Undergraduate medical education in the Gulf Cooperation Council: a multi-countries study (Part 1)

Teaching Cellular Architecture: The Global Status of Histology Education

Histology or microanatomy is the science of the structure and function of tissues and organs in metazoic organisms at the cellular level. By definition, histology is dependent on a variety of microscope techniques, usually light or more recently virtual, as well as electron microscopy. Since its inception more than two centuries ago, histology has been an integral component of biomedical education, specifically for medical, dental, and veterinary students. Traditionally, histology has been taught in two sequential phases, first a didactic transfer of information to learners and secondly a laboratory segment in which students develop the skill of analyzing micrographic images. In this chapter, the authors provide an overview of how histology is currently taught in different global regions. This overview also outlines which educational strategies and technologies are used, and how the local and cultural environment influences the histology education of medical and other students in different countries and continents. Also discussed are current trends that change the teaching of this basic science subject.

Virtual Microscopy Goes Global: The Images Are Virtual and the Problems Are Real

For the last two centuries, the scholarly education of histology and pathology has been based on technology, initially on the availability of low-cost, high-quality light microscopes, and more recently on the introduction of computers and e-learning approaches to biomedical education. Consequently, virtual microscopy (VM) is replacing glass slides and the traditional light microscope as the main instruments of instruction in histology and pathology laboratories. However, as with most educational changes, there are advantages and disadvantages associated with a new technology. The use of VM for the teaching of histology and pathology requires an extensive infrastructure and the availability of computing devices to all learners, both posing a considerable financial strain on schools and students. Furthermore, there may be valid reasons for practicing healthcare professionals to maintain competency in using light microscopes. In addition, some educators may be reluctant to embrace new technologies. These are some of the reasons why the introduction of VM as an integral part of histology and pathology instruction has been globally uneven. This paper compares the teaching of histology and pathology using traditional or VM in five different countries and their adjacent regions, representing developed, as well as developing areas of the globe. We identify general and local roadblocks to the introduction of this still-emerging didactic technology and outline solutions for overcoming these barriers.

Medical education in the United Arab Emirates: Challenges and opportunities

Medical education (ME) in the United Arab Emirates (UAE) has a relatively short history that begins with the inception of the UAE almost 50 years ago. The UAE has made great strides in widening access to ME through the rapid implementation of national agendas aimed at advancing healthcare and expanding higher education, in addition to the presence of a strong infrastructure for privatization and business development. While progress is being made at all levels of ME, complex challenges for both undergraduate and postgraduate ME remain. Going forward, issues of standardization, quality, sustainability of academic and healthcare workforces, and research must continue to be addressed.

Learning difficulties of medicine. Perceptions and expectations of medical students in Morocco

CONTEXT

Morocco, like other countries of the Great Maghreb, does not use their mother language (Arabic) nor the dominant one (English), in teaching medicine, which could create cognitive barriers in assimilating knowledge and developing innovations.

OBJECTIVE

To explore attitudes of a representative sample of students from Moroccan medical faculties, towards their current learning difficulties and their expectations, vis-à-vis their linguistic reform projects at the Moroccan University.

METHODS

This descriptive study included a proportional stratified sample of students (both sexes) from the Faculties of Medicine and Pharmacy of Moroccan universities, during the 2019-2020 academic year. It used an exploratory questionnaire of language skills, academic assimilation, and suggestions for language alternatives.

RESULTS

A sample of 891 Moroccan medical students, responding to the questionnaire (sex ratio of 0.68), from the eight faculties of medicine, were from two secondary education streams: Arabic and French. The students declared their good level in "reading and comprehension" and "speaking" in Arabic, respectively by 63% and 39% of the respondents, and in using the French language respectively by 44% and 26%. Third of the respondents admitted that the French language negatively affected their academic success, by increasing the time required for learning (44%) and by weakening their ability to communicate with patients (21%). More than half of the students were aware of the dialectic relationship between the language used, and assimilation, identity, scientific creativity, and economics. The future options of the linguistic problems of medical training in Morocco were mainly distributed, according to the respondents, either on using the English language (69%) or on partial (42%), total (37%) arabization of medical courses.

CONCLUSION

Despite linguistic mastery of medical students, in Morocco, they recognized their learning difficulties in French and expressed their conviction to linguistic review, based currently on a triad of languages (including the mother language). While waiting for linguistic standardization in medical schools, bilingualism (mother language and English language) was the option suggested by the majority of Moroccan students.

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.

Progress and prospects of medical education research in Asian Countries

BACKGROUND AND OBJECTIVES

Medical education has a profound impact on health care system. Progress in achieving medical education research goals varies over time and across countries. This study aimed to investigate the medical education research ambience in Asia during the period 1965-2015.

METHODS

We investigated the bibliometric indicators of 49 Asian states in medical education research from 1965-2015. The data about Asian countries, their per capita GDP, expenditure on R&D, universities and indexed scientific journals were collected. We recorded medical education related research documents published in Institute of Scientific Information (ISI) Web of Science, Thomson Reuters during the period 1965-2015.

RESULTS

Asian countries collectively published 12721799 research articles, among them 40628 (0.31%) publications were in medical education. China contributed total of 3351565 articles among which 5414 (0.16%) research articles were in medical education; India added 1328725 papers with 4563 (0.34%) in medical education; Japan produced 3080257 papers with 4199 (0.13%) in medical education; Israel 561531 with 3848 (0.68%) in medical education; and lastly, Georgia contributed a total of 296532 research articles with 2565 (0.86%) in medical education.

CONCLUSIONS

In Asia, the top five countries in medical education research are China, Georgia, Israel, Japan and India. The countries at low ranking are Yemen, Palestine, Myanmar, Kazakhstan, Syria and Armenia. In Asian states, the overall performance in medical science research needs policies to enhance its impact globally. Medical universities should offer research programs for learning and understanding the challengeable issues in medical education research.

Nursing and midwifery research activity in Arab countries from 1950 to 2017

BACKGROUND

Nursing and midwifery research activity is an important indicator of the quality of healthcare services and the status of nursing profession. The main aim of this study was to assess the research activity in nursing and midwifery field in Arab countries.

METHOD

The current study implemented bibliometric method using Scopus database. The search strategy used country affiliation or journal name or keywords as a strategy to retrieve the required documents. The study period was from 1950 to2017. Analysis included a presentation of bibliometric indicators and VOSviewer mapping of the retrieved data.

RESULT

2935 documents were retrieved making up less than 1% of global nursing and midwifery research output. Of the retrieved documents, 25% were published in high rank (first quartile = Q1) journals. The majority (56.7%) of the retrieved documents were published in the last five years of the study period. The retrieved documents received an average of 6.9 citations per document with an h-index of 47. The total number of authors who took part in publishing the retrieved documents was 10,572, giving an average of 3.6 authors per article. Jordan ranked first in research output. Researchers from Jordan took part in over than one third (1023; 34.9%) of the retrieved documents. Lebanon (35.5%) ranked first in the percentage of documents published in Q1 journals. The United Arab Emirates ranked first in the percentage (67.4%) of publications with international authors. The most active journal involved in publishing nursing research from Arab countries was Life Science Journal (158; 5.4%). The University of Jordan was the most productive institution while the American University of Beirut ranked first in the percentage (36.9%) of documents published in Q1 journals. Author keyword analysis and10 most cited articles showed that non-communicable diseases and nursing education were the focus of nursing research in Arab countries.

CONCLUSIONS

Nursing and midwifery research activity in Arab countries has dramatically increased especially over the past five years. Despite this, nursing research is still in its infancy, lagging in quantity and quality compared to developed countries.

Why research productivity of medical faculty declines after attaining professor rank? A multi-center study from Saudi Arabia, Malaysia and Pakistan

OBJECTIVES

Research has shown a fall of research productivity of faculty after their promotion to professor rank. This study explores the factors that lead to this decline in research productivity of professors in medical discipline.

METHODS

A 20-item questionnaire was distributed online to medical professors of a Saudi, Malaysian and a Pakistani medical school. The participants were instructed to select their responses on a 5-point Likert's scale and the collected data was analyzed for quantitative and qualitative results.

RESULTS

Of 161, 110 responded; response rate of 68.3%. About 35% professors spent 1-4 hours and 2% spent 19-25 hours per week for research. As many as 7% did not publish a single article and 29% had published 10 or more articles after attaining professor rank. During the last two years, 44% professors had published 5 or more research articles. Majority pointed out a lack of research support and funds, administrative burden and difficulty in data collection as the main obstacles to their research.

CONCLUSIONS

This research has identified time constraints and insufficient support for research as key barriers to medical professors' research productivity. Financial and technical support and lesser administrative work load are some suggested remedies to foster the professors' research output.

Contemporary Professional Skills Development for Pharmacists in the Middle East

Objective. To determine professional skills development and its utility among the "bridge" curriculum for undergraduate and graduate students in the Middle East. Methods. Qatar University College of Pharmacy offers a part-time Doctor of Pharmacy (PharmD) program for licensed pharmacists, which includes pre-internship or "bridge" courses adapted from the undergraduate baccalaureate program. Assessments for all professional skills courses delivered in the undergraduate and post-baccalaureate part-time PharmD curriculums between 2011 and 2015 academic years were inventoried. The number and nature of assignments and exams administered to both student cohorts were identified and aggregate class scores recorded. Results were compared using Mann-Whitney tests for non-parametric continuous data with significance level (2-sided) set at α <.05. Results. Twenty-seven common assessments were conducted over a 5-year period. Overall, the performance between the undergraduate and graduate students was comparable except for specific assignments and in certain cohorts. Chart note documentation skills were poor among part-time PharmD students in both professional skills years and may be attributed to lack of prior instruction or current use in practice. Conclusion. Our comparison of graduate and undergraduate student performance in a professional skills course series has reinforced its legitimacy in our part-time PharmD bridge curriculum. Such quality assurance is relevant for programs offering advanced degree training for licensed professionals to ensure ongoing alignment of student abilities with desired educational outcomes and ultimately, delivery of patient care.

Pharmacy Student and Preceptor Impressions of Faculty Liaison Visits to Experiential Training Sites

OBJECTIVE

To characterize preceptor and student views about and experiences with faculty liaison visits to practice sites during clinical internships.

METHODS

A survey was administered at the conclusion of each of the first 3 academic years of a new postbaccalaureate doctor of pharmacy (PharmD) program.

RESULTS

Preceptors were satisfied overall with faculty liaison visits, while students initially were not; however, their perception increased in subsequent years. Students felt development of their patient care skills benefited, but less so their interpersonal communication skills. Each year, almost all preceptors indicated faculty liaison visits were helpful in developing and refining their mentorship skills.

CONCLUSION

Faculty liaison visits provided a valuable opportunity to interact and support preceptors and students during advanced pharmacy internships in a nascent PharmD program.

Medical education research in GCC countries

BACKGROUND

Medical education is an essential domain to produce physicians with high standards of medical knowledge, skills and professionalism in medical practice. This study aimed to investigate the research progress and prospects of GCC countries in medical education during the period 1996-2013.

METHODS

In this study, the research papers published in various global scientific journals during the period 1996-2013 were accessed. We recorded the total number of research documents having an affiliation with GCC Countries including Saudi Arabia, Bahrain, Kuwait, Qatar, United Arab Emirates and Oman. The main source for information was Institute of Scientific Information (ISI) Web of Science, Thomson Reuters.

RESULTS

In ISI-Web of Science, Saudi Arabia contributed 40797 research papers, Kuwait 1666, United Arab Emirates 3045, Qatar 4265, Bahrain 1666 and Oman 4848 research papers. However, in Medical Education only Saudi Arabia contributed 323 (0.79%) research papers, Kuwait 52 (0.03%), United Arab Emirates 41(0.01%), Qatar 37(0.008%), Bahrain 28 (0.06%) and Oman 22 (0.45%) research papers in in ISI indexed journals. In medical education the Hirsch index (h-index) of Saudi Arabia is 14, United Arab Emirates 14, Kuwait 11, Qatar 8, Bahrain 8 and Oman 5.

CONCLUSION

GCC countries produced very little research in medical education during the period 1996-2013. They must improve their research outcomes in medical education to produce better physicians to enhance the standards in medical practice in the region.

The summer premedical program for matriculating medical students: a student-led initiative

The freshman academic year is one of the most difficult years that a medical student experiences in his/her academic life at a medical school. Freshmen are frequently faced with several challenges, such as adaptation to a new academic environment and its associated different methods of teaching, learning, skills, and assessment. The aim of this study was to describe a 4-wk innovative summer premedical program developed by senior medical students at the College of Medicine, Alfaisal University, in an attempt to improve/smooth the experience(s) of prospective freshmen. This report describes the objectives/strategies/methodologies used to tackle the top three identified freshman challenges, namely, 1) advancement of the academic/scholastic/educational background, 2) the development of college-required skills to succeed and excel in the freshman year, and 3) adaption to the college environment. At the end of the program, a survey was conducted to evaluate the effectiveness of the summer premedical program. Seventy-two students attended this program over the past three summers from 2010 to 2012, and twenty-nine students answered the survey with a response rate of 74.1%. Overall, >90% of the survey respondents reported an improvement in their understanding of basic medical science, integration, presentation skills, medical terminology, and junior-senior relationships. Furthermore, the survey highlighted the need for more focus on skills such as time management, participation in large-group discussions, and use of electronic resources, as >50% of respondents reported no improvement in these areas. In conclusion, this is the first report, to our knowledge, that describes a program developed by senior medical students to improve the experience of freshmen.

Student response to team-based learning and mixed gender teams in an undergraduate medical informatics course

OBJECTIVES

Team-based learning (TBL) is increasingly being used in medical and medically-related courses. The aim of this study was to evaluate student responses to a TBL-based course in medical informatics at the Sultan Qaboos University, Oman.

METHODS

A total of 11 TBL sessions were run during a 14-week semester of the Medical Informatics II course at SQU. An online student evaluation was performed in week 13 of the course.

RESULTS

Of the 108 students on the course, 96 (88.9%) of the students responded to the survey. For the most part, the students regarded TBL favourably, and derived great benefit from the TBL sessions. Cultural norms, however, appear to have impacted negatively on the females' experience of the TBL sessions.

CONCLUSION

TBL's benefits in the medical informatics course were recognised by the students. In such an environment, however, facilitators will have to bear in mind and continually address cultural issues.

An emigration versus a globalization perspective of the Lebanese physician workforce: a qualitative study

BACKGROUND

Lebanon is witnessing an increased emigration of physicians. The objective of this study was to understand the perceptions of Lebanese policymakers of this emigration, and elicit their proposals for future policies and strategies to deal with this emigration.

METHODS

We conducted semi-structured individual interviews with the deans of Lebanon's seven medical schools, the presidents of the two physicians professional associations, and governmental officials. We analyzed the results qualitatively.

RESULTS

Participants differed in the assessment of the extent and gravity of emigration. Lebanon has a surplus of physicians, driven largely by the over-production of graduates by a growing number of medical schools. Participants cited advantages and disadvantages of the emigration on the personal, financial, medical education system, healthcare system, and national levels. Proposed strategies included limiting the number of students entering medical schools, creating job opportunities for graduating students, and implementing quality standards. Most participants acknowledged the globalization of the Lebanese physician workforce, including exchanges with the Gulf region, exchanges with developed countries, and the involvement of North American medical education institutions in the region.

CONCLUSION

Many Lebanese policy makers, particularly deans of medical schools, perceive the emigration of the physician workforce as an opportunity in the context of the globalization of the profession.