Chapter (1)

Introduction

1.1 Objectives of Residential Field Training

1. Aware of community lifestyle, values, norms, tradition, and customs
2. Know the setup and function of health departments, centers, programs and
projects at the peripheral level
3. Observe roles of government and NGOs in healthcare activities
4. Notice conditions in community that may facilitate or impede healthcare
5. Improve communication skills in health service provision
6. Acquire the knowledge and skills concerning health research
7. Eager to be involved in health and community activities for the total
development of the country

1.2 Introduction to Residential Field Training

Residential field training program (RFT), a three-week course, is a required

curricular activity for Final Part (1) MBBS students to acquire community exposure
and graduate medical training in accordance with the guidelines recommended by the
medical education seminars. Groups of 37 students of mixed gender are sent to
various townships assigned by the university. With the joint effort of the Department
of Human Resource for Health, Department of Medical Care, Department of Public
Health and Regional Health Department (Yangon), Department of Preventive and
Social Medicine, University of Medicine (2) Yangon, a total of nine townships were
selected in the Yangon region. The students went to their respective townships on
October 23rd and 24th, 2023.

The RFT program has provided us with intellectual abilities and awareness of
community lifestyles. In addition, it helps the students experience self-dependency,
the strength of unity, and adaptation to a new environment.

1
 In the future, medical students will become doctors responsible for creating
optimal health conditions in the community. RFT is a stepping stone, allowing us to
know what community needs are, how the community works, and what problems the
community is encountering.

On October 16, 2023, the 1st day of RFT, we did the survey at the University
of Medicine (2), Yangon. The topic of our survey is “Readiness for AI among
Medical Students." After collecting and analyzing these data, our group had written a
report.

On RFT day 2, we learned about Health Care Administration in Myanmar. On

day 3, we had a chance to get the point of Universal Health Coverage and Primary
Health Care activities at the township level. On days 4 and 5, we got to know about
the organization and facilities, the setup of the Township Health Department, Station
Health Unit, and Rural Health Centre, the duties and responsibilities of the Township
Medical Officer, Station Medical Officer, and Basic Health Staff and Maternal and
Reproductive health and Adolescent health.

On days 6 and 7, we went to Hlegu Township and got wise to the facts about
the organization, setup, and functions of the Hlegu Township Health Department. On
days 8 and 9, we had a chance to become aware of vector-borne disease control
(Malaria, Dengue Hemorrhagic Fever, Filariasis and Japanese Encephalitis). In the
afternoon, we ascertained one of the important topics in Epidemiology “Outbreak
Investigation and Surveillance”.

On day 10, we gained an understanding of occupational and environmental

health. In the afternoon, we came to know about the routine immunization program
and current TB control activities in Myanmar. On day 11, we assimilated about food
and drug control activities, current elderly activities, and current HIV/STI control
activities in Myanmar. In the afternoon, we discussed the important nutritional
problems in Myanmar and the prevention and control of these nutritional problems.

2
 On day 12, we acquired knowledge of the non-communicable diseases
(NCDs) in Myanmar, the important NCDs in Myanmar, their prevalence, modifiable
and non-modifiable risk factors, and PEN projects in Myanmar. On day 13, we
finalized our report writing and did rehearsals for our grand presentation on RFT, a
photo show by the respective RFT groups, and our academic poster display. All in all,
our RFT gave us knowledge of the organization and setup of THD, SHU, RHC, and
subcenters, as well as the roles and responsibilities of basic health staff. Besides, we
had a great chance to meet these basic health staff and observe what they were doing
in real life.

1.3 Residential Field Training to Hlegu Township

On the first day, we are warmly welcomed by the Township Medical Officer
(TMO) of Hlegu General Hospital, Dr. Thaung Dan Oo, letting us experience the
generosity and hospitability. Then TMO explained the organization setup and
functions of Hlegu Township Health Department, hospital management, public health
services, disease control program, maternal and child health, EPI program, and
disaster management. And we had a chance to learn about the Cold Chain System,
and he briefly explained about vaccine vial monitoring and adverse events following
immunization.

After that, Township Health Nurse (THN) Daw Kyi Kyi Lwin explained the
nine components of School Health in detail. She also provided information about the
COVID-19 vaccination in every school from June to September. Later, Health
Assistant (HA) Daw Moe Moe Hlaing described the Epidemiology and treatment
procedures of sexually transmitted diseases, mainly HIV and Syphilis. She then
explained that pregnant women should perform screening tests for HIV at the time of
antenatal care, and if the test result is positive, they should immediately start ART
regimen and suggested elective caesarean delivery to prevent mother to child
transmission. She also explained how to treat HIV patients with TB. She shared
knowledge about Malaria prevention and control programs.

3
 In Gyo Gon Rural Health Center, Health Assistant (HA) U Zaw Min Htun
gave an explanation about RHC profiles, setup, and functions. He also explained
about Antenatal care, Maternal and Child Health, under-5 children's Health Care,
deworming, EPI programs, and environmental sanitation services that are performed
by RHC. Then we went to Phaung Gyi Station Health Unit. Station Medical Officer
(SMO) Dr. Thant Zin Htun explained the setup and functions of SHU.

On the second day, our contributors gave health education about “Seasonal
Flu” and “Antimicrobial Drug Resistance” to the people of Hlegu. Meanwhile, TMO
took some medical students to the operation theatre and taught them about the history
and treatment steps of the patients in the ward.

During RFT, we managed to take care of one another. We are also involved in
community activities and know that our communication skills are essential in health
care. In addition, we got to contact different cultures, customs, norms, and values in
rural and urban areas.

Hlegu Township Residential Field Training Group

Final Part -1, M.B., B.S (5/2023)

University of Medicine (2), Yangon

4
 Chapter (2)

GENERAL DESCRIPTION OF TOWNSHIP

GEOGRAPHIC AND SOCIO-DEMOGRAPHIC DATA

1. Area 1787.1 Sq.Km

2. Location Yangon Region, North of the City of Yangon

3. Contour

a. East - Bago

b. West - Taik Kyi, Hmawbi, Mingalardon

c. South - North Okkalapa, Dagon Myothit

d. North - Bago Yoma

4. Population (2022)

Total - 265930

Urban - 41376

Rural - 224554

Male - 129904

Female - 106026

Sex Ratio - 0.48:0.52

<1 yr - 4625

<5 yr - 20916

0-14 yr - 55704

5
 15-49 yr - 64834

>60 yr - 36783

No. of housing - 58217

5. Population density - 135.71 per sq-km

6. Wards &villages in township

Wards 5

Village Tracts 52

Village 194

7. Health facilities

Township Hospital (50) Bedded 1

Station Hospital 3

M.C.H /UHC 1

School Health Team 1

Rural Health Centers 8

1) Gyo Gone RHC

2) Sar Bu Taung RHC
3) Kali Htaw RHC
4) Nar Su Taung RHC
5) Inn Tine RHC
6) Bo Yin Kalay RHC
7) Ngwe Na Thar RHC
8) Kyungalay RHC

6
Sub Health Centers 37

Station Health Unit 3

7
TOWNSHIP HEALTH PROFILE

1. Organization setup of Township Health Department

8
Organization setup of Rural Health Center

9
2. Health manpower

DR N HA LHV THN MW PHS II

Sanction 10 39 13 14 2 67 68
Appointed 8 27 12 7 1 37 36
Vacant 2 12 1 7 1 30 32

3. Health volunteers
C.H.W A.M.W T.T.B.A
Trained (New) 0 0 0
Functioning 28 43 1

4. School health

2020 2021 2022

% Coverage of Schools Examined 100 99 100

% Coverage of primary school Students Examined 0 90 96

% Coverage of school with Sanitary Latrine 99 99 99

5. Health education

2020 2021 2022

Average No. of HE frequencies per month 627.8 254.3 1425.6

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Average No. of HE frequencies by BHS 56.6 1526 208.6

6. Environmental health

2020 2021 2022

% Coverage of Sanitary Latrine (Total) 74 77 94.7

% Coverage of Sanitary Latrine (Urban) 77.5 84.8 99.2

% Coverage of Sanitary Latrine (Rural) 92 95 92

7. Primary health care

2020 2021 2022

Rate of General Clinic Attendance (%) 29.9 17 25

No. of Cases Referred 1.5 1.4 0.3

8. Reproductive health

2020 2021 2022

AN Care Coverage (%) 98.5 65 91

% of Home Deliveries by BHS 10.2 13 7

% of Institutional Delivery 56.2 59 50

% of skilled birth attendant 98 84 82

Rate of Referral (%) 29.3 22.8 24

Avg. no. of Attendance (AN) 5 4 5

11
Avg. no. of Attendance (PN) 6 5 5

% of Postnatal care coverage 68.3 65.3 67.2

9. Child health
2020 2021 2022
% of ORT Use Rate 100 97.4 94.7
% of Antibiotic coverage in Pneumonia Cases 100 100 100
% of newborn care coverage within 3 days 69.2 61.1 65

10. Nutrition
2020 2021 2022
% of newborns with LBW 0.3 0.2 0.6

% of under five children with underweight 2.5 1.8 2

% of villages/wards with qualified

100 100 100
consumption of adequately iodized salt

11. E.P.I
2020 2021 2022

BCG % 97.5 65 88

OPV3 % 85.7 70.2 87

Pentavalent3 % 97.9 70.2 33

Measles% 82.5 59.8 85
TT2 % 82.5 49.2 60

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12. E.P.I Target diseases
2021 2022

DISEASES
Cases Death Cases Death

Diphtheria 0 0 0 0
Pertussis 0 0 0 0
Neonatal Tetanus 0 0 0 0

Measles 0 0 0 0

13. Common diseases in DUNS

2022

Morbidity Mortality

Malaria (per 100000 Pop) 9.3 0

ARI (Pneumonia) (per 100000 Children) 922.7 4.8

Diarrhoea (per 100000 Pop) 244.8 0

Dysentery (per 100000 Pop) 104.9 0

TB (Sputum Smear +) (per 100000 Pop) 3.2 0.45

Snake Bite (per 100000 Pop) 24.4 1.1

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14. Health impact indicators
2020 2021 2022

Population Growth Rate % 17.7 12.6 16.3

Reported IMR / 1000 LB 4 2.2 2
Reported U5MR / 1000 LB 5.1 2.5 2.8
Reported MMR / 100,000 LB 66 30.8 69
Abortion Rate % 1.3 0.67 4

15. Malaria, Tuberculosis and Leprosy

2020 2021 2022
No. of malaria cases among out-patients (New) 0.001 0.0002 0.06
No. of new TB sputum positive patients 207 186 304
No. of TB sputum negative patients 168 158 348
No. of extra pulmonary TB cases 35 28 24
Remaining leprosy cases (PB) 0 0 0
Remaining leprosy cases (MB) 6 1 5

16. Non-communicable diseases & risk factors

2020 2021 2022

Number of Hypertension Cases 2465 1295 2331

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Smoking Cases per 1000 >15 Years Population 147 168 197.1
Alcoholic Cases per 1000 Population 6 3.9 4.1

Deafness Cases per 1000 Population 0 0 0

Blindness Cases per 1000 Population 0 0 0

17. Accident and Injury

2020 2021 2022

RTA Cases per 1000 Population 4.6 2.6 2

Injury Cases due to Assaults per 1000 Population 1.7 1.3 1.4

Suicide Cases per 1000 Population 0.07 0.03 0.03

FUNCTION OF TOWNSHIP HEALTH DEPARTMENT

1. Medical Care
2. Community Health Care
3. Disease Control Activities
4. Environmental Sanitation Activities
5. Administration

Medical Care

Hlegu Township Health Department give hospital services and care providing
both inpatient and outpatient care. 50 bedded township hospital is provided for
inpatient care services. UHC, RHC, Sub Centre are provided for outpatient care
services. It also provides social security services, dental health services and eye
care. Social security services cover sickness benefits, maternity benefit, disability
benefits and etc.

15
Community Health Care

(a) Urban Health Care

 By providing through Urban Township Units led by TMO. It provided the
following health services
 General medical, pediatric and dental care
 Maternity and child health care (MCH)
 School health care (SCH)
 Control of communicable diseases and immunization
 Environmental sanitation
 Health education including the subject of nutrition
 Recording and report of vital statistics
 MCH & SH have medical officers (MCHO and SHO). If they are present,
they assist TMO. If they are absent, TMO serves as these officers.
 These centers provide no hospital service.
(b) Maternal and Child Health Services
 Not a separate vertical program but are provided by urban MCH center in
small towns and Urban Health Center in Large Cities like Yangon and
Mandalay and by rural health center in rural areas
 In large cities, there is a medical officer for this service known as Maternal
and child health officer (MCHO) and other staffs particularly assigned for
MCH works
 In other areas, it was provided by TMO, THO and basic health staffs
(c) School Health Services
 SHS are provided only in large cities and certain big town. School Health
Team included School Health Officer (SHO), Dental Surgeon and other
staffs.
 In Small Township with no SH services, TMO and THO conduct school
health service with the help of MCH staffs.
 In rural areas, SH services are provided with the help of RHC staffs.
(d) Occupational Health Services

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  It provides
 Occupational safety, health and welfare of the workers
 Preventive health services to workers in different trades
 Factory medical officers in factories provide OH service. If they are
absent, TMO provided as the ex-official medical inspector of the factory.
(e) Environmental Health Services
 Include services for providing water supply to health institutions, hospital
sanitation and improvement of village water supply through chlorination
and water testing.
(f) Nutritional Services
 Risk population to nutritional disorders
 Children under 5 years of age
 Pregnant and lactating mothers
 Nutritional services (Demonstration programs) can be launched in
MCH centers and RHCs
 For pregnant and lactating mothers, vitamins, iron and folic acid
tablets are provided
 For under 5 and primary school children, high potency vitamin A
capsule and nutritious food are provided
(g) Health Education
 Training courses on HE for health workers, members from Red Cross
Association, USDA and MCWA members
 In some township, health education officers have been appointed
(h) Rural Health Center
 RHC are situated in village tracts and provided ambulatory health care to
the rural population. The services include medical care, community health
care and disease control.

Disease Control Activities

(a) Communicable Diseases

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 Vector Borne Disease Control program: To control four principle vector borne
diseases (Malaria, DHF, Filariasis and JBE) with community participation.

TB Control Program: Early detection and treatment by DOTS, STOP Strategy

and END TB Strategy, BCG vaccination to all under one-year children .

Leprosy Control Program: To reduce the prevalence to less than 10,000

populations, By Intensive Case Finding and Treat with MDT, Disability
limitation and Rehabilitation.

Trachoma control and prevention of blindness project: To reduce blindness

rate to less than 0.5%, Eye health examination by field teams, Train BHS to
recognize emergency eye conditions and common eye disease, “SAFE”
strategies to prevent trachoma (S - Surgery to treat advanced form of
trachoma, A - Antibiotics to treat and prevent infection, F - Facial cleanliness,
E - Environmental improvements, particularly in water sanitation and fly
control).

HIV/STD control project: Case finding, Contact tracing, Syndromic

Management of STD cases.

(b) Non-Communicable Diseases such as hypertension, diabetes mellitus and mental

health

(c) Epidemiological Surveillance: Case Detection, Reporting, Investigation and

Information, Analysis and Interpretation, Action and Control

Environmental Sanitation Activities

1. Environmental Health
2. Community water supply and sanitation
3. Air and water pollution control
4. Food and Drug Control

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 5. Efficient and safe animal, human, and industrial waste disposal

Administration

1. General Administration
 Working in coordination with other Government Organization, NGO
and Community Leaders
 Supervision of THD, SHU, and RHC
 Work allocation to THO
 Office Administration
2. Hospital Administration
 Work allocation among MOs, Nurses and other staffs
 Maintenance of equipment, drugs, buildings and medical stores
 Cooperation with Hospital Administration committee
 Issue Instructions
3. Field Administration
 Regular touring and supervision to SHU and RHCs
 Cooperation and coordination with other Government sectors

DESCRIPTION OF HEALTH PROBLEMS OF THE TOWNSHIP

Road Traffic Accident

It is the first leading cause of death in Hlegu Township in 2022. It is mostly

found in motorcyclists. The rate of injury and death among motorcyclists is far higher
than among car drivers. This vulnerability is mainly because of the instability of the
two-wheeled vehicle, but the generally younger age group of the riders with more rash
driving behavior, the greater the acceleration capability, and the lack of structural
protection are contributory factors.

The related risk factors of road traffic accident in this area are having low
driving standards, defective roads and poor street lighting, widespread disregard of
traffic roles and increasing number of motorcycles and scooters.

19
 Road traffic accidents can be prevented by promoting of safety measures like
seat belts and safety helmets, giving safety education about risk factors, obeys traffic
rules and regulations. Alcohol and drugs such as barbiturates and cannabis should be
controlled to decrease accidents. Using mobile phone while driving should also be
prohibited. First aid course should be provided to voluntary health workers and it is
important to timely rescue the injured person by treating with first aid trauma care and
transporting to nearest hospital in this township.

Cirrhosis

It is the second most common health problem in Hlegu. It is a condition in

which the liver is scarred & permanently damaged. Scar tissues replace healthy liver
tissues & prevent the liver from working normally. As Cirrhosis gets worse, the liver
will begin to fail.

The major treatment should be aimed at alcohol addicts. Cirrhosis is caused by

excessive alcohol consumption and alcohol drinking should be reduced or avoided. It
is not only important to maintain weight and eat healthy food but also need to take
medication for control of hepatitis, other causes and symptoms of Cirrhosis.

To prevent Cirrhosis, avoid drinking alcohol as much as possible, eat healthy

diet, maintain ideal weight and try to reduce other risks of hepatitis.

Chronic Obstructive Pulmonary Disease

The third most common health problem is COPD. Exposure to lung irritants
like tobacco smoke or chemicals can damage lungs and airways. Long-term exposure
can cause COPD, which included chronic bronchitis and emphysema. Leading cause
of COPD is smoking, however 1 person in 4 with COPD never smoked.

COPD is often referred to as a “Smoker’s disease” but people who never

smoke may also develop COPD due to other risk factors like -

20
 1. History of childhood respiratory infections
2. Smoke exposure from coal or wood burning stove
3. People with history of asthma
4. Age 40 and over
Beyond smoking, some reasons for the increased risk of developing COPD may
include exposures to indoor and outdoor pollutants, occupational exposures & lack of
access to healthcare.
To reduce risk for COPD, quit smoking, avoid secondhand smoke exposure, stay
up to date with vaccinations. If the workplaces expose chemicals, dusts & fumes, use
appropriate protective equipment & attend safety training. COPD is a progressive
disease & it can get worse overtime. The earlier COPD is diagnosed, the sooner the
treatment can begin.

Abortion

It is the fourth most common health problem in this township. Unsafe

abortions are common and are provided by traditional birth attendants, usually
through the use of abdominal messages or traditional medicine, through sometimes by
introducing of foreign bodies like bicycles spokes in the cervix. Misinformation and
fear of harassment keep many women from accessing timely care of mortality and
morbidity in this township.

The major risk factor of abortion is the lack of antenatal care due to three
delay models which are delay in reaching care, delay in receiving care and delay in
seeking care. The others related risk factors of abortion are having low socio-
economic status, lack of medical knowledge about contraception, dangers of abortion.

To help to reduce the number of abortion cases, we need to provide health

education about the use of contraceptives to prevent unwanted pregnancy and about
the early warning signs of complications of abortion. Midwives and lady health
visitors play a significant role in management of post abortion care, complication,
counselling for birth spacing and contraception and infection control. It is important

21
to provide follow up checkup with the aim of improving coverage and quality of
contraceptive after abortion.

Diabetes Mellitus

Diabetes Mellitus is the fifth most common disease at Hlegu. Diabetes is a

heterogonous group of diseases characterized by chronic hyperglycemia, resulting
from a diversity of etiologies, environmental and genetic, acting jointly. Genetic
factors are non-modifiable but environmental factors are modifiable to prevent
diabetes. It is linked with sedentary lifestyle, over nutrition and obesity, correction of
these may reduce the risk and complication.

Aim of treatment is to maintain blood glucose level near normal, maintain

ideal body weight and prevent complication such as blindness, gangrene of the lower
limbs and etc. Treatment is based on diet alone or diet and oral anti-diabetic drugs or
diet and insulin.

Health education to individual, family and community about prevention of

environmental risk factors and disability through its complication by without
treatment and Screening of high-risk groups for early detection and effective control
of hyperglycemia in asymptomatic diabetes reduces not only morbidity but also
mortality.

Snakebite

Snakebite is common in tropical countries. The main effects of envenoming

are local swelling, bruising, and regional lymphadenopathy, descending paralysis, loin
pain and renal angle tenderness due to acute kidney injury, shock and DIC.

According to Myanmar Snakebite Management Guidelines,

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 1. First Aid Management (Pre-hospital)– Clean the bitten parts and folded
cloth pad placed on the bitten area and apply a firm bandage and
immobilize the bitten limb with posterior splint, if possible, not to allow
working.
2. Emergency Care – Check airways, breathing and circulation.
3. Local Wound Management – wound debridement, anti-inflammatory
drug, antibiotics and anti-tetanus toxoid.
4. Anti-snake venom should be given as soon as possible if there is
indication.

The snakebite is associated with environmental and occupational hazards like

agriculture. The agricultural workers must wear top boots to prevent snakebite. There
is also primary health care to community by voluntary health workers and basic health
staff. First aids measure for snakebite and timely referral would be lifesaving. Killing
the snake is not recommended but if the snake has been killed, it may be taken to the
hospital and may provide a clue towards treatment. Prevention is more effective. So, it
is needed to avoid area where there is tall grass and brush, resist sticking a hand or
foot into hole, realize that snake can climb trees and wear heavy boots and long pants
when being out in the wilderness.

ROLE OF NGOS IN HEALTH CARE OF COMMUNITY

There are NGOs such as MMGWA, MMA, IRC, Red Cross, Nurse
Association & HA Associations. There NGOs are in official relationship with WHO
& UNICEF. NGOs endorse the present WHO/ UNICEF concept of primary public
health activities such as community health care & disease control activities.

1. Medical care
2. Health education, promote literacy
3. MCH Services, SH services, AN care, IN care, PN care, delivery with
skilled health personal
4. Nutritional promoting & growth monitoring

23
 5. Occupational health Services
6. Environmental sanitation activities such as water sanitation, food
sanitation, maintenance of sanitary latrines, air pollution food sanitation,
maintenance of sanitary latrines, air pollution control, & sanitary refuse
disposal
7. Provision of immunization EPIUCI
8. Management of fairs & festivals, emergency situations
9. Blood donation
10. Expanding their training efforts to respond to the needs of primary
health care programs

NGOs involve in the prevention & control of these discase by providing

resources, manpower & money. They also participate in preventing accidents such as
RTA & industrial accidents, 8 also building - related illness for reeducation of
morbidity & mortality.

NGOs also integrate approach to responsibility of individual families for their

own health care, such as well - informed self-medication & modification of life styles.
With the help of NGOs, these activities can be effectively accomplished. So, NGOs
play an important role in health care of community.

RECOMMENDATION

Recommendations to Hlegu township will be categorized into promotive, preventive,

curative, and rehabilitative measures.

Promotive measures.:

1. Implement health education programs at the township hospital, SHU, RHCs,

and sub centers to promote long-term disease prevention through
environmental sanitation, vector control, and water chlorination.

24
 2. Provide maternal health education on disease transmission, healthy practices,
and the significance of a nutritious diet.

Preventive measures:

1. Supply masks and hand sanitizers to patients at township hospital, SHU,

RHCs, and sub centers to prevent the spread of respiratory diseases, including
Tuberculosis.

2. Offer first aid courses to voluntary health workers to enable timely

intervention and injury prevention.

3. Conduct health education sessions about contraception, birth spacing, and

associated risks to ensure informed family planning.

4. Educate the community on preventing snakebites through measures like

eradicating rats and using protective gear while working in high-risk areas.

5. Educate the community regarding the dangers and potential complications

associated with road traffic accidents.

Curative measures:

1. Ensure that the township hospital provides sufficient, high-quality, and easily
accessible curative facilities for patients in need of medical treatment.

2. Supply anti-TB drugs effectively and adequately to patients to control the

development of MDR-TB.

25
 3. Enhance antiretroviral treatment to individuals living with HIV.

4. Provide anti-snake venoms in all health centers for the curative treatment of
snakebite victims.

5. Equip hospitals with adequate drugs, modern laboratory, radiology, and

diagnostic facilities for early diagnosis and prompt curative treatment.

6. Guarantee the swift referral and immediate treatment of individuals injured in

road traffic accidents.

Rehabilitative measures:

1. Provide rehabilitation programs for individuals affected by HIV,

encompassing antiretroviral treatment and counseling to assist those impacted
by the virus while promoting family planning.Provide rehabilitative support
for individuals living with HIV

2. Implement rehabilitation programs for individuals injured by snakebites,

including timely referral and first aid care to save lives.

3. Establish rehabilitation initiatives for individuals harmed in road traffic

incidents.

26
 Chapter (3)

SURVEY

3.1 Abstract

“Artificial intelligence, often referred to as AI, means computer programs

performing tasks that smart beings usually do. According to a definition by the
Council on Artificial Intelligence of the OECD, AI is a machine-based system. It can
predict, recommend, or decide things based on specific human-defined goals,
affecting real or virtual situations. AI systems are designed to work with different
levels of independence. The Medical Artificial Intelligence Readiness Scale for
Medical Students (MAIRS-MS) is a tool designed to assess the level of readiness for
AI among medical students.

The aim of the study was to study the status of readiness to Artificial
Intelligence (AI) technology among undergraduate medical students at University of

27
Medicine (2), Yangon. This study was institutional based cross-sectional descriptive
study, conducted among 327 undergraduate medical students (Final Part-1) at
University of Medicine (2), Yangon, from 16th October 2023 to 2nd November 2023.
About 20.2% of respondents reported having a good knowledge of AI while
about 79.8% of respondents reported having poor knowledge of AI. A vast majority,
92.4% of respondents, expressed a positive attitude toward AI while small percentage,
6.4% of respondents, had a negative attitude toward AI. Only 4.9% of respondents
reported having good practices related to AI while the majority, 95.1% of
respondents, reported having poor practices related to AI.

The overall AI readiness score combines the scores from the four sub-scales of
MAIRS - MS, providing an average readiness score of 70.51 out of a possible 110.
About 67.3% of respondents are categorized as ready for AI adoption while over
32.7% of respondents are categorized as having poor or no readiness for AI adoption.

Therefore, a majority of participants were opened and prepared for AI

integration into their medical practice or education while minority were lack of
knowledge, or held a negative attitude toward AI in healthcare. Since the study was a
cross-sectional study and the participants who were receiving the same education in a
same medical university were recruited by non-probability sampling, there may be
potential biases and the findings were not able to explore detailed. Future studies and
researches should consider this implication.

28
 3.2 Introduction to research

Background Information

Digital technologies and artificial intelligence (AI), particularly machine

learning, are transforming medicine, medical research, and public health.
Technologies based on AI are now used in health services in countries of the
Organization for Economic Co-operation and Development (OECD), and its utility is
being assessed in low- and middle-income countries (LMIC). The United Nations
Secretary-General has stated that the safe deployment of new technologies, including
AI, can help the world to achieve the United Nations Sustainable Development Goals
(United Nations, 2019).

Artificial Intelligence (AI) is utilized to describe the multidisciplinary

approach that utilizes statistical, mathematical, and computer sciences to simulate
intelligent behavior (Bajwa et al., 2021). It encompasses various technologies that
enable machines to perform tasks that typically require human intelligence. The field

29
of AI has rapidly progressed, particularly in the healthcare sector, where it has
addressed numerous challenges in delivering medical services (Esteva et al., 2017).

Artificial intelligence (AI) emerged as an academic discipline in 1956 and has

since undergone multiple cycles of optimism, disappointment, and resurgence. These
cycles, known as "AI winters," involved periods of reduced funding and setbacks.
However, each downturn was followed by new approaches, achievements, and
renewed financial support. AI research has explored diverse methodologies, including
brain stimulation, human problem-solving modeling, formal logic, extensive
knowledge databases, and animal behavior imitation. In recent years, the field has
been dominated by highly mathematical and statistical machine-learning techniques.
This approach has proven exceptionally effective, enabling significant breakthroughs
in industry and academia, solving complex challenges across various domains
(Buchanan & Bruce, 2005).

Artificial intelligence (AI) emerged as an academic discipline in 1956 and has

since undergone multiple cycles of optimism, disappointment, and resurgence. These
cycles, known as "AI winters," involved periods of reduced funding and setbacks.
However, each downturn was followed by new approaches, achievements, and
renewed financial support. AI research has explored diverse methodologies, including
brain stimulation, human problem-solving modeling, formal logic, extensive
knowledge databases, and animal behavior imitation. In recent years, the field has
been dominated by highly mathematical and statistical machine-learning techniques.
This approach has proven exceptionally effective, enabling significant breakthroughs
in industry and academia, solving complex challenges across various domains
(Buchanan & Bruce, 2005).

AI technologies,such as machine learning and deep learning have

revoultionized healthcare by enabling machines to understand and achieve specific
goals. Machine learning allows devices to automatically learn from existing data
without human assistance, while deep knowledge empowers machines to absorb vast
amounts of unstructured data, including text, images, and audio. AAI technologies,

30
such as machine learning and deep learning, have revolutionized I systems exhibit
characteristics such as observation, analytical ability, problem solving, and learning
(Charrière et al., 2019).

Studies have explored AI literacy and knowledge among healthcare

professionals, highlighting the importance of AI readiness. AI readiness encompasses
the knowledge, attitudes, and skills required health professionals to use AI
applications effectively in prevention, diagnosis, treatment, and rehabilitation. AI
literacy, along with confidence and perception, plays a vital role in influencing AI
readiness.

Some medical schools and universities had started to introduce AI-related

courses or modules to familiarize students with the basic concepts of AI and its
applications in medicine. These initiatives aimed to prepare future healthcare
professionals to work alongside AI systems, interpret AI-generated insights, and
understand the ethical implications of AI in healthcare.

Problem statement

The integration of Artificial Intelligence (AI) technology in the medical field

holds great potential for improving patient care and medical outcomes (Noorbakhsh et
al., 2019). In Myanmar, there is a lack of research on the readiness of AI in
healthcare, particularly among undergraduate medical students. Limited research
exists on their cognition, ability, vision, and ethical considerations regarding AI in
healthcare.

However, the successful implementation of AI in healthcare heavily relies on

the readiness and acceptance of medical professionals, particularly medical students.
It is imperative to understand the factors that influence the readiness to Artificial
Intelligence (AI) in medicine and medical education among students and faculty in
University of Medicine (2), in order to effectively promote and support their adoption
of AI technologies and integration of AI in healthcare and medical education.

31
Additionally, exploring the impact of prior AI training and exposure on the ability,
vision, and ethical considerations related to medical AI readiness will provide insights
into the educational requirements necessary for preparing future medical professionals
to leverage AI in their practice.

Moreover, the Medical Artificial Intelligence Readiness Scale for Medical

Students (MAIRS-MS) is a tool designed to assess the level of readiness. There is a
need to evaluate the current level of readiness among medical students in University
of Medicine (2) using the MAIRS-MS. By understanding the level of readiness,
institutions can identify gaps in knowledge, skills, and attitudes towards AI in
medicine, and develop targeted educational interventions to enhance the readiness of
medical students to utilize AI technologies effectively.

Justification

Artificial intelligence (AI) is rapidly transforming the field of medicine, and

medical students need to be prepared to use AI in their future practice. AI has the
potential to improve the quality of healthcare in many ways, such as by assisting with
diagnosis, treatment planning, and patient monitoring. However, it is important for
medical students to understand the limitations of AI and to be able to use it ethically
and responsibly.

AI is playing an increasingly important role in medicine. AI is already being

used in a variety of medical settings, such as in radiology, pathology, and oncology so
AI will play an even greater role in medicine in the future. Medical students need to
be prepared to use AI in their future practice. Medical students need to have a basic
understanding of AI and its applications in medicine. There is a gap in the literature
on AI readiness among medical students. There is limited research on the readiness of
medical students to use AI in their practice. A study at University of Medicine would

32
 help to fill this gap in the literature and provide valuable insights into the needs of
medical students in terms of AI education and training.

Overall, a study of readiness to AI among undergraduate medical students at

University of Medicine would be a valuable and justified piece of research. The
findings of the study could be used to inform the development of AI education and
training programs, advocate for the inclusion of AI in medical school curricula, and
raise awareness of the importance of AI readiness among medical students, faculty,
and stakeholders.

Conceptual framework

Background Characteristics of
Undergraduate medical students
 Age, Sex,
 IT skill, English Proficiency
 Expense on Internet
 Time spent on Internet
 Academic status, Specialty
 Position

Medical Artificial
Intelligence Readiness
Scale (MAIRS- MS)
 Cognition
 Ability
 Vision
 Ethics
Training Related Artificial 33

Intelligence Factors
 Knowledge about AI
Literature Review

Artificial intelligence

“Artificial intelligence, often referred to as AI, means computer programs

performing tasks that smart beings usually do. According to a definition by the
Council on Artificial Intelligence of the OECD, AI is a machine-based system. It can
predict, recommend, or decide things based on specific human-defined goals,
affecting real or virtual situations. AI systems are designed to work with different
levels of independence. (WHO, 2021).

Artificial intelligence has the power to address the shortage of healthcare

workers. It does this by learning from computer data and analyzing new information,
just like the human brain does. AI boosts the ability to search through vast medical
data and offers decision-making support on a large scale. This is reshaping the future
of healthcare, making it more efficient and effective. (Noorbakhsh et al., 2019).

Medical artificial intelligence readiness

Merriam-Webster dictionary defines readiness as “the quality or state of being

ready”. In the educational context, readiness is considered an indispensable
component of teaching and learning process (Hill et al., 1976). The emergence of a
new behavior change in the education depends on the student’s level of readiness. For
this reason, a student must have cognitive, affective, and psychomotor behaviors,
which is necessary for the acquisition of new behavior (Başar et al., 2001).

Measuring the level of readiness allows, beginning from the first day to
provide guidance in accordance with the individual and characteristic features of the
individual, to examine the needs of the individual and to make plans, programs, and
preparations in accordance with these needs. Keeping aforementioned facts in view,
describing the readiness of medical artificial intelligence will be a guide to work on
this issue. We propose medical artificial intelligence readiness is the healthcare

34
provider’s preparedness state in knowledge, skills, and attitude to utilize healthcare-
AI applications during delivering prevention, diagnosis, treatment, and rehabilitation
services in amalgam with own professional knowledge. Considering global AI boom
in view, it is expected that AI will be the one of the main elements of medical
education in the coming years (Goh et al., 2020).

Related studies on Medical artificial intelligence readiness

Many countries comprehend that AI is a foundational technology and are

competing to obtain a worldwide innovation gain in AI. The United States is currently
leading in AI technology, closely followed by China, and the European Union. So, the
measurement of perceived medical artificial intelligence readiness of medical school
students is important to guide for various educational design and developmental
processes such as curriculum development, instructional design or needs analysis, etc.
Although, some researchers have tried to put forth the concurrent AI knowledge and
attitudes of medical students (Sit et al., 2020).

The course was tested and evaluated at Bonn Medical School in Germany with
medical students in semester three or higher and consisted of a mixture of online self-
study units and online classroom lessons. While the online content provided the
theoretical underpinnings and demonstrated different perspectives on AI in medical
imaging, the classroom sessions offered deeper insight into how "human" diagnostic
decision-making differs from AI diagnoses. This was achieved through interactive
exercises in which students first diagnosed medical image data themselves and then
compared their results with the AI diagnoses. We adapted the "Medical Artificial
Intelligence Scale for Medical Students" to evaluate differences in "AI readiness"
before and after taking part in the course. These differences were measured by
calculating the so called "comparative self-assessment gain" (CSA gain) which
enables a valid and reliable representation of changes in behavior, attitudes, or
knowledge.

35
 A recent study validated the Medical Artificial Intelligence Readiness Scale
(MAIRS) as a tool for measuring AI readiness among medical professionals (Karaca
et al., 2021). Readiness towards Artificial Intelligence among Undergraduate Medical
Students in Malaysia have been reported. In a survey with 105 respondents
participated in this survey. Their readiness was measured through the total marks that
the students scored on the medical artificial intelligence readiness scale, which
included four domains: cognitive, ability, vision, and ethics. A higher score indicated
a higher agreement with the survey questionnaire statements, and a higher level of
readiness towards AI among undergraduate medical students of a private medical
university in Malaysia (Xuan et al., 2023).

The study shows that Turkiye medical students, Medical artificial intelligence
readiness of medical students in Turkiye showed the study group consisted of 2407
students and the scores obtained from the scale ranged 22-110, with a median of 67.
Of 60.4% students scored above the average (Sungur et al., 2023).

The next study showed Medical and Dental Professionals Readiness for
Artificial Intelligence for Saudi Arabia Vision 2030. The study’s 334 participants who
completed the questionnaire were from 19 cities in Saudi Arabia and the results
showed that most of the participants scored 2.26–2.76 on a scale of 1 to 5, which is
less than the midpoint of “3” This indicates low levels of readiness for AI
(Aboalshamat et al., 2022).

“Humans were always far better at inventing tools than using them wisely”
(National Academy of Medicine, 2019). To be effectively prepared for AI in the
medical field, medical educators will need at least a basic understanding of AI in
connection with learning and teaching, and the extent of AI integration with medicine.
A study conducted in the UK revealed that the majority of students (78%) were
concerned According to a report on artificial intelligence in 2019, it had been
mentioned that about working with, and expected to have prior training in AI. In the
same research, after receiving basic training, the students felt more confident about AI
(Sit et al., 2021).

36
 3.3 RESEARCH QUESTION

 What is the status of readiness for Artificial Intelligence and factors affecting it
among undergraduate medical students at the University of Medicine (2),
Yangon?

3.4 AIM AND OBJECTIVES

Aim

To study the status of readiness to Artificial Intelligence (AI) technology

among undergraduate medical students at University of Medicine (2), Yangon

Objectives

(1) To identify the background characteristics of the study population

(2) To determine the training related artificial intelligence factors among study
population
(3) To assess the level of readiness to AI by using MAIRS-MS among study
population

37
 3.5 Material and Methods

3.5.1 Study Design

This study was institutional based cross-sectional descriptive study.

3.5.2 Study Period

This study was conducted from 16th October 2023 to 2nd November 2023.

3.5.3 Study Area

This study was carried out at University of Medicine (2), Yangon.

3.5.4 Reference Population

The reference population was all undergraduate medical students of Medical

Universities in Myanmar

3.5.5 Study Population

The study population was all undergraduate medical students (Final Part-1) at
University of Medicine (2), Yangon.

3.5.6 Selection Criteria

Inclusion criteria

All undergraduate medical students (Final Part-1) at University of Medicine

(2), Yangon during study period.

Exclusion criteria

Medical students who were absentees at the time of data collection

38
3.5.7 Sample size

All undergraduate medical students (Final Part-1) at University of Medicine (2),

Yangon were assessed.

3.5.8 Sampling Methods

Sampling frame was constructed after asking to the administrative office of

University of Medicine (2), Yangon. All undergraduate medical students (Final Part-
1) who were attending at University of Medicine (2), Yangon were included in this
frame. By applying purposive sampling method, all undergraduate medical students
(Final Part-1) who were eligible for inclusion criteria were invited to participate in
this research. After explaining the purpose and nature of the study, informed verbal
consent was obtained from each participant. After getting consent, data was collected
by self-administered questionnaires.

3.5.9 Research Procedure

Firstly, permission to conduct the study was taken from the Rector of
University of Medicine (2), Yangon. After getting the permission, all undergraduate
medical students according to selection criteria had a chance to participate in this
study. They were thoroughly explained in detail about the research by the researcher
with the information sheet. Only after they had fully understood, they were invited to
participate in the study. Participation was absolutely voluntary. If they agreed to
participate in this study, the researcher obtained the verbal consent. After getting
verbal consent, the data was collected by using self-administered questionnaire.

The questionnaire was developed based on the research objectives and

questions. The survey form included three components: background characteristics,
training related AI factors and participants' MAIRS-MS scale. In background
characteristics, age, sex, academic status, specialty and position of respondents were
included. The training related AI factors included knowledge about AI (8 questions),
attitudes towards AI (11 questions), practices of AI (7 questions), expected benefits of
AI (9 questions) and fear toward AI in healthcare (5 questions). Five Points Likert

39
Scale or multiple-choice questions used for rating responses. MAIRS-MS scale
consisted of four subscales such as cognition (8 questions), ability (8 questions),
vision (3 questions), and ethics (3 questions). These scales were administered to the
undergraduate medical students to evaluate their perceived readiness levels and
identify areas of strengths and weaknesses.

3.5.10 Data collection tool

The data was collected by using self-administered questionnaire. Survey
questionnaires consisted of,

1. The background characteristics of respondents

2. The training related Artificial Intelligence factors including knowledge of AI,
attitudes towards AI, practices of AI, expected benefits of AI and fear toward
AI in healthcare.
3. The Medical Artificial Intelligence Readiness for Medical Students (MAIRS-
MS) questionnaire encompassing four sub-scales: cognition, ability, vision,
and ethics. MAIRS-MS was validated in a prior study with Cronbach’s alpha
of 0.73 (Sungur et al., 2023).

3.5.11 Working Definition

Readiness to AI

Readiness to AI was assessed by using Medical Artificial Intelligence

Readiness Scale for Medical Students (MAIRS-MS) which is a standardized designed
questionnaire. It had four sub-domains, namely cognition (8 questions), ability (8
questions), vision (3 questions) and ethics (3 questions). Responses to each item will
be rated on Five Points Likert scale and total scores wereranging from 22 to 110
points. More than 66 scores indicated a readiness for AI and, equal or lower than 66
scores were poor or un-readiness for AI.

40
Knowledge about AI

Knowledge about AI refers to the level of understanding, familiarity, and

awareness about AI technology. Total of eight questions were included in this
component. Responses to each item were in form of yes, no or don’t know, yes = 1,
no/don’t know = 0. Total scores for knowledge session were ranged from 0 to 8 points
and a good knowledge status was more than or equal 5 points.

Attitudes towards AI

Attitudes towards AI refer to the level perception in AI. This sub-scale had 11
questions about the perception of AI, including the necessity of AI in the medical
field. Responses to each were rated on a Five Point Likert scale and total scores were
ranging from 11 to 55 points. More than 33 scores indicated a good attitude and,
equal or lower than 33 scores were poor attitude towards AI.

Practices of AI

Practices of AI refer to the extent to which undergraduate medical students

had received formal education, training, or practical exposure to AI technology in
healthcare. This component had 7 questions about practices of AI. Questions of each
item were in form of yes or no questions, yes = 1, no = 0 and good practices was more
than 4 points.

Expected benefits of AI

Expected benefits of AI referred to the anticipated positive outcomes and

advantages that could result from the development, implementation, and utilization of
AI technologies. This sub-scale had nine questions and was presented descriptive
table.

41
Fear toward AI

Fear towards AI referred to apprehension regarding AI's potential negative

impact, including job loss, ethics, biases, and privacy concerns. This sub-scale had
five questions and was presented descriptive table.

3.5.12 Data management

Data entry

Data entry was done using Epi-data 3.1 version, which used range checks and
other controls to minimize human errors. Then collected data was entered with
checking done simultaneously as value label was shown during data entry applying
frequency distribution table for each variable for final data checking.

Data summarization and analysis

Data summarization was done by using table and graphs, presented by using
descriptive statistics such as frequency, percent, Mean ± standard deviation.

3.5.13 Ethical considerations

Before the interview, the researchers explained the study objectives, ensured
confidentiality, and ensured that the research participants understood that they could
withdraw from the study at any time with no adverse effects. Informed consent was
obtained from all the participants before starting the research. To ensure anonymity,
the names of the participants were not recorded the personal identification on the
answer sheets, and all the research documents were kept under lock and key so that no
unauthorized person could access these documents. Permission to take notes and
digital recording of the interview was also be asked from the interviewees. The
participants were free to terminate their involvement in research at any stage without
any consequences. All the information of the participants were kept confidential. The
data was only be assessable by the principal investigator and co-investigator. The

42
approval from the ethical review committee of University of Medicine (2), Yangon,
Myanmar was obtained for the ethical clearance procedure.

43
 3.6 Findings and Discussion

This study aimed to assess the readiness for artificial intelligence (AI) among
undergraduate medical students. The background characteristics of the students,
including their age, gender, urban/rural residence, self-rated English proficiency, self-
rated IT skills, monthly expenses on the Internet, and time spent on the Internet per
day, were examined to understand the factors influencing their readiness for AI.

Table 1. Background characteristics of participants (n = 327)

Variables Frequency Percentage

Age groups (years)

21-24 311 95.1%

25-28 16 4.9%
Sex

Male 154 47.1%

Female 173 52.9%

Urban/Rural

Urban 280 85.6

Rural 47 14.4
Self-rated English Proficiency
skills
Mean ± SD 5.55 ± 1.573

Range 1-9
Self-rated IT skills

Mean ± SD 4.01 ± 1.802

Range 1-9
Monthly expenses on the

44
Internet (MMK)
Mean ± SD 29248.34 ± 35560.414

Range 1000-600000
Time spent on the Internet per
day (hours)
Mean ± SD 7.26 ± 3.513

Range 1-12

In Table 1, the majority of the undergraduate medical students (95.1%) fell

within the age group of 21-24 years, while only a small proportion (4.9%) belonged to
the 25-28 age group. Gender distribution among the students was relatively balanced,
with 47.1% being male and 52.9% female. A significant majority of the students
(85.6%) resided in urban areas, while a smaller proportion (14.4%) came from rural
areas. The majority of students living in urban areas may have better access to
advanced technology and resources, potentially giving them an advantage in AI
readiness compared to their rural counterparts.

The students, on average, rated their English proficiency skills at 5.55 on a

scale ranging from 1 to 9, with a standard deviation of 1.573. On average, students
self-rated their IT skills at 4.01 on a scale of 1 to 9, with a standard deviation of 1.802.
In current study, the moderate levels of self-rated English proficiency and IT skills
indicate a foundation that can be built upon through AI education. Effective AI
implementation often requires a certain level of proficiency in these areas.

The students reported varying monthly expenses on the Internet, with a mean
of 29,248.34 MMK and a wide range from 1,000 to 600,000 MMK. The diverse range
of monthly Internet expenses highlights differences in access to online resources.
Higher expenses might indicate greater access to AI-related content and resources,
potentially enhancing AI readiness.

45
 On average, students spent 7.26 hours per day on the Internet, with a standard
deviation of 3.513. This signifies a significant amount of time spent online, which
could potentially impact their exposure to AI-related content. The significant time
spent on the Internet suggests that students have the opportunity to explore AI-related
topics, which could positively influence their readiness and familiarity with AI
technologies.

Table 2. Responses on Knowledge Questions (n = 327)

Percentag
Variables Frequency
e
Do you know what AI is? 303 92.7
 Meaning of AI 278 90.8
 AI is a broad term that refers to the ability of a
digital computer or computer-controlled robot to
268 87.6
perform tasks commonly associated with human
intelligence.
Do you know what Machine learning is? 107 32.7
 Machine learning (ML) is a subfield of AI. 85 78.0
 ML is a method to train a computer to learn from
its raw input to perform complex regression and 84 77.8
classification tasks.
Do you know what Neural network is? 30 9.2
 Neural network (NN) is a Machine Learning
18 58.1
program.
 NN operates in a manner inspired by the
21 67.7
organization of neurons in the human brain.
Do you know what Deep learning is? 25 7.6
 Deep learning is a class of NN. 15 60.0
 Deep learning uses a high number of neuron-type 15 60.0
units and layers to hierarchically extract features

46
 from the raw input.
 Popular applications of Deep learning are in
18 72.0
image and speech recognition.
Do you know types of AI software commonly used 67 20.5
in the medical field?
AI is used in radiology to assist with tasks like image
196 59.9
analysis, detection of anomalies, and diagnosis.
AI is also being used to analyze tissue samples and
140 42.8
identify patterns that might indicate disease.
Do you know how AI can assist to you in work? 129 39.4

Table 2 provides insights into the level of knowledge and awareness about
Artificial Intelligence (AI) among the survey respondents, specifically in relation to
various AI-related concepts and its applications in the medical field. The majority of
the respondents, 92.7%, indicated that they know what AI is, suggesting a high level
of awareness about the term "AI". However, when asked about the specific meaning
of AI, 90.8% were able to provide an explanation, indicating a fairly comprehensive
understanding of AI. It is noteworthy that 87.6% of respondents correctly identified
AI as a broad term related to computer systems' ability to perform tasks associated
with human intelligence. This demonstrates a strong understanding of the
fundamental concept behind AI.

Only 32.7% of the respondents stated that they know what machine learning
(ML) is, showing a significant gap in understanding compared to AI. Of those
familiar with ML, 78.0% correctly recognized that ML is a sub-field of AI, indicating
some grasp of the relationship between these two concepts.

About 77.8% of respondents also understood that ML involves training

computers on raw data for complex tasks, suggesting a reasonably good
comprehension of machine learning. A smaller proportion of respondents, 9.2%, knew
what a neural network (NN) is, which is not unexpected given its more specialized
nature. Among those who knew what NN is, 58.1% correctly identified it as a

47
machine learning program. Furthermore, 67.7% recognized that NN operates in a
manner inspired by the organization of neurons in the human brain. When it comes to
deep learning, only 7.6% of respondents had knowledge of it. Among these
respondents, 60.0% identified deep learning as a class of NN, and 60.0% recognized
its use in hierarchically extracting features from raw data, with 72.0% acknowledging
its popular applications in image and speech recognition. A relatively smaller segment
of respondents, 20.5%, had knowledge of AI software commonly used in the medical
field.

When asked to provide two applications of AI in medicine, 59.9% mentioned

its use in radiology for tasks like image analysis and disease diagnosis, and 42.8%
recognized its role in analyzing tissue samples for disease indication. Only 39.4% of
the respondents knew how AI could assist them at work. Interestingly, a previous
study found that around 68% were unaware of the AI application in radiology (Dos
Santos et al., 2019).

In current study, most respondents could define AI and correctly identify it as

a broad concept associated with human-like computer intelligence. However, there
was a significant knowledge gap when it came to more specialized areas like machine
learning, neural networks, and deep learning. The current study aligned with a
previous French study in which less than a third (31%) of participants knew the
difference between “artificial intelligence”, “machine learning”, “neural network”,
and “deep learning” (Perrier et al., 2022). However, A cohort study in UK also
showed that the majority of the students (88%) were aware of the uses of AI (Sit et
al., 2021).

Table 3. Responses on Attitude Questions (n = 327)

48
 Strongly Disagree
Strongly Agree

Disagree
Variables

Neutral
Agree
% % % % %
AI is becoming essential in the medical
24.5 57.8 15.9 1.5 0.3
field in the near future.
AI must be included in existing curricula
9.2 48.5 34.7 5.8 1.8
in medical schools.
AI has greatly helped in early diagnosis
14.1 52.3 26.9 6.4 0.3
and assessment of severity of disease.
In future, physicians will be replaced by
1.2 4.9 21.7 42.5 29.7
AI.
AI is very essential in field of radiology. 11.7 48.2 36.2 3.7 0.3

AI is very essential in field of pathology. 9.5 48.6 36.1 5.5 0.3

AI is very essential in field of medical
10.7 53.1 31.6 4.0 0.6
education.
Introducing AI to current COVID-19
5.8 44.3 41.0 8.6 0.3
pandemic is essential.
AI would be a great threat for general
8.6 29.7 35.5 19.0 7.3
practitioners (GP).
All medical personnel need to receive
specific training on the use of AI tools in 17.1 59.3 17.1 5.5 0.9
healthcare.
AI will increase the percentage of errors in
9.8 32.4 38.5 15.9 3.4
diagnosis.

According to the data in Table 3, most of the participants have positive attitude
towards integration of AI in medical field. A significant majority of respondents

49
(82.3%) either strongly agree or agree that AI is becoming essential in the medical
field. In current study, the strong agreement might stem from the increasing use of AI
in tasks like medical imaging analysis, drug discovery, and patient data analysis.AI
can process large volumes of data quickly, potentially leading to more accurate and
efficient healthcare practices. Similarly, a previous study showed that the majority of
respondents (87%) were in agreement that AI would play an essential role in
healthcare (Xuan et al., 2023).

About (57.7%) of respondents agree that AI should be included in medical

school curricula, while a significant portion (34.7%) is neutral on the topic.
Integrating AI into medical education is critical for preparing future healthcare
professionals for a technology-driven healthcare environment. However, the neutrality
of a large portion of respondents suggests that there may be concerns or debate over
how and to what extent AI should be included in curricula.

More than two-thirds (66.4%) either strongly agree or agree that AI has greatly
helped in early diagnosis and disease severity assessment which is a positive sign for
AI's role in improving patient outcomes.

Most respondents (72.2%) either disagree or strongly disagree with the idea
that physicians will be replaced by AI in the future. A significant number see AI as
essential in radiology, pathology, medical education and during a COVID - 19
pandemic, 59.9%, 58.1%, 63.8% and 50.1% respectively. The positive response
reflects the need for AI-based tools during health crises but it should complement, not
replace, human expertise.

More than one third (38.3%) of respondents see that AI would be a great threat
to general practitioners, over one third (35.5%) are neutral and the rest disagree to the
topic. The majority (76.4%) agree with the need for AI training for medical personnel.
Views are mixed, with 42.2% agreeing or strongly agreeing that AI will increase
errors in diagnosis, while 57.8% are either neutral or disagree with this idea.

Table 4. Responses on Practice Questions (n = 327)

50
 Percentag
Variables Frequency
e
Have you seen AI tool being used in your medical
118 36.1
course or practice?
Have you ever been experience of formal or informal
37 11.3
AI training?
Have you been taught about AI in your medical
49 15.0
course?
Have you got any AI training for medical practice? 20 6.1
Have you learnt about Ethical issues for AI in medical
21 6.4
practice?
Are you currently using an AI tool for medical
109 33.3
education or medical practice?
Have you been discussion about AI among your friends
116 35.5
frequently?

Table 4 provides insights into the respondents' readiness for AI adoption in the
medical field based on their exposure to AI tools, training, education, and discussions
with peers. About 36.1% of the respondents have seen AI tools being used in their
medical course or practice. This suggests that a minority of the respondents have
witnessed the practical application of AI in a medical context.

A mere 11.3% of respondents have had some form of formal or informal AI

training. This indicates that the majority of the respondents lack AI-specific training,
which may be crucial for leveraging AI in healthcare effectively.

Only 15.0% of respondents have been taught about AI in their medical course,
which highlights a gap in incorporating AI education into medical curricula.

A small percentage (6.1%) of the respondents has received AI training

specifically tailored for medical practice. This indicates a limited number of

51
healthcare professionals who are equipped with AI skills for medical applications. In
a previous study, approximately 35% of respondents were pessimistic that they would
acquire the expertise to work with AI after medical school (Xuan et al., 2023).

Only 6.4% of the respondents have received education or information about

ethical issues related to AI in medical practice. This suggests that there is limited
awareness and understanding of the ethical considerations associated with AI in
healthcare.

About 33.3% of the respondents are currently using AI tools for medical
education or medical practice. This indicates that there is a significant proportion of
medical professionals who have adopted AI in their work.

A notable 35.5% of respondents report having frequent discussions about AI

among their friends. This suggests a growing interest in AI in the medical community.

Table 5. Responses on Expected Benefits of AI on Medicine (n = 327)

Variables Frequency Percentage

Do you expect AI will further improve medical

279 85.3
practice?
Do you expect AI will facilitate gathering information
252 77.1
form patients?
Do you expect AI will help analyze patient’s medical
256 78.3
data to come up with potential diagnoses?
Do you expect AI will improve access to healthcare
212 65.0
in areas where experts are unavailable?
Do you expect AI will improve patient’s compliance
with treatment and follow-up will be much improved 169 51.7
by using AI?
Do you expect AI will help to assess prognosis of 216 66.1

52
disease?
Do you expect AI will help to provide the most
124 38.0
appropriate therapeutic options for patients?
Do you expect AI will revolutionize the world of
127 38.8
medicine?
Do you expect there will be a favorable condition to
205 63.1
install or apply AI tools in your specialty?

Table 5 presents responses related to the expected benefits of AI in the field of

medicine. Respondents were asked about their expectations regarding the potential
positive impacts of AI on various aspects of medical practice.

A substantial majority of respondents, 85.3%, expect that AI will further

improve medical practice. This suggests a high level of optimism regarding the
potential contributions of AI to the medical field.

About 77.1% of respondents believe that AI will facilitate the gathering of

information from patients which indicates that a significant portion expects AI to
enhance the collection and analysis of patient data.

A similar percentage, 78.3%, anticipates that AI will help analyze patients'

medical data to come up with potential diagnoses. This reflects a positive outlook on
the role of AI in aiding healthcare professionals in diagnosis.

About 65.0% of respondents expect that AI will improve access to healthcare

in areas where experts are unavailable. This indicates the perception that AI can help
bridge healthcare gaps in underserved or remote regions.

Nearly 52% of respondents expect that AI will improve patient compliance

with treatment and follow-up which suggests that AI could play a role in enhancing
patient engagement and adherence to medical recommendations.

53
 About 66.1% of respondents expect that AI will help assess the prognosis of
diseases, demonstrating confidence in AI's ability to predict and understand disease
progression.

Around 38.0% of respondents expect AI to provide the most appropriate

therapeutic options for patients suggesting a more reserved expectation regarding AI's
involvement in treatment decisions.

Nearly 38.8% of respondents believe that AI will revolutionize the world of

medicine indicating a portion of the respondents anticipates significant transformative
effects on the medical field due to AI.

Most of the respondents (63.1%) expect favorable conditions to install or

apply AI tools in their specialty, indicating a positive outlook regarding the
integration of AI within their specific medical domains.

In short, according to current study, undergraduate medical students were

excited about AI's potential to improve medical care, from diagnosis to better access
to healthcare staying realistic and ensuring ethical guidelines. This study was
supported by a previous study in which over half of the respondents stated that the
development of AI would bring benefits to humankind, especially in the medical field
(Gherheș V, 2018).

Table 6. Responses on Fears toward AI on Medicine (n = 327)

Variables Frequency Percentage

Are you afraid that it would be challenging to create 174 53.2

54
a legal regulatory framework for AI use in
healthcare?
Are you afraid that AI may threaten patient data
247 75.5
security?
Do you see AI as a threat to the ethical and human
163 49.8
dimensions of medicine?
Are you afraid to lose your job because of AI? 108 33.0
Are you afraid doctors will lose some of their skills
177 54.1
if AI is implemented in their workflow?

Table 6 presents responses related to the fears and concerns of healthcare

professionals regarding the use of AI in the medical field. The variables in the table
represent different fears associated with AI adoption in healthcare. Half of
respondents (53.2%) are afraid that it would be challenging to create a legal
regulatory framework for AI use in healthcare. This indicates concerns about the legal
and regulatory complexities that may arise with AI implementation.

A significant majority, 75.5%, are afraid that AI may threaten patient data
security. This highlights a major apprehension about the potential vulnerabilities in
patient data when AI is introduced into medical workflows.

Nearly half of the respondents, 49.8%, see AI as a threat to the ethical and
human dimensions of medicine. This suggests concerns about the impact of AI on the
human touch, empathy, and ethical considerations in patient care.

About 33.0% of respondents are afraid of losing their jobs because of AI

reflecting job security concerns, particularly about potential workforce displacement
due to automation. However, only 6% of participants expressed their fear of losing
their job because of AI (Perrier et al., 2022).

Nearly 54.1% of respondents fear that doctors may lose some of their skills if
AI is implemented in their workflow. This concern revolves around the potential
erosion of medical expertise and skills as AI takes on more responsibilities.

55
Table 7. Responses on MAIRS-MS (Cognition) (n = 327)

Strongly Disagree
Strongly Agree

Disagree
Variables

Neutral
Agree
% % % % %
I can define the basic concepts of data
2.8 23.9 45.6 24.5 3.4
science.
I can define the basic concepts of statistics. 1.5 25.4 44.3 25.4 3.4

I can explain how AI systems are trained. 2.4 13.8 37.9 41.3 4.6
I can define the basic concepts and
1.8 30.3 33.9 30.3 3.7
terminology of AI.
I can properly analyze the data obtained by AI
2.5 31.0 39.0 25.5 2.1
in healthcare.
I can differentiate the functions and features
2.8 24.2 41.9 29.7 1.5
of AI related tools and applications.
I can organize workflows compatible with AI. .6 23.0 44.8 29.1 2.5
I can express the importance of data
collection, analysis, evaluation and safety; for 4.0 37.3 35.5 21.4 1.8
the development of AI in healthcare.

Interpreting the data in Table 7 of respondents' self-assessed cognition can

provide valuable insights into their cognitive self-perception.
Explaining how AI systems are trained: This area has the highest percentage
(41.3%) of respondents who disagree or strongly disagree, indicating a significant
lack of confidence in their ability to explain AI system training.
Organizing workflows compatible with AI: The next highest percentage
(44.8%) is neutral, indicating that many respondents are uncertain about their ability
to organize workflows compatible with AI.
Defining basic concepts of data science and statistics: A substantial portion
(45.6%) of respondents is neutral, reflecting uncertainty regarding their ability to

56
define basic data science concepts while 44.3% are neutral, uncertain about their
capacity to define basic statistical concepts.
Differentiating the functions and features of AI-related tools and applications:
In this category, 41.9% of respondents are neutral, suggesting that many are uncertain
about their ability to differentiate AI-related tools and applications.
Defining basic concepts and terminology of AI: Approximately 30.3% of
respondents agree, and 30.3% disagree, resulting in a mixed level of understanding in
this area.
Properly analyzing the data obtained by AI in healthcare: Around 39% agree,
while 25.5% disagree, indicating a moderate level of confidence in their data analysis
skills.
Expressing the importance of data for AI in healthcare: This area has the
highest percentage (41.3%) of respondents who agree, suggesting that many
respondents understand the importance of data for AI in healthcare.

Table 8. Responses on MAIRS-MS (Ability) (n = 327)

Strongly Disagree
Strongly Agree

Disagree

Variables
Neutral
Agree

% % % % %

57
I can harness AI-based information combined
6.1 43.7 38.2 11.0 .9
with my professional knowledge.
I can use AI technologies effectively and
4.3 39.8 36.7 17.4 1.8
efficiently in healthcare delivery.
I can use artificial intelligence applications in
4.0 51.2 28.8 14.7 1.2
accordance with its purpose.
I can access, evaluate, use, share and create
new knowledge using information and 6.4 47.4 32.4 12.5 1.2
communication technologies.
I can explain how AI applications offer a
2.1 29.7 44.3 22.6 1.2
solution to which problem in healthcare.
I find valuable to use AI for education, service
9.5 60.9 19.6 8.6 1.5
and research purposes.
I can explain the AI applications used in
2.4 41.3 36.7 17.7 1.8
healthcare services to the patient.
I can choose proper AI application for the
2.1 30.9 45.0 19.9 2.1
problem encountered in healthcare.

Table 8 displays the responses to the MAIRS-MS (Ability) questionnaire,

where respondents have provided their self-assessments regarding their abilities and
skills in various aspects of utilizing artificial intelligence in healthcare.
The majority of respondents (50.8%) either "Strongly Agree" or "Agree" that
they can combine AI-based information with their professional expertise suggesting
that many respondents feel confident about integrating AI information into their
professional work.
A significant portion is neutral (38.2%), indicating some uncertainty or
hesitation in this area. Similar to the previous statement, a significant percentage
(around 44.1%) feel confident about using AI technologies effectively in healthcare
while a considerable portion is in the "Neutral" or "Disagree" categories, indicating
uncertainty or a lack of confidence in their efficiency with these technologies.

58
 The majority of respondents (55.2%) feel capable of using AI applications in
accordance with their intended purpose, indicating a relatively strong understanding
of the appropriate use of AI technologies.
However, there's a notable proportion (16.0%) who seem to have reservations
or lack confidence in using AI applications appropriately. A significant percentage
(around 54%) appears confident in their ability to handle information and
communication technologies (ICT) effectively for knowledge-related tasks.
A notable portion (47.0% between "Agree" and "Strongly Agree") feels
confident in explaining how AI applications provide solutions in healthcare while a
substantial portion (44.3%) are neutral when it comes to explain how AI applications
offer solutions to healthcare problems suggesting uncertainty or lack of clarity among
respondents in understanding the specific problem-solving capacities of AI in
healthcare.
The majority (70.4%) acknowledge the value of using AI for education,
service, and research purposes, with a lower percentage (10.1%) expressing neutral or
opposing views. This indicates a generally positive perception of AI's utility in these
domains.
A notable portion, 43.7%, feels they can explain AI applications in healthcare
services to patients. This suggests some level of patient education regarding AI
applications.
On the other hand, 19.5% express uncertainty or a lack of confidence in
explaining AI applications to patients. The high percentage of respondents in the
"Neutral" category that they can choose the proper AI application for healthcare
problems suggesting that many respondents are unsure or have not formed a strong
opinion on their ability to choose the right AI applications. This is followed by about
30.9% who "Agree" to some extent that they possess this capability.

Table 9. Responses on MAIRS-MS (Vision) (n = 327)

59
 Strongly Disagree
Strongly Agree

Disagree
Variables

Neutral
Agree
% % % % %
I can explain the limitations of AI
3.7 25.7 45.6 22.6 2.4
technology.
I can explain the strengths and weaknesses of
3.4 45.3 33.3 15.9 2.1
AI technology.
I can foresee the opportunities and threats
5.8 43.7 35.8 12.8 1.8
that AI technology can create.

In Table 9, the data presents respondents' self-assessed abilities to understand

and anticipate the capabilities and drawbacks of AI technology. The highest
percentage of respondents (49.5%), combining those who "Strongly Agree" and
"Agree," feel confident in their ability to foresee the opportunities and threats that AI
technology can create suggesting that a strong level of confidence in their ability to
understand the broader implications of AI.
Approximately 48.7% of respondents, combining those who "Strongly Agree"
and "Agree," believe they can explain the strengths and weaknesses of AI technology.
This reflects a good level of confidence in their knowledge of AI's pros and cons.
The lowest percentage of respondents (29.4%), combining those who
"Strongly Agree" and "Agree," feel confident in their ability to explain the limitations
of AI technology. This indicates a comparatively lower level of confidence in
understanding AI's limitations.

In current study, Table 9 shows that a substantial number of respondents

feeling confident in their understanding of AI, especially in foreseeing opportunities
and threats and explaining the strengths and weaknesses.

60
Table 10. Responses on MAIRS-MS (Ethics) (n = 327)

Strongly Disagree
Strongly Agree

Disagree
Variables

Neutral
Agree
% % % % %
I can use health data in accordance with legal
5.2 50.2 34.3 9.5 0.9
and ethical norms.
I can conduct under ethical principles while
3.4 45.0 36.4 14.1 1.2
using AI technologies.
I can follow legal regulations regarding the use
5.8 49.5 33.0 11.3 0.3
of AI technologies in healthcare.

In Table 10, the data presents responses from participants regarding their
perceived ability to work within legal and ethical boundaries when utilizing health
data and AI technologies in the context of healthcare.
The highest percentage of respondents, 55.4% (combining "Strongly Agree"
and "Agree"), feel confident in their ability to use health data in accordance with legal
and ethical norms, which is crucial in healthcare to protect patient privacy and comply
with regulations.
Approximately 55.3% of respondents, combining those who "Strongly Agree"
and "Agree," believe they can follow legal regulations regarding the use of AI
technologies in healthcare. This is another positive finding, indicating a strong grasp
of legal compliance in healthcare AI.
About 48.4% of respondents, combining those who "Strongly Agree" and
"Agree," feel confident in conducting under ethical principles while using AI
technologies indicating that many respondents are confident in conducting themselves
ethically when using AI technologies, but there's a significant proportion who are

61
neutral or express a lack of confidence. More education and awareness on ethical AI
use may be beneficial.

Table 11. Training related Artificial Intelligence factors among respondents

(n = 327)
Training related AI factors Frequency Percentage

Knowledge of AI
Good knowledge 66 20.2%
Poor knowledge 261 79.8%

Attitude toward AI
Positive attitude 302 92.4%
Negative attitude 21 6.4%

Practices of AI
Good practices 16 4.9%
Poor practices 311 95.1%

Table 11 presents responses related to training-related factors in Artificial

Intelligence (AI) among the surveyed respondents. These factors include knowledge
of AI, attitude toward AI, and practices of AI.
About 20.2% of respondents reported having a good knowledge of AI while
about 79.8% of respondents reported having poor knowledge of AI. This indicates a
substantial gap in AI knowledge and awareness within the healthcare community. A
previous study also proved that the participants have low or moderate AI knowledge
levels (Aboalshamat et al., 2022).
A vast majority, 92.4% of respondents, expressed a positive attitude toward AI
while small percentage, 6.4% of respondents, had a negative attitude toward AI. The
overwhelmingly positive attitude toward AI (92.4%) is a positive sign for AI adoption
in the medical field, also a precursor to successful integration and utilization of AI
technologies. Similarly, a study in Malaysia proved that most of the medical students

62
 showed a positive attitude to the integration of AI in medical programs (Xuan et al.,
2023).
Only 4.9% of respondents reported having good practices related to AI while
the majority, 95.1% of respondents, reported having poor practices related to AI. This
implies that very few healthcare professionals are actively utilizing AI in their medical
practice or education. However, a previous study showed that less than half the
students (44%) felt confident in using basic healthcare AI tools at the end of their
medical degrees (Xuan et al., 2023).

Table 12. Subscale of Artificial Intelligence readiness among respondents

(n = 327)

Subscale Mean (SD) Minimum-Maximum Possible Total Score

Cognitive 23.70 ± 4.653 8.00-38.00 40

Ability 26.68 ± 4.80 8.00-40.00 40

Vision 9.77 ± 2.18 3.00-15.00 15

Ethics 10.34 ± 2.10 3.00-15.00 15

Overall 70.51 ± 11.07 22.00-102.00 110

Table 12 provides information on the sub-scale scores of Artificial Intelligence

(AI) readiness among the surveyed respondents. The table includes mean values,

63
standard deviations, minimum and maximum scores, and the possible total score for
each sub-scale, as well as an overall AI readiness score.
The overall AI readiness score combines the scores from the four sub-scales,
providing an average readiness score of 70.51 out of a possible 110. The current study
shows that the participants are somewhat prepared to use AI in their work. They have
some basic knowledge and are aware of the ethical issues involved. However, they
could improve their understanding of AI, how to use it, and how it can be more
helpful in healthcare. In general, they seem open to the idea of using AI, but they need
more training to make the most of it in healthcare.
Similarly, a Malaysian also showed that the mean score of AI readiness was
75.04, the cognitive domain was 27.61, the ability domain was 27.17, the vision
domain was 10.19 and the ethics domain was 10.07.(Xuan et al., 2023).

Table 13. Readiness status to Artificial Intelligence among respondents (n = 327)

Status of readiness to AI Frequency Percentage

Readiness to AI 220 67.3

Poor or un-readiness to AI 710 32.7

Total 327 100.0

Table 13 presents the status of readiness to Artificial Intelligence (AI) among

the surveyed respondents. It classifies respondents into two categories based on their
readiness for AI: "Readiness to AI" and "Poor or un-readiness to AI." About 67.3% of
respondents are categorized as ready for AI adoption while over 32.7% of respondents
are categorized as having poor or no readiness for AI adoption.

64
 This suggests that a majority of participants are open and prepared for AI
integration into their medical practice or education while minority are lack of
knowledge, or hold a negative attitude toward AI in healthcare. However, a previous
study in Saudi Arabia found out that the readiness levels for AI among medical
professionals were not satisfactory (Aboalshamat et al., 2022)

3.7 Conclusion

During our Residential Field Training Program of Final Part-I MBBS, we had
done survey on ‘Readiness on AI among undergraduate medical students of
University of Medicine (2), Yangon, during 16th October 2023 to 2nd November 2023.
A total of 327 medical students (Final Part-1) were participated.

The background characteristics of the students, including their age, gender,

urban/rural residence, self-rated English proficiency, self-rated IT skills, monthly
expenses on the Internet, and time spent on the Internet per day, were examined to
understand the factors influencing their readiness for AI. The moderate levels of self-
rated English proficiency and IT skills indicate a foundation that can be built upon
through AI education. Effective AI implementation often requires a certain level of
proficiency in these areas.

65
 Only a minority of the respondents (20.2%) of the respondents reported having
a good knowledge of AI, indicating a substantial gap in AI knowledge and awareness
within the healthcare community. Majority of the respondents (92.4%) expressed a
positive attitude toward AI which is a positive sign for AI adoption in the medical
field. A minority of the respondents (36%) had witnessed the practical application of
AI in a medical context.

Only very small amount of the respondents (4.9%) reported having good
practices related to AI which implies that very few healthcare professionals are
actively utilizing AI in their medical practice or education. More than half of the
respondents (67.3%) were categorized as ready for AI adoption.

Therefore, a majority of participants were opened and prepared for AI

integration into their medical practice or education while minority were lack of
knowledge, or held a negative attitude toward AI in healthcare.

3.8 Recommendation

The majority of the respondents reported broad and deep interest in AI

applications in medicine, but the study identified a low level of AI literacy,
necessitating the establishment of training centers to provide both online and offline
courses in medical schools.

Well-trained multidisciplinary medical educators, in collaboration with AI-

experienced computer scientists, should develop an integrated AI training approach
within the medical curriculum, with government participation through the provision
of regulations, guidelines, and teaching resources.

Most participants are not concerned about AI taking their jobs but rather about
potential skill loss; they must realize that AI is a human-made tool, and a doctor's role

66
encompasses more than diagnosis, involving social, legal, personal, and ethical
considerations.

Some respondents fear medical errors with AI, necessitating risk reduction
solutions and student belief in the technology's benefits and ease of use before
adoption.

Limitations

There are some limitations to this study. Since the study was a cross-sectional
study and the participants who were receiving the same education in a same medical
university were recruited by non-probability sampling, there may be potential biases
and the findings were not able to explore detailed. For these reasons, future studies
and researches should consider this implication.

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