Professionalism is a crucial component of medical practice. It is a culturally sensitive notion that generally consists of behaviors, values, communication, and relationships. This study is a ...qualitative study exploring physician professionalism from the patients' perspective.
Focus group discussions with patients attending a family medicine center attached to a tertiary care hospital were carried out using the four gates model of Arabian medical professionalism that is appropriate to Arab culture. Discussions with patients were recorded and transcribed. Data were thematically analyzed using NVivo software.
Three main themes emerged from the data. (1) In dealing with patients, participants expected respect but understood delays in seeing physicians due to their busy schedules. In communication, participants expected to be informed about their health conditions and to have their questions answered. (2) In dealing with tasks, participants expected proper examination and transparency of diagnosis, but some expected the physician to know everything and did not appreciate them seeking outside opinions. They expected to see the same physician at every visit. (3) In physician characteristics preferences, participants preferred friendly smiling physicians. Some cared about the outer appearance of the physician whereas others did not.
The findings of the study explained only two themes of the four gates model namely dealing with patients and dealing with tasks. Cultural competence and how to benefit from patients' perceptions to be an ideal physician should be incorporated into the process of physicians' training.
Saudi Arabia is considered one of the most influential Muslim countries being as the host of the two most holy places for Muslims, namely Makkah and Madina. This was reflected in the emphasis on ...teaching medical ethics in a lecture-based format as a part of the subject of Islamic culture taught to medical students. Over the last few years, both teaching and evaluation of medical ethics have been changing as more Saudi academics received specialized training and qualifications in bioethics from western universities.
This study aims at studying the current teaching methods and evaluation tools used by the Saudi public medical schools. It is done using a self-administered online questionnaire.
Out of the 14 medical schools that responded, the majority of the responding schools (6; 42.8%), had no ethics departments; but all schools had a curriculum dedicated to medical ethics. These curricula were mostly developed by the faculty staff (12; 85.7%). The most popular teaching method was lecturing (13; 92.8%). The most popular form of student assessment was a paper-based final examination (6; 42.8%) at the end of the course that was allocated 40% or more of the total grade of the ethics course. Six schools (42.8%) allocated 15-30% of the total grade to research.
Although there is a growing interest and commitment in teaching ethics to medical students in Saudi schools; there is lack of standardization in teaching and evaluation methods. There is a need for a national body to provide guidance for the medical schools to harmonize the teaching methods, particularly introducing more interactive and students-engaging methods on the account of passive lecturing.
PURPOSE: The purpose of this study is to explore the role of King Salman Relief Centre (KSRC) in providing prostheses and orthotics to amputation victims of landmine explosions in the conflict zone ...in Yemen.DESIGN/METHODOLOGY/APPROACH: Aggregated secondary data from KSRC were analysed. Variables used include sex, age group, affected limb, type of intervention, and area of residency. Data were entered into an Excel spreadsheet and further analysed using numbers and percentages.STUDY FINDINGS: A total of 6,351 prostheses and orthotics were provided for people affected with amputations as a result of landmine explosions over a period of three years (2020-2022) in Yemen. The project was implemented in 14 governorates of Yemen. Under the project, the majority of the limb prostheses (53.2%) and orthoses (46.8%) were provided for lower limb amputations (60.3%) due to landmine explosions in addition to those for other medical reasons (36.8%). Up to 3% of the prosthetics and orthotics were provided to victims of landmines who had their upper limbs amputated. Most of the beneficiaries of the interventions were adults (65.2%), of which 85.9% and 14.1% were males and females, respectively. The remaining 35.8% of beneficiaries were children under 18 years of age (boys comprising 64.3% and girls 35.7%) two-thirds of which were under 15 years of age.ORIGINALITY/VALUE: This is the first study in Yemen to explore the role of KSRC; however, the lessons learned from the correlation of the intervention study with the aid efforts can be used as a guide by KSRC themselves as well as by the other organisations working to deliver medical aid to conflict-ridden countries, to better manage the precious resources, and to identify any lacunae that may hinder full utilisation of the relief efforts. The data generated through these efforts can be used to further improve the efficiency of the relief effort and can guide policy-makers to judge the effectiveness of the project. This is in addition to utilising the resources diligently and closing any lacunae in the form of under-representation of any particular group of sex, age or geographic location. The study can be broadened further to include the parameters related to lifestyle, economic, and psychological benefits to the victims.RESEARCH LIMITATIONS/IMPLICATIONS: A clear correlation between the actual levels of mine contamination in Yemen is not yet clear as ongoing armed conflict still acts to add to the extent and complexity of contamination, including improvised mines. Economic implications and other variables to assess the consequences of the intervention as well as amputations were not collected; this should be included in further studies.PRACTICAL IMPLICATIONS: Disadvantaged countries, such as Yemen, with limited economic resources, have many obstacles to rehabilitating landmine victims due to low societal awareness, low resources, as well as the existence of war. Therefore, KSRC is an example of an effort contribution to provide much-needed humanitarian assistance and physical rehabilitation as part of health sector programmes.
This paper presents the perspective that conflicts between the ideal and the actual emergency room practice can be resolved by reference to the purposes of the law, maqasid al shari’at, and ...principles of the law, qawa’id al fiqh. The principle of necessity, qa’idat al dharurat, allows waiving normal practices like informed consent to protect life. The principle of intention, qa’idat al yaqeen, requires that all intervention and research must be based on evidence as much as is possible in an emergency. The principle of injury, qa’idat al dharar, requires minimizing harm while maximizing benefits in emergency procedures, protection of privacy and confidentiality. End of life decisions involving artificial life support are based on finding the right evidence-based balance between the purpose of protecting life, hifdh al nafs, and the purpose of conserving resources, hifdh al maal; the final decision guided by the principle of certainty depends on evidence of benefit of the resuscitation. Under the principle of custom/precedence, qa’idat al ‘aadat, programmed decision-making routines, protocols and guidelines should be used in the emergency room. Under the principle of necessity, research necessary for improvement of emergency care can be carried out without prior consent by the patient or the guardians if certain specific conditions are fulfilled.
تعرف المهنية أنها سلوكيات واتجاهات. وقد قام المجلس الأمريكي للطب الباطني بعرض6 محاور للكفاءة المهنية الجيدة وهي: الإيثار، والمساءلة، والتميز، والواجب، والشرف، والنزاهة، واحترام الآخرين، وأدرج العناصر ...التالية كعناصر تنقص من كفاءة المهنية: كإساءة استخدام السلطة، والتحرش الجنسي، والصراعات على المصالح، والغطرسة المهنية، وضعف الطبيب، والغش في البحوث. ويقترح المؤلف صياغة المهنية الطبية من وجهة نظر إسلامية على المحاور السبعة التالية: الإيمان، والتقوى، والأخلاق الحسنة، واتقان العمل، والإحسان، والأمانة، ومحاسبة النفس. وبالرجوع لتاريخ الإنسان القديم كانت الممارسة الطبية تقدم من قبل غير المتخصصين، وأعضاء الأسرة، والزعماء الدينيين. إن تطور العلوم الطبية وتقنياتها تطلب تدريب الأطباء المهنيين ذو المهارات التخصصية الدقيقة معاتباع القواعد المهنية. لقد قامت المنظمات المهنية بالدفاع عن حقوق أعضاءها، وتنظيم ضوابط للممارسات المهنية، وتنظيم التدريب، وتشجيع البحث العلمي والتبادل المعرفي. تدرس المهنية الطبية إما ضمن مقررات منهجية مدروسة أو من خلال اكتسابها بالاحتكاك مع القدوة أصحاب الخبرة المهنية. وهناك طرق عديدة لتقييم الكفاءة المهنية مثل استخدام مقياس "نيميغن" المهني المطور في هولندا والتقييم المهني البسيط المطور في كندا. ويمكن أيضا تقييم الكفاءة المهنية من خلال تقييم المعرفة والمواقف والممارسات المهنية، وتقييم السلوكيات الطلابية من خلال انضباطهم العملي، وتحليلهم الدقيق الحوادث الحرجة. وتخلص ورقة البحث إلى استنتاجها أن المهنية لاتزال في مرحلة التطور من ناحية التعريف والتدريس، والتقييم.
الكلمات المفتاحية: المهنية؛ المنظمة المهنية.
Professionalism is defined as behaviors and attitudes. The American Board of Internal Medicine (ABIM) listed 6 dimensions of good professionalism as: altruism, accountability, excellence, duty, honor and integrity, and respect for others; and listed elements that erode professionalism: abuse of power and sexual harassment, conflicts of interest, professional arrogance, physician impairment, and fraud in research. The formulation of professionalism from an Islamic perspective consists of 7 dimensions: (faith (iman), consciousness (taqwat), best character (ahsan al akhlaq), excellent performance (itqaan al ‘amal), strife toward perfection (ihsan), responsibility (amanat), and self-accountability (muhasabat al nafs). From the earliest human history medical practice was by non-professionals, members of the family and religious leaders. Development of scientific medicine and its technology required training of dedicated professionals who had specialized skills and had to follow codes of professionalism. Professional organizations were set up to defend the rights of members, regulate and discipline practitioners, regulate training, and promote scientific research and exchange. Professionalism is taught actively as structured curriculum courses or passively as apprenticeship under good role models. Various approaches are used in the assessment of professionalism such as using special instruments like the Nijmegen Professional Scale developed in the Netherlands and the Professional Mini Evaluation instrument developed in Canada. Professionalism can also be assessed by (a) assessing knowledge, attitudes, and practice of professionalism; peer assessment of professionalism, (b) assessment of student behaviors such as fulfilling duties, and (c) analysis of student narratives on critical incidents.
Purpose: The COVID-19 pandemic has limited the traditional way of teaching due to contact restrictions and the trainees being the front-line providers of patient care in certain specialties. During ...the pandemic, many academic institutes have adopted various methods for utilizing online learning as an alternative to traditional teaching. Numerous studies reported the impact of these changes on medical education with varying results. As such, comprehensive assessments are necessary to evaluate the outcomes of this rapid transformation. The aim of this study was to provide qualitative and quantitative assessments of post-graduate online medical education during the COVID-19 pandemic in Saudi Arabia. Participants and Methods: In this cross-sectional study, an online questionnaire was distributed among postgraduate trainers and trainees in Riyadh second health cluster. The questionnaire was used to assess the experiences, perception, coping, satisfaction and preferences of medical trainers and trainees towards online education during the COVID-19 pandemic. Results: A total of 207 participants were involved in this study. While the sociodemographics differed between trainers and trainees, age was significantly associated with negative pre-pandemic online learning experiences. Stress was reported among both groups and was significantly correlated with the pre-pandemic computer and internet competency. Coping was reported to be easier by trainers compared to trainees. The overall perception of online learning was positive in 73% of the respondents. Perception significantly correlated with age, stress, coping and satisfaction (P < 0.0001). The majority of trainees were interested in a hybrid mode learning, combining traditional teaching with online education. Conclusion: There is a significant difference between trainers and trainees with regard to their experience of online education. Further studies are required to assess how to effectively implement online education in postgraduate training programs and identify strategies to overcome the reported deficiencies. Keywords: COVID-19, pandemic, online education, academic training, education medical graduate
Purpose: The COVID-19 pandemic has limited the traditional way of teaching due to contact restrictions and the trainees being the front-line providers of patient care in certain specialties. During ...the pandemic, many academic institutes have adopted various methods for utilizing online learning as an alternative to traditional teaching. Numerous studies reported the impact of these changes on medical education with varying results. As such, comprehensive assessments are necessary to evaluate the outcomes of this rapid transformation. The aim of this study was to provide qualitative and quantitative assessments of post-graduate online medical education during the COVID-19 pandemic in Saudi Arabia. Participants and Methods: In this cross-sectional study, an online questionnaire was distributed among postgraduate trainers and trainees in Riyadh second health cluster. The questionnaire was used to assess the experiences, perception, coping, satisfaction and preferences of medical trainers and trainees towards online education during the COVID-19 pandemic. Results: A total of 207 participants were involved in this study. While the sociodemographics differed between trainers and trainees, age was significantly associated with negative pre-pandemic online learning experiences. Stress was reported among both groups and was significantly correlated with the pre-pandemic computer and internet competency. Coping was reported to be easier by trainers compared to trainees. The overall perception of online learning was positive in 73% of the respondents. Perception significantly correlated with age, stress, coping and satisfaction (P < 0.0001). The majority of trainees were interested in a hybrid mode learning, combining traditional teaching with online education. Conclusion: There is a significant difference between trainers and trainees with regard to their experience of online education. Further studies are required to assess how to effectively implement online education in postgraduate training programs and identify strategies to overcome the reported deficiencies.
نوقشت المشاكل الصحية للمراهقين (ممن أعمارهم 13–19 عاما) من وجهة نظر الأغراض الخمسة لمقاصد الشريعة. يرتبط غرض حماية الدين، حفظ الدين، بأزمات هوية المراهقين، ودور الغموض وتهميش الروحانية. ويرتبط غرض ...حفظ النفس بحماية وتعزيز الصحة البدنية للمراهقين. ويرتبط هذا الغرض أيضا بالكفاءة المحدودة للمراهقين في أخذ القرارات الطبية، نظرا لعدم نضج عقولهم. كما يرتبط غرض حفظ النسل بالصحة الجنسية والإنجابية للمراهقين. بينما يرتبط غرض حفظ العقل بمشاكل الاكتئاب لدى المراهقين، والانتحار، والانتحار التظاهري، والإدمان (النيكوتين، والكحول، والمخدرات) وجنوح الأحداث. تقترح الورقة تدابير هندسية اجتماعية عملية للتعامل مع مشاكل المراهقين، تتكون من النهج المعرفي والعلاج بالإيمان، والزواج المبكر مع وسائل منع الحمل، والعيش في أسرة ممتدة للحصول على الدعم النفسي وتعزيز الثقة.
The health problems of adolescents (aged 13–19years) are discussed from the perspective of the five purposes of the Law, maqasid al shari’at. The purpose of protecting diin, maqsad hifdh al ddiin, is related to adolescent identity crises, role ambiguity and marginalizing spirituality. The purpose of protecting life, maqsad hifdh al nafs, is related to protecting and promoting the physical health of adolescents. This purpose is also related to the limited competence of adolescents in making medical decisions, because of their immature brains. The purpose of protecting progeny, maqsad hifdh al nasl, is related to the sexual and reproductive health of adolescents. The purpose of protecting the mind, maqsad hifdh al ‘aql, is related to adolescent problems of depression, suicide, para-suicide, addiction (nicotine, alcohol and drugs) and juvenile delinquency. The paper suggests practical social engineering measures for dealing with adolescent problems, consisting of cognitive approaches, faith (iman) therapy, early marriage with contraception, living in an extended family for psychological support and enhancing esteem.
تناقش الورقة مختلف القضايا المتعلقة بالتقييم الطبي في سياق العالم العربي مع التركيز على شكلين من أشكال التقييم: الشكل الأول يتضمن أسئلة الاختيار من متعدد والشكل الثاني للتقييم يتضمن الطريقة الموضوعية ...المنظمة للامتحانات السريرية. ويتم تحديد نظام التقييم المناسب حسب المحتوى وطريقة التدريس والمعلومات والمهارات المفروض اكتسابها من قبل الممارس الصحي. يحفز التقييم الطلاب على الدراسة الجادة, كما أنه يستخدم لنقل الطلاب لمستوى تدريسي أعلى. إن التقييم الجيد لا يمكن استيراده بل يجب أن ينبع من البيئة المحلية مع مراعاة الخلفية الثقافية واللغوية والتعليمية للطلاب. في المقابل فإن التقييم المركزي الذي لا يخضع لسيطرة مباشرة من المعلمين المتصلين بطلابهم يناسب الامتحانات الموحدة مثل فحص التراخيص الطبية بالولايات المتحدة, لكنه يرتبط بالعديد من التحديات في الامتحانات الداخلية داخل المؤسسة التعليمية: فهو يُعقِّد إدارة الامتحان، مع تهميش لدور المعلمين، مع وجود ظلم في معاملة غير المتساويين كالمتساويين من الطلاب. ويغطي التقييم عنصري الطب: العلم النظري والعملي. بحيث تقيم أسئلة الاختيار من متعدد المعرفة وتطبيقاتها. بينما تقيم الطريقة الموضوعية المنظمة للامتحانات السريرية المهارات العملية. في المقابل تعتبر كتابة أسئلة الاختيار من متعدد بطريقة جيدة ومتقنة عملية صعبة فهي تأخذ الكثير من الجهد والوقت للتحضير لكنها سهلة التقديم للطلاب وسهلة التصحيح. وتعتمد الطريقة الموضوعية المنظمة للامتحانات السريرية على محاكاة المرضى مستبدلة الطريقة التقليدية للحالات الحقيقية السريرية الطويلة والقصيرة. لكن هذه الطريقة تحرم الطلاب المتميزين من طرح أسئلة على حالات محاكاة المرضى خارج النص المقرر. لذا اقترح استخدام محاكاة المرضى باستعمال أشخاص لديهم تجربة شخصية سابقة للحالة المرضية التي يجري الامتحان عليها. كما أقترح أيضا التركيز على تقييم المعلومات المهمة والحاسمة لدى الطلاب وتخصيص نسبة كبيرة من الدرجات لها. وينبغي أن يحكم على فشل الطلاب في كامل الامتحان إذا أخفقوا في بعض من هذه العناصر المهمة
The paper discusses various issues related to assessment in the context of the Arab world and focusing on 2 forms of assessment: multiple choice questions (MCQs) and objective structured clinical examinations (OSCEs). The appropriate assessment system is determined by the content and method of teaching as well as the expected knowledge and skills of the final product, the health professional. Assessment motivates students to study hard. It is also used to make decisions on promotion of students. A good assessment system cannot be imported; it must be home grown taking into consideration the cultural, linguistic, and educational background of the students. Centralized assessment not under the immediate control of teachers in contact with the students is appropriate for standardized examinations like the United States Medical Licensure Examination (USMLE) but is associated with many challenges in internal examinations within the teaching institution: complicated logistics, marginalization of the teachers, and the injustice of treating un-equals as equals. Assessment covers the two components of medicine: the science and the art (practical). The MCQ format assesses knowledge and its applications. The OSCE format assesses practical skills. Writing good MCQ items takes a lot of effort and time to review but is easy to administer and score. The OSCE based on simulated patients (SP) has ably replaced the traditional long and short clinical cases but penalizes the advanced candidate who asks the SP questions off the script. I propose using SPs who actually had personal experience of the condition being tested. I also propose some items in the OSCE that are of critical knowledge for professionals and which should have higher scores assigned to them. Students should be failed in the whole examination if they do not know some of these critical items.
This paper identified ethical issues relating to brain death and analyzed them according to the purposes of the Law, maqasid al shari’at, and principles of the law, qawa’id al fiqh, to reach ...conclusions of practical importance.
Issues arising in brain death were selected from articles retrieved from PUBMED over a 10-year period. Practical and conceptual issues identified in the articles were analyzed using maqasid al shari’atand qawa’id al fiqh.
Early determination of death by use of brain death criteria was motivated by the need to harvest transplantation organs earlier, to save intensive care resources by earlier cessation of life support, and to obtain tissues for research before deterioration. These motives would violate the principle of intention which requires that actions be judged by underlying intentions and that the end does not justify the means. In this case the nobility of the ends and their public interest were overriding considerations. The requirements, by the principle of certainty, of evidence-based proof of death were partially fulfilled by brain death criteria, tests, and examinations. The principle of custom was partially fulfilled because there was no universal consensus on criteria of brain death; the criteria varied by country, by institution, and over time.
Brain stem death, determined by clinical examination with or without instrumental confirmation, should remain the mainstay of death definition. Legal rulings on brain death should be reviewed every 3years to take into consideration new developments in medical knowledge and technology.
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