provoking that parents' education and occupation also found to be related kids' academic performance. Thereafter, it was also found there was also the influence of sex in academic performance. A number of research reported that preadmission academic grading and English language competencies were principal determinants in medical school performance, especially among non-English mother tongue communities including Malaysia.,,,,, A number studies described that medical students' inherent motivation was the principal determinant factor for his/her academic performance in medical school., Overprotection and over control during upbringing of a medical student by the family has been identified as one of the important factors for poor performance. Another study observed that the students who had poor performance in examination, on average, they tend to use University's recreational facilities less; however, those who used recreational facilities very regularly, on average, tend to do improved on examinations. Malaysian medical students have opined that their medical school does not have enough recreational facilities. Therefore, they faced difficulties to ease their academic and extra-academic stress and consequently suffering increased.,,, Another important issue among low achievers was they frequently do not attend the class than higher achievers.,, This is also evident among Malaysian medical students. Sleep-wake patterns have dominant consequences over daytime effective working ability. Therefore, a number studies verified that reduced night-time sleeping, over-slept during throughout weekdays and weekends, hence, always fail to attend early morning classes and drowsy in daytime were negatively associated with academic performance in both university and medical students.,,
Consequently, there are many issues that remain side by the side of every medical students' life. These factors often play as prognosticators for the achievement of future health care providers and leaders' life when they are graduated. Universiti Sultan Zainal Abidin (UniSZA) is second last public medical school of Malaysia. Just first three batches medical student graduated and served as a house officer in different public tertiary care hospitals in Malaysia.,, This study aims to determine the potential academic/non-academic factors and extra-curricular activities influencing the performance of students of Faculty of Medicine, UniSZA. It was hoped that study finding would serve as a baseline data to determine the QOL of the medical students and to formulate future policy to design curriculum and extra-curricular activities for setting a conducive educational environment.
| Materials and Methods|| |
This was a cross-sectional study conducted in Sept 2015 on medical students of Year I to V of academic session 2014/2015 of the Faculty of Medicine, UniSZA, Terengganu, Malaysia. The universal sampling method was adopted as the total population of medical students was only 300. The questionnaire [Appendix 1] [Additional file 1] was adopted, modified and validated from a previous study conducted in Saudi Arabia. A pilot study was conducted to verify the validity and reliability of the questionnaire. Ten students of the faculty of medicine, UniSZA (2 from each year) participated in a pre-tested programme in which were excluded from the main study. Minor changes were made based on the findings of the pilot study. This questionnaire contains a total of 36 questions; almost all questions were close-ended. Most of the sections of this questionnaire demonstrated acceptable values in terms of internal consistency and reliability, with a range between 0.672 and 0.882. The evidence of convergent validity was shown by the significant correlations between the items of each section and the overall mean in each section (rs = 0.332–0.718; P < 0.05).,
Therefore, 290 questionnaires were distributed among the students in pre-decided time. Necessary information concerning the purpose of the study was provided to the participants and took on average 20 min was taken to fill up the instrument. This study was anonymous, participation was voluntary, and written informed consent was taken before data uptake procedure was initiated. This research obtained the certificate of ethical approval from UniSZA Research Ethics Committee (UniSZA, C/1/UHREC/628-1, (5) 12th March, 2015). The data were then compiled and analysed using SPSS Version 21 (IBM Corporation, Armonk, NY, USA).
| Results|| |
Précises of the study participants
Out of 290 questionnaires distributed randomly among Years I–V MSs of UniSZA, 229 returned, giving a response rate of 79%. The details of the characteristics are shown in [Table 1]. The average age of the study participants was 21.8 ± 1.55 years. Among 290 participants, 27% and 73% of them were male and female, respectively. The highest number of students was from Year I (27%), single (96.1%) and from Malay ethnic origin (70.3%).
Approximately 80% of the current students completed matriculation before joining the medicine course. The average pre-university grade-point-average (GPA) of Year-I, II, III, IV and V was 4.00 ± 0.20, 4.00 ± 0.07, 4.00 ± 0.00, 3.89 ± 0.10, and 3.80 ± 0.16, respectively, and the average GPA for all students was 3.95 ± 0.15. When asked about last professional or semester grade, 48.7% of participants did not mention their grade. More than half of the students who responded received grade A in their respective examination. UniSZA grading policy incorporated as Appendix 2 [Additional file 2].
On an average, participants had 6.3 ± 1.86 family members, and 73.2% of the students live with the family. Approximately, 85% of the students declared that they did not have any kind of family problems. Five percent (5%) of the students were from broken family, 2% encountered recent death of close relatives, and 10% indicated chronic illness of their close family members.
Approximately 90% of the students' family income was between RM5000–20,000 and 78.6% of the students' self-income was RM 1000. It was noted that 4.3% of the students were financially responsible for other family members.
Conveyance mode and household chores
It was also found that approximately 60% of the students walked to attend the university, and 41.3% of the current students shared their personal transport with other fellow students. More than 14% of students were responsible for driving for their family members. Approximately one-sixth of the students were unable to drive. The majority of the students (61.6%) were responsible for housing chores (cleaning, shopping, etc.).
Movies, social networking, hobbies
Among the participants, 63.3% spent 2–4 h/day watching television and listening music. Approximately one-quarter of the students reported that they did not watch television. Majority of the students (80.8%) students spent 2–4 h for social networking and chatting; 7.4% of students claimed that they do use social networking. Regarding hobbies, 42.4% usually spent some time every day.
Smoking, caffeine-containing beverages and social life
The majority (97%) of the students were non-smokers and 48.5% never consumed caffeine containing drinks and beverages. However, 40.2% mentioned that they consumed such drinks once a day. Approximately 45% spent some time every day outside the University for socialisation.
Extracurricular activities, conferences/seminars, after university hours, and sleeping time
The students were involved in several extracurricular activities like voluntary and charity works, organising committees, etc., Much of the students (56.3%) were involved 1–2 events per year and at least 5 h/week. Much of the students (63.2%) attended <4 medical conferences and seminars per year and 15.8% did not attend any conferences and seminars. Much of the students (55.9%) slept (include nap hours) 6–8 h a day and 80.4% used to take a nap before studying.
Learning profiles including motivation
The SPs were motivated to study harder as the majority (56.5%) claimed that they enjoyed studying medicine. Others were motivated due to obtaining high scores in previous examinations, emotional pressure from family, securing a scholarship/hiring by the university. Much of the students (67.4%) preferred to study alone, 40.7% spent 3–4 h’ day for study and >8 h during weekends. Approximately 70% of the respondents claimed that their proficiency in English was good enough for study and understand day-to-day conversations. Most of the students utilised (76.2%) textbooks and handouts as their first choice of resources to prepare lessons and majority of the students used note forming, highlighting and summarising techniques when study.
On average, 86% students claimed that they had attended all the lectures, tutorials, practical, problem-based learning and clinical classes. Furthermore, 87.6% attended all the clinical sessions. More than 90% either use self-directed learning technique or sought colleagues' help when faced difficulties during studying. While studying, 51.9% preferred silence and no interruptions, 42.9% favoured a certain place and 29.9% listened/watched Qur'an/music and television. Although much of the students (91.3%) enjoyed their vacation, some of the students mentioned that they started reading for the next year students, had participated in clinical training and conducted research regarding preparing for the examinations. Regarding examination preparation, three-quarter of the students mentioned that started preparing for 2–4 weeks before the examination.
Comparison between clinical and pre-clinical students and genders
In comparison to clinical students, a majority of the pre-clinical students spent time online which is related to the academic purpose (P < 0.001), and co-curricular activities (P = 0.003).(Note: P <0.05 shows significant difference, therefore it should be related.) Besides, a greater number of pre-clinical students admitted to always having high academic scores as compared to the clinical students (P = 0.051) and like to study alone (P = 0.021). Majority of pre-clinical students also admitted to spent more time on studying during the weekend (P < 0.001), and use handouts as the primary source of studying as compared to majority of clinical students who use books (P < 0.001), need to ensure silence or no interruptions during studying (P = 0.020), enjoy their vacations (P = 0.010) and preparing earlier for examinations (P < 0.001). The summary of the results above is shown in [Table 2]. In a comparison of the above factors between male and female students, only one factor was found to have a significant result, where the bigger percentage of male students spent more time on social life as compared to female students with the (P = 0.001) as depicted in [Table 3]. Association between the above factors with grade was not analysed because most the participants did not provide their grades during data collection which render a lot of missing values and this might not have resulted in valid or accurate results if analysed.
|Table 2: Association between clinical and non-clinical years in terms of time spent for different activities and factors on studying using Chi-square test|
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|Table 3: Association between time spent on social life and gender using Chi-square test|
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| Discussion|| |
This study identified several academic, personal, sociodemographic, cultural and extra-curricular factors which influence the performance of medical students of Faculty of Medicine, UniSZA. The response rate was adequate as supported by related studies., The present study had more participation from female students (73%), which supports a recent trend in Malaysian and Asian countries,,,,,,,,,,, and in the UK and Canada., The sex equilibrium of the medical profession throughout the world was moving so fast it endangered the patient care. Women were more prospective to work part time and ‘to break their careers to have families, and competition for less female-friendly disciplines such as surgery would be reduced’. Therefore, new issues are rising to address for policy makers to gender imbalance among medical doctors both for developed and developing countries including Malaysia. Most the SPs were Malay in ethnic origin. This obvious as in Malaysia Malays are the predominant community.,, Most the students had matriculation as pre-University study; these findings were also in line with a number earlier studies.,,, As part of University regulation, students needed to live dormitory including local students. Much of them walked to university; and therefore, not responsible for driving family members. Malaysian are third highest throughout the world owns car. As such, there is a very high tendency among young Malaysian (including medical students) to buy/own a car. A good number medical students shared vehicles with their friends and colleagues. The average age marriage in Malaysia is 28.8 years and 25.3 years for men and women, respectively. Therefore, the current study findings of the far majority were unmarried are in the same line of Malaysian statistic. The average earnings of the parents of the students (RM5000) which correspond with several earlier studies.,, Moreover, the Department of Statistics Malaysia published that in 2012 and 2014 the mean family income was RM 5000 and RM6141, respectively.
The current study findings revealed 76% watches television and movies almost every day, which was lower that the studies conducted in the US and Australia may be due to religious and cultural reason. About 90% or more of both US medical and nursing students reported watching dramas, comedies, news and movies on television. Watching television among medical students of Australia was 99.5% and it was like a day-to-day work. Furthermore, several studies have informed poor study habits and academic achievement due to major time consumed for modern online social networking.,,,,, The students of the current study also spent a great amount time on social networking and internet. This is very alarming as this issue may lead to not only poor academic performance but can also damage physical health and leads to the internet addiction.,, It has recommended that ‘having a regular hobby and enjoying a normal social life does not significantly affect academic performance’. It was found that our student indulged to more hobbies than the students from Saudi Arabia.
UniSZA MSs were almost non-smokers. The lower number of smokers among medical students in the current study may be due to an influence of an anti-smoking campaign in Malaysia. This is highly commendable achievement shows the effectiveness of anti-smoking campaign. A study among Year I and II MSs at Saint Louis University, USA revealed only 6% of current smokers. Similar low prevalence of smoking among medical students were also observed in Japan (6.4%) and Brazil (16.5%)., However, increased smoking habits also reported among health professionals and students; for example, 44% were smokers in Italy in 2010 which was more than two-fold that of the general population. The breakup was in nurses 48.2%, medical doctors 33.9%, medical students 35% and postgraduate students 52.9%. Similar high prevalence (46%) also observed in India. Regarding caffeine-containing beverages, the current study findings (40.2%) are quite similar with one Southeast Asian study (42.89%) but much lower than South African (94%) and earlier Malaysian studies (83%–85%).,, It was reported in an earlier study that medical students socialised much more with their friends than an earlier one study conducted in Saudi Arabia. As the current students live in a single dormitory, henceforth, they have much more opportunity to spend time with friends. As much of the students were from different parts of Malaysia they usually depended on friends for socialisation. Extra-curricular activities generally include sports, clubs, debate, drama, school publications, student council and other social events and offer real-world experience and understandings that are not counted in the formal course of study. These activities offer openings for students to improve their ingenuity, endorse self-discipline, adopt perception of self-esteem and sense of determination, contribute to developing well-balanced human traits and provide a channel to mitigate day-to-day stress., Multiple studies reported that student involvement with extra-curricular activities was positively associated to several upshots including academic performance, student motivation and early career earnings.,, Medical students need to balance between academic and non-academic activities, as the academic performance is the first and foremost issue to obtain a medical degree and residency or house officership. Our student used to involve with a number community and voluntary services, such as, helping flood-affected people, giving service to physically challenged people, etc., which was supported by the findings of the current study. It was also positive news that most of the student attended which provided the opportunities to build their network, socialising with colleagues from other institutes, increase awareness of new social trends, and furthermore, a trip to a possibly interesting location., ‘Publish or perish’ the full sentence was ‘I'm an academic. It's publish or perish’. Mentioned phrase was coined by Dr. Daniel J. Bernstein, American Mathematician. Later many of articles quoted this phrase and discusses several times regarding the issue.,,, At present, this is known throughout the world, especially academia and claimed ‘important motivating factor for most university professors’. Postgraduate and undergraduates promising students also understand this message is equally important for them, too. As like any professional requires a notable resume to obtain and effectively compete for the best jobs. Presentation or publication of research findings became very significant for medical and university students to get into a ‘top-rated PhD programme or land a good postdoctoral research position’. Graduate scholars should have the opportunity to present their research results at conferences. At many occasion, medical students are not considered to be presenting authors, may be only a co-author which ultimately enrich their curriculum vitae. As UniSZA medical students at large attended conferences regularly, therefore, they are in right track to familiar with the development of biomedical and clinical research.
Medical students are one subcategory of every community who are particularly susceptible to poor sleep, perhaps due to their workload, pattern and lifestyle choices.,,,,, Sleep is the solitary and utmost vital health behaviour and healthy sleep patterns perform a serious role in self-regulation-a supervisory function in the brain that controls human behaviours.,,, Medical students critically require a good QOL that can help them to achieve high academic performance and sustain their medical career. Poor sleep pattern significantly damages QOL of medical students.,,,,,,,, The finding of the current study shows that most of the students had adequate sleep which indicates better QOL practised by medical students. One earlier Malaysian study regarding sleep quality data among medical students was almost similar to the current study. Although, there are many other issues which are also necessary to maintain better QOL of medical students.
Another important issue is a motivation of the medical students to pursue medicine. Medical students are adult learners and studying medicine should be integrally interesting and enjoyable, rather than any other issues related to financially gain/reward, status or parenteral pressure, etc.,, It has been observed that motivation among students has positively correlated with good study hours, deep study strategy, higher study effort, good academic performance and low exhaustion., It was also concluded that motivational concepts, ideas and methods were greatly underestimated aspect in many undergraduate medical curricula. Medical course plan should incorporate career counselling throughout the curriculum to produce much better quality medical doctors for community., The findings of the present study show that more than half of UniSZA medical students were self-motivated to join in medical school which is quite inspiring.
The learning styles and study skills of medical students are also unique. In our study, most of the students preferred to study alone. A very recent Syrian study reported only one-fourth of postgraduate medical students do practice group-study. However, studies showed no statistically significant educational benefits in relation to assessment scores was observed,, though students' attitude was more in favour of group study. This strategy improves the group dynamics skills and more knowledge gain and retention compared to learning alone. However, it should be considered that students have their own preferred learning styles and several factors tend to affect their learning. Teachers need to recognize that every student does not learn in the same way.
English language expertise is an imperative aspect in shaping academic proficiency of medical students in many non-English speaking countries like Malaysia as the language of instruction is in English and all major textbooks are in English.,,,, Most of the respondents in the present study claimed that their proficiency in English was good enough for study and understand day-to-day conversations. However, another study found no significant relationship between the English literacy and the academic performance of the medical students.
The findings of the current study also demonstrated that majority of students spent substantial time every day and weekends for study which quite consistent with one earlier report. It has been reported from China that regular study ensures high academic achievement. Medical students in the present study utilised mainly lecture notes, textbooks and internet as their first choice of learning resources. One earlier study reported that textbook was the major resources followed by lecture notes and internet. Another recent study conducted in Technische Universität München similarly reported that students mostly utilise their lecture notes as learning resources. Medical schools in developed and developing countries are using educational technology in response to digital revolution to teach medical students. Medical students are now accustomed to technology-enhanced learning, and medical educators are also increasingly utilising technology to teach students., Multiple researches have reported that class attendance in medical schools is believed to be an imperative influence in the academic accomplishment of students.,,,, Non-attendance of class not only damages personally but also disrupts the whole learning-teaching process and hinders the well-being of the session. Furthermore, non-attendance lead to waste of educational resources, time, human potential and causes rework and wasted time for professors. Majority of students in the present study attended all teaching and clinical sessions. This is noteworthy finding may be due to a quite stringent policy of the university regarding class attendance.
Regarding tackling learning difficulties and seeking help, the current study findings were quite consistent with the earlier study as most the respondents in the present study use ‘self-help is the best help’ policy. Coffee has been identified as a common drink during the study as consistent with findings of other countries., Students' activities during vacation and examination preparation were also quite similar with the earlier study. To add little more, UniSZA educational environment has been assessed before using DREEM instrument was found positive and a student-friendly educational environment.
The current study found that pre-clinical students spend statistically significant time in online activity than clinical students. A similar observation was also reported among preclinical students of UniSZA in an earlier study. This observation can be explained as clinical students are busier with clinical clerking and classes. At many occasion, clinical classes extend beyond office hours, and therefore, clinical students have less free time in comparison to preclinical students. This also allowed preclinical students to engage with more co-curricular and community works. Clinical students prefer group study may be because clinical years' study is mainly of procedural, and on the other preclinical studies are principally factual., Preclinical students studied in a weekend, but clinical students did not use a weekend to study. This finding can be explained as clinical students on many occasions were on call, or have special classes on weekend with part-time clinical teachers and may be physically tired. As preclinical teaching and learning are more factual and they mostly rely on lecture notes. Nowadays, majority clinical studies are evidence-based, therefore, clinical students need to depend on textbooks. Clinical students in medical schools are more involving in teaching and clinical sessions than preclinical students; therefore, preclinical students can enjoy their vacation and start preparing earlier for the examination than clinical students. The transition between the notional preclinical to procedural and evidence-based clinical phase is the most stressful period for the medical students.,,,, Hence, because of stress clinical students cannot enjoy their vacation and start reading earlier. Moreover, all clinical examinations should impersonator of real-life and very comprehensive in nature. All these generate more stress among clinical students. Although the present study found that male students socialise more than their female counterparts, there are no major neurological variances between the sexes. There are some behavioural differences exist the sexes. These alterations increase with age because ‘our children's intellectual biases are being exaggerated and intensified by our gendered culture. Children do not inherit intellectual differences. Every skill, attribute and personality trait is moulded by experience’. There are lot controversies whether there are any differences exist or not. As why males are five times as likely to develop autism, or why females are twice as likely to suffer from depression. Therefore, Margaret McCarthy disagrees that it might not be useful to consider sex as a variable when studying the brain and behaviour issue.
Limitation of the study
Present findings should be generalised with cautions to Malaysian and other settings. Multi-centre in-depth study is advocated to understand all aspects of medical students' QOL.
| Conclusion|| |
Most the UniSZA MSs were non-smokers and had habit caffeine-containing drink. A good percentage of participate extracurricular work, especially community services, socialisation, and had the opportunity to conference. The current SPs sleep well. Much of them have good command in the English language. Besides all good qualities one, an alarming issue is an abuse of the Internet. Finally, UniSZA MSs had a quality life with a congenial educational environment.
Authors are grateful to medical students of UniSZA, who had participated in the current study. The authors are also obliged to Dr Ahmad A. Abulaban, Department of Medicine-Neurology, King Fahad National Guard Hospital, King Abdul-Aziz Medical City, Kingdom of Saudi Arabia for providing permission to use his questionnaire for this study. The authors also like to extend their heartfelt thanks to all members of the Universiti Sultan Zainal Abidin Research Ethics Committee.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Wolf TM. Stress, coping and health: Enhancing well-being during medical school. Med Educ 1994;28:8-17.
Finkelstein C, Brownstein A, Scott C, Lan YL. Anxiety and stress reduction in medical education: An intervention. Med Educ 2007;41:258-64.
Chew-Graham CA, Rogers A, Yassin N. ‘I wouldn't want it on my CV or their records’: Medical students' experiences of help-seeking for mental health problems. Med Educ 2003;37:873-80.
Bonne O, Segman R, Katz M, Kaplan-DeNour A. Emotional distress in Israeli medical students. Harefuah 2003;142:588-91, 647.
Rahman NI, Ismail S, Binti TN, Seman T, Binti NF, Mat SA, et al
. Stress among preclinical medical students of University Sultan Zainal Abidin. J Appl Pharm Sci 2013;3:76-81.
Eva EO, Islam MZ, Mosaddek AS, Rahman MF, Rozario RJ, Iftekhar AF, et al.
Prevalence of stress among medical students: A comparative study between public and private medical schools in Bangladesh. BMC Res Notes 2015;8:327.
Rahman NI, Ismail SB, Ali RM, Alattraqchi AG, Dali WP, Umar BU, et al
. Stress among first batch of MBBS students of Faculty of Medicine and Health Sciences, Universiti Sultan Zainal Abidin, Malaysia: When final professional examination is knocking the door. Int Med J 2015;22:254-9.
The World Health Organization quality of life assessment (WHOQOL): Position paper from the world health organization. Soc Sci Med 1995;41:1403-9.
Parkerson GR Jr., Broadhead WE, Tse CK. The health status and life satisfaction of first-year medical students. Acad Med 1990;65:586-8.
Shareef MA, AlAmodi AA, Al-Khateeb AA, Abudan Z, Alkhani MA, Zebian SI, et al.
The interplay between academic performance and quality of life among preclinical students. BMC Med Educ 2015;15:193.
Saravanan C, Wilks R. Medical students' experience of and reaction to stress: The role of depression and anxiety. ScientificWorldJournal 2014;2014:737382.
Bamuhair SS, Farhan AI, Althubaiti A, Agha S, Rahman SU, Ibrahim NO. Sources of stress and coping strategies among undergraduate medical students enrolled in a problem-based learning curriculum. J Biomed Educ 2015; 2015 (Article ID 575139):1-8.
Yusoff MS, Abdul Rahim AF, Yaacob MJ. Prevalence and sources of stress among Universiti Sains Malaysia medical students. Malays J Med Sci 2010;17:30-7.
Salam A, Mahadevan R, Abdul Rahman A, Abdullah N, Abd Harith AA, Shan CP, et al.
Stress among first and third year medical students at university Kebangsaan Malaysia. Pak J Med Sci 2015;31:169-73.
Rafidah K, Azizah A, Norzaidi MD, Chong SC, Salwani MI, Noraini I. The impact of perceived stress and stress factors on academic performance of pre-diploma science students: A Malaysian study. Int J Sci Res Educ 2009;2:13-26.
Azad MC, Fraser K, Rumana N, Abdullah AF, Shahana N, Hanly PJ, et al.
Sleep disturbances among medical students: A global perspective. J Clin Sleep Med 2015;11:69-74.
Sugathan S, Singh DS, Bakar AS, Azizan MH, Nasaruddin MF. Personal, environmental and lifestyle factors affecting learning among medical students: A cross sectional study. Int J Prev Ther Med 2015;1.
Yusoff MS, Abdul Rahim AF, Baba AA, Ismail SB, Mat Pa MN, Esa AR, et al.
Prevalence and associated factors of stress, anxiety and depression among prospective medical students. Asian J Psychiatr 2013;6:128-33.
Fujita K. The effects of extracurricular activities on the academic performance of junior high students. Undergrad Res J Hum Sci 2006;5:1-15.
Farooq MS, Chaudhry AH, Shafiq M, Berhanu G. Factors affecting students' quality of academic performance: A case of secondary school level. J Qual Technol M 2011;7:1-4.
House JD. The independent effects of student characteristics and instructional activities on achievement: An application of the input environment-outcome assessment model. Int J Instrum Med 2002;29:225-39.
Credé M, Kuncel NR. Study habits, skills, and attitudes: The third pillar supporting collegiate academic performance. Perspect Psychol Sci 2008;3:425-53.
Alfayez SF, Strand DA, Carline JD. Academic, social and cultural factors influencing medical school grade performance. Med Educ 1990;24:230-8.
Arkoudis S, Hawthorne L, Baik C, Hawthorne G, O'Loughlin K, Leach D, et al
. The impact of English language proficiency and workplace readiness on the employment outcomes of tertiary international students. Centre for the Study of Higher Education, The University of Melbourne. Study commissioned by the Department of Education, Employment and Workplace Relations, Australian Government; 2009. Available from: https://www.internationaleducation.gov.au/research/Publications/Documents/ELP_Full_Report.pdf
. [Last accessed on 2016 Aug 09].
Rhoads JM, Gallemore JL Jr., Gianturco DT, Osterhout S. Motivation, medical school admissions, and student performance. J Med Educ 1974;49:1119-27.
Amin Z, Tani M, Eng KH, Samarasekara DD, Huak CY. Motivation, study habits, and expectations of medical students in Singapore. Med Teach 2009;31:e560-9.
Pinyopornpanish M, Sribanditmongkok P, Boonyanaruthee V, Chan-Ob T, Maneetorn N, Uuphanthasath R. Factors affecting low academic achievement of medical students in the Faculty of Medicine, Chiang Mai University. Chiang Mai Med J 2010;43:15-23.
Slade AN, Kies SM. The relationship between academic performance and recreation use among first-year medical students. Med Educ Online 2015;20:25105.
Rahman NI, Aziz AA, Zulkifli Z, Haj MA, Mohd Nasir FH, Pergalathan S, et al.
Perceptions of students in different phases of medical education of the educational environment: Universiti Sultan Zainal Abidin. Adv Med Educ Pract 2015;6:211-22.
Ismail S, Rahman NI, Mohamad N, Jusoh NM, Hood AI, Arif LA, et al
. Preference of teaching and learning methods in a new medical school of Malaysia. J Appl Pharm Sci 2014;4:48-55.
BinSaeed AA, Al-Otaibi MS, Al-Ziyadi HG, Babsail AA, Shaik SA. Association between student absenteeism at a medical college and their academic grades. JIAMSE 2009;19:155-9.
Deane RP, Murphy DJ. Student attendance and academic performance in undergraduate obstetrics/gynecology clinical rotations. JAMA 2013;310:2282-8.
Yusoff MS. Association of academic performance and absenteeism among medical students. Educ Med J 2014;6:E40-4.
Gomes AA, Tavares J, Azevedo MH. Sleep-wake patterns and academic performance in university students. Paper presented at the European Conference on Educational Research, University of Lisbon; 2002. Available from: http://www.leeds.ac.uk/educol/documents/00002200.htm
. [Last accessed on 2016 Aug 10].
Bahammam AS, Alaseem AM, Alzakri AA, Almeneessier AS, Sharif MM. The relationship between sleep and wake habits and academic performance in medical students: A cross-sectional study. BMC Med Educ 2012;12:61.
Unalan D, Ozturk A, Ismailogullari S, Akgul N, Aksu M. The effect of sleep duration and quality on academical success of the elementary school children in Kayseri Turkey. J Pak Med Assoc 2013;63:576-80.
Haque M, Zulkifli Z, Haque SZ, Kamal ZM, Salam A, Bhagat V, et al.
Professionalism perspectives among medical students of a novel medical graduate school in Malaysia. Adv Med Educ Pract 2016;7:407-22.
Ismail S, Salam A, Alattraqchi AG, Annamalai L, Chockalingam A, Elena WP, et al.
Evaluation of doctors' performance as facilitators in basic medical science lecture classes in a new Malaysian medical school. Adv Med Educ Pract 2015;6:231-7.
Al Shawwa L, Abulaban AA, Abulaban AA, Merdad A, Baghlaf S, Algethami A, et al.
Factors potentially influencing academic performance among medical students. Adv Med Educ Pract 2015;6:65-75.
Nunnally JC. Psychometric Theory. 2nd
ed. New York: McGraw-Hill; 1978.
Barman MP, Hazarika J, Kalita A. Reliability, and validity of Assamese version of EORTC QLQ-C30 questionnaire for studying the quality of life of cancer patients of Assam. World Appl Sci J 2012;17:672-8.
Fincham JE. Response rates and responsiveness for surveys, standards, and the journal. Am J Pharm Educ 2008;72:43.
Nulty DD. The adequacy of response rates to online and paper surveys: What can be done? Assess Eval High Educ 2008;33:301-14.
Ahmed SM, Majumdar MA, Karim R, Rahman S, Rahman N. Career choices among medical students in Bangladesh. Adv Med Educ Pract 2011;2:51-8.
King V, Wilder WD. The Modern Anthropology of South-East Asia: An Introduction. 1st
ed. London: Routledge Curzon, Taylor & Francis Group; 2003.
Yusoff MS, Esa AR, Mat Pa MN, Mey SC, Aziz RA, Abdul Rahim AF, et al.
A longitudinal study of relationships between previous academic achievement, emotional intelligence and personality traits with psychological health of medical students during stressful periods. Educ Health (Abingdon) 2013;26:39-47.
Yusoff MS, Rahim AF, Baba AA, Ismail SB, Sidi H, Esa AR. Psychological distress of first year medical students who underwent two different admission processes during a stressful period. Sains Malays 2013;42:423-8.
Peng TN. Trends in delayed and non-marriage in Peninsular Malaysia. Asian Popul Stud 2007;3:243-61.
Latifah I. Factors influencing Malaysian students' choice of major in universities in the United Kingdom. Online J Q High Educ 2015;4:10-23.
Al-Naggar RA, Bobryshev YV, Mohd Noor NA. Lifestyle practice among Malaysian university students. Asian Pac J Cancer Prev 2013;14:1895-903.
Czarny MJ, Faden RR, Nolan MT, Bodensiek E, Sugarman J. Medical and nursing students' television viewing habits: Potential implications for bioethics. Am J Bioeth 2008;8:1-8.
Weaver R, Wilson I. Australian medical students' perceptions of professionalism and ethics in medical television programs. BMC Med Educ 2011;11:50.
Kraushaar JM, Novak DC. Examining the affects of student multitasking with laptops during the lecture. J Further High Educ 2010;21:241-51.
Wood E, Zivcakova L, Gentile P, Archer K, De Pasquale D, Nosko A. Examining the impact of off-task multi-tasking with technology on real-time classroom learning. Comput Educ 2011;58:365-74.
Paul JA, Baker HM, Cochran JD. Effect of online social networking on student academic performance. Comput Human Behav 2012;28:2117-27.
Karpinski AC, Kirschner PA, Ozer I, Mellott JA, Ochwo P. An exploration of social networking site use, multitasking, and academic performance among United States and European university students. Comput Human Behav 2013;29:1182-92.
Bickerdike A, O'Deasmhunaigh C, O'Flynn S, O'Tuathaigh C. Learning strategies, study habits and social networking activity of undergraduate medical students. Int J Med Educ 2016;7:230-6.
Haque M, Rahman NA, Majumder MA, Haque SZ, Kamal ZM, Islam Z, et al.
Internet use and addiction among medical students of Universiti Sultan Zainal Abidin, Malaysia. Psychol Res Behav Manag 2016;9:297-307.
Bessière K, Pressman S, Kiesler S, Kraut R. Effects of internet use on health and depression: A longitudinal study. J Med Internet Res 2010;12:e6.
Bickham DS, Hswen Y, Rich M. Media use and depression: Exposure, household rules, and symptoms among young adolescents in the USA. Int J Public Health 2015;60:147-55.
Coe RM, Cohen JD. Cigarette smoking among medical students. Am J Public Health 1980;70:169-71.
Takeuchi Y, Morita E, Naito M, Hamajima N. Smoking rates and attitudes to smoking among medical students: A 2009 survey at the Nagoya University School of Medicine. Nagoya J Med Sci 2010;72:151-9.
Stramari LM, Kurtz M, Silva LC. Prevalence of and variables related to smoking among medical students at a university in the city of Passo Fundo, Brazil. J Bras Pneumol 2009;35:442-8.
Ficarra MG, Gualano MR, Capizzi S, Siliquini R, Liguori G, Manzoli L, et al.
Tobacco use prevalence, knowledge and attitudes among Italian hospital healthcare professionals. Eur J Public Health 2011;21:29-34.
Singh VV, Singh Z, Banerjee A, Basannar DR. Determinants of smoking habit among medical students. Med J Armed Forces India 2003;59:209-11.
Aslam HM, Mughal A, Edhi MM, Saleem S, Rao MH, Aftab A, et al.
Assessment of pattern for consumption and awareness regarding energy drinks among medical students. Arch Public Health 2013;71:31.
Lee KH, Human GP, Fourie JJ, Louw WA, Larson CO, Joubert G. Medical students' use of caffeine for ‘academic purposes’ and their knowledge of its benefits, side-effects and withdrawal symptoms. S Afr Fam Pract 2009;51:322-7.
Lawrence P, Janarthanam JB. A survey of energy drinks consumption patterns among Malaysian students of management and science university. J Manag Sci 2014;12:1-12.
Haque AT, Hashim NB, Ruslan NA, Haque M. Lifestyle diseases and their association with coffee consumption at Ipoh, Malaysia. Res J Pharm Tech 2015;8:285-91.
Shamsudin S, Ismail SF, Al-Mamun A, Nordin SK. Examining the effect of extracurricular activities on academic achievements among the public university students in Malaysia. Asian Soc Sci 2014;10:171-7.
Zaff JF, Moore KA, Papillo AR, Williams S. Implications of extracurricular activity participation during adolescence on positive outcomes. J Adolesc Res 2003;18:599-630.
Fredricks JA, Eccles JS. Developmental benefits of extracurricular involvement: Do peer characteristics mediate the link between activities and youth outcomes? J Youth Adolesc 2005;34:507-20.
Holloway JH. Extracurricular activities and student motivation. Educ Leadersh 2002;60:80-1.
Alexander M Jr. An Exploration of the Relationship between Student Engagement and Academic Performance of Undergraduate Students at a Public Historically Black Higher Education Institution in the Southeast. The University of Alabama, Tuscaloosa, Alabama, USA; 2009. Available from: http://www.sci-hub.cc/doi/10.0000/proquest/304826068
. [Last accessed on 2016 Oct 29].
Hu S, Wolniak GC. Initial evidence on the influence of college student engagement on early career earnings. Res High Educ 2010;51:750-66.
Cirone J, Saks NS. Medical student engagement in extracurricular activities. Med Sci Educ 2015;25:293-7.
Neill US. Publish or perish, but at what cost? J Clin Invest 2008;118:2368.
Fanelli D. Do pressures to publish increase scientists' bias? An empirical support from US states data. PLoS One 2010;5:e10271.
Publish or perish: China needs to elaborate on plans to modernize its flagging academic journals. Nature 2010;467:252.
Grunstein RR. Global perspectives on sleep and health issues. J Natl Inst Public Health 2012;61:35-42.
Alsaggaf MA, Wali SO, Merdad RA, Merdad LA. Sleep quantity, quality, and insomnia symptoms of medical students during clinical years. Relationship with stress and academic performance. Saudi Med J 2016;37:173-82.
Giri P, Baviskar M, Phalke D. Study of sleep habits and sleep problems among medical students of pravara institute of medical sciences loni, Western Maharashtra, India. Ann Med Health Sci Res 2013;3:51-4.
] [Full text]
Fattahzadeh-Ardalani G, Valizadeh M, Mohebbipour A, Mohammadi P, Kahnamouei-Aghdam F, Fouladi N, et al
. Prevalence of sleep disorders among Ardabil city's people: North-West of Iran. J Sleep Med Disord 2016;3:1042.
Barber LK, Rupprecht EA, Munz DC. Sleep habits may undermine well-being through the stressor appraisal process. J Happiness Stud 2014;15:285.
Barber LK, Munz DC. Consistent-sufficient sleep predicts improvements in self-regulatory performance and psychological strain. Stress Health 2011;27:314-24.
Barber LK, Munz DC, Bagsby PG, Powell E. Sleep consistency and sufficiency: Are both necessary for less psychological strain? Stress Health 2010;26:186-93.
Norlander T, Johansson A, Bood SA. The affective personality: Its relation to quality of sleep, well-being, and stress. Soc Behav Pers 2005;33:709-22.
Zailinawati AH, Teng CL, Chung YC, Teow TL, Lee PN, Jagmohni KS, et al.
Daytime sleepiness and sleep quality among Malaysian medical students. Med J Malaysia 2009;64:108-10.
Brissette A, Howes D. Motivation in medical education: A systematic review. WebmedCentral Med Educ 2010;1:WMC001261.
Mann KV. Motivation in medical education: How theory can inform our practice. Acad Med 1999;74:237-9.
Ryan RM, Frederick CM, Lepes D, Rubio N, Sheldon KM. Intrinsic motivation and exercise adherence. Int J Sport Psychol 1997;28:335-54.
Kusurkar RA, Croiset G, Mann KV, Custers E, Ten Cate O. Have motivation theories guided the development and reform of medical education curricula? A review of the literature. Acad Med 2012;87:735-43.
Kusurkar RA, Ten Cate TJ, Vos CM, Westers P, Croiset G. How motivation affects academic performance: A structural equation modelling analysis. Adv Health Sci Educ Theory Pract 2013;18:57-69.
Idris A, Al Saadi T, Edris B, Sawaf B, Zakaria MI, Alkhatib M, et al.
Self-reported study habits for enhancing medical students' performance in the national medical unified examination. Avicenna J Med 2016;6:39-46.
] [Full text]
Majumder MA. How can we teach students if we do not know how they learn? South Asia J Public Health 2013;3:70-3.
Rybczynski SM, Schussler EE. Student use of out-of-class study groups in an introductory undergraduate biology course. CBE Life Sci Educ 2011;10:74-82.
Kaliyadan F, Thalamkandathil N, Parupalli SR, Amin TT, Balaha MH, Al Bu Ali WH, et al.
English language proficiency and academic performance: A study of a medical preparatory year program in Saudi Arabia. Avicenna J Med 2015;5:140-4.
] [Full text]
Hossain S, Shamim KM, Shahana N, Habib MA, Rahman A. Is English as a medium of instruction problem for undergraduate medical students? J Armed Forces Med Coll Bangladesh 2010;6:32-6.
Dhaliwal G. Teaching medicine to non-English speaking background learners in a foreign country. J Gen Intern Med 2009;24:771-3.
Sadeghi B, Kashanian NM, Maleki A, Haghdoost A. English language proficiency as a predictor of academic achievement among medical students in Iran. Theor Pract Lang Stud 2013;3:2315-21.
Sanip S, Zulkifli NF. Significance of English literacy and academic performance of medical students in USIM. Int J Educ Stud 2011;4:93-8.
Cerna MA, Pavliushchenko K. Influence of study habits on academic performance of international college students in Shanghai. High Educ Stud 2015;5:42-55.
Leong KC, Teng CL, Ng CJ. Learning resources and activities: Students' feedback from two Malaysian medical schools. Med J Malaysia 2007;62:265-7.
Guze PA. Using technology to meet the challenges of medical education. Trans Am Clin Climatol Assoc 2015;126:260-70.
Kennedy G, Gray K, Tse J. ‘Net generation’ medical students: Technological experiences of pre-clinical and clinical students. Med Teach 2008;30:10-6.
Augustin M. How to learn effectively in medical school: Test yourself, learn actively, and repeat in intervals. Yale J Biol Med 2014;87:207-12.
Cohall DH, Skeete D. The impact of an attendance policy on the academic performance of first year medical students taking the Fundamentals of Disease and Treatment course. Caribb Teach Scholar 2012;2:115-23.
Bamuhair SS, Al Farhan AI, Althubaiti A, Ur. Rahman S, Al-Kadri HM. Class attendance and cardiology examination performance: A study in problem-based medical curriculum. Int J Gen Med 2016;9:1-5.
Credé M, Roch SG, Kieszczynka UM. Class attendance in college a meta-analytic review of the relationship of class attendance with grades and student characteristics. Rev Educ Res 2010;80:272-95.
Subramaniam B, Hande S, Komattil R. Attendance and achievement in medicine: Investigating the impact of attendance policies on academic performance of medical students. Ann Med Health Sci Res 2013;3:202-5.
] [Full text]
Desalegn AA, Berhan A, Berhan Y. Absenteeism among medical and health science undergraduate students at Hawassa University, Ethiopia. BMC Med Educ 2014;14:81.
Segal C. Classroom behavior. J Hum Resour 2008;43:783-814.
Rumberger RW. High school dropouts: A review of issues and evidence. Rev Educ Res 1987;57:101-21.
Gutmann J, Kühbeck F, Berberat PO, Fischer MR, Engelhardt S, Sarikas A, et al.
Use of learning media by undergraduate medical students in pharmacology: A prospective cohort study. PLoS One 2015;10:e0122624.
Schmidmaier R, Eiber S, Ebersbach R, Schiller M, Hege I, Holzer M, et al.
Learning the facts in medical school is not enough: Which factors predict successful application of procedural knowledge in a laboratory setting? BMC Med Educ 2013;13:28.
Al-Turki Y, Alenazy B, Algadheeb AR, Alanazi M, Almarzouqi AS, Alanazi A, et al
. Caffeine habits among medical students in King Saud university. Int J Sci Res 2016;5:754-64.
Godefrooij MB, Diemers AD, Scherpbier AJ. Students' perceptions about the transition to the clinical phase of a medical curriculum with preclinical patient contacts; a focus group study. BMC Med Educ 2010;10:28.
Palés J, Gual A, Escanero J, Tomás I, Rodríguez-de Castro F, Elorduy M, et al.
Educational climate perception by preclinical and clinical medical students in five Spanish medical schools. Int J Med Educ 2015;6:65-75.
Morrison J, Moffat K. More on medical student stress. Med Educ 2001;35:617-8.
Moss F, McManus IC. The anxieties of new clinical students. Med Educ 1992;26:17-20.
Radcliffe C, Lester H. Perceived stress during undergraduate medical training: A qualitative study. Med Educ 2003;37:32-8.
Aaraas IJ, Holtedahl K, Anvik T, Bentzen N, Berg E, Fleten N, et al.
Examination of final-year medical students in general practice. Scand J Prim Health Care 2007;25:198-201.
Fine C. Delusions of Gender: How Our Minds, Society, and Neurosexism Create Difference. New York: W.W. Norton and Company, Inc.; 2010.
Eliot L. Pink Brain, Blue Brain: How Small Differences Grow into Troublesome Gaps – And What we can do about it. Permissions. New York, USA: Houghton Muffin Harcourt Publishing Company; 2009.
Zosuls KM, Miller CF, Ruble DN, Martin CL, Fabes RA. Gender development research in sex roles: Historical trends and future directions. Sex Roles 2011;64:826-42.
[Table 1], [Table 2], [Table 3]
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