College of Medicine

Background: Physicians are primary customers of laboratory services and their perception of the provided services is considered an important measure of quality assurance. This study investigates the physicians’ satisfaction of laboratories’ services, in Maternity and Children Hospital in Makkah, to identify strength and possible limitations, which might inform the development plans for more efficient services.
Methods: The study measured satisfaction of laboratories’ primary customer (physicians) of provided services in fourfold: quality of reports, communication, management, and TAT. Paper-based survey of 5-Likert Scale, ranged from Strongly Disagree (1) to Strongly Agree (5) was developed based on the CAP survey and related published studies. The questionnaire was piloted and then demonstrated between May and June 2014.
Results: Sixty-three physicians complete the survey. The overall satisfaction of the provided services were limited with mean score 64/120. Respondents were not pleased with the majority of items with mean ranged between 3.4 (Unsure) to 2.3 (Disagree). Physicians were most satisfied with courtesy of laboratory personnel (mean= 3.4), accuracy of laboratory results (mean= 3.2) and staff support to research projects (mean= 3.1). However, the lowest satisfaction rete was reported with the test turnaround times (TAT) for state, and routine tests for inpatient and outpatient.
Conclusion: This study presented a number of negative observations of laboratory services at the Maternity and Children Hospital in Makkah, which mainly related to administration, communication, quality and delay in TAT. The efficiency and optimization of laboratory service need to be readdressed by the laboratory administration. Effective extra laboratory communication channels needed to be established to improve interaction between laboratory and physicians. Point-of-care testing (POCT) is one of the promising implementing to improve TAT since, no time required for sample's preparation and transportation.

Background: Worldwide research anticipates that a current shortage of rheumatologists will exacerbate over the next decade, whereas the need for arthritis specialists will continue to escalate. Saudi Arabia (SA) also encounters a limited geographical distribution of rheumatologists and rheumatology fellowship training centres. Objective: Reporting the Saudi rheumatologists' advisory meeting conducted in Makkah, SA in January 2020 with the aim to discuss the "Saudi Vision 2030" for rheumatology training programs. Materials and Methods: A meeting of Saudi rheumatology experts and consultants was conducted to address the future directions, challenges, and recommendations of rheumatology training. The 10th Rheumatology Practice Symposium was organised by Alzaidi Chair of Research in Rheumatic Diseases (ZCRD), and conducted in Makkah Commerce Chamber, Makkah, SA on January 28, 2020. More than 30 consultants and rheumatology fellows with five Saudi experts in the field of rheumatology assembled to form 10 recommendations that tackle rheumatology training challenges in SA. Results: The meeting recommendations shed light on the clinical practice of rheumatology training in SA; challenges and opportunities in rheumatology fellowship programs; efforts of the Saudi Commission for Health Specialties (SCFHS) to design and implement a competent postgraduate rheumatology training; and challenges with trainers, trainee, and within training centres. Conclusion: To address rheumatology challenges in SA, rheumatology consultants and fellows assembled to form 10 recommendations. The recommendations tackled the challenges of rheumatology fellowship programs and the efforts to implement a competent postgraduate rheumatology training. These recommendations are expected to lead us successfully to fulfil our ambition in the "Saudi Vision of 2030".

Peer-assisted learning (PAL) is increasingly used in different fields of education, including medical education, due to its established advantages. However, there are scarce data about the best practice guidelines for PAL program evaluation. The aim of this work was to develop a framework that can describe and develop PAL programs and consequently provide a tool for evaluation and comparison of PAL programs among different institutions. Approach: A thorough literature review was made for assessment of different PAL programs development and implementation strategies, and PAL leaders at the University of Umm Al-Qura in Saudi Arabia were interviewed for development and revision of a framework for PAL program development, description and evaluation. Findings: A framework of four sections was developed ie context, theory, implementation processes and outcomes, and emergence. The context includes the learning objectives and the logistics. The theory includes the content nature, program design, number of tutees and tutors, participation, program orientation, program duration and timing, tutor recruitment and preparation and faculty involvement. Implementation process and outcome section includes the feedback collection and the pre-and post-intervention students' assessment. The emergence includes tracking the program evolution. Insights: Development of a clear well-defined framework for description, implementation and evaluation of a PAL educational program can provide a foundation to unify the terms organizations use to communicate the parameters of PAL programs and overcome the jargon about PAL in the literature. It also can provide comparisons between the programs in an attempt to set best practice guidelines in the future for PAL program developing and implementation.

The fundamental pillar of a safe and efficient healthcare system is the competence of the healthcare providers. Judging whether a provider is competent is usually decided about by medical licensing boards. The dire need of competent practitioners has led to pushing the boundaries of mere licensing, and has led to the development of an approach that ensures the proficiency of a medical graduate, culminating into the conception of competency-based medical education (CBME). CBME is an approach to preparing physicians for practice who possess the desired knowledge, skills, and attitude outlined by the careful consideration of societal and patient needs. CBME has gained immense popularity and is broadly implemented in the health sciences during the past couple of decades. Gradually, many undergraduate as well as postgraduate training programs are shifting their curriculum to align with so-called "competency frameworks." The most well-known among these are the Canadian CanMEDS framework, the Accreditation Council for Graduate Medical Education proposal, the Scottish Doctor learning outcomes, and the Dutch national framework. Recently, in response to the national vision titled "the Saudi Future Doctor", a competency framework namely Saudi MEDS has been developed for Saudi medical graduates. 1 The idea behind developing this generic competency framework was to formulate minimum competency standards that any medical graduate has to meet. The collaborative team, consisting of representatives from five major Saudi health sciences universities, chalked out the competencies framework that reflect the principles of medical practice in Saudi Arabia.

Systemic lupus erythematosus (SLE) is a wide spectrum disease with many clinical manifestations. Lack of awareness of the disease itself, with its common and rare presentations results in significant delay in diagnosis and consequently serious compromise of patients’ care. Physical examination will always retain its importance as the most common diagnostic test used by doctors and as an essential tool for modern practice(Joshua, Celermajer et al. 2005). Findings from proper musculoskeletal (MSK) examination is extremely useful in diagnosing rheumatologic disorders especially where gold standard diagnostic tests are lacking. From this perspective there should be much emphasis on basic bedside skills among clinicians searching for arthritis. Asking about morning stiffness and joint swelling are simple enough to pick up early arthritis (Paget 2007). Performing an active range of motion testing of joints as a screening method would pick up limitations in joints mobility from active arth...

Background: Physicians are primary customers of laboratory services and their perception of the provided services is considered an important measure of quality assurance. This study investigates the physicians’ satisfaction of laboratories’ services, in Maternity and Children Hospital in Makkah, to identify strength and possible limitations, which might inform the development plans for more efficient services. Methods: The study measured satisfaction of laboratories’ primary customer (physicians) of provided services in fourfold: quality of reports, communication, management, and TAT. Paper-based survey of 5-Likert Scale, ranged from Strongly Disagree (1) to Strongly Agree (5) was developed based on the CAP survey and related published studies. The questionnaire was piloted and then demonstrated between May and June 2014. Results: Sixty-three physicians complete the survey. The overall satisfaction of the provided services were limited with mean score 64/120. Respondents were not pl...

Phenomenon Peer-assisted learning (PAL) is increasingly used in different fields of education, including medical education, due to its established advantages. However, there are scarce data about the best practice guidelines for PAL program evaluation. The aim of this work was to develop a framework that can describe and develop PAL programs and consequently provide a tool for evaluation and comparison of PAL programs among different institutions. Approach A thorough literature review was made for assessment of different PAL programs development and implementation strategies, and PAL leaders at the University of Umm Al-Qura in Saudi Arabia were interviewed for development and revision of a framework for PAL program development, description and evaluation. Findings A framework of four sections was developed ie context, theory, implementation processes and outcomes, and emergence. The context includes the learning objectives and the logistics. The theory includes the content nature, p...

1Department of Internal Medicine, Security Forces Hospital, Riyadh, Saudi Arabia; 2Department of Medical Education, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; 3Medical Education, College of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia; 4College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia Purpose: The purpose of the Saudi Medical Education Directives Framework (SaudiMEDs) is to assure the essential level of competencies for medical graduates, which should be reflected in the Saudi Medical Licensure Examination (SMLE). This study explored the opinions of key stakeholders of the alignment and integration of the SMLE’s blueprint and contents with the SaudiMEDs competency framework’s themes...

of Yemen are traditional, like most of the medical schools in the Middle East region. The curriculum in Dundee University Medical School, UK, claims to follow the prescriptions of the UK General Medical Council to be outcome based with three interlocking phases and students encouraged to take responsibility for their own learning. The aim of this study is to measure the educational environment, using the 50-item Dundee Ready Education Environment Measure (DREEM), in each medical school and to compare the educational environment as perceived by the responding students of the traditional medical schools in developing countries with that of the ''modernised'' medical school in Dundee University, UK. Methods: The DREEM was administered to 1072 medical students in the four different universities. Using SPSS, data were expressed as means of scores. Comparisons between schools, years of study and gender were made using non-parametric tests. Results: For all three traditional medical schools, the mean scores of the inventory were lower compared with Dundee Medical School. Students from traditional schools rated their learning and teaching environment significantly lower than their counterparts in

Background: Physicians are primary customers of laboratory services and their perception of the provided services is considered an important measure of quality assurance. This study investigates the physicians' satisfaction of laboratories' services, in Maternity and Children Hospital in Makkah, to identify strength and possible limitations, which might inform the development plans for more efficient services. Methods: The study measured satisfaction of laboratories' primary customer (physicians) of provided services in fourfold: quality of reports, communication, management, and TAT. Paper-based survey of 5-Likert Scale, ranged from Strongly Disagree (1) to Strongly Agree (5) was developed based on the CAP survey and related published studies. The questionnaire was piloted and then demonstrated between May and June 2014. Results: Sixty-three physicians complete the survey. The overall satisfaction of the provided services were limited with mean score 64/120. Respondents were not pleased with the majority of items with mean ranged between 3.4 (Unsure) to 2.3 (Disagree). Physicians were most satisfied with courtesy of laboratory personnel (mean= 3.4), accuracy of laboratory results (mean= 3.2) and staff support to research projects (mean= 3.1). However, the lowest satisfaction rete was reported with the test turnaround times (TAT) for state, and routine tests for inpatient and outpatient. Conclusion: This study presented a number of negative observations of laboratory services at the Maternity and Children Hospital in Makkah, which mainly related to administration, communication, quality and delay in TAT. The efficiency and optimization of laboratory service need to be readdressed by the laboratory administration. Effective extra laboratory communication channels needed to be established to improve interaction between laboratory and physicians. Point-of-care testing (POCT) is one of the promising implementing to improve TAT since, no time required for sample's preparation and transportation.

Background: Musculoskeletal (MSK) conditions are among the most common complains presented at the clinical practice, accounting about 15%-30% of all primary care encounters. However, clinical doctors continue to document a low level of confidence in their musculoskeletal clinical skills. Objectives: The aim of this study is to evaluate the internal medicine (IM) residents for confidence and perception in demonstrating musculoskeletal clinical skills. Methods: 37 items paper-based questionnaire was developed and piloted to investigate IM residents in Saudi Arabia during June-December 2011. Results: The study indicates residents' low self-confidence in demonstrating MSK physical examinations with total mean (10/24). Respondents also show general agreement that MSK problems are very common in patient visits, and indicate the importance of MSK clinical screening in all standard clinical examination of patients, yet they point to current inappropriate practice in handling most cases. Respondents show lower perception of undergraduate and postgraduate training, regarding the inadequate training and assessment in MSK. Conclusions: The study shows inadequate MSK education, during and post, medical school training and that there are different training approaches for the different specialties, which undermines MSK training altogether.

MSK symptoms are the most common health complications that require medical attention, accounting to 20% of both primary care and emergency-room visits (Rasker 1995). In a health survey, MSK disorders were ranked first in prevalence as the cause of chronic health www.intechopen.com Systemic Lupus Erythematosus 220 problems, long term disabilities, and consultations with a health professional (Badley, Rasooly et al. 1994). In Saudi Arabia, MSK disorders is the second major cause of outpatients visit in primary care centers and private clinics (MOH 2009). A number of different medical specialties are involved in treating patients with musculoskeletal complaints, including general practitioners, family physicians, internists, orthopedic and surgeons, working in teams with other health professionals, but often without a multispecialty focus. In order to truly improve the outcome of treatment for musculoskeletal conditions, it is important that experts in the various specialties work more closely together and look for commonality of approach, as they often treat the same patients but from different angles. Despite the high prevalence of musculoskeletal disorders in all fields of clinical practice, studies show a lower level of competence and confidence in MSK cognitive and clinical skills (including physical examinations) across clinicians (Akesson, Dreinhofer et al. 2003; Almoallim, Khojah et al. 2007; Beattie, Bobba et al. 2008). Also, a continuous neglect of musculoskeletal examination skills in clinical practice is observed. We reported a case of SLE with active arthritis where the diagnosis was delayed for seven days after hospital admission due to the lack of basic skills in MSK examination (Almoallim, Khojah et al. 2007). The patient in the report presented to the emergency room with fever and pancytopenia and apparently the focus of the treating medical team was mainly on these presenting findings. This might had restricted the clerking done on admission to "hematology and infectious diseases" while what should had been done was a complete history and thorough physical examination regardless of initial impression. Musculoskeletal assessment should be a part of routine clerking (Lillicrap, Byrne et al. 2003). Assuring such attitude among clinicians will prevent unnecessary delay in diagnosis. If a simple musculoskeletal screening examination focused mainly on range of motion testing to assess function was done, this patient's active arthritis would have been picked up on admission. This would have initiated early search for a rheumatological disease and start treatment without a delay. Despite this impact of MSK disorders on health care, rheumatological diseases are often overlooked or inadequately assessed by doctors (Jones, Maddison et al. 1992). Thus, patients with complaints about bones and joints are often ignored and their problems underestimated by doctors. In a study among 200 general medical inpatients in a teaching hospital, it was found out that the signs and symptoms of MSK disorder which were recorded in the hospital notes was only 5.5% and 14% respectively. This compared poorly with recorded examinations of other systems and regions for example, cardiovascular symptoms were recorded in 100% of the cases; respiratory and abdominal symptoms were recorded in 99%, the nervous system , skin and female breasts symptoms were recorded in 77% and 13% respectively (Doherty, Abawi et al. 1990). In another report, only 40%of patients admitted to general medicine ward had the history of their MSK symptoms recorded and only 14.5% of these patients received comprehensive MSK examination (Ahern, Soden et al. 1991). Furthermore, 80% of symptomatic patients received either no treatment for their rheumatic disorders, or treatment that was regarded as suboptimal or inappropriate (Ahern, Soden et al. 1991). Another report showed even a higher percentage of patients-63% of all patient admitted to general medicine ward-had MSK symptoms or its signs, but relevant MSK history was missed in 49% of the patients records, while signs were missed in 78%; 42% of those with MSK conditions would have benefitted from additional treatment (Lillicrap, Byrne et al. 2003). A more recent report reviewed 150 patient notes in three different hospitals from the acute admission wards for medicine and surgery and the medical assessment unit. Factors considered included whether GALS screenings

Background: Burnout is considered a work-related stress syndrome. We investigate the burnout prevalence and the risk factors associated with burnout during the coronavirus disease-2019 (COVID-19) pandemic online teaching at Umm Al-Qura University (UQU) medical school. Method: During online teaching, an analytical cross-sectional study was conducted among UQU medical students. Data were collected between February to March 2021. Burnout was assessed using a validated tool. Result: About 568 students from year two to six medical school completed the survey. The study revealed that a total of 224 (39.44%) students experience burnout. Multiple logistic regression exhibited students with chronic disease were 2-times likely to have burnout. Moderate GPA students (GPA of 3-3.4 out of 4) scored high burnout compared to peers with GPA 3.4-4. There was a statistically higher likelihood between burnout and students who reported negative effects of studying on their social life, high family expectation, and dissatisfaction with blended learning experience. Conclusion: The overall burnout prevalence was 39.44% among UQU medical students. Many factors were associated with student's burnout, such as chronic disease, moderate GPA, and high family expectations.

This study aimed at developing a national consensus on entrustable professional activities (EPAs) for Saudi undergraduate medical education and mapping them with the "Saudi Meds" competency framework. Methods: A three phased approach was used. Phase 1 consisted of identifying and developing EPAs; Phase 2 consisted of building a national consensus on developed EPAs (validation process); and Phase 3 consisted of mapping the validated EPAs with the Saudi Meds competency framework. Nominal group and modified Delphi techniques were used to develop consensus on EPAs. Classical test theory-based item analysis was conducted to establish validity and reliability of finalized EPAs. Results: Fifteen expert medical educationists and 109 academic leaders from 23 medical schools participated in the validation process. The study achieved a consensus on 10 core EPAs with an overall reliability (Cronbach's Alpha) of 0.814. The item-total correlation ranged from 0.341 to 0.642. Conclusion: This study results in a national consensus on generic, comprehensive and region-specific EPAs that have been mapped with Saudi Meds competency framework. Our study is the first step in the direction of facilitating EPA-based curricular reforms in Saudi medical schools.

Background
Medical education in Saudi Arabia is facing multiple challenges, including the rapid increase in the number of medical schools over a short period of time, the influx of foreign medical graduates to work in Saudi Arabia, the award of scholarships to hundreds of students to study medicine in various countries, and the absence of published national guidelines for minimal acceptable competencies of a medical graduate.

Discussion
We are arguing for the need for a Saudi national medical licensing examination that consists of two parts: Part I (Written) which tests the basic science and clinical knowledge and Part II (Objective Structured Clinical Examination) which tests the clinical skills and attitudes. We propose this examination to be mandated as a licensure requirement for practicing medicine in Saudi Arabia.

Conclusion
The driving and hindering forces as well as the strengths and weaknesses of implementing the licensing examination are discussed in details in this debate.

Purpose: To review the imaging results of a novel posterior lumbar interbody fusion (PLIF) construct using local bone graft for supplemental intertransverse arthrodesis, and to determine intraobserver and interobserver reliability in the radiographic assessment of these lumbar fusions.

Results: Six experienced observers each made 2 separately blinded reviews of randomized radiographic images from a consecutive series of 43 adult patients who had had posterolateral lumbar interbody fusions at 62 lumbar motion segments performed with a unique osteoconductive lumbar interbody implant, allowing for 360° lumbar fusion without iliac bone graft harvest. All 63 instrumented motion segments were reviewed independently. Fusions were graded according to previously established radiographic criteria from the literature. Weighted kappa statistics were calculated from the resulting Microsoft Excel database and SPSS software.

Intraobserver reliability was slight to substantial (kappa ranged from 0.13 to 0.76) and interobserver variability was only slight to moderate (kappa 0.19–0.52). Seniority or experience of the observers produced no trend to improved consistency in intraobserver reliability.

Significance: The use of local autograft bone for intertransverse arthrodesis in this PLIF construct is supported, and simple radiographs may be adequate to assess the presence of lumbar fusion.

Discussion: Plain radiograph analysis of lumbar fusion constructs, according to standardized criteria taken from the literature, was found to be moderately consistent. The use of local autograft bone for intertransverse arthrodesis in this PLIF application is supported.

High-quality randomized controlled trials (RCTs) are the highest level of evidence in assessing the effectiveness of a treatment. It is random allocation that places RCTs in the highest level of evidence. The purpose of randomization is to create groups of patients that are comparable for known and unknown factors at the start of the trial so that any differences at the completion of the trial can be attributed to the treatment under investigation. The purpose of this article is to discuss the processes that would help create balanced groups and maintain between-group comparability throughout the study period.