Exploring medical students' experience of the learning environment: a mixed methods study in Saudi medical college.

BACKGROUND: In medical education, the learning environment (LE) significantly impacts students' professionalism and academic performance. Positive LE perceptions are linked to better academic outcomes. Our study, which was conducted 15 years after curriculum reform at King Saud University's College of Medicine, aimed to explore students' perspectives on their LE and identify areas for improvement. By understanding their experiences, we strive to enhance LE and promote academic success. METHODS: This mixed-method study employed an explanatory sequential approach in which a cross-sectional analytical survey phase was collected first using the Johns Hopkins Learning Environment Scale (JHLES), followed by qualitative focus groups. Findings from quantitative and qualitative methods were integrated using joint display. RESULTS: A total of 653 medical students completed the JHLES. The total average score was 81 out of 140 (16.8), and the average subscale scores ranged from 2.27 (0.95) for inclusion and safety to 3.37 (0.91) for community of peers. The qualitative approach encompasses both inductive and deductive analyses, identifying overarching themes comprising proudness, high expectations and competition, and views about the curriculum. The integration of results emphasizes the need for continued efforts to create a supportive and inclusive LE that positively influences students' experiences and academic success. CONCLUSION: This research offers valuable insights for educational institutions seeking to enhance medical education quality and support systems. Recommendations include faculty development, the cultivation of supportive environments, curriculum revision, improved mentorship programs, and initiatives to promote inclusivity and gender equity. Future research should explore longitudinal and comparative studies, innovative mixed methods approaches, and interventions to further optimize medical education experiences. Overall, this study contributes to the ongoing dialog on medical education, offering a nuanced understanding of the complex factors influencing students' perceptions and suggesting actionable strategies for improvement.

Hepatitis C virus infection in Jeddah city, Saudi Arabia: Seroprevalence and knowledge.

The infection rate of the hepatitis C virus (HCV) in Saudi Arabia is among the lowest in the world. However, it is likely that poor knowledge and awareness of HCV infection could minimize the effectiveness of prevention and control programs in the kingdom. Thus, the study objective was to estimate the prevalence of HCV infection, and to assess current knowledge about it, in the targeted population. Data on 5482 Saudi people attending primary healthcare centers in Jeddah City in 2014/2015 were analyzed in this cross-sectional study. Questions that covered the natural history, risk behavior, and prevention, and treatment of HCV were collected using a predesigned questionnaire. HCV seroprevalence was assessed using an enzyme-linked immunosorbent assay. HCV prevalence of 0.38% (95% confidence interval: 0.22-0.54) was found. The level of knowledge of the natural history, risk behavior, and prevention and treatment of HCV was poor among the participants. The lowest level of knowledge for all participants pertained to its prevention and treatment. The prevalence of HCV was low in Saudi Arabia (0.38%). However, adequate knowledge of HCV was lacking. Thus, the need to increase knowledge and awareness of HCV in the Saudi population is warranted.

Showcasing the Saudi e-referral system experience: the epidemiology and pattern of referrals utilising nationwide secondary data.

Introduction: Referrals are an integral part of any healthcare system. In the Kingdom of Saudi Arabia (KSA) an electronic referral (e-referral) system known as the Saudi Medical Appointments and Referrals Centre (SMARC) began formally functioning in 2019. This study aims to showcase the Saudi experience of the e-referral system and explore the epidemiology of referrals nationally. Methods: This retrospective descriptive study utilised secondary collected data between 2020 and 2021 from the SMARC system. Cross tabulations with significance testing and colour-coded maps were used to highlight the patterns across all regions. Results: The study analysed over 600,000 referral requests. The mean age of patients was 40.70 ± 24.66 years. Males had a higher number of referrals (55.43%). Referrals in 2021 were higher than those in 2020 (56.21%). Both the Autumn and Winter seasons had the highest number of referrals (27.09% and 27.43%, respectively). The Surgical specialty followed by Medicine had the highest referrals (26.07% and 22.27%, respectively). Life-saving referrals in the Central region were more than double those in other regions (14.56%). Emergency referrals were also highest in the Southern regions (44.06%). The Central and Eastern regions had higher referrals due to unavailable sub-speciality (68.86% and 67.93%, respectively). The Southern regions had higher referrals due to both unavailable machine and unavailable beds (18.44% and 6.24%, respectively). Conclusion: This study shows a unique system in which referrals are between secondary, tertiary, and specialised care. It also highlights areas of improvement for equitable resource allocation and specialised care in slightly problematic areas as well as the use of population density in future planning.

External Vs Internal e-Referrals: Results from a Nationwide Epidemiological Study Utilizing Secondary Collected Data.

Background: E-referral systems, streamlining patient access to specialists, have gained global recognition yet lacked a comparative study between internal and external referrals in Saudi Arabia (KSA). Methods: This retrospective study utilized secondary data from the Saudi Medical Appointments and Referrals Centre system. The data covers 2020 and 2021, including socio-demographic data, referral characteristics, and specialties. Logistic regression analysis was used to assess factors associated with external referrals. Results: Out of 645,425 e-referrals from more than 300 hospitals, 19.87% were external. The northern region led with 48.65%. Males were 55%, and those aged 25-64 were 56.68% of referrals. Outpatient clinic referrals comprised 47%, while 61% of referrals were due to a lack of specialty services. Several significant determinants are associated with higher rates of external referral with (p-value <0.001) and a 95% Confidence interval. Younger individuals under 25 exhibit higher referral rates than those aged 25-64. Geographically, compared to the central region, in descending order, there were increasing trends of external referral in the northern, western, and southern regions, respectively (OR = 19.26, OR = 4.48, OR 3.63). External referrals for outpatient departments (OPD) and dialysis services were higher than for routine admissions (OR = 1.38, OR = 1.26). The rate of external referrals due to the lack of available equipment was more predominant than other causes. Furthermore, in descending order, external referrals for organ transplantation and oncology are more frequent than for medical specialties, respectively (OR = 9.39, OR = 4.50). Conclusion: The study reveals trends in e-referrals within the KSA, noting regional differences, demographic factors, and types of specialties regarding external referrals, benefiting the New Model of Care for the 2030 Vision. Findings suggest expanding virtual consultations to reduce external referrals. Strengthening primary care and preventive medicine could also decrease future referrals. Future studies should assess resource distribution, including infrastructure and workforce, to further inform healthcare strategy.

Acceptance of electronic referrals across the Kingdom of Saudi Arabia: results from a national e-health database.

Introduction: An effective referral system is necessary to ensure quality and an optimum continuum of care. In the Kingdom of Saudi Arabia, an e-referral system known as the Saudi Medical Appointments and Referrals Centre (SMARC), has been fully functioning since 2019. This study aims to explore the rate of medical e-referral request acceptance in the KSA, and to study the factors associated with acceptance. Methods: This period cross-sectional study utilised secondary collected data from the SMARC e-referral system. The data spans both 2020 and 2021 and covers the entirety of the KSA. Bivariate analyses and binary logistic regression analyses were performed to compute adjusted Odds Ratios (aORs) and 95% confidence intervals. Results: Of the total 632,763 referral requests across the 2 years, 469,073 requests (74.13%) were accepted. Absence of available machinery was a significant predictor for referral acceptance compared to other reasons. Acceptance was highest for children under 14 with 28,956 (75.48%) and 63,979 (75.48%) accepted referrals, respectively. Patients requiring critical care from all age groups also had the highest acceptance including 6,237 referrals for paediatric intensive care unit (83.54%) and 34,126 referrals for intensive care unit (79.65%). All lifesaving referrals, 42,087 referrals, were accepted (100.00%). Psychiatric patients were observed to have the highest proportion for accepted referrals with 8,170 requests (82.50%) followed by organ transplantations with 1,005 requests (80.92%). Sex was seen to be a significant predictor for referrals, where the odds of acceptances for females increased by 2% compared to their male counterparts (95% CI = 1.01-1.04). Also, proportion of acceptance was highest for the Eastern business unit compared to all other units. External referrals were 32% less likely to be accepted than internal referrals (95% CI = 0.67-0.69). Conclusion: The current findings indicate that the e-referral system is mostly able to cater to the health services of the most vulnerable of patients. However, there remains areas for health policy improvement, especially in terms of resource allocation.

Translation, cultural adaptation, and evaluation of the psychometric properties of the Arabic Gastroesophageal Reflux Disease Questionnaire (Ar-GerdQ).

BACKGROUND: Gastroesophageal reflux disease (GERD) is a common chronic digestive disease that affects people in different communities at different rates. Because of the absence of a validated Arabic tool to assess GERD symptoms, this study aimed to validate and culturally adapt the GERD questionnaire (GerdQ) tool to Arabic speakers. METHODS: Patients referred for pH testing with symptoms suggestive of GERD were recruited. A cross-sectional study was conducted from March 2023 to April 2023 by administering the Arabic GERD questionnaire (Ar-GerdQ) tool on two different occasions and comparing it with the short-form leeds dyspepsia questionnaire and the Reflux Symptom Index to establish reliability and construct validity. RESULTS: A total of 52 participants were included in the study. The results of the internal consistency analysis of the Ar-GerdQ indicate that the test has good reliability, with a Cronbach's alpha coefficient of 0.86 (95% CI: 0.75-0.91). Significant positive correlations with the short form leeds dyspepsia questionnaire (r = 0.59, P < 0.001, 95% CI: 0.29-0.78) and the reflux symptom index (r = 0.47, P = 0.01, 95% CI: 0.13-0.71) were demonstrated. Moreover, the intraclass correlation coefficient value was 0.60 (P < 0.001, 95% CI: 0.28-0.77), indicating a substantial level of agreement between the measurements. CONCLUSIONS: Our findings indicate that the Ar-GerdQ is useful for assessing reflux disease symptoms among Arabic speakers. Effective utilization of Ar-GerdQ will reduce unnecessary endoscopic requests in primary care settings.

Knowledge, Attitude, and Practice of Vaccination Among Parents in Jeddah City, Saudi Arabia.

Background Vaccine misconception plays an important role in delaying vaccination for children, which can lead to serious health problems. Assessing the knowledge, attitude, and practice (KAP) and potential associated factors among Saudi parents of preschool and school-age children and adolescents for all types of vaccines would help increase vaccine coverage. Methodology This cross-sectional, questionnaire-based survey was performed among parents in Jeddah, Saudi Arabia. The study enrolled all Saudi parents visiting primary healthcare centers (PHC) in Jeddah with their children aged 3-18 years old. A self-administered questionnaire in Arabic was used to assess KAP. Descriptive statistics were performed, and the chi-square test was used to assess the association between KAP and sociodemographic factors with significance set at p-values <0.05. Results Out of 301 participants, 68.1% were mothers, and 55.8% of children were female. The largest percentage (81.7%) of the parents were aged between 31 and 50 years old. Although 94.4% of the parents agreed or strongly agreed that childhood vaccines protect their children from serious diseases, 26.6% of parents agreed or strongly agreed that vaccines can potentially cause autism, and 18.6% believed they could lead to learning difficulties. Most parents (67.4%) were in favor of vaccination, while others were hesitant about vaccinating their children and believed in alternative methods of disease prevention. About one-third knew other parents who did not vaccinate their children for religious, ideological, or cultural reasons. Sociodemographic factors such as gender (p = 0.042), educational level (p = 0.017), nationality (p = 0.001), and first child (p = 0.013) had some influence on parents' beliefs and knowledge about vaccination, while the number of children (child order) (p = 0.022) and parents' education level were associated with hesitancy (p = 0.028). Conclusions These findings show that most parents had good KAP toward vaccination, influenced by sociodemographic factors. However, there is a need to address vaccination hesitancy by acting on identified contributing factors.

Assessment of Knowledge, Attitude, and Adherence to National Guidelines for Preventing Central Line-Associated Bloodstream Infections Among ICU Nurses of Adult Patients in Jeddah, Saudi Arabia: A Cross-Sectional Survey.

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) pose a significant burden on patient outcomes in intensive care units (ICUs). Adherence to evidence-based guidelines for CLABSI prevention is crucial in reducing healthcare-associated infections. This study aimed to assess the knowledge, attitude, and practice adherence to national guidelines for preventing CLABSIs among adult ICU nurses in Ministry of Health (MOH) hospitals in Jeddah, Saudi Arabia.  Methods: This cross-sectional survey included all adult ICU nurses with a minimum of one year of experience from the four major MOH hospitals in Jeddah with operational adult ICUs. A self-administered online questionnaire was utilized for data collection. Descriptive statistics, t-tests, ANOVA, and Pearson correlation were employed for data analysis.  Results: A total of 203 nurses completed the questionnaire (response rate: 91.5%). The overall knowledge score was 71%. Only 20% of nurses answered over 90% of the knowledge questions correctly, and merely 8% answered all questions correctly. Higher knowledge levels were significantly associated with older age, longer ICU nursing experience, higher education, holding a head nurse position, and attending educational courses on CLABSI prevention. Regarding attitudes, 58% of respondents had a positive perception of guideline utility for CLABSI prevention. In terms of adherence, the overall score was 65%, with only 5% reporting complete adherence to evidence-based practices for preventing CLABSIs.  Conclusion: This study highlights knowledge gaps, suboptimal adherence, and the need for targeted interventions to enhance nurses' understanding of and adherence to evidence-based guidelines for preventing CLABSIs among adult ICU nurses in Jeddah's MOH hospitals. Enhancing knowledge, attitudes, and practice adherence is crucial for reducing CLABSI risks and improving patient outcomes. Further research investigating the factors influencing nurses' knowledge, acceptance, and application of evidence-based guidelines is warranted to inform the development of tailored interventions and educational strategies.

Self-medication with Antibiotics in a primary care setting in King Khalid University Hospital, Riyadh, Saudi Arabia.

OBJECTIVES: The objectives of this study are to estimate the prevalence of self-medication with antibiotics in King Khalid University Hospital population and evaluate the factors affecting this behavior. MATERIALS AND METHODS: This was a cross-sectional study conducted at King Khalid university hospital from April to May 2016. A pretested self-administered questionnaire was handed to a random selection of 519 patients attending the primary care clinics . Data were entered into Microsoft Office Excel 2007 and sent to SPSS version 20 for analysis. Descriptive statistics and logistic regression were applied. RESULTS: The prevalence rate of self-medication with antibiotics was 40.8%. Older patients and males were most likely to use antibiotics without a prescription. The most common illnesses that made patients use antibiotics was upper respiratory tract infections (73.2%). Commercial pharmacies were the major source 82.8%. Only 27.8% patients consulted their physicians for the correct dosage . The previous experience with a similar illness (67.2%) and difficulty in obtaining medical help (29.3%) were the most common reasons for self-administration of antibiotics. Improved health condition (57.8%) was the main reason for stopping the use of antibiotics while lack of improvement in health status led to a shift to another antibiotic in 62.5% of the respondents. CONCLUSION: The prevalence of using antibiotics without a prescription is relatively high. Proper education of the public on the dangers of the misuse of antibiotics through the media might help to reduce this practice.

Prevalence and predictors of hepatitis B in Jeddah City, Saudi Arabia: a population-based seroprevalence study.

INTRODUCTION: Despite solid preventive strategies to reduce the risk of hepatitis B virus (HBV) infection, recent reports about its prevalence and predictors are lacking in several Saudi cities at the community level. This study aimed to assess the seroprevalence of HBV and to identify the most important predictors among the Saudi population in Jeddah city, Saudi Arabia. METHODOLOGY: A cross-sectional study was conducted among 5,584 Saudi people attending primary health-care centers in Jeddah city during 2012/2013. Sociodemographic and hepatitis-related data were collected. HBV was diagnosed by ELISA test. The seroprevalence of HBV was estimated, and appropriate statistical analyses were performed, including univariate and multivariable regression analyses. RESULTS: The seroprevalence of HBV was 2.2% (95% CI = 1.82-2.58) in the studied participants. The prevalence was higher among non-governmental workers (3.5%), male participants (3.4%) and those aged ≥ 25 years (2.4%). The most important predictors for increasing the risk of HBV in this study were HBV contacts, male sex, history of dental procedures and blood transfusion. The significant positive risks associated with these predictors were 3.3, 2.5, 2.0 and 1.65, respectively. HBV vaccination, on the other hand, was associated with a significant risk reduction of 88% (OR = 0.12; 95% CI = 0.03-0.51). CONCLUSIONS: The seroprevalence of HBV was relatively low among the Saudi population in Jeddah city reflecting the actions taken by health authorities to control HBV infection. However, more efforts, particularly in relation to health education programmes, strict control of blood banks and dental clinics, are still needed.

Quality of healthcare for hemodialysis patients in various health sectors in Jeddah, Saudi Arabia.

BACKGROUND AND OBJECTIVE: We compared the adequacy of the management of hemodialysis patients in different health sectors in a major city in Saudi Arabia. DESIGN AND SETTINGS: Cross-sectional analytic study conducted in three different health sectors in Jeddah, Saudi Arabia. METHODS: Data was collected from nine hemodialysis centers, which represent three sectors: Ministry of Health, governmental (but not health ministry) hospitals, and charity centers. A simple random sampling tech.nique was employed for gathering data from the participating centers. Medical records were reviewed and all the relevant data were retrieved using a pre-designed form. RESULTS: In the 587 subjects, hypertension, diabetes mellitus and an idiopathic etiology accounted for 85.3% of end-stage renal disease. Only 25.4% of the patients had a hemoglobin level of 110-120 g/L and 12.1% achieved target levels of ferritin and transferrin saturation. The percentage of patients meeting targeted levels of calcium (2.1-2.38 mmol/L), phosphorous (1.13-1.78 mmol/L) and albumin (>=40 g/L) were 54.2%, 38.7% and 23.5%, respectively. The variation between different health sectors was statistically significant (P < .001). Arteriovenous fistula was used for 84% of the patients and catheter for 15.7%. CONCLUSION: The quality of healthcare for hemodialysis patients in Jeddah needs improvement to meet the recommendations of the Kidney Disease Outcomes Quality Initiative guidelines.