Measuring medical students' professional competencies in a problem-based curriculum: A reliability study

Identification and assessment of professional competencies for medical students is challenging. We have recently developed an instrument for assessing the essential professional competencies for medical students in Problem-Based Learning (PBL) programs by PBL tutors. This study aims to evaluate the reliability and validity of professional competency scores of medical students using this instrument in PBL tutorials. Methods: Each group of seven to eight students in PBL tutorials (Year 2, n = 46) were assessed independently by two faculty members. Each tutor assessed students in his/her group every five weeks on four occasions. The instrument consists of ten items, which measure three main competency domains: interpersonal, cognitive and professional behavior. Each item is scored using a five-point Likert scale (1 = poor, 5 = exceptional). Reliability of professional competencies scores was calculated using G-theory with raters nested in occasions. Furthermore, criterion-related validity was measured by testing the correlations with students' scores in written examination. Results: The overall generalizability coefficient (G) of the professional competency scores was 0.80. Students' professional competencies scores (universe scores) accounted for 27% of the total variance across all score comparisons. The variance due to occasions accounted for 10%, while the student-occasion interaction was zero. The variance due to raters to occasions represented 8% of the total variance, and the remaining 55% of the variance was due to unexplained sources of error. The highest reliability measured was the interpersonal domain (G = 0.84) and the lowest reliability was the professional behavior domain (G = 0.76). Results from the decision (D) study suggested that an adequate dependability (G = 0.71) can be achieved by using one rater for five occasions. Furthermore, there was a positive correlation between the written examination scores and cognitive competencies scores (r = 0.46, P < 0.01), but not with the other two competency domains (interpersonal and professionalism). Conclusions: This study demonstrates that professional competency assessment scores of medical students in PBL tutorials have an acceptable reliability. Further studies for validating the instrument are required before using it for summative evaluation of students by PBL tutors.Scopu

Health sciences students' and instructors' perceptions of the emergency switch to virtual internship amid the COVID-19 pandemic: A case from Qatar

In efforts to contain the COVID-19 pandemic, health colleges at Qatar University shifted their clinical training to virtual internships (VI) and project-based learning (PBL). The shift was new to students and faculty alike, and a major change that posed many challenges. This study aimed to explore the experience of changing to VIs during the pandemic from both the clinical instructors' and health sciences students' perspectives. A qualitative study was conducted based on the framework of readiness to change. It involved focus group discussions with students from the departments of Public Health and Human Nutrition and in-depth interviews with clinical instructors using appropriate online platforms. A total of 4 focus groups with 20 students and 4 interviews with instructors were conducted. Transcripts were analyzed following the inductive-deductive approach. The major themes that emerged from the analysis described students' and clinical instructors' perceptions of the necessity and efficiency of the switch to VI; the design of the VI and the extent of the clinical/field experience and skills that it offered; confidence in the ability to succeed in this type of internship and confidence about reaching expected goals; academic and moral support from clinical faculty and coordinators and the communication process with faculty and preceptors; and finally, the benefits gained and how employers would view this type of internship. Health sciences students' readiness for VI was generally low. Several student and faculty needs have to be addressed, specifically regarding the design of the program and the level of preceptors' communication with students. The findings would direct health programs, clinical instructors, and preceptors to better understand students' needs and efficiently plan for virtual internships during not only emergencies but also whenever there is a need to deliver online experiential learning courses.This study was funded by a Qatar University Emergency Response Grant (QUERG-CHS-2020-1)

Measuring medical students' professional competencies in a problem-based curriculum: A reliability study

Background: Identification and assessment of professional competencies for medical students is challenging. We have recently developed an instrument for assessing the essential professional competencies for medical students in Problem-Based Learning (PBL) programs by PBL tutors. This study aims to evaluate the reliability and validity of professional competency scores of medical students using this instrument in PBL tutorials. Methods: Each group of seven to eight students in PBL tutorials (Year 2, n = 46) were assessed independently by two faculty members. Each tutor assessed students in his/her group every five weeks on four occasions. The instrument consists of ten items, which measure three main competency domains: interpersonal, cognitive and professional behavior. Each item is scored using a five-point Likert scale (1 = poor, 5 = exceptional). Reliability of professional competencies scores was calculated using G-theory with raters nested in occasions. Furthermore, criterion-related validity was measured by testing the correlations with students’ scores in written examination. Results: The overall generalizability coefficient (G) of the professional competency scores was 0.80. Students’ professional competencies scores (universe scores) accounted for 27% of the total variance across all score comparisons. The variance due to occasions accounted for 10%, while the student-occasion interaction was zero. The variance due to raters to occasions represented 8% of the total variance, and the remaining 55% of the variance was due to unexplained sources of error. The highest reliability measured was the interpersonal domain (G = 0.84) and the lowest reliability was the professional behavior domain (G = 0.76). Results from the decision (D) study suggested that an adequate dependability (G = 0.71) can be achieved by using one rater for five occasions. Furthermore, there was a positive correlation between the written examination scores and cognitive competencies scores (r = 0.46, P < 0.01), but not with the other two competency domains (interpersonal and professionalism). Conclusions: This study demonstrates that professional competency assessment scores of medical students in PBL tutorials have an acceptable reliability. Further studies for validating the instrument are required before using it for summative evaluation of students by PBL tutors

Intravenous fluids in hot pre-hospital environments: Thermal and physical stability of normal saline after exposure to simulated stress conditions

Background: Normal saline 0.9 % (NS) is the most widespread crystalloid used as a life-saving intravenous (IV) fluid. 1 NS contains sodium and chloride in equal concentrations and is subject to thermal stress conditions while stored and transported by clinicians in the pre-hospital environment. 2 This study aimed to investigate the effect of high-temperature exposure on NS bags used by the Hamad Medical Corporation Ambulance Service in Qatar. Methods: Five-hundred mL polyolefin NS soft bags (Qatar-Pharma, BN:1929013008) were divided into 4 groups of 24 each and stored at constant temperature (22, 50, or 70°C), or subjected to a temperature of 70°C for 8 hours followed by 22°C for 16 hours repeatedly over 28 days. Inspection and chromatographic analysis of the bags was performed at 0, 12, 24, 48, and 72 hours in the 72-hour study, and at 1, 2, 3, and 4 weeks in the 28-day study. Results: NS bags slightly bulged at 50°C and significantly bulged at 70°C or in the long experiment with temperature variation (Figure 1). During the exposure period, there was no discoloration, turbidity, or leaching of plastic components observed in the NS fluid. The pH readings were 5.59 ± 0.08 (22°C-Control sample), 5.73 ± 0.04 (50°C), 5.86 ± 0.02 (70°C), and 5.79 ± 0.03 following prolonged temperature variation. The sodium and chloride levels for the short-term study ranged from 100.2 ± 0.26% to 107.9 ± 0.75% and from 99.04 ± 0.76 to 102.11 ± 1.71%, and for the long-term study they ranged from 101.93 ± 0.90% to 111.27 ± 2.61 and from 99.05 ± 0.94% to 110.95 ± 1.63%; respectively (Figure 2) in comparison to manufacturer stated concentrations. Conclusion: There was no evidence to suggest that the NS fluid inside the PO bags is physically and chemically different when exposed up to 28 days to 50°C, 70°C, and prolonged temperature variations compared to 22°C. These simulated conditions are subject to further testing under real-life pre-hospital care emergency conditions in a hot country

A program evaluation reporting student perceptions of early clinical exposure to primary care at a new medical college in Qatar

Background: Though common practice in Europe, few studies have described the efficacy of early clinical exposure (ECE) in the Middle East. The barriers to clinical learning experienced by these novice medical students have not been reported. This evaluation reports on introducing ECE in primary care, supported by Experiential Review (ER) debriefing sessions. The evaluation explores students' experiences of their acquisition of clinical and non-technical skills, sociocultural issues commonly encountered but underreported and barriers to clinical learning experienced. Methods: We conducted a cross-sectional study of three student cohorts in 2017-19: All second and third-year students at the new College of Medicine were invited to participate. The primary outcome was students' perceptions of the aims of the Primary Health Centre Placement (PHCP) programme and how it facilitated learning. Secondary outcome measures were students' perceptions of their learning in ER sessions and perceived barriers to learning during PHCPs. Student perceptions of the PHCPs were measured using a Likert scale-based questionnaire. Results: One hundred and fifty-one students participated: 107 in year 2 and 44 in year 3; 72.3% were female. Overall, most students (> 70%) strongly agreed or agreed with the purposes of the PCHPs. Most students (71%) strongly agreed or agreed that the PCHPs allowed them to learn about patient care; 58% to observe doctors as role models and 55% to discuss managing common clinical problems with family physicians. Most students (year 2 = 62.5% and year 3 = 67%) strongly agreed/agreed that they were now confident taking histories and examining patients. Student barriers to clinical learning included: Unclear learning outcomes (48.3%); faculty too busy to teach (41.7%); lacking understanding of clinical medicine (29.1%); shyness (26.5%); and finding talking to patients difficult and embarrassing (25.8%). Over 70% reported that ER enabled them to discuss ethical and professional issues. Conclusions: Overall, our Middle Eastern students regard ECE as beneficial to their clinical learning. PHCPs and ER sessions together provide useful educational experiences for novice learners. We recommend further exploration of the barriers to learning to explore whether these novice students' perceptions are manifesting underlying cultural sensitivities or acculturation to their new environment.Scopu

“The Association between Waiting Time and Patient Satisfaction in Outpatient Clinics” at “King Abdullah Medical City, Makkah”

BACKGROUND: Patients have historically found lengthy wait times to be annoying, and this appears to be a consistent and important contributing factor in their unhappiness.&nbsp; The timely, effective, and patient-centered delivery of high-quality healthcare is influenced by patient happiness, and patient satisfaction is linked to clinical outcomes, making it a key indicator for determining the quality of healthcare. Waiting time, which is a crucial component in determining service quality, could be a useful instrument for assessing patient satisfaction. It has been proven that waiting times and patient satisfaction have a significant inverse relationship.&nbsp; “OBJECTIVE”: The goal of this examination is to recognize the association among to come time and patient pleasure and to identify predictor’s patient satisfaction and waiting time in outpatient clinics in a KAMC, Makkah SETTINGS/DESIGN: The project type is a descriptive-analytical research design. Undertaken at “King Abdullah Medical City, Makkah”. “SUBJECTS AND METHODS”: A sample of 499 patients was recruited. The investigator collected the socio demographic data from patients’ electronic /files, the other data included patient waiting time, and patient satisfaction score, which was collected from the hospital quality department and patient experience department during the period of 2021. RESULTS: The result shows that the remaining patients weren\u27t happy, but nearly half of them were. Participants\u27 satisfaction scores varied significantly according on their gender, age group, and type of visit. There is no statistical differences between satisfaction score with nationality and place of resident. The result also shows that by waiting time, the satisfaction rating varied dramatically. In addition, most of the participants who waited more than 20 minutes shows that they were dissatisfied. The test result also demonstrates that waiting time and satisfaction are related except consultation time it shows that no statistical relationship. Finally the result identified that age, gender and type of visit as significant predictors of patient satisfaction. CONCLUSION: The necessity of assessment should be the emphasis of healthcare organizations the patient’s satisfaction in relation with waiting time in outpatient department since doing so will give a rudimentary comprehension of the patient\u27s viewpoints on improving their satisfaction. This outcome can aid healthcare organizations in determining where they need to improve. In order to reduce outpatient waiting times, improve patient happiness, and determine the efficacy of interventions in healthcare settings, additional experimental research is necessary