Integrated Medical Education Resources: 990521P - IMPACT OF THE MEDICAL CURRICULUM ON THE KNOWLEDGE, ATTITUDES, AND PRACTICE (KAP) OF MEDICAL STUDENTS RELATING TO CANCER PREVENTION

Abstract written for the First Asean Conference on Medical Sciences, Kelantan. Malaysia, 18-21 May 2001 by Prof Dr Omar Hasan Kasule, Sr., Faculty of Medicine, International Islamic University, Kuantan, Malaysia

ABSTRACT

Introduction: Knowledge, attitudes, and practice of medical students relating to cancer prevention have been recognized as important variables that can be changed by the medical curriculum. Change of attitudes requires continuous effort throughout the medical. The attitudes of today's medical students will determine the commitment of tomorrow's physicians to cancer prevention.

Objectives: The present cross-sectional study will investigate the types and sources of medical student KAP relating to cancer prevention and how they change as students go through the medical curriculum. Suggestions on curriculum improvement will be made in light of the study's findings.

Methodology: A KAP questionnaire has already been constructed and validated. It is administered to three groups of students: first year students who are just entering the medical school, second year, and third year students. The questionnaire includes items from the medical curriculum to investigate their impact on KAP. In-depth qualitative interviews are carried out with a small sample of the students to extend and explain the findings of the questionnaire.

Results: The research will be completed in June 1999 and results will be reported at the symposium

Conclusions: The study will reveal students KAP and how it relates to the curriculum. Suggestions on curricular changes will be made in the light of the findings.

Key words: KAP, students, medical

References:

Jerkegren E, et al. Sun-related behaviour and melanoma awareness among Swedish university students.

Eur J Cancer Prev. 1999 Feb;8(1):27-34.

Kolasa KM, et al. Teaching medical students cancer risk reduction nutrition counseling using a multimedia program.

Fam Med. 1999 Mar;31(3):200-4.

Lee KC, et al. Do clinical breast examination skills improve during medical school? Acad Med. 1998 Sep;73(9):1013

Kann PE, et al. Breast cancer screening knowledge and skills of students upon entering and exiting a medical school.

Acad Med. 1998 Aug;73(8):904-6.

Reichart PA, et al. Khmer dental and medical students' knowledge about the betel quid chewing habit in Cambodia.

Eur J Dent Educ. 1997 Aug;1(3):129-32.

Haagedoorn EM, et al. Report of an international summer school--oncology for medical students--in 1996 in Groningen, The Netherlands. J Cancer Educ. 1997 Spring;12(1):56-8.

Ho SM, et al. Attitudes of Hong Kong medical students toward different modalities of treatment for cancer.

Psychol Rep. 1995 Jun;76(3 Pt 2):1291-6.

Derman U, et al. Is awareness of its risk enough to stop people from smoking? J Cancer Educ. 1995 Summer;10(2):68-70.

Crofton JW, et al. Medical education on tobacco: implications of a worldwide survey. Tobacco and Health Committee of the International Union against Tuberculosis and Lung Disease (IUATLD). Med Educ. 1994 May;28(3):187-96.

Leung SF, et al. A cancer attitude survey among medical undergraduates in Hong Kong.

J Cancer Educ. 1994 Summer;9(2):73-6.

Phillips B, et al. Preventive medicine: what do future practitioners really need? Are they getting it in medical school? J Ky Med Assoc. 1993 Mar;91(3):104-11.

Axelrod RS, et al. Elective introduction to oncology. J Cancer Educ. 1993 Spring;8(1):31-4.

Sanidas EE, et al. The influence of undergraduate medical cancer education on students' sensitivity towards cancer.

J Cancer Educ. 1993 Spring;8(1):19-23.

Wist E. Teaching communication with cancer patients and terminally ill patients to medical students. J Cancer Educ. 1993 Summer;8(2):119-22.

Tessier JF, et al. Smoking habits and attitudes of medical students towards smoking and antismoking campaigns in nine Asian countries. The Tobacco and Health Committee of the International Union Against Tuberculosis and Lung

Diseases. Int J Epidemiol. 1992 Apr;21(2):298-304.

St Claire L Evaluating a workshop designed to help medical students improve their skills in communicating about cancer: methodological considerations--and worries. Med Teach. 1992;14(1):65-76.

Bakemeier RF, et al. Survey design and observations relating to cancer education funding. Cancer Education Survey II: cancer education in United States medical schools (conducted by The American Association for Cancer Education with the support of the American Cancer Society). J Cancer Educ. 1992;7(2):85-93.

Chamberlain RM, et al. Cancer prevention education in United States medical schools. Cancer Education Survey II: cancer education in United States medical schools. J Cancer Educ. 1992;7(2):105-14.

Varon J, et al. Resuscitation attitudes among medical personnel: how much do we really want to be done? Resuscitation. 1991 Dec;22(3):229-35.

Christensen C, et al. Framing bias among expert and novice physicians. Acad Med. 1991 Sep;66(9 Suppl):S76-8.

Isen AM, et al. The influence of positive affect on clinical problem solving. Med Decis Making. 1991 Jul-Sep;11(3):221-7.

Stern M, et al. Medical students' perceptions of children: modifying a childhood cancer stereotype.

J Pediatr Psychol. 1991 Feb;16(1):27-38.

Weissman DE, et al. Attitudes about cancer pain: a survey of Wisconsin's first-year medical students. J Pain Symptom Manage. 1990 Dec;5(6):345-9.

Krackov SK, et al. Effects of an oncology elective on first-year medical students' knowledge and attitudes about cancer. J Cancer Educ. 1990;5(1):43-9.

Kane MA. Medical oncology in a sophomore medical student pathophysiology course. J Cancer Educ. 1990;5(3):181-6.

Stern M, et al. Childhood cancer stereotype: impact on adult perceptions of children. J Pediatr Psychol. 1989 Dec;14(4):593-605.

Berlin RM. A piece of my mind. Mr Turner's toenails. JAMA. 1989 Apr 14;261(14):2124.

Mlodinow SG, et al. Physicians' and medical students' knowledge of nutrition. Acad Med. 1989 Feb;64(2):105-6.

Dignan M, et al. Helping students respond to stressful interactions with cancer patients and their families: a pilot program. J Cancer Educ. 1989;4(3):179-83.

Hoerni B, et al. Value of attitude questionnaires for assessing oncology teaching of medical students: experience of Fondation Bergonie, Bordeaux. J Cancer Educ. 1989;4(2):91-5.

Stedeford A, et al. Care of the patient with advanced cancer: a course for clinical medical students at Oxford. J Cancer Educ. 1989;4(2):103-8.

Schmelkin LP, et al. The dimensional structure of medical students' perceptions of diseases. J Behav Med. 1988 Apr;11(2):171-83.

Hays DM, et al. Medical students' attitudes towards cancer: influence of the type of clerkship experience. Med Pediatr Oncol. 1988;16(3):175-81.

Peters AS, et al. Effect of a course in cancer prevention on students' attitudes and clinical behavior. J Med Educ. 1987 Jul;62(7):592-600.

Luedke DW, et al. An integrated oncology course for second year medical students. J Cancer Educ. 1987;2(3):153-8.

Chamberlain RM, et al. Application of cancer prevention knowledge: a longitudinal follow-up study of medical students. J Cancer Educ. 1987;2(2):93-106.

Schmelkin LP, et al. Cancer Opinionnaire. Medical students' attitudes toward psychosocial cancer care. Cancer. 1986 Aug 1;58(3):801-6.

Peters AS, et al. Effect of a cancer education program on student interest and learning in cancer. J Med Educ. 1986 Mar;61(3):163-8.

Madden RE, et al. Attitudes of medical students and faculty toward cancer. J Cancer Educ. 1986;1(3):177-81.

Raina S, et al. Limitations in testing for attitudes toward cancer. J Cancer Educ. 1986;1(3):153-60.

Blanchard CG, et al. Psychosocial aspects of cancer in adults: implications for teaching medical students. J Cancer Educ. 1986;1(4):237-48. Review.

Smith IK, et al. Effect of a breast examination teaching unit in physical diagnosis on medical students' practices. J Med Educ. 1985 Sep;60(9):730-3.

Kaye J. The effect of counseling cancer patients on attitudes of medical students. J Med Educ. 1985 Jun;60(6):491-2.

Neilan BA, et al. Clinical oncology assistantship program for medical students. J Med Educ. 1985 Jun;60(6):473-7.

Hays DM, et al. Effects of intensive clinical exposure on attitudes of medical students toward cancer-related problems.

Cancer. 1985 Feb 1;55(3):636-42.

Hays DM, et al. Medical students' concepts of childhood cancer and its management. Med Pediatr Oncol. 1985;13(2):78-82.

Crumbaugh J. Informed consent: a medical student's view. Mich Med. 1984 Nov;83(51):559-60.

Lebovits AH, et al. Attitudes towards cancer. Development of the cancer attitudes questionnaire.

Cancer. 1984 Sep 15;54(6):1124-9.

Terasaki MR, et al. Medical student interactions with cancer patients: evaluation with videotaped interviews.

Med Pediatr Oncol. 1984;12(1):38-42.

Bakemeier RF, et al. The teaching of cancer medicine by educational objectives. J Med Educ. 1984 Jan;59(1):24-32.

Taylor KM, et al. The integration of behavioral science theory and clinical experience for second-year medical students. J Med Educ. 1983 Apr;58(4):353-5.

Cohen RE, et al. Attitudes toward cancer. II: A comparative analysis of cancer patients, medical students, medical residents, physicians and cancer educators. Cancer. 1982 Sep 15;50(6):1218-23.

Appel MH, et al. The impact of an oncology course on attitudes of freshman medical students. J Med Educ. 1981 Nov;56(11):919-21.

Scott N, et al. Cognitive style and instructional materials for medical students. J Med Educ. 1981 Jul;56(7):565-71.

Blanchard CG, et al. Attitudes toward cancer: I. The impact of a comprehensive oncology course on second-year medical students. Cancer. 1981 Jun 1;47(11):2756-62.

Cooper-Stephenson C, et al. Nutrition in cancer: physicians' knowledge, opinions, and educational needs.

J Am Diet Assoc. 1981 May;78(5):472-6.

Kaye J, et al. Attitudes of medical students and residents toward cancer. J Psychol. 1981 Jan;107(1st Half):87-96.

Cooper S, et al. Medical students' attitudes toward cancer. J Med Educ. 1980 May;55(5):434-9.

Cassileth BR, et al. Modification of medical student perceptions of the cancer experience. J Med Educ. 1979 Oct;54(10):797-802.

Kennedy BJ. Medical student training in medical oncology. Med Pediatr Oncol. 1979;7(1):69-75.

Haley HB, et al. Students' attitudes toward cancer: changes in medical school. J Med Educ. 1977 Jun;52(6):500-7.

Rippere V. Preclinical students' views on knowing cancer diagnosis: a data-based class exercise.

Med Educ. 1976 Jul;10(4):264-8.

Thomas CB. What becomes of medical students: the dark side. Johns Hopkins Med J. 1976 May;138(5):185-95.

Ervin T. Oncology education and the preclinical medical student. J Med Educ. 1974 Feb;49(2):197-9.

Chang RS, et al. Prevalence of oropharyngeal excreters of leukocyte-transforming agents among a human population. N Engl J Med. 1973 Dec 20;289(25):1325-9.

Munson PJ, et al. Oncology education: a behavioral approach. J Med Educ. 1973 Aug;48(8):739-42.

Aho WR. Cancer choice and identification with the medical profession. Soc Sci Med. 1972 Dec;6(6):753-8.

Cauffman JG, et al. Medical students teach to community. J Med Educ. 1971 Jul;46(7):618-20.

Gall EA, et al. Questionnaire on cancer. CA Cancer J Clin. 1971 Mar-Apr;21(2):102-8 passim.

Sherman CD Jr, et al. A survey of the attitudes of second, third and fourth year medical students toward the "curability" of breast cancer. CA Cancer J Clin. 1970 Nov-Dec;20(6):365-7.

O'Rourke DA. Observations from overseas. Med J Aust. 1970 Apr 25;1(17):859-61.

Haley HB Jr, et al. Research in medical education. Facctor-analytic approach to attitude scale construction. J Med Educ. 1968 Mar;43(3):331-6.

IMPACT OF THE MEDICAL CURRICULUM ON THE KNOWLEDGE, ATTITUDES, AND PRACTICE (KAP) OF MEDICAL STUDENTS RELATING TO CANCER PREVENTION: BASELINE SURVEY

RESEARCH QUESTIONNAIRE - #1

INSTRUCTIONS

You are participating in a very important study whose results will contribute to cancer prevention strategies. All data collected will be used for aggregate analysis and no information about any personal information will be published.

This is a self-coding questionnaire. Please make sure you answer all questions. Read each question carefully before answering.

Start by writing your ID on each page of the questionnaire. This will help put the different pages of the questionnaire together in case of separation. The ID will also be used to link this questionnaire with follow-up questionnaires. The ID may be your matriculation number, IC number, or passport number. Make sure you remember to use the same ID on completing follow-up questionnaires in the future. Remember to write the time and date you completed the questionnaire

The questionnaire has a total of 9 pages and a blank. and consists of 16 sections listed below. Make sure you complete all of them. Write additional information, comments, and suggestions on the blank page.

The sections of the questionnaire are as follows:

1. Study Particulars:

2. Personal And Social Profile

3. Family History Of Cancer

4. Source Of Information About Cancer

5. Knowledge Of Cancer Sites

6. Knowledge Of Cancer Symptoms And Signs

7. Knowledge Of Cancer Detection Methods

8. Knowledge Of Cancer Treatment Methods

9. Knowledge Of Cancer Risk Factors

10. Knowledge Of Cancer Prevention Measures

11. Opinions About Cancer

12. Attitudes To Cancer

13. Health-Seeking Behavior

14. Smoking And Dietary Habits

15. Occupational/Environmental Exposure

16. The medical curriculum

1. STUDY PARTICULARS:

Complete the following identifying information by ticking the correct response or writing the correct answer. Ignore questions or responses that do not apply

1. ID Number (Matric No, IC Number, Passport Number, any other Identifying Number)

2. Date of birth (dd/mm/yyyy)

3. Year enrolled in UIA Kulliyah of Medicine

1. 1997 2. 1998 3. 1999 4. 2000 5. 2001

4. Current year of study

1. First 2. Second 3. Third 4. Fourth 5. Fifth

5. Date questionnaire completed (dd/mm/yy)

6. Initials to indicate informed consent

1. Yes 2. No

2. PERSONAL AND SOCIAL PROFILE

Complete the following identifying information by ticking the correct response or writing the correct answer. Ignore questions or responses that do not apply

7. Age (write your age in years at the last birthday anniversary)

8. Gender

1. Male 2. Female

9. Ethnic Group

1. Malay 2. Chinese 3. Indian 4. Other (please specify)

10-11. District of birth and Home District

Please write the number of the respective district from the table in the box below

10. District of birth ________

11. Home District (where permanent family home is) _________

Johor: 1.Batu Pahat 2. Johor Baru 3. Kluang 4. Kota Tinggi 5. Mersing 6. Muar 7. Pontian 8. Segamat Kedah: 9. Baling 10. Bandar Baru 11. Kota Setar 12. Kuala Muda 13. Kubang Pasu 14. Kulim 15. Langkawi 16. Pada. Terap 17. Sik 18. Yan 19. Pendang Kelantan: 20. Bachok 21. K. Bharu 22. Machang 23. Pasir Mas 24. Pasir Puteh 25. Tanah Merah 26. Tumpat 27. Gua Musang 28. Kuala Krai 29. Jeli Melaka: 30. Alor Gaja 31. Jasin 32. Melaka Tengah N. Sembilan: 33. Jelebu 34. Kuala Pilah 35. Port Dickson 36. Rembau 37. Seremban 38. Tampin 39. Jempol Pahang: 40. Bentong 41. Cameron H 42. Jerantut 43. Kuantan 44. Lipis 45. Pekan 46. Raub 47. Temerloh 48. Rompin 49. Maran Perak: 50. B. Padang 51. Manjung 52. Kinta 53. Kerian 54. Kuala Kangsar 55. Larut&Matang 56. Hilir Perak 57. Ulu Perak 58. Perak Tengah Pulau Pinang: 59. SP Tengah 60. SP Utara 61. SP Selatan 62. Timur Laut 63. Barat Daya Selangor: 64. Gombak 65. Klang 66. K. Langat 67. K. Selangor 68. Petaling 69. Sebak Bernam 70. Sepang 71. U.Langat 72. U. Selangor Terengannu: 73. Besut 74. Dungun 75. Kemaman 76. K. Terengannu 77. Marang 78. H. Terengannu 79. Setiu Federal Territory: 80. Kuala Lumpur 81. Labuan Sabah: 82. Kota Kinabalu83. Rest of Sabah Sarawak: 84. Kuching 85. Rest of Sarawak Other countries (specify country: 86. ______________ and district: 87__________

12. Weight in Kg

13. Height in cm

14. Religion

Muslim

Hindu

Budhist

Christian

5. Other (specify)

15. Marital Status:

Married

Divorced

Widowed

Never married

3. FAMILY HISTORY OF CANCER

16-25. Indicate if you know that any of your relatives had any cancers.

(please tick yes or no).

	RELATION	YES	NO	DO NOT KNOW
16	Father
17	Mother
18	Brother
19	Sister
20	Grandfather
21	Grandmother
22	Uncle
23	Aunt
24	Other (specify
25	Other (specify)

4. SOURCE OF INFORMATION ABOUT CANCER

26- 50 From your knowledge of cancer, indicate the source of your information. (please tick yes or no)

	SOURCE	YES	NO
26	Doctor
27	Nurse at a health centre
28	Nurse in a hospital
29	Other health staff
30	Volunteer non-health staff
31	National television
32	Foreign television (satellite/cable)
33	Radio
34	Primary School Classes
35	Newspaper
36	Magazines
37	Books (academic)
38	Books (General and popular)
39	Pamphlets & Newsletters
40	Family members
41	Secondary School teachers
42	Neighbours
43	Friends
44	Religious leaders
45	Matriculation teachers
46	Internet
47	Political leaders or Govt. officials
48	University lecturers
49	Social clubs or social gatherings
50	Exhibitions/Advertisements (posters)

5. KNOWLEDGE OF CANCER SITES

51-64 Which of the following types of cancer have you heard of or read about? (please tick yes or no)

	SITE	YES	NO
51	Lung
52	Breast
53	Cervix
54	Mouth
55	Uterus
56	Blood
57	Intestine
58	Stomach
59	Bone
60	Skin
61	Eyes
62	Bladder
63	Kidney
64	Brain

6. KNOWLEDGE OF CANCER SYMPTOMS and SIGNS

65-79 The following are suspicious for the presence of cancer. (tick all that you know)

	SYMPTOM	YES	NO
65	Non-healing Ulcer
66	Inability to fall asleep (insomnia)
67	Abnormal secretion or bleeding
68	Increased appetite
69	Gradual hair loss (balding)
70	Swelling or thickening of any part of the body
71	Frequently passing urine at night in a young person
72	Chronic cough
73	Prolonged diarrhoea (at least 2 weeks)
74	Bloody cough
75	Sudden chest pain
76	Swelling of the brest during menstrual period
77	Difficulty in swallowing
78	Difficulty in passing motion (constipation) for more than 2 weeks
79	Frequent Bone Pains

7. KNOWLEDGE OF CANCER DETECTION METHODS

80-85. Which of the following methods are used for early detection of the cancers indicated (please tick yes or no)

	METHOD	YES	NO
80	Pap smear
81	Mammography
82	Breast Self-examination
83	Chest X-ray
84	Physician Regular Check-up
85	Stool Examination for blood

8. KNOWLEDGE OF CANCER TREATMENT METHODS

86- Indicate which of the following cancer treatment methods you have heard or read about. (please tick yes or no)

	TREATMENT METHOD	YES	NO
86	Chemotherapy
87	Radiotherapy
88	Surgery
89	Hormone therapy

9. KNOWLEDGE OF CANCER RISK FACTORS

95-105 Indicate which of the following do you know are risk factors for cancer

	SITE	YES	NO
90	Tobacco: Cigarette smoking
91	Tobacco: chewing
92	Betel nut chewing
93	Diet: high lipid content
94	Diet: Low vegetables & Fruits
95	Diet: Low in fiber
96	Infections: Viral
97	Multiple sexual partners
98	Alcohol
99	Occupational Exposure
100	Chemicals and Drugs

10. KNOWLEDGE OF CANCER PREVENTION MEASURES

101-115. Which of the following measures could you take to prevent cancer

	SITE	YES	NO
101	Stopping smoking
102	Avoid overeating
103	Frequently eating preserved food
104	Avoid drinking alcohol
105	Increase the intake of meat
106	Include green vegetables and fruits in the diet
107	Increase fiber in the diet
108	Use of herbal medicine
109	Washing hands before meals
110	Avoiding sex with multiple partners
111	Get hepatitis B immunisation
112	Other (specify)
113	Other (specify)
114	Other (specify)
115	Other (specify)

11. OPINIONS ABOUT CANCER

116-125. Indicate your views or perception about cancer in general by ticking the appropriate cell

	ATTITUDE	AGREE	DIS AGREE
116	Cancer can be cured if detected early
117	Cancer is a serious problem
111	Cancer is a punishment for sins and should not be treated
119	Most cancers are life-threatening
120	Only smokers will get cancer
121	Some cancers can be detected early
122	All cancers can be detected early
123	Cancer is very rare and affects only those who are unlucky
124	Some cancers are hereditary
125	Cancer is contagious

12. ATTITUDES TO CANCER

126-131. Indicate your attitudes about cancer in general by ticking the appropriate cell

	ATTITUDE	AGREE	DIS AGREE
126	I would liketo detect cancer early in order to save my life
127	All individuals are at risk of getting cancer
128	I prefer traditional treatment If I have breast cancer
129	I will not see a doctor even if I have early signs of cancer
130	I do not like to sit next to someone smoking
131	I am not concerned about what I eat

13. HEALTH-SEEKING BEHAVIORS

132- 137 Indicate which of the following behaviours you have practised in the past 5 years

	ACTIVITY	YES	NO
132	Hepatitis B vaccination
133	Breast examination by a doctor or a nurse
134	Mammography
135	Breast self-examination
136	Pap smear
137	Annual physical examination

14. SMOKING AND DIETARY HABITS

138-141. Answer to the best of your recollection your smoking and dietary habits

138. Cigarette Smoking Status

Never smoked

Current smoker

Stopped smoking more than 1 year ago

139. Estimate the number of times a week that you consume green vegetables

1-3

4-6

140. Estimate the number of times a week that you consume fruits

1-3

4-6

141. Estimate the number of times a week that you consume meats (beef, mutton, chicken)

1-3

4-6

15. OCCUPATIONAL/ENVIRONMENTAL EXPOSURE

142-150 Indicate your exposure to the following

	OCCUPATION/ENVIRONMENT	Yes	No
142	Farm pesticides
143	Timber factory
144	Chemical industry
145	Automobile factory
146	Mine
147	Batik factory
148	Truck, taxi, or bus driver
149	Garbage disposal or cleaning
150	Electronic factory

16. THE MEDICAL CURRICULUM

In each cell against the item number, indicate 'Y' for 'yes; or 'N' for 'no' the kulliyah of medicine discipline or activity that affected your knowledge, opinions, or attitudes to cancer. Choose as many as apply. Do not leave any cell empty. If you have not taken the discipline yet, indicate 'no'. If you are not sure indicate 'no'

	Knowledge About Various Aspects Of Cancer						Opinions About Cancer	Attitudes To Cancer	Health Seeking Behavior
	Sites	Symptoms & Signs	Detection Methods	Treatment Methods	Risk Factors	Prevention Measures	Opinions About Cancer	Attitudes To Cancer	Health Seeking Behavior
PRE-CLINICAL DISCIPLINES
Anatomy	151.	181.	211.	241.	271.	301.	331.	361.	391.
Biochemistry	152.	182.	212.	242.	272.	302.	332.	362.	392.
Physiology	153.	183.	213.	243.	273.	303.	333.	363.	393.
Pathology	154.	184.	214.	244.	274.	304.	334.	364.	394.
Pharmacology	155.	185.	215.	245.	275.	305.	335.	365.	395.
Microbiology	156.	186.	216.	246.	276.	306.	336.	366.	396.
Parasitology	157.	187.	217.	247.	277.	307.	337.	367.	397.
Psychology	158.	188.	218.	248.	278.	308.	338.	368.	398.
PUB HEALTH DISCIPLINES
Epidemiology	159.	189.	219.	249.	279.	309.	339.	369.	399.
Biostatistics	160.	190.	220.	250.	280.	310.	340.	370.	400.
Community/Family Medicine	161.	191.	221.	251.	281.	311.	341.	371.	401.
CLINICAL DISCIPLINES
Surgery	162.	192.	222.	252.	282.	312.	342.	372.	402.
Internal Medicine	163.	193.	223.	253.	283.	313.	343.	373.	403.
Obstetrics & Gynecology	164.	194.	224.	254.	284.	314.	344.	374.	404.
Pediatrics	165.	195.	225.	255.	285.	315.	345.	375.	405.
Orthopedics	166.	196.	226.	256.	286.	316.	346.	376.	406.
Ear, Nose and Throat	167.	197.	227.	257.	287.	317.	347.	377.	407.
Ophthalmology	168.	198.	228.	258.	288.	318.	348.	378.	408.
Anesthesiology	169.	199.	229.	259.	289.	319.	349.	379.	409.
Radiology	170.	200.	230.	260.	290.	320.	350.	380.	410.
Dermatology	171.	201.	231.	261.	291.	321.	351.	381.	411..
Psychiatry	172.	202.	232.	262.	292.	322.	252.	382,	412.
Sexually transmitted Diseases	173.	203.	233.	263.	293.	323.	253.	383.	413.
ACTIVITIES
Problem-based Learning	174	204.	234.	264.	294.	324.	354.	384.	414.
Seminars	175.	205.	235.	265.	295.	325.	355.	385.	415.
Community Activities	176.	206.	236.	266.	296.	326.	356.	386.	416.
Hospital and ClinicVisits	177.	207.	237.	267.	297.	327.	357.	387.	417.
Research Projects	178.	208.	238.	268.	298.	328.	358.	388.	418.
Medical & Books	179.	209.	239.	269.	299.	329.	359.	389.	419.
Health-related Mass Media	180.	210.	240.	270.	300.	330.	360.	390.	420.

IMPACT OF THE MEDICAL CURRICULUM ON THE KNOWLEDGE, ATTITUDES, AND PRACTICE (KAP) OF MEDICAL STUDENTS RELATING TO CANCER PREVENTION

RESEARCH QUESTIONNAIRE - #2

INSTRUCTIONS

This self-coding questionnaire is used to obtain information from all students. Some questions may not be relevant to some subjects; please skip them by watching out for instructions on the skip patterns.

Start by writing your ID on each page of the questionnaire. This will help put the different pages of the questionnaire together in case of being lost. The ID will also be used to link this questionnaire with subsequent questionnaires that will be administered later. The ID may be your matriculation number, IC number or any other number that you make up. Record your ID in a safe place because you will have to use it on the subsequent questionnaire

Read each question carefully before answering

Remember to write the time and date you completed the questionnaire

The questionnaire has a total of ….. pages and consists of …sections listed below. Make sure you complete all of them

The sections of the questionnaire are as follows:

1. Study Particulars:

2. Personal And Social Profile

3. Family History Of Cancer

4. Source Of Information About Cancer

5. Knowledge Of Cancer Sites

6. Knowledge Of Cancer Symptoms And Signs

7. Knowledge Of Cancer Detection Methods

8. Knowledge Of Cancer Treatment Methods

9. Knowledge Of Cancer Risk Factors

10. Knowledge Of Cancer Prevention Measures

11. Opinions About Cancer

12. Attitudes To Cancer

13. Health-Seeking Behavior

14. Smoking And Dietary Habits

15. Occupational/Environmental Exposure

1. STUDY PARTICULARS:

Complete the following identifying information by ticking the correct response or writing the correct answer. Ignore questions or responses that do not apply

1. ID Number (Matric No, IC Number, Passport Number, any other Identifying Number)

2. Date of birth (dd/mm/yyyy)

3. Year enrolled in UIA Kulliyah of Medicine

1. 1997 2. 1998 3. 1999 4. 2000 5. 2001

4. Current year of study

1. 1^st year 2. 2^nd year 3. 3^rd year 4. 4^th year 5. 5^th year

5. Date questionnaire completed (dd/mm/yy)

6. Initials to indicate informed consent

1. Yes 2. No

2. PERSONAL AND SOCIAL PROFILE

Complete the following identifying information by ticking the correct response or writing the correct answer. Ignore questions or responses that do not apply

7. Age (write your age in years at the last birthday anniversary)

8. Gender

9. Ethnic Group

10-11. District of birth and Home District

Please write the number of the respective district from the table in the box below

10. District of birth ________

11. Home District (where permanent family home is) _________

12. Weight in Kg

13. Height in cm

14. Religion

Muslim

Hindu

Budhist

Christian

Other (specify)

15. Marital Status:

Married

Divorced

Widowed

4. Never married

3. FAMILY HISTORY OF CANCER

16-25. Indicate if you know that any of your relatives had any cancers.

(please tick yes or no).

	RELATION	YES	NO	DO NOT KNOW
16	Father
17	Mother
18	Brother
19	Sister
20	Grandfather
21	Grandmother
22	Uncle
23	Aunt
24	Other (specify
25	Other (specify)

4. SOURCE OF INFORMATION ABOUT CANCER

26- 50 From your knowledge of cancer, indicate the source of your information. (please tick yes or no)

	SOURCE	YES	NO
26	Doctor
27	Nurse at a health centre
28	Nurse in a hospital
29	Other health staff
30	Volunteer non-health staff
31	National television
32	Foreign television (satellite/cable)
33	Radio
34	Primary School Classes
35	Newspaper
36	Magazines
37	Books (academic)
38	Books (General and popular)
39	Pamphlets & Newsletters
40	Family members
41	Secondary School teachers
42	Neighbours
43	Friends
44	Religious leaders
45	Matriculation teachers
46	Internet
47	Political leaders or Govt. officials
48	University lecturers
49	Social clubs or social gatherings
50	Exhibitions/Advertisements (posters)

5. KNOWLEDGE OF CANCER SITES

51-64 Which of the following types of cancer have you heard of or read about? (please tick yes or no)

	SITE	YES	NO
51	Lung
52	Breast
53	Cervix
54	Mouth
55	Uterus
56	Blood
57	Intestine
58	Stomach
59	Bone
60	Skin
61	Eyes
62	Bladder
63	Kidney
64	Brain

6. KNOWLEDGE OF CANCER SYMPTOMS and SIGNS

65-79 The following are suspicious for the presence of cancer. (tick all that you know)

	SYMPTOM	YES	NO
65	Non-healing Ulcer
66	Inability to fall asleep (insomnia)
67	Abnormal secretion or bleeding
68	Increased appetite
69	Gradual hair loss (balding)
70	Swelling or thickening of any part of the body
71	Frequently passing urine at night in a young person
72	Chronic cough
73	Prolonged diarrhoea (at least 2 weeks)
74	Bloody cough
75	Sudden chest pain
76	Swelling of the brest during menstrual period
77	Difficulty in swallowing
78	Difficulty in passing motion (constipation) for more than 2 weeks
79	Frequent Bone Pains

7. KNOWLEDGE OF CANCER DETECTION METHODS

80-85. Which of the following methods are used for early detection of the cancers indicated (please tick yes or no)

	METHOD	YES	NO
80	Pap smear
81	Mammography
82	Breast Self-examination
83	Chest X-ray
84	Physician Regular Check-up
85	Stool Examination for blood

8. KNOWLEDGE OF CANCER TREATMENT METHODS

86- Indicate which of the following cancer treatment methods you have heard or read about. (please tick yes or no)

	TREATMENT METHOD	YES	NO
86	Chemotherapy
87	Radiotherapy
88	Surgery
89	Hormone therapy

9. KNOWLEDGE OF CANCER RISK FACTORS

95-105 Indicate which of the following do you know are risk factors for cancer

	SITE	YES	NO
90	Tobacco: Cigarette smoking
91	Tobacco: chewing
92	Betel nut chewing
93	Diet: high lipid content
94	Diet: Low vegetables & Fruits
95	Diet: Low in fiber
96	Infections: Viral
97	Multiple sexual partners
98	Alcohol
99	Occupational Exposure
100	Chemicals and Drugs

10. KNOWLEDGE OF CANCER PREVENTION MEASURES

101-115. Which of the following measures could you take to prevent cancer

	SITE	YES	NO
101	Stopping smoking
102	Avoid overeating
103	Frequently eating preserved food
104	Avoid drinking alcohol
105	Increase the intake of meat
106	Include green vegetables and fruits in the diet
107	Increase fiber in the diet
108	Use of herbal medicine
109	Washing hands before meals
110	Avoiding sex with multiple partners
111	Get hepatitis B immunisation
112	Other (specify)
113	Other (specify)
114	Other (specify)
115	Other (specify)

11. OPINIONS ABOUT CANCER

116-125. Indicate your views or perception about cancer in general by ticking the appropriate cell

	ATTITUDE	AGREE	DIS AGREE
116	Cancer can be cured if detected early
117	Cancer is a serious problem
111	Cancer is a punishment for sins and should not be treated
119	Most cancers are life-threatening
120	Only smokers will get cancer
121	Some cancers can be detected early
122	All cancers can be detected early
123	Cancer is very rare and affects only those who are unlucky
124	Some cancers are hereditary
125	Cancer is contagious

12. ATTITUDES TO CANCER

126-131. Indicate your attitudes about cancer in general by ticking the appropriate cell

	ATTITUDE	AGREE	DIS AGREE
126	I would liketo detect cancer early in order to save my life
127	All individuals are at risk of getting cancer
128	I prefer traditional treatment If I have breast cancer
129	I will not see a doctor even if I have early signs of cancer
130	I do not like to sit next to someone smoking
131	I am not concerned about what I eat

13. HEALTH-SEEKING BEHAVIOR

132- 137 Indicate which of the following behaviours you have practised in the past 5 years

	ACTIVITY	YES	NO
132	Hepatitis B vaccination
133	Breast examination by a doctor or a nurse
134	Mammography
135	Breast self-examination
136	Pap smear
137	Annual physical examination

14. SMOKING AND DIETARY HABITS

138-141. Answer to the best of your recollection your smoking and dietary habits

138. Cigarette Smoking Status

1. Never smoked 2. Current smoker 3. Stopped > 1 year ago

139. Estimate the number of times a week that you consume green vegetables

a. 0

b. 1-3

c. 4-6

d. 7+

140. Estimate the number of times a week that you consume fruits

a. 0

b. 1-3

c. 4-6

d. 7+

141. Estimate the number of times a week that you consume meats (beef, mutton, chicken)

a. 0

b. 1-3

c. 4-6

d. 7+

15. OCCUPATIONAL/ENVIRONMENTAL EXPOSURE

142-150 Indicate your exposure to the following

	OCCUPATION/ENVIRONMENT	Yes	No
142	Farm pesticides
143	Timber factory
144	Chemical industry
145	Automobile factory
146	Mine
147	Batik factory
148	Truck, taxi, or bus driver
149	Garbage disposal or cleaning
150	Electronic factory

KNOWLEDGE FROM THE MEDICAL CURRICULUM

Indicate by marking 'yes' or 'no' the disciplines from which you learned the specific information about cancer

ATTITUDES ABOUT CANCER FROM THE MEDICAL CURRICULUM

18. PRACTICE and BEHAVIORS REGARDING CANCER FROM THE CURRICULUM

IMPACT OF THE MEDICAL CURRICULUM ON THE KNOWLEDGE, ATTITUDES, AND PRACTICE (KAP) OF MEDICAL STUDENTS RELATING TO CANCER PREVENTION

RESEARCH QUESTIONNAIRE - #2

INSTRUCTIONS

Read each question carefully before answering

Remember to write the time and date you completed the questionnaire

The questionnaire has a total of ….. pages and consists of …sections listed below. Make sure you complete all of them

The sections of the questionnaire are as follows:

1. Study Particulars:

2. Personal And Social Profile

3. Family History Of Cancer

4. Source Of Information About Cancer

5. Knowledge Of Cancer Sites

6. Knowledge Of Cancer Symptoms And Signs

7. Knowledge Of Cancer Detection Methods

8. Knowledge Of Cancer Treatment Methods

9. Knowledge Of Cancer Risk Factors

10. Knowledge Of Cancer Prevention Measures

11. Opinions About Cancer

12. Attitudes To Cancer

13. Health-Seeking Behavior

14. Smoking And Dietary Habits

15. Occupational/Environmental Exposure

1. STUDY PARTICULARS:

Complete the following identifying information by ticking the correct response or writing the correct answer. Ignore questions or responses that do not apply

1. ID Number (Matric No, IC Number, Passport Number, any other Identifying Number)

2. Date of birth (dd/mm/yyyy)

3. Year enrolled in UIA Kulliyah of Medicine

1. 1997 2. 1998 3. 1999 4. 2000 5. 2001

4. Current year of study

1. 1^st year 2. 2^nd year 3. 3^rd year 4. 4^th year 5. 5^th year

5. Date questionnaire completed (dd/mm/yy)

6. Initials to indicate informed consent

1. Yes 2. No

2. PERSONAL AND SOCIAL PROFILE

Complete the following identifying information by ticking the correct response or writing the correct answer. Ignore questions or responses that do not apply

7. Age (write your age in years at the last birthday anniversary)

8. Gender

1. Male

2. Female

9. Ethnic Group

1. Malay

2. Chinese

3.Indian

4.Other (please specify)

10-11. District of birth and Home District

Please write the number of the respective district from the table in the box below

10. District of birth ________

11. Home District (where permanent family home is) _________

12. Weight in Kg

13. Height in cm

14. Religion

Muslim

Hindu

Budhist

Christian

Other (specify)

15. Marital Status:

Married

Divorced

Widowed

4. Never married

3. FAMILY HISTORY OF CANCER

16-25. Indicate if you know that any of your relatives had any cancers.

(please tick yes or no).

	RELATION	YES	NO	DO NOT KNOW
16	Father
17	Mother
18	Brother
19	Sister
20	Grandfather
21	Grandmother
22	Uncle
23	Aunt
24	Other (specify
25	Other (specify)

4. SOURCE OF INFORMATION ABOUT CANCER

26- 50 From your knowledge of cancer, indicate the source of your information. (please tick yes or no)

	SOURCE	YES	NO
26	Doctor
27	Nurse at a health centre
28	Nurse in a hospital
29	Other health staff
30	Volunteer non-health staff
31	National television
32	Foreign television (satellite/cable)
33	Radio
34	Primary School Classes
35	Newspaper
36	Magazines
37	Books (academic)
38	Books (General and popular)
39	Pamphlets & Newsletters
40	Family members
41	Secondary School teachers
42	Neighbours
43	Friends
44	Religious leaders
45	Matriculation teachers
46	Internet
47	Political leaders or Govt. officials
48	University lecturers
49	Social clubs or social gatherings
50	Exhibitions/Advertisements (posters)

5. KNOWLEDGE OF CANCER SITES

51-64 Which of the following types of cancer have you heard of or read about? (please tick yes or no)

	SITE	YES	NO
51	Lung
52	Breast
53	Cervix
54	Mouth
55	Uterus
56	Blood
57	Intestine
58	Stomach
59	Bone
60	Skin
61	Eyes
62	Bladder
63	Kidney
64	Brain

6. KNOWLEDGE OF CANCER SYMPTOMS and SIGNS

65-79 The following are suspicious for the presence of cancer. (tick all that you know)

	SYMPTOM	YES	NO
65	Non-healing Ulcer
66	Inability to fall asleep (insomnia)
67	Abnormal secretion or bleeding
68	Increased appetite
69	Gradual hair loss (balding)
70	Swelling or thickening of any part of the body
71	Frequently passing urine at night in a young person
72	Chronic cough
73	Prolonged diarrhoea (at least 2 weeks)
74	Bloody cough
75	Sudden chest pain
76	Swelling of the brest during menstrual period
77	Difficulty in swallowing
78	Difficulty in passing motion (constipation) for more than 2 weeks
79	Frequent Bone Pains

7. KNOWLEDGE OF CANCER DETECTION METHODS

80-85. Which of the following methods are used for early detection of the cancers indicated (please tick yes or no)

	METHOD	YES	NO
80	Pap smear
81	Mammography
82	Breast Self-examination
83	Chest X-ray
84	Physician Regular Check-up
85	Stool Examination for blood

8. KNOWLEDGE OF CANCER TREATMENT METHODS

86- Indicate which of the following cancer treatment methods you have heard or read about. (please tick yes or no)

	TREATMENT METHOD	YES	NO
86	Chemotherapy
87	Radiotherapy
88	Surgery
89	Hormone therapy

9. KNOWLEDGE OF CANCER RISK FACTORS

95-105 Indicate which of the following do you know are risk factors for cancer

	SITE	YES	NO
90	Tobacco: Cigarette smoking
91	Tobacco: chewing
92	Betel nut chewing
93	Diet: high lipid content
94	Diet: Low vegetables & Fruits
95	Diet: Low in fiber
96	Infections: Viral
97	Multiple sexual partners
98	Alcohol
99	Occupational Exposure
100	Chemicals and Drugs

10. KNOWLEDGE OF CANCER PREVENTION MEASURES

101-115. Which of the following measures could you take to prevent cancer

	SITE	YES	NO
101	Stopping smoking
102	Avoid overeating
103	Frequently eating preserved food
104	Avoid drinking alcohol
105	Increase the intake of meat
106	Include green vegetables and fruits in the diet
107	Increase fiber in the diet
108	Use of herbal medicine
109	Washing hands before meals
110	Avoiding sex with multiple partners
111	Get hepatitis B immunisation
112	Other (specify)
113	Other (specify)
114	Other (specify)
115	Other (specify)

11. OPINIONS ABOUT CANCER

116-125. Indicate your views or perception about cancer in general by ticking the appropriate cell

	ATTITUDE	AGREE	DIS AGREE
116	Cancer can be cured if detected early
117	Cancer is a serious problem
111	Cancer is a punishment for sins and should not be treated
119	Most cancers are life-threatening
120	Only smokers will get cancer
121	Some cancers can be detected early
122	All cancers can be detected early
123	Cancer is very rare and affects only those who are unlucky
124	Some cancers are hereditary
125	Cancer is contagious

12. ATTITUDES TO CANCER

126-131. Indicate your attitudes about cancer in general by ticking the appropriate cell

	ATTITUDE	AGREE	DIS AGREE
126	I would liketo detect cancer early in order to save my life
127	All individuals are at risk of getting cancer
128	I prefer traditional treatment If I have breast cancer
129	I will not see a doctor even if I have early signs of cancer
130	I do not like to sit next to someone smoking
131	I am not concerned about what I eat

13. HEALTH-SEEKING BEHAVIOR

132- 137 Indicate which of the following behaviours you have practised in the past 5 years

	ACTIVITY	YES	NO
132	Hepatitis B vaccination
133	Breast examination by a doctor or a nurse
134	Mammography
135	Breast self-examination
136	Pap smear
137	Annual physical examination

14. SMOKING AND DIETARY HABITS

138-141. Answer to the best of your recollection your smoking and dietary habits

138. Cigarette Smoking Status

1. Never smoked 2. Current smoker 3. Stopped > 1 year ago

139. Estimate the number of times a week that you consume green vegetables

a. 0

b. 1-3

c. 4-6

d. 7+

140. Estimate the number of times a week that you consume fruits

a. 0

b. 1-3

c. 4-6

d. 7+

141. Estimate the number of times a week that you consume meats (beef, mutton, chicken)

a. 0

b. 1-3

c. 4-6

d. 7+

15. OCCUPATIONAL/ENVIRONMENTAL EXPOSURE

142-150 Indicate your exposure to the following

	OCCUPATION/ENVIRONMENT	Yes	No
142	Farm pesticides
143	Timber factory
144	Chemical industry
145	Automobile factory
146	Mine
147	Batik factory
148	Truck, taxi, or bus driver
149	Garbage disposal or cleaning
150	Electronic factory