A medical degree is a five-year program at this university. The Basic Medical Science (BMS) subjects taught in the pre-clinical students are anatomy, pathology, physiology, biochemistry, parasitology, microbiology, pharmacology, immunology, and genetics. These subjects are taught in year 1 and year 2 with the least interdisciplinary interaction and focus on the need and application of the subjects during the clinical years of their medical education. The significance of basic medical sciences should be reached in pre-clinical year students as it is a vital role for them in the clinical years. Medical students build their clinical knowledge from previously obtained BMS knowledge during the pre-clinical year¹. The pre-clinical performances have some predictive value in the clinical discipline² and the clinical years require the pre-clinical basic medical sciences as its foundation as it improved integrative thinking and decision making³. BMS taught in pre-clinical years also supports the development of clinical reasoning skills and critical analysis of medical intervention⁴. Students’ attitudes and perceptions are vital in their medical program⁴. However, the concept of an attitude towards basic science is nebulous, poorly articulated, and not well understood⁵.

Medical students in Punjab showed a positive perception toward BMS and understood the importance of medical aptitude⁶. Medical students in the University Medical Center in Punjab showed a positive perception toward BMS and understood the importance of medical aptitude⁶. In the University Medical Center Utrecht of Netherlands, students enjoyed studying organ systems with the clinical approach but had a less positive perception of BMS subjects⁷. In the Netherlands, students enjoyed studying organ systems with the clinical approach but had a less positive perception of BMS subjects⁷. Gupta et al., 2014⁶ found that students understood the significance of BMS subjects for inclusive medical aptitude and knowledge, but they developed negative opinions about basic medical science as they processed through their medical program. The classical method of teaching in BMS subjects could not provide better learning outcomes among medical students, which led to increased concern among medical educators⁶. Which persuaded the experimental approach of learning greater coordination among different basic and clinical departments to improve the standard of medical education⁸.

Many studies about the attitude and perception of medical students towards BMS subjects have been carried out all around the world. There is a lack of information on pre-clinical medical students’ preferences, attitudes, and perceptions toward BMS subjects in this university. Investigating these aspects throughout their pre-clinical years can give a few guidelines to educational planners to help students in their studies. Thus, the current study aimed at exploring the students’ preference attitude, and perception toward BMS subjects. This investigation may act as a guideline for educators to enable medical students to perform better in clinical years with pre-learned BMS knowledge.

MATERIALS AND METHODS:

An institutional cross-sectional study was conducted among the pre-clinical medical students of a public university in East Malaysia in December 2019. The pre-clinical medical students of year 1 and year 2 ages between 19 to 22 years have participated in the study; a simple random sampling method was used in the selection process. The minimum sample required was determined using the Open EPI Version 3 based on a sampling frame of 303, the proportion of positive perception of 72.4 %,⁹ confidence level of 5%, and design effect of 1. The estimated sample size required with a non-response rate of 20% is around 185 students.

Study Tools A modified self-administered questionnaire⁹ presented in both English and Malay language was used in this study. Information regarding the respondent’s background included academic year, gender, ethnicity, financial source, pre-university program and the family members who are currently taking the medical course or working in the medical field. The respondents were also asked to choose only one subject that they are most interested in. After that, they were asked to choose the reasons for their most preferred subject.

The Nine scale items produced by West and co-workers¹⁰ were used to explore the perception and attitude toward BMS subjects. In this questionnaire, the students’ opinions were assessed by using a three-point Likert scale which ranges from “agree” “neutral” to “disagree”. The first five items measured the perceived importance and relevance of BMS to clinical medicine. The next four items measured students’ attitudes and the perceived effectiveness of their education in BMS. All the respondents were briefed regarding the research before obtaining the consent. They were also informed about the procedure and protocols, the benefits of the research, the confidentiality of their personal information, and their rights to take part or withdraw from this research. Data were collected by distributing questionnaires to all respondents during the Problem-Based Learning (PBL) session. The data was subjected to data cleaning in which after collecting the questionnaire from the pre-clinical medical students, it was made sure that all the questions were answered. All the data obtained were stored in the soft copy form and were kept confidential. Before administering the questionnaires, there was a pilot study with a group of randomly chosen 30 pre-clinical students in order to assess the feasibility of the questionnaires.

Statistical Analysis:

The collected data of the study population were tabulated and analyzed statistically using the (SPSS) program version 22.0 (SPSS Inc.; Chicago, USA). Descriptive analysis was carried out to analyze all the items and the results were expressed as mean±SD for quantitative continuous variables, and frequencies and percentages for qualitative variables. An independent sample t-test and one-way ANOVA were used to compare between groups. Pearson correlation and simple linear regression were used to determine the strength and direction of the relationship between attitude and perception. Values of p ≤ 0.05 were considered significant.

Ethical consideration:

This study was approved by the Ethics Committee of the Faculty of Medicine and Health Sciences, of this university. Informed consent for students’ participation was taken before distributed the questionnaires. The students were assured that their information would be confidential.

RESULT:

The study was carried out on 189 pre-clinical medical students, which included 83 students from year 1 (43.9%), and 106 students from year 2 (56.1%), among them the female students were 138 (73.0%), and male students were 51 (27.0%). Among the students most of the students, 93 (49.2%) were Malay. For the pre-university program, there were 49 (25.9%) students coming from matriculation, 21 (11.1%) from Form 6 or STPM, and 119 (63.0%) from the foundation (Program Asasi). Among them, the scholarship students were 117 (61.9%), and the rest were self-financed for their medical education. In 189 samples, 67 samples (35.4%) have a family member who is currently taking a medical course or working in the medical field. (Table 1)

Table 1. Socio-demographic characteristics of the students (n= 189)

Variable	Sub-variables	Frequency	%
Academic year	Year 1	83	43.9
	Year 2	106	56.1
Gender	Male	51	27.0
	Female	138	73.0
Ethnicity	Malay	93	49.2
	Chinese	33	17.5
	Indian	12	6.4
	Iban	17	9.0
	Bidayuh	15	7.9
	Kadazandusun	4	2.1
	Others (Melanau, Kayan, Bajau, Kenyah, Punjabi)	15	7.9
Pre-university program	Matriculation	49	25.9
	Form 6	21	11.1
	Foundation	119	63.0
Financial support	Self-finance	72	38.1
Financial support	Scholarship	117	61.9
Family member (s) in medical field	Yes	67	35.4
Family member (s) in medical field	No	122	64.6

Preferred BMS subjects and underlying causes:

Among 10 BMS subjects, anatomy (29.1%) was the most preferred, followed by pathology (24.9%) and physiology (14.3%) subjects. The least preferred subject was microbiology (0%). Around 9% of the students have no preference for BMS subjects. Their reasons to prefer the above BMS subjects were due to interesting curriculum (100%), followed by clinically useful (72.0%), knowledgeable educator (65.1%), friendly and nice educator (60.6%), clear teaching method (54.3%) and accessible teaching aids (48.6%) respectively. (Table 2)

Table 2. Preferred basic medical science subjects and underlying causes

Variable	Sub-variables	Frequency	%
Preferred BMS subjects with hierarchy (n=189)	Anatomy	55	29.1
	Pathology	47	24.9
	Physiology	27	14.3
	No preference	17	9.0
	Embryology	16	8.5
	Immunology	14	7.4
	Parasitology	5	2.6
	Biochemistry	4	2.1
	Pharmacology	3	1.6
	Genetics	1	0.5
	Microbiology	0	0.0
Reasons to prefer BMS subjects (n=175)	Interesting curriculum	175	100.0
	Knowledgeable educators	114	65.1
	Friendly & nice educators	106	60.6
	Clear teaching method	95	54.3
	Accessible teaching aids	85	48.6
	Clinically useful	126	72.0
	Other causes*	2	1.1

Others* Easier to understand compare to others/ I don’t find which field that I like yet

Perception and Attitude toward BMS subjects:

The majority of students, i.e., 82% accepted, the physician can effectively treat most patients, knowing the details of the biological process involved. Among the study population, 73.5% disagreed that in order to be a good physician, knowledge of biological mechanisms is most important. Further, 66% of students among the total sample population were doubtful to accept the usefulness of BMS subjects for the practicing doctors. The 89.9% disagreed on applying BMS to clinical practice, and that should be reinforced early on in medical education Based on the overall results, most of the students have poor perception of some items toward BMS subjects. (Table 3.1)

Regarding attitude towards BMS subjects, they disagreed the BMS are necessary to learn with regard to its applicability in the clinical years (81.5%), and also essential to their future role in becoming a physician (63%). The students’ attitudes toward BMS subjects, as well as their perception toward some items of BMS, were poor. (Table 3.2) Table 3.2. Attitude towards basic medical science subjects (n=189)

Table 3.1. Perception towards basic medical science subjects (n=189)

No	Variables	Agree n (%)	Neutral n (%)	Disagree n (%)
1.	A physician can effectively treat most patients without knowing the details of the biological processes involved. *	12(6.4%)	22 (11.6%)	155(82.0%)
2.	Most basic science study is so far removed from clinical medicine because its usefulness to the practicing doctor is slight. *	27(14.3%)	98(51.8%)	64(33.9%)
3.	Psychological factors are just as important as physical factors in the healing process.	5(2.7%)	22(11.6%)	162(85.7%)
4.	In order to be a good physician, his/her knowledge of biological mechanisms is most important.	7(3.7%)	43(22.8%)	139(73.5%)
5.	Applying the basic medical science to clinical practice is a skill which should be reinforced early on in medical education.	2(1.1%)	17(9.0%)	170(89.9%)

*negative responses

No	Variables	Agree n (%)	Neutral n (%)	Disagree n (%)
6.	It is first necessary to learn as many facts as possible in the basic medical sciences and then learn to apply them later on in the clinical years.	2(1.1%)	33(17.4%)	154(81.5%)
7.	What students should learn in the basic medical sciences are the general concepts, in order that they might have a good working knowledge without knowing all the facts.	38(20.1%)	68(36.0%)	83(43.9%)
8.	The information I have gained are essential to my future role as a physician.	24(12.7%)	46(24.3%)	119(63.0%)
9.	Faculty members motivate students’ interest through teaching of the basic medical sciences.	3(1.6%)	73(38.6%)	113(59.8%)

Factors associated with perception and attitude toward BMS subjects

Table 4. Association between socio-demographic characteristics & attitude and perception toward BMS sub jects

Variable	Sub-variables		Perception (Mean and SD)	Attitude (Mean and SD)
Academic Year	Year 1 (n=83)		13.24(1.4)	10.04(1.3)
	Year 2 (n=106)		13.47(1.4)	10.2(1.5)
Test and p value			t= 1.096, p=0.274	t= -0.782, p= 0.435
Gender	Male (n=51)		13.14(1.4)	10.43(1.4)
	Female (n=138)		13.46(1.4)	10.01(1.5)
Test and p value			t= -1.366, p=0.174	t= 1.696,p= 0.091
Financial support	Self-finance (n=72)		13.32(1.4)	9.88(1.5)
	Scholarship (n=117)		13.40(1.4)	10.28(1.4)
Test and p value			t= -0.383, p=0.702	t= -1.814, p= 0.071
Family member(s) in medical field		Yes(n=67)	13.50(1.4)	9.94(1,5)
		No(n=122)	13.30(1.4)	10.22(1.5)
Test and p value			t= 0.908, p=0.365	t= -1.212, p=0.227
Pre-university program	Matriculation (n=49)		13.35(1.4)	10.02(1.3)
	Form 6 (n=21)		13(1.5)	10.55(1.1)
	Foundation (n=119)		13.45(1.4)	10.01(1.5)
Test and p value (ANOVA)			F= 0.914, p= 0.403	F= 1.264p= 0.285

Correlation between attitude and perception toward BMS subjects

According to the mean scores on perception and attitude toward BMS subjects, all the independent variables have generally (around 85%) positive perception and positive attitude toward BMS subjects with all their mean scores were around 13/15 (perception) and 10/12 (attitude). The determinant factors such as year of the study (year 1 and year 2), gender, financial support (self-finance and scholarship), pre-university program (matriculation, form 6, foundation), and family member in the medical field were not statistically significantly associated with the perception and attitude toward BMS subjects. (Table 4).

The relation between students’ attitude towards BMS subjects and perception towards BMS subjects was a significant weak positive linear relationship with the Pearson correlation coefficient score of r=.178, p =0.014. Here, only 3.2% of the variation in the perception on BMS subjects can be explained by attitude on BMS subjects with (R2=.032, F=6.124, p=0.14).

DISCUSSION:

Preferred BMS Subjects and Underlying Reasons Among underlying reasons to prefer BMS subjects, all students chose an interesting curriculum as the reason for preference, suggesting that personal interest determines subject preference. Since preclinical students have less exposure, the presumption can be made that most students had certain choices when they first join the course. Second, highest reason is that students preferred certain subject because it is clinically useful (72.0%). Research done at the University of the West Indies suggested that scores in some preclinical subjects can predict clinical performances (11). Other reasons with high frequency include knowledgeable educator (65.1%), friendly and nice educator (60.6%), and clear teaching method (54.3%). These reasons can all be categorized as educator influence. A study has shown that role models from faculty and residents also play an important role in career decisions (12). Among 10 BMS subjects, anatomy (29.1%) was most preferred, followed by pathology (24.9%) and Physiology (14.3%). Among 189 preclinical medical students, 17 students have no preference for BMS subjects. This favoritism may be due to their unbiased attitude toward studying all BMS subjects. However, the negative attitude may be their disinterest in studying medical programs.

Attitude and Perception Toward BMS Subject:

Based on an article in the African Journal of Medicine and Medical Sciences¹³, 41% of students preferred surgery while specialty of radiology, anesthesia, psychiatry, pathology, community medicine, and general medicine were unattractive to most students. According to Kumar and Dhaliwal (2011)¹⁴, medicine and surgery were the most preferred career choices in both clinical and pre-clinical students, with more than half opting for BMS. Both these studies have surgery as the most preferred discipline which is closely related to anatomy.

The respondents of the current study have a poor attitude and perception toward some questions on BMS subjects. A high percentage of respondents disagree that BMS subjects are necessary to be learned and that these subjects are applicable later in their clinical years. Most students did not agree that these subjects are essential to their future role as a physician. A study conducted by El-Bab et al. (2011)¹ reveals the lower basic knowledge in clinical students may be their readings of clinical textbooks, which do not give detailed coverage of basic sciences; their basic concepts are generally not tested in the exams, thus the knowledge will eventually be faded off.

Relationship between sociodemographic data and attitude and perception toward BMS subjects

Academic year A study showed that academic year did not affect medical students’ attitude and perception towards science³. Like in our findings, there is no significant difference in an academic year. This suggests that 1^st year and 2^nd year medical students can have the same opinion in medical subjects.

Gender:

A study showed that students’ gender did not influence their positive attitude towards science¹⁵. It is similar to our findings. This result also suggests that the opportunity for pre-clinical female and male medical students who may choose the same interested BMS subjects.

Different pre-university program:

To be a medical student in Malaysia, after taking SPM or O-level, students need to take a pre-u program (A-level, STPM, etc) for 1-2 years or taking a foundation in science for 1 year before being eligible for an interview for a degree in medicine. Mostly, medical students of this university are from Foundation in Life Science from this university and other local universities, matriculation, and students from STPM.

In our study, the respondents are (63%) from the foundation in Life science, (25.9%) from matriculation, and (11.1 %) from Form 6. The highest attitude was from Form 6 while the perception means is highest in Foundation. There is no significant difference in both attitude and perception for the different pre-university programs. The means of perception is higher compared to other groups of the pre-university program as they are already exposed to the curriculum and teaching techniques such as problem-based learning (PBL) before they enter medical school. Comparing to matriculation students that need to study both of the subjects, pre-university students already have a positive perception towards life science before entering medical school.

Scholarship and self-finance:

Based on the result obtained, (61.9%) students are having a scholarship, and (38.1%) are self-financed. Our results showed that the mean attitude of scholarship students is higher (Mean=10.29) than self-financed students.

A study by Shankar P.R. et al. (2007) (16), also reveals that self-financing students have a more positive attitude towards BMS subjects, they expressed their preference in considering the basic sciences as a career option. Scholarship students have a disagreement in the effectiveness of their education in basic science. In contrast, a study by Moreira G.et al., (2019)¹⁷ states that students who received scholarships performed better in their medical courses and developed better academic performance also noted significant personal growth.

Our study showed that financial status may or may not have any role on the students’ attitude and perception contradicted with the study done previously that showed self-financed students have positive attitude and another study showed scholarship students that have the positive attitude and perception towards BMS subjects.

Family members in Medical Field:

Attitude is slightly low in students with family member in the medical field but they have high in perception. However, there is no significant different between the two groups. A study by Naugah J and Reiss M. J. (2019)¹⁸ showed that parents did not influence their children choice of subjects and eventually careers although, they usually put science as choice for their children. Another contrary research by Nawabi S. and Mahboob U. (2016)¹⁹ on the perception of parents foreseeing dentistry as a career option for their children showed that parents greatly affect their children's career of choice, especially in the medical field. The student's attitude is slightly lower among whose family members who have a background in the medical field but their perception depicted a higher level. However, no significant differences between the two groups. Naugah J and Reiss M. J. (2019)¹⁸ in their expressed, that parents did not influence their children's choice of subjects and their advancing careers, they usually put science as a choice for their children.

The research has shown that family members in the medical field can contribute to a positive attitude and perception towards BMS. However, those without a family member in the medical field also had shown a positive attitude and perception. Thus, this implies that family members in the medical field do not necessarily influence one’s attitude and perception toward BMS. The limitations in this study were that year 1 student had only a few months of exposure to BMS subjects. Moreover, both year 1 and year 2 students’ have very limited exposure to clinical cases. The findings of this study may not be represented to all medical students of public and private universities in Malaysia.

CONCLUSION:

Currently, the medical educators at the different levels are instrumental in conceptualizing medical student’s attitudes perceptions towards BMS with different perspectives. The current study made an effort to conceptualize medical students’ preference, attitude, and perception toward Basic Medical Science Subjects; and draw the conclusion that there is no significant difference in socio-demographic data and attitude and perceptions toward BMS. Regardless of the academic year, gender, different pre-university programs, financial sources and family background. More than half of the students have poor attitude and perception in some items of BMS subject’s questionnaires. As the study is only limited to pre-clinical students, it is recommended for future studies to differentiate the pre-clinical and clinical students regarding their attitude and perception toward BMS, clinical students’ retentions of their knowledge on BMS and, thus their significance for a future career as a physician. Research on how to integrate BMS into the learning of medical practice not to be covered just as a syllabus but as a part of a practical curriculum that can lead to more independent thinking medical students should also be conducted.

CONFLICT OF INTEREST:

None declared.

ACKNOWLEDGE:

By using this opportunity, we would like to express our deepest gratitude to everyone who has supported us in University Malaysia Sarawak. We would like to express our gratitude and appreciation to Associate Professor Dr. Cheah Whey Lian for her constrictive comments, suggestion and critiquing that helped us bring this study to success.

We would like to thank pre-clinical medical students of UNIMAS who gave their precious time by answering our questionnaires and to all our friends, who had helped us in completing this study.

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Received on 18.03.2021 Modified on 21.04.2021

Research J. Pharm. and Tech. 2021; 14(6):3232-3238.

DOI: 10.52711/0974-360X.2021.00562