The impact of the Systematic Assessment for Resilience (SAR) framework on students' resilience, anxiety, depression, burnout, and academic-related stress: a quasi-experimental study.

BACKGROUND: Medical students face significant psychological stress, impacting their academic performance and well-being. The Systematic Assessment for Resilience (SAR) framework is designed to enhance resilience and mitigate stress among medical students, addressing the need for interventions within the assessment system in medical education. The aim of this study was to evaluate the implementation of SAR framework on medical students' resilience, anxiety, depression, burnout, and academic stress. METHODS: This study employed a quasi-experimental design with pre- and post-testing. It involved the training of course coordinators in implementing the SAR framework and its integration into the daily learning activities. Fourth-year medical students were assessed before and after the intervention using standardized measures of resilience, anxiety, depression, burnout, and academic stress. Data were analyzed using quantitative methods and thematic analysis for qualitative feedback. RESULTS: Post-intervention, students demonstrated a significant increase in resilience scores (p < 0.001) and a notable decrease in measures of anxiety, depression, and academic stress (p < 0.001). The burnout types were also statistically different (p < 0.001) except client-related burnout (p > 0.05). Qualitative feedback of the course coordinators highlighted an improved learning environment, increased coping strategies, and a more supportive academic culture. CONCLUSION: The SAR framework significantly contributes to enhancing medical students' resilience and reducing psychological distress. Its implementation suggests a promising approach to fostering a supportive educational environment that not only addresses the psychological challenges faced by medical students but also enhances their academic performance and overall well-being. Further research is warranted to explore the long-term impacts of SAR across different medical education contexts.

Development, implementation, and evaluation of an undergraduate family medicine program in the United Arab Emirates.

BACKGROUND: Healthcare systems rely on well-trained family medicine physicians who can offer continuous quality services to their communities and beyond. The American Academy of Family Physicians and the World Organization of Family Doctors recommend that medical curricula should have adequately supervised education and training of the learners in family medicine during their preclinical and clinical placements. However, some medical schools don't have a comprehensive family medicine program to prepare graduates who can meet the community needs. This work aims to report the essential steps for the development, implementation, and evaluation of the family medicine program at the College of Medicine at the University of Sharjah in United Arab Emirates. METHODS: We used the Kern's 6-step model to describe the development, implementation, and evaluation of the family medicine program. This includes problem identification, needs assessment, goals setting, educational strategies, implementation, and evaluation. During 2014-2022, we longitudinally collected essential information about the family medicine program from different stakeholders including the feedback of clinical coordinators, adjunct clinical faculty, and medical students at the end-of-clerkship. All responses were analysed to determine the effective implementation and evaluation of the family medicine program. RESULTS: Over the course of 8 academic years, 804 medical students, 49 adjunct clinical faculty and three College of Medicine faculty participated in the evaluation of the family medicine program. The majority of respondents were satisfied with various aspects of the family medicine program, including the skills gained, the organisation of program, and the variety of clinical encounters. The medical students and adjunct clinical faculty suggested the inclusion of e-clinics, faculty development program, and the expansion of more clinical sites for the effectiveness of the family medicine program. CONCLUSIONS: We report a successful development, implementation, and evaluation of the family medicine program in United Arab Emirates with a positive and impactful learning experience. More attention should be paid towards a suitable representation of family medicine program in the medical curriculum with focused and targeted educational plans for medical students.

Telemedicine perception and interest among medical students at the University of Sharjah, United Arab Emirates, 2023.

BACKGROUND: Telemedicine is becoming an integral part of healthcare. Training medical students in telemedicine is encouraged by many medical organizations. However, in the United Arab Emirates in particular, most medical schools have not incorporated it into their curriculum. Therefore, this study aims to assess medical students' perceptions and interest in telemedicine teaching at the University of Sharjah, UAE. METHODS: A questionnaire-based survey was built based on the current literature and was distributed to all medical students at the University of Sharjah between February and March 2023. The questionnaire assessed the participants for their demographic data, access to and use of digital devices, exposure to and beliefs related to telemedicine, and their medical school experience with distance learning and telemedicine. The data were analyzed via simple statistics, and the Chi-square test was used to assess the associated factors affecting the participants' interest in receiving telemedicine teaching. RESULTS: The questionnaire had a 70.4% (547/777) response rate. The mean age (SD) of the participants was 20.7 years (1.57), and the majority were female (68.4%). Over 98% of the students reported having easy access to and being comfortable with using computers and the internet. Most students (90.5%) believed that the medical school curriculum should include teaching in telemedicine; however, 78.2% of these students stated that it should be included as an elective course. The participants' interest in receiving teaching in telemedicine had a statistically significant association with the following factors: being female, being familiar with telemedicine, having read literature on telemedicine, having beliefs that telemedicine is an opportunity to improve current medical practice, that its use should be encouraged, that it has an important role to play in healthcare, that it does not pose greater threat to current medical practice, having a preference to continue distance learning at medical school and having an interest in incorporating telemedicine in their future careers. CONCLUSIONS: It is an ideal time to incorporate telemedicine into the medical curriculum at the University of Sharjah with most students expressing interest in it. However, further research is needed to assess its applicability to other medical schools in the country and elsewhere.

Health professions students' approaches towards practice-driven ethical dilemmas; a case-based qualitative study.

BACKGROUND: In healthcare practice, ethical challenges are inevitable and their optimal handling may potentialy improve patient care. Ethical development in medical education is critical for the transition from a medical and health sciences student to an ethical healthcare practitioner. Understanding the health professions students' approaches towards practice-driven ethical dilemmas could harness i the effective ethical development in their medical education. This study attempts to identify the health professions students' approaches towards practice-driven ethical dilemmas. METHODS: An inductive qualitative evaluation was conducted on six recorded videos of health professions students' case-based online group discussions, followed by a one-hour online ethics workshop. The online ethics workshop was organized with students from the College of Medicine, College of Dental Medicine and College of Pharmacy at the University of Sharjah, and the College of Medicine at the United Arab Emirates University. . The recorded videos were transcribed verbatim and imported to the qualitative data analysis software of MAXQDA 2022. Data were analyzed applying four stages of review, reflect, reduce and retrieve and two different coders triangulated the findings. RESULTS: Six themes emerged from the qualitative analysis of the health professions students' approaches to the practice-based ethical dilemmas; (1) emotions, (2) personal experiences, (3) law and legal system, (4) professional background, (5) knowledge of medical research and (6) inter-professional education. In addition, during the case-based group discussions in the ethics workshop, students efficiently applied the relevant ethical principles of autonomy, beneficence, non-maleficence and justice in their reasoning process to reach an ethical decision. CONCLUSION: The findings of this study explained how health professions students resolve ethical dilemmas in their ethical reasoning process. This work sheds light on ethical development in medical education by gaining students' perspectives in dealing with complex clinical scenarios. The findings from this qualitative evaluation will aid academic medical institutions in developing medical and research-based ethics curriculum to transform students to ethical leaders.

The framework of Systematic Assessment for Resilience (SAR): development and validation.

BACKGROUND: Burnout and depression among health professions education (HPE) students continue to rise, leading to unwanted effects that ultimately jeopardise optimal medical care and patient health. Promoting the resilience of medical students is one solution to this issue. Several interventions have been implemented to foster resilience, but they focus on aspects other than the primary cause: the assessment system. The purpose of this study is to develop a framework to promote resilience in assessment planning and practice. METHODS: We followed the guidelines suggested by Whetten for constructing a theoretical model for framework development. There were four phases in the model development. In the first phase, different literature review methods were used, and additional students' perspectives were collected through focus group discussions. Then, using the data, we constructed the theoretical model in the second phase. In the third phase, we validated the newly developed model and its related guidelines. Finally, we performed response process validation of the model with a group of medical teachers. RESULTS: The developed systematic assessment resilience framework (SAR) promotes four constructs: self-control, management, engagement, and growth, through five phases of assessment: assessment experience, assessment direction, assessment preparation, examiner focus, and student reflection. Each phase contains a number of practical guidelines to promote resilience. We rigorously triangulated each approach with its theoretical foundations and evaluated it on the basis of its content and process. The model showed high levels of content and face validity. CONCLUSIONS: The SAR model offers a novel guideline for fostering resilience through assessment planning and practice. It includes a number of attainable and practical guidelines for enhancing resilience. In addition, it opens a new horizon for HPE students' future use of this framework in the new normal condition (post COVID 19).

Evaluation of the integration of social accountability values into medical education using a problem-based learning curriculum.

BACKGROUND: Medical schools have the obligation to direct their education toward addressing the priority health concerns of the societies that they serve. The purpose of this study was to evaluate the integration of the concepts and values of social accountability into the case scenarios that are used in a problem-based learning (PBL) curriculum at a medical school in the United Arab Emirates (UAE). METHODS: A validated "social accountability inventory for PBL" was used for examining 70 case scenarios in a problem-based learning (PBL) medical curriculum. RESULTS: The findings of the study showed that patient gender and age were included in all the 70 case scenarios. Vast majority of the case scenarios had successfully integrated the social accountably values in addressing the following: the major health problems or social health concerns of the UAE (73%), the social determinants of health (70%), the contextual integration of medical professionalism (87%), the evolving roles of doctors in the health system (79%), the healthcare referral system based on the case complexity (73%), the involvement of different stakeholders in healthcare (87%), psychosocial issues rather than only the disease-oriented issues (80%) and the values of health promotion/prevention (59%) cases. On the other hand, the case scenarios were deficient in integrating other social accountability values that related to the importance of treatment cost-effectiveness (91%), consideration of the underserved, disadvantaged or vulnerable populations in the society (89%), patient's ethnicity (77%), multidisciplinary approach to patient management (67%), the socioeconomic statuses of patients (53%), the issues regarding the management of the health system (39%) respectively. There was variability in integrating the social accountability values in case scenarios across different units which are based on organ system. CONCLUSION: Medical educators and healthcare leaders can use this valuable data to calibrate the curriculum content, especially when using a problem-based learning curriculum to integrate the values of social accountability such as relevance, quality, equity and cost-effectiveness to train the future generation of healthcare providers to be ready to address the ever-changing and diverse needs of the societies.

Assessing the utility and efficacy of e-OSCE among undergraduate medical students during the COVID-19 pandemic.

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) and its quick progression to a global pandemic has urged medical schools to shift from didactic to distance learning and assessment approaches. The quality of clinical training and assessment have been jeopardized due to the regulatory restrictions and potential hazards to human lives. The aim of this paper is to evaluate the utility and efficacy of an electronic Objective Structured Clinical Examination (e-OSCE), which attempted to transform the format of a face-to-face OSCE to an e-OSCE. METHODS: We conducted three end of clerkship e-OSCEs for final year medical students in Surgery, Medicine and Family Medicine using the teleconferencing application of Microsoft Teams (MST). The e-OSCE blueprint included the assessment of all clinical skills except physical examination and procedural skills. Examiners supervised e-OSCE from the college campus, while all students were remotely assessed through the MST channels. During the exam, the students stayed in their specified MST channel and examiners rotated across all students. The utility and efficacy of e-OSCE was evaluated using a self-administered questionnaire for students, examiners and e-OSCE team. RESULTS: The data analysis showed that 93.4% students and 92.2% examiners agreed with the quality and process of e-OSCE. Similarly, 83.6% students and 98% examiners agreed with the seamless organization of e-OSCE. As many as 45.9% students and 74.5% examiners agreed that e-OSCE was close to real life practice. Approximately one fifth of students and one third of examiners preferred e-OSCE over the face-to-face OSCE. The analysis of qualitative data generated the themes of e-OSCE structure and technology. While majority of participants were satisfied with e-OSCE, students were concerned about examiners' training and e-OSCE contents. Examiners and e-OSCE team recognized the paper-less, tech-savy, fast and reliable format of e-OSCE. CONCLUSION: During and beyond COVID- 19 era, e-OSCE is a strong substitute to standard OSCE for assessing clinical competence except for physical examination and procedural skills. The planning and implementation of e-OSCE reflects an ingenuity in the assessment of clinical competencies of medical students.

Sleep patterns and its relation to lifestyle habits: a study of secondary high school students in Sharjah, United Arab Emirates.

OBJECTIVES: Sleep is a fundamental element in the growth and development of adolescents. Sleep undergoes significant changes during adolescence due to physiological and environmental factors. It has been scientifically shown that the required sleep duration in adolescence is more than 8 hours per day. The aim of this study is to understand sleep patterns and sleep-wake cycle of Sharjah adolescents, and identify lifestyle habits affecting those sleep patterns, and to assess the prevalence of sleep problems. METHODS: The study was a cross-sectional survey of 519 high-school students, ages 14-21 years, in Sharjah city, United Arab Emirates. It was conducted using a self-filled questionnaire that included questions about demographic data, sleep and lifestyle habits and sleep problems of adolescents. RESULTS: The mean age of our sample was 16.24. Most students (64.5%) were reported to sleep between 5 and 8 hours on school nights. The average time to go to bed on weekdays was 11:25 PM. The average time to wake up on weekdays was 6:12 AM. Frequent arousals with difficulty getting back to sleep was the most encountered sleep problem among our sample. CONCLUSION: A large proportion of adolescents in our study had insufficient sleep duration and suffer from some sleep disturbances. Smoking was found to be associated with sleep as non-smokers obtained longer sleep durations. There was no association between physical activity or usage of electrical devices and sleep. Therefore, it is necessary to intervene by organizing awareness programs to improve sleep patterns among adolescent students.

Preclerkship medical students' perceptions of medical professionalism in the College of Medicine-University of Sharjah: A vision to sustain success in medical education.

INTRODUCTION: Professionalism is an essential theme in both undergraduate and postgraduate medical education. The current study aimed to assess the preclerkship medical students' perception on medical professionalism. METHODS: A cross-sectional qualitative study using the critical incident technique was conducted at the University of Sharjah in the United Arab Emirates (UAE). An online survey was sent to 300 medical students (years 1-3). Participants were asked to describe an official doctor-patient encounter that they have experienced in a health-care setting and to highlight the professional behaviors in that encounter. They were then requested to list the top five characteristics of a professional doctor. Thirty (10%) medical students responded to the study; only 13 reported real incidents. The responses were independently reviewed by the authors. The descriptions of the professional attitudes were grouped according to the six domains of professionalism defined by the American Board of Internal Medicine (ABIM) Physicians Charter and then plotted against the nine domains of medical professionalism published in the UAE Consensus Statement. RESULTS: The most common professional behaviors reported were patience, honesty, respect, and patient care. The participants addressed all six domains of professionalism described by the ABIM physicians charter (altruism, accountability, duty , excellence, honor and integrity, and respect for others) and all the domains of medical professionalism published in the UAE Consensus Statement, except for "commitment to advocacy" and "commitment to education" domains. CONCLUSION: Preclerkship medical students had an insight about the professional behaviors needed from doctors before formal teaching about professionalism in the curriculum.

Challenges faced by medical students during their first clerkship training: A cross-sectional study from a medical school in the Middle East.

OBJECTIVES: The transition from preclinical to clinical training is characterized by several challenging experiences ranging from new roles, with their associated tasks, to unfamiliar settings. The aim of this study was to explore the difficulties faced by medical students during the transition from preclinical to clinical training in the Middle East region. METHODS: This cross-sectional study was conducted on fourth-year medical students at the end of their first clerkship. A self-administered questionnaire containing different aspects of students' perceived stress, preparation and clinical supervision was administered to the participants. RESULTS: Of the 89 students, 63 responded (response rate of 71%). Almost half of the students (59%) experienced stress at the beginning of their clinical training, while 33% thought that they were ready to begin their clerkship training. A majority of the students (81%) reported the need for more time to adjust to the new environment, and 84% indicated that a good introduction to the clerkship would make the transition easy for them. About half of the students (54%) reported receiving feedback during their clinical training. CONCLUSION: This study highlighted the difficulties faced by medical students during their transition from preclinical to clinical training. There is a need to implement measures to ease this transition through a structured orientation about clerkship for both students and clinical faculty. In addition, it is recommended to organize faculty development workshops on feedback and supervision.

Group OSCE (GOSCE) as a formative clinical assessment tool for pre-clerkship medical students at the University of Sharjah.

OBJECTIVES: Continuous formative assessment with appropriate feedback is the pillar of effective clinical teaching and learning. Group Objective Structured Clinical Examination (GOSCE) has been reported as a resource-effective method of formative assessment. The present study aims to describe the development and evaluation of GOSCE as a formative assessment for pre-clerkship medical students. METHODS: At the University of Sharjah, GOSCE was introduced to medical students in Years 1, 2, and 3. The GOSCE was conducted as a formative assessment in which groups of 4-5 students were observed while they performed various clinical skills, followed by structured feedback from clinical tutors and peers. GOSCE was evaluated both quantitatively and qualitatively and appropriate statistical analysis was applied to evaluate their responses. RESULTS: A total of 232 students who attended the GOSCE responded to the questionnaires. Most of the students and clinical tutors preferred formative GOSCE over individual feedback. Both students and clinical tutors valued the experience as it helped students to identify gaps and to share knowledge and skills among group members. CONCLUSION: This study found that formative GOSCE provided a valuable and feasible educational opportunity for students to receive feedback about their clinical skills.