|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 2020 Mar 28];8:3-18. Available from: http://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.
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[Table 1], [Table 2], [Table 3]
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