Analyzing the application of mixed method methodology in medical education: a qualitative study.

BACKGROUND: Interest in mixed methods methodology within medical education research has seen a notable increase in the past two decades, yet its utilization remains less prominent compared to quantitative methods. This study aimed to investigate the application and integration of mixed methods methodology in medical education research, with a specific focus on researchers' perceptions, strategies, and readiness, including the necessary skills and expertise. This study adheres to the COREQ guidelines for reporting qualitative research. METHODS: Faculty members from King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Saudi Arabia, across its three campuses in Riyadh, Jeddah, and Al Ahsa, participated in this study during the 2021-2022 academic year. We conducted 15 in-depth, one-on-one interviews with researchers who had previously used mixed methods in their medical education research. Theoretical saturation was reached with no refusals or dropouts. Data were collected using a semi-structured interview guide developed from literature review and mixed methods guidelines. Thematic analysis was employed to analyze the data, enabling a comprehensive understanding of the participants' perspectives. RESULTS: The thematic analysis of the interviews yielded three key themes. The first theme, 'Understanding and Perceptions of Mixed Methods in Medical Education Research,' delved into researchers' depth of knowledge and conceptualization of mixed methods. The second theme, 'Strategies and Integration in Mixed Methods Implementation,' explored how these methodologies are applied and the challenges involved in their integration. The final theme, 'Mastery in Mixed Methods: Prerequisites and Expert Consultation in Research,' highlighted the gaps in readiness and expertise among researchers, emphasizing the importance of expert guidance in this field. CONCLUSION: Findings indicate a varied understanding of mixed methods among participants. Some lacked a comprehensive grasp of its application, while others perceived mixed methods primarily as a means to enhance the publication prospects of their studies. There was a general lack of recognition of mixed methods as a guiding methodology for all study aspects, pointing to the need for more in-depth training and resources in this area.

The Impact of Facilitators' Competencies and Characteristics on Faculty Enhancement Activities in Saudi Arabia: A Mixed-Methods Research.

Background and objective Seminar-based workshops envision an active learning environment that creates opportunities for faculty to learn how to become effective workshop facilitators themselves. In this study, we employed a mixed-methods design focusing on an in-depth analysis of the data to examine the impact of the competencies and characteristics of a workshop facilitator on faculty development activities and programs. Methodology This study involved 159 faculty members and was conducted via a web-based survey and 13 in-depth interviews. Results The Pearson correlation coefficients between the three effectiveness ratings showed that all three correlations are significant at the 0.01 level, which signifies a statistically significant relationship between the three variables. The strongest relationship is between facilitator knowledge and facilitator communication, followed by that between facilitator communication and facilitator attitude, and between facilitator knowledge and facilitator attitude. This suggests that the three effectiveness ratings are positively correlated. Qualitatively, four themes emerged in our study: attributes of a good facilitator, participant engagement's role, feedback's impact, and workshop organization challenges. Knowledge, communication, and attitude were identified as effective facilitator characteristics, with knowledge being the most crucial. Conclusions Our findings highlight the importance of enhancing participant understanding, providing timely feedback, and bridging theory to practice. Ultimately, effective facilitators strike a balance in terms of knowledge, communication, and attitude, acknowledging the importance of participant engagement and overcoming workshop challenges. We believe our findings will help inform the revision of the current faculty development programs and the development of such endeavors in the future at institutions of higher education.

The Influence of Saudi Board of Emergency Medicine Residency Educators on Residents' Academic and Clinical Performance in Riyadh, Saudi Arabia.

INTRODUCTION: The Saudi Board of Emergency Medicine (SBEM) is required to assign educators including program directors to supervise their residents. These educators may impact the residents' academic and clinical performances. After thorough review, we noticed that the current literature lacks information about the direct influence of emergency medicine educators on their residents' academic and clinical performances. The main purpose of this study is to assess the residents' confidence level, and to measure the program directors' satisfaction of the residents' performances during their SBEM training years in Riyadh hospitals. METHODS: This concurrent mixed-methods study was conducted in nine training hospitals in Riyadh, Saudi Arabia, during the 2021-2022 academic year. For the quantitative aspect, a cross-sectional survey was used, based on a questionnaire administered to postgraduate year (PGY)-2 to PGY-4 SBEM residents (n=120) using a nonprobability convenient sampling technique. The survey aimed to assess residents' confidence in their academic and clinical performance, influenced by their educators. A Likert scale with a total of 25 items, covering the seven roles of the CANMEDs framework, was employed. This assessment utilized a published tool called the In-Training Evaluation Report. For the qualitative aspect, program directors' perspectives were gathered through one-on-one unstructured interviews (n=9), guided by theoretical saturation. A purposive sampling technique was employed to select program directors. The interview tool collected demographic data, including gender, years of experience, and training hospital, and included 17 open-ended questions to explore program directors' opinions. RESULTS: The result of mixed methods showed that both quantitative and qualitative data sets were divergent with all independent variables (resident's age, gender, and training level) with the exception of the training hospital which was convergent. Thus, the residents' confidence toward their academic and clinical performances induced by their institutional educators was high. However, the program directors indicated changes that related to residents' training level. CONCLUSION: The residents' confidence toward their academic and clinical performance induced by their institutional educators was high. The educators had a great deal of influence over the academic and clinical performance of the residents. However, the program directors thought there were some issues with the performance of the residents. Most of the program directors also believed that several influential factors that may have affected the residents' overall performance include stress and receipt of constructive feedback.

Insight into prevalence, etiology, and modalities of pediatric chronic dialysis: a comprehensive nationwide analysis.

BACKGROUND: This study aimed to determine the prevalence and etiology of kidney failure (KF) among children below 15 years of age receiving chronic dialysis in Saudi Arabia and describe their dialysis modalities. METHODS: This cross-sectional descriptive study was conducted on 8 August 2022, encompassing all 23 pediatric dialysis centers in Saudi Arabia. Data gathered comprised patient demographics, causes of KF, and the dialysis methods employed. Collected data underwent analysis to determine prevalence of children undergoing chronic dialysis, discern underlying causes of KF, and evaluate distribution of patients across different dialysis modalities. RESULTS: The prevalence of children on chronic dialysis is 77.6 per million children living in Saudi Arabia, equating to 419 children. The predominant underlying cause of KF was congenital anomalies of the kidneys and urinary tract (CAKUT), representing a substantial 41% of cases. Following this, others or unknown etiologies accounted for a noteworthy 25% of cases, with focal segmental glomerulosclerosis (FSGS) comprising 13%, glomerulonephritis at 11%, and congenital nephrotic syndrome contributing 10% to etiological distribution. Regarding dialysis modalities employed, 67% of patients were on peritoneal dialysis (PD), while the remaining 33% were on hemodialysis (HD). CONCLUSIONS: This first nationwide study of pediatric chronic dialysis in Saudi Arabia sheds light on the prevalence of children undergoing chronic dialysis and underlying causes of their KF, thereby contributing to our understanding of clinical management considerations. This research serves as a stepping stone for the development of national registries.

Assessing the Critical Thinking and Deep Analysis in Medical Education Among Instructional Practices.

Objective: The purpose of this study was to examine the application of faculty to stimulate the critical thinking and deep analysis of their students through instructional practice including lecture design, assessment structure, and assignment instructions. Methods: Faculty from multiple different health colleges at Saudi Arabia were asked to respond to survey items about the activities they use in their classrooms with regards to designing lectures, assessment structures, and instructional assignments. A correlation analysis was performed to determine if the level of applied critical thinking and deep analysis that is stimulated by faculty members were statistically related between designing lectures, assessment structure, and instructional assignments. An analysis of variance (ANOVA) was also performed to determine if there were significant differences based on the demographic characteristics of the participants and level of applied critical thinking and deep analysis. Results: A correlational analysis revealed that the mean score for designing lectures was 67.276, following by a mean score of 65.233 for instructional assignment and 64.688 for assessment structure. The result of the ANOVA showed that there was a significant difference in the perceptions of the participants between designing lectures, assessment structure, and instructional assignment (p<0.05). Conclusion: The participants applied critical thinking and deep analysis when they design their lectures more than assessments and instructional assignments. They had the flexibility to stimulate critical thinking during the lecture activities. In contrast, this flexibility was limited when they were structuring the assessment as they had instructions to consider and were required to provide a rubric with unified key answer which is a mandatory requirement from the assessment department. This is due to the nature of high level of critical thinking answers that lead to high subjectivity in student responses.

Impact of Audience Response System in Enhancing Teaching of Anatomy and Physiology for Health Sciences Students at King Saud bin Abdulaziz University for Health Sciences.

Purpose: Instructional methods that offer students' opportunity for engagement are essential to develop an active learning environment. This paper aims (1) to assess whether the use of an Audience Response System (ARS) during anatomy and physiology lectures improves students' engagement, knowledge retention and academic achievement and (2) to evaluate the feasibility of introducing ARS as a formative tool from both instructors' and students' perspectives. Materials and Methods: This quasi-experimental study was conducted across ten lectures for the second-year Pre-Applied Medical Science (PAMS) and Pre-Medical (PMED) students at the College of Sciences and Health Professions, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia. The ARS was integrated into five lectures, whereas the remaining were conducted without ARS. A comparison of the immediate post-lecture and prior laboratory session quiz scores between the lectures with and without ARS was performed using an independent sample t-test. An online survey was completed by the students as well as informal feedback was taken from the instructors to assess ARS usefulness. Results: A total of 65 PMAS and 126 PMED students participated in the study. Students achieved significantly better scores for ARS lectures than non-ARS lectures: PAMS (p 0.038) and PMED (p 0.018). Students and instructors agreed that ARS was easy to use, allowing students to engage and actively participate in the teaching process by responding to questions and receiving instant and anonymous feedback about their learning progress. Conclusion: Employing suitable interactive teaching methods facilitates students' learning and improves their retention of knowledge. Students and instructors positively view the ARS strategy as a means to promote learning in a traditional lecture setting. Increased practice on how to integrate its use into classrooms could lead to further utilization.

The Successful Implementation of a Modified Pediatric Acute Lymphoblastic Leukemia Protocol to Treat an Elderly Patient With T-cell Lymphoblastic Leukemia: A Case Report.

Acute lymphoblastic leukemia (ALL) is a group of hematological malignancies most commonly seen in pediatrics. The disease process localizes in lymphoid organs, the central nervous system, the mediastinum, and bone marrow (BM). The clinical features of T-cell acute lymphoblastic leukemia (T-ALL) in adults include evidence of generalized lymphadenopathy, hepatosplenomegaly, immunosuppression, and hypercalcemia. There is limited research on the efficacy of using modified pediatric treatment regimens in the elderly over the age of 60 with ALL; this case report aims to illustrate the successful treatment of a 67-year-old male patient diagnosed with T-ALL, using a modified Children's Oncology Group (COG) protocol. Through this, it has been shown to be an effective, safe, and efficacious treatment option for our patient.

Implementing Faculty Development Programs in Medical Education Utilizing Kirkpatrick's Model.

Since the 1970s, the definition of faculty development has evolved from improving teaching skills and classroom performance to a full range of activities involving teaching, leadership, mentorship of students, and impacting institutional culture. Unfortunately, in many educational programs, the focus of faculty development is still on classroom performance and research activities. This is troubling given the increased competitive nature of higher education in general, and even medical education, to attract the best students. The purpose of this article is to demonstrate how the Kirkpatrick model can be used as a framework for the development, implementation, and management of a comprehensive faculty development program. An important gap exists within the academic literature regarding a lack of discussion and analysis about how faculty development can be implemented in a way that helps healthcare faculty improve their skills in all areas of academic performance. At the same time, there is a lack of discussion and analysis about the need for medical schools to align faculty development with larger institutional goals and outcomes. The discussion included in this article serves to begin the process of filling that gap within the academic literature by demonstrating that the Kirkpatrick model can be used to implement and manage faculty development programs in which there is an institutional focus rather than an individual focus. By focusing on faculty development that is aligned with larger institutional goals, medical schools can be more competitive and better serve the future healthcare professionals they are training.

Pediculosis Is a Risk Factor for Iron Deficiency Anaemia.

Pediculosis capitis is obligate ectoparasite that lives and feeds on host blood, affecting commonly children. Lice are transmitted easily and respond to topical treatment with good personal hygiene. Chronic infestation can lead to different complications such as bacterial infection dermatitis and anaemia. Haematological complications are not reported frequently. We report a case series of five patients presented with a clear manifestation of anaemia with heavy lice infestation. Laboratory evaluation revealed microcytic hypochromic anaemia (red blood cell indices) with low serum iron levels and other causes that were excluded. All patients who were admitted received blood transfusions. There was not a possible explanation for this severe anaemia other than head lice.

Congenital Nephrotic Syndrome With a Novel Presentation in Saudi Arabia.

Congenital nephrotic syndrome (CNS) is a rare and serious entity of renal diseases diagnosed in infants younger than three months. The triad of this syndrome is proteinuria, hypoalbuminemia, and edema. Without renal transplantation, these patients rarely live beyond the age of three years. Infections and sepsis are the most common causes of this condition among children. The majority of patients progress to end-stage renal disease early in life, even with aggressive supportive therapy. In this study, we present a case of a 10-year-old Saudi boy who had been diagnosed with CNS since he was two months old and has improved without renal transplantation.

Level of awareness of Saudi medical students of the internet-based health-related information seeking and developing to support health services.

BACKGROUND: Many studies are available in the literature about e-health in Saudi Arabia, however, data is limited to a few organizations and does not necessarily reflect the current and potential use of e-health for health care organizations in the country. This study aimed to determine the level of awareness of Saudi medical students of the internet-based health-related information seeking and developing to support health services and significant predictors of their practice. METHODS: A cross-sectional survey of 440 medical students in Riyadh, Saudi Arabia, was conducted, during October/November 2019, using a previously validated questionnaire, to assess: (1) knowledge in three domains; e-health definition (13 statements), fields of application of e-health (8 statements), methods of using e-health (7 statements), (2) attitude toward using e-health (8 statements) and (3) reported practice of e-health in medical training (5 statements). A scoring system was used to calculate the total and percentage score of knowledge, attitude, and practice for each student. Multiple regression analysis was applied to identify predictors of e-health practice. Significance was considered at p < 0.05. RESULTS: Of 440 medical students, the majority were females (55.7%) and from families whose monthly income was more than 10,000SR (82.8%). Overall knowledge about e-health was unsatisfactory (percentage mean score, PMS = 71.6%), with only 43.6% of students reporting a satisfactory level. However, this level was satisfactory for fields of application (Percentage mean score-PMS = 76.6%) and unsatisfactory for the definition of e-health (PMS = 70.7%) and methods of its use (PMS = 65.7%) domains. The overall attitude towards e-health use was positive (PMS = 82.3%), with nearly three-quarters of students (73.4%) reporting a positive attitude. Generally, a good level of practice of e-health was reported by students (PMS = 84.3%), with more than three-quarters of students (78.4%) reporting good practice. Adjusting for age, gender, stream, educational grade, and family monthly income, good practice was significantly predicted with higher knowledge (t = 2.22, p = 0.03) and attitude (t = 2.11, p = 0.04) scores. CONCLUSION: This study provides basic information regarding medical students' level of awareness of internet-based health-related information seeking and developing to support health services. More resources should be directed to elevate medical students' knowledge and to motivate them to practice e-health using the available tools.

Prevalence of constipation among central region population, Riyadh and Qassim provinces, Saudi Arabia, 2018-2019.

BACKGROUND: Due to the lack of data and studies concerning the prevalence of constipation in Saudi Arabia, this study aimed at determining the level of prevalence among central region population in Saudi Arabia, specifically in Riyadh and Qassim provinces. AIMS: To determine the prevalence of constipation, to estimate the overall prevalence of constipation among the society, and to identify risk factors of constipation. MATERIALS AND METHODS: In this cross-sectional study, 543 individuals were covered, both males and females in the targeted areas. A standardized questionnaire was used to cover eight different aspects concerning constipation. SPSS package was used to analyze the data collected from the sample. RESULTS: The results of the scoring system showed that the prevalence of constipation among the sampled individuals is only 4.4%, whereas those whose result indicates no suffering from constipation represented 95.6%. Constipation is more prevalent among females (79.2%) rather than males (20.8%). Moreover, constipation is more sever among those who are between 20- and 35-year old, while it reaches 0% among old people (over 51 years). Riyadh residents are more likely to suffer from constipation rather than Qassim residents. In Riyadh, 83.3% suffered from constipation, whereas the percentage in Qassim was 16.7%. The results show also that constipation is more prevalent among those who eat fiber-rich food once in a week, who are getting stressed all the time, nonsmokers, and who get dehydrated and do not carry a bottle of water. There is a significant relationship between suffering from constipation and only two variables, which are regularity of being stressed and regularity of getting dehydrated. The test value for these two variables were (0.0) in the two cases. CONCLUSION: The prevalence of constipation is relatively very low among population of central region in Saudi Arabia.

Patterns of childhood nephrotic syndrome in Aljouf region, Saudi Arabia.

To determine the patterns in children with nephrotic syndrome (NS) in our region, we retrospectively studied 25 nephrotic patients evaluated and followed-up in the hospitals of the Aljouf region in Saudi Arabia. The male to female ratio was 2:1. The incidence of idiopathic NS was two to six cases per 100,000 children/year, while the prevalence was 12 cases per 100,000 children. Five patients presented with hypertension, seven (28%) with respiratory tract infection, three (12%) with tender abdomen, two (8%) with gross hematuria, one (4%) with thrombosis of renal veins with seizure and shock and the remaining seven presented to the hospital without complications. Twenty-three (92%) patients were sensitive to the first steroid course and two (8%) patients were steroid resistant, and both of them proved to have focal segmental glomerulosclerosis (FSGS) on biopsy. Of those who responded, six (24%) patients remained in remission, while 17 (68%) patients became steroid dependant. Of those who were diagnosed as steroid dependent, three patients were biopsied and one of them was diagnosed as FSGS, while the remaining two had minimal change glomerulonephritis. Regarding steroid-dependent patient relapses, seven (41%) patients showed infrequent relapses and ten (59%) patients had frequent relapses. We conclude that the patterns of NS and the response to treatment observed in this study did not differ significantly from studies from other places in the world.