Khoo Hoon Eng

Immunogenicity of venoms from four common snakes in the South of Vietnam and development of ELISA kit for venom detection.

The antigenicity and antigenic relationship between venoms of four common snakes in the South of Vietnam-Trimeresurus popeorum, Calloselasma rhodostoma, Naja naja and Ophiophagus hannah-were studied. Most of venom components expressed antigenicity and produced high titre antivenoms. The venoms share common components and antivenoms cross-reacted along them. Furthermore, cross-reactions were observed among non-common antigens, indicating that they share common epitopes. Hence, using single component as immunogen for species diagnosis of snakebites can reduce cross-reaction, perhaps may not be totally specific. A three-step affinity purification protocol was set up for preparation of species-specific antivenom antibodies. The steps involved affinity chromatography of IgG from hyper-immunized rabbit sera with protein A columns, immuno-affinity chromatography of monovalent antivenom antibodies with respective homologous venom columns, and immuno-absorption of cross-species reacting antibody molecules with heterologous venom columns. The antibodies were then used for construction of an enzyme-linked immunosorbent assay (ELISA) test kit. The kit can differentiate among the four common snake venoms in various types of samples with the detection limit of 0.2-1.6 ng/ml, depending on the type of samples and species of the snake. The efficacy of this kit for snake venom detection was successfully demonstrated in experimental envenomation in rats. Preliminary evaluation with 140 samples taken from 88 human snakebite victims in Vietnam showed that the kit could detect venom in human samples and would be a very useful tool for fast identification of snakebites in clinics.

Addressing the needs and priorities of medical teachers through a collaborative intensive faculty development programme

Faculty development in medical education is crucial for developing and sustaining quality education in medical schools. However, examples of successful intensive programmes based on experiential and collaborative learning are generally lacking in the literature. The Medical Education Unit of National University of Singapore conducted a three-day intensive programme on core competences in medical education. This paper highlights the process of programme development, programme structure, challenges faced and strategies adopted. It also describes the approach taken to educational programme evaluation along with the results. The programme structure was based on experiential and collaborative learning models. Participants contributed to all activities and emerged as facilitators and learners to gain first-hand experience of the complex educational processes. Each individual session was sequential with a brief plenary, demonstration, practicum and reflection. Pre-programme needs assessment showed that even the experienced teachers perceived a need to further improve their educational competencies.

Adenosine and its receptor agonists regulate nitric oxide production in RAW 264.7 macrophages via both receptor binding and its downstream metabolites — Inosine

Adenosine and its receptor agonists enhanced the production of nitric oxide (NO) in lipopolysaccharide (LPS)-treated RAW 264.7 cells. The enhancement of LPS-induced NO production by adenosine, as represented by the amount of its oxidation products, nitrite and nitrate, was inhibited by adenosine uptake inhibitors, such as dipyridamole, S(4-nitrobenzyl)-6-thioinosine (NBTI) and S(4-nitrobenzyl)-6-thioguanosine (NBTG). These indicate that the uptake of adenosine by macrophages is a prerequisite for the enhancement effects observed. A downstream metabolite of adenosine, inosine, also potentiated the LPS-induced NO production in a dose-dependent manner while its enhancement effect was also inhibited by dipyridamole. However, the degree of enhancement by inosine on NO production and nitric oxide synthase (NOS) activity in LPS-treated RAW 264.7 was weaker than the effect of adenosine. Furthermore, adenosine agonists also enhanced the NO production in a dose-dependent manner, but were not specific for A1, A2 nor A3 adenosine receptor. Adenosine uptake inhibitors had no effects on the enhancement activity of the adenosine receptor agonists. Thus, extracellular receptor/s may also play an important role in the observed enhancement responses. The results of this study indicate that the enhancement effects of adenosine on NO production in macrophages could be mediated by the extracellular adenosine receptors as well as the downstream metabolites of adenosine.

Motivation, study habits, and expectations of medical students in Singapore.

Objectives: To determine the motivation and incentives in education, learning experience and teaching techniques, and expectations about future careers among medical students from a multi-ethnic Asian country. Methods: Pre-validated questionnaire-based survey with stratified random sampling among medical students. The questionnaire combined qualitative responses with semi-quantitative measures of available alternatives. Results: The response rate was 83.1%. The most important factor for pursuing university study was ‘prospect of finding an interesting challenging job’ (rank 1–75%). Family made a significant contribution in decision making. Given the chance, a majority (67.2%) of respondents would prefer to study overseas. The main deterring factors were cost (67.7%), distance from home (28%), and local opportunity for post-graduation (23.4%). Despite their inclination of study overseas, the majority (73.9%) of the respondents indicated they were either very satisfied or satisfied with their current choice of university study. Only 20% of students were comfortable in asking questions in classroom as asking questions was deemed ‘too risky’ and ‘unnecessary to get better grades’. Students adopted strategies related to assessment and competition to monitor their study. Senior students reported university education as less relevant to their future careers as compared to junior students (p = 0.002). Conclusions: Students’ learning behaviour is determined by complex factors such as educational incentives, learning support, assessment and competition. Among several external factors, family, job prospects and expectations about the future play a critical role in education.

A multi-institutional survey on faculty development needs, priorities and preferences in medical education in an Asian medical school.

Abstract Background: Faculty development in medical education is crucial for maintaining academic vitality. The authors conducted a needs assessment survey in Singapore to determine the educational needs and priorities of clinical faculty. Methods: This study implemented a questionnaire-based, anonymous, multi-institutional survey with stratified random sampling. Each question was anchored with two statements on a 9-point scale. Respondents were asked to determine their current knowledge and the knowledge they would need in future. Results: The response rate was 81.9%. Overall, the participants’ current knowledge was rated either “modest” (scale 4-6) or “substantial” (scale 7-9), irrespective of teaching experience. Participants reported higher knowledge in areas related to teaching and modest knowledge in educational concepts and assessment. They reported a need for higher knowledge in most areas to function well as a teacher. Conclusion: The need for faculty development is universal and independent of teaching experience in this group. Teaching faculty from the institutes studied understood the need for improved knowledge in pedagogical knowledge.

Direct Observation of Procedural Skills (DOPS)

Who can be a DOPS assessor? Assessors must be trained in assessment and feedback methodology. You must be able to competently perform the interaction including the procedure yourself. Assessors should be consultants, GPs, doctors in core or higher training (ST3 or above/SpR), or specialty doctors/staff grade or associate specialists. If possible, different assessors should be used for each encounter wherever possible.

Why Do We Assess

To talk about what is important to learn. The process of developing assessment plans, assessment tasks, and scoring rubrics provides an opportunity for faculty, staff, and students to discuss what is important to learn. When there is so much that could be highlighted, how do instructors and programs decide what is worthy of their limited time with students? How do students become aware of the skills they are developing across their experiences at an institution? Increased awareness of the intended learning outcomes helps faculty, staff, and students be more intentional and systematic in their teaching and learning—which has a positive impact on student learning.