Evaluating competency-based medical education: a systematized review of current practices.

BACKGROUND: Few published articles provide a comprehensive overview of the available evidence on the topic of evaluating competency-based medical education (CBME) curricula. The purpose of this review is therefore to synthesize the available evidence on the evaluation practices for competency-based curricula employed in schools and programs for undergraduate and postgraduate health professionals. METHOD: This systematized review was conducted following the systematic reviews approach with minor modifications to synthesize the findings of published studies that examined the evaluation of CBME undergraduate and postgraduate programs for health professionals. RESULTS: Thirty-eight articles met the inclusion criteria and reported evaluation practices in CBME curricula from various countries and regions worldwide, such as Canada, China, Turkey, and West Africa. 57% of the evaluated programs were at the postgraduate level, and 71% were in the field of medicine. The results revealed variation in reporting evaluation practices, with numerous studies failing to clarify evaluations' objectives, approaches, tools, and standards as well as how evaluations were reported and communicated. It was noted that questionnaires were the primary tool employed for evaluating programs, often combined with interviews or focus groups. Furthermore, the utilized evaluation standards considered the well-known competencies framework, specialized association guidelines, and accreditation criteria. CONCLUSION: This review calls attention to the importance of ensuring that reports of evaluation experiences include certain essential elements of evaluation to better inform theory and practice.

Media use, dietary intake, and diet quality of adolescents in Saudi Arabia.

BACKGROUND: Excessive media use can affect diet of adolescents, but relevant data in Saudi Arabia are lacking. The present study aimed to explore the association between media use, dietary intake, and diet quality among adolescents. METHODS: This cross-sectional study included data of 631 adolescents (ages 11-18 years) who were randomly recruited from 16 schools located in two main cities in the Western region of Saudi Arabia (Madinah and Jeddah). Envelopes including a questionnaire were sent home to collect sociodemographic data. Students then completed the short-form food frequency questionnaire to assess diet quality. Data on media use, anthropometrics, and 24-h dietary recalls were also collected. RESULTS: A high proportion of adolescents (86.2%) exceeded media use recommendations of ≤2 h per day. Significantly higher proportions of younger adolescents, males, and non-Saudis reported media use within the recommendation compared to their peers. Media use predicted lower diet quality score (B = -0.67 [95% CI: -1.09 to -0.28]) and lower intake of calcium, zinc, vitamin D, and vitamin C (B = -104 [95% CI: -203 to -5.24], B = -2.13 [95% CI: -4.15 to -0.11], B = -23.5 [95% CI: -41.3 to -5.65], B = -24.0 [95% CI: -45.1 to -2.96], respectively). CONCLUSION: Interventions to limit media use are urgently needed for adolescents in Saudi Arabia to improve diet quality and overall nutritional health. IMPACT: Excessive media use can affect diet of adolescents, but relevant data are lacking in Saudi Arabia. The majority of adolescents exceed the recommendations for media use. Media use was negatively associated with diet quality and intake of calcium, zinc, vitamin D, and vitamin C. This study will inform public health entities and policy makers to draw evidence-based, culturally tailored recommendations and develop nutrition interventions to enhance diet quality and nutritional status of adolescents. Findings of this study highlight the urgency to develop intervention programs and policies that aim to limit media use among adolescents.

An Evidence Theory Based Embedding Model for the Management of Smart Water Environments.

Having access to safe water and using it properly is crucial for human well-being, sustainable development, and environmental conservation. Nonetheless, the increasing disparity between human demands and natural freshwater resources is causing water scarcity, negatively impacting agricultural and industrial efficiency, and giving rise to numerous social and economic issues. Understanding and managing the causes of water scarcity and water quality degradation are essential steps toward more sustainable water management and use. In this context, continuous Internet of Things (IoT)-based water measurements are becoming increasingly crucial in environmental monitoring. However, these measurements are plagued by uncertainty issues that, if not handled correctly, can introduce bias and inaccuracy into our analysis, decision-making processes, and results. To cope with uncertainty issues related to sensed water data, we propose combining network representation learning with uncertainty handling methods to ensure rigorous and efficient modeling management of water resources. The proposed approach involves accounting for uncertainties in the water information system by leveraging probabilistic techniques and network representation learning. It creates a probabilistic embedding of the network, enabling the classification of uncertain representations of water information entities, and applies evidence theory to enable decision making that is aware of uncertainties, ultimately choosing appropriate management strategies for affected water areas.

The consumption of dietary supplements in Saudi Arabia during the COVID-19 pandemic: A cross-sectional study.

Background and Objectives: People frequently utilize dietary supplements (DS), notably during the COVID-19 epidemic, despite the lack of data supporting their usefulness and safety in enhancing general health. This study aimed to measure the consumption of DS in Saudi Arabia during COVID-19. Previous studies focused on using dietary supplements for preventing or reducing mental health. Materials and Methods: A cross-sectional study was conducted with 1572 participants aged 18-65, from all-over Saudi Arabia who were invited to complete a self-administered questionnaire to measure the consumption of supplements during the pandemic lockdown period. Also, it investigates the factor that effect supplements consumption. Results: Around 63% of the participants did not change their consumption patterns during the pandemic, while 16% consumed more and 21.4% consumed fewer supplements during the pandemic. The most commonly used supplements were iron; calcium, especially among pregnant women; omega-3, especially in people older than 65 years; and vitamin D. Females (81%; P < 0.002); age (94.7%; P < 0.002); married people (84%; P < 0.001); those with a higher educational level (83.9%; P = 0.02); those with a higher monthly income (86.1%; P = 0.006); and pregnant women (100%; P < 0.007) reported the highest rates of consumption. Conclusion: Dietary supplements have recently become popular in Saudi Arabia, but large differences remain between Saudis in their consumption of supplements. Additional research should be conducted to examine the level of knowledge of dietary supplements among Saudi population.

Undergraduate-level teaching and learning approaches for interprofessional education in the health professions: a systematic review.

BACKGROUND: Although most systematic reviews of interprofessional education (IPE) evaluated the impact of IPE on the students' acquisition of knowledge in relation to other professions, the development of teamwork skills, and the changes in collaborative behaviour, the processes involved in IPE (i.e., approaches to teaching and learning) are under-researched. The purpose of the study was to conduct a systematic review to establish how IPE has been implemented in university-based undergraduate curricula, focusing on the teaching and learning approaches. METHODS: The systematic review was performed in 2020 with three databases: PubMed, Science Direct, and the Cochrane Library. Titles and abstracts were included based on pre-identified eligibility criteria. We used the article entitled 'Systematic reviews in medical education: a practical approach: AMEE guide 94' as the basis to establish the aim and methods of the current systematic review from 2010 to 2019. RESULTS: We found 16 articles that met the inclusion criteria and reported the implementation process of IPE in universities from Western, Asian, and African countries. A combination of at least two teaching and learning approaches was used to deliver IPE. The findings indicated that of all the teaching and learning approaches, simulation-based education, e-learning, and problem-based learning were the most prevalent approaches used to deliver IPE. This systematic review also revealed a lack of IPE programmes in the Middle East region. CONCLUSIONS: The evidence synthesised in the current systematic review could support IPE curriculum planners and educators when planning an IPE programme. More global IPE initiatives are required to meet the global health workforce needs. Further studies are required to identify the effectiveness of the different teaching and learning approaches in the development of IPE competencies.

Failure to demonstrate effects of interruptions on diagnostic reasoning: three experiments.

BACKGROUND: Diagnostic error is a major source of patient suffering. Researchshows that physicians experience frequent interruptions while being engaged with patients and indicate that diagnostic accuracy may be impaired as a result. Since most studies in the field are observational, there is as yet no evidence suggesting a direct causal link between being interrupted and diagnostic error. Theexperiments reported in this article were intended to assess this hypothesis. METHODS: Three experiments were conducted to test the hypothesis that interruptions hurt diagnostic reasoning and increase time on task. In the first experiment (N = 42), internal medicine residents, while diagnosing vignettes of actual clinical cases were interrupted halfway with a task unrelated to medicine, solving word-spotting puzzles and anagrams. In the second experiment (N = 78), the interruptions were medically relevant ones. In the third experiment (N = 30), we put additional time pressure on the participants. In all these experiments, a control group diagnosed the cases without interruption. Dependent variables were diagnostic accuracy and amount of time spent on the vignettes. RESULTS: In none of the experiments interruptions were demonstrated to influence diagnostic accuracy. In Experiment 1: Mean of interrupted group was 0.88 (SD = 0.37) versus non- interrupted group 0.91 (SD = 0.32). In Experiment 2: Mean of interrupted group was 0.95 (SD = 0.32) versus non-interrupted group 0.94 (SD = 0.38). In Experiment 3: Mean of interrupted group was 0.42 (SD = 0.12) versus non-interrupted group 0.37 (SD = 0.08). Although interrupted residents in all experiments needed more time to complete the diagnostic task, only in Experiment 2, this effect was statistically significant. CONCLUSIONS: These three experiments, taken together, failed to demonstrate negative effects of interruptions on diagnostic reasoning. Perhaps physicians who are interrupted may still have sufficient cognitive resources available to recover from it most of the time.

Enhancing Graph Routing Algorithm of Industrial Wireless Sensor Networks Using the Covariance-Matrix Adaptation Evolution Strategy.

The emergence of the Industrial Internet of Things (IIoT) has accelerated the adoption of Industrial Wireless Sensor Networks (IWSNs) for numerous applications. Effective communication in such applications requires reduced end-to-end transmission time, balanced energy consumption and increased communication reliability. Graph routing, the main routing method in IWSNs, has a significant impact on achieving effective communication in terms of satisfying these requirements. Graph routing algorithms involve applying the first-path available approach and using path redundancy to transmit data packets from a source sensor node to the gateway. However, this approach can affect end-to-end transmission time by creating conflicts among transmissions involving a common sensor node and promoting imbalanced energy consumption due to centralised management. The characteristics and requirements of these networks encounter further complications due to the need to find the best path on the basis of the requirements of IWSNs to overcome these challenges rather than using the available first-path. Such a requirement affects the network performance and prolongs the network lifetime. To address this problem, we adopt a Covariance-Matrix Adaptation Evolution Strategy (CMA-ES) to create and select the graph paths. Firstly, this article proposes three best single-objective graph routing paths according to the IWSN requirements that this research focused on. The sensor nodes select best paths based on three objective functions of CMA-ES: the best Path based on Distance (PODis), the best Path based on residual Energy (POEng) and the best Path based on End-to-End transmission time (POE2E). Secondly, to enhance energy consumption balance and achieve a balance among IWSN requirements, we adapt the CMA-ES to select the best path with multiple-objectives, otherwise known as the Best Path of Graph Routing with a CMA-ES (BPGR-ES). A simulation using MATALB with different configurations and parameters is applied to evaluate the enhanced graph routing algorithms. Furthermore, the performance of PODis, POEng, POE2E and BPGR-ES is compared with existing state-of-the-art graph routing algorithms. The simulation results reveal that the BPGR-ES algorithm achieved 87.53% more balanced energy consumption among sensor nodes in the network compared to other algorithms, and the delivery of data packets of BPGR-ES reached 99.86%, indicating more reliable communication.

Imaging photonic crystals using hemispherical digital condensers and phase-recovery techniques.

We describe experiments where Fourier ptychographic microscopy (FPM) and dual-space microscopy (DSM) are implemented for imaging photonic crystals using a hemispherical digital condenser (HDC). Phase-recovery imaging simulations show that both techniques should be able to image photonic crystals with a period below the Rayleigh resolution limit. However, after processing the experimental images using both phase-recovery algorithms, we found that DSM can, but FPM cannot, image periodic structures with a period below the diffraction limit. We studied the origin of this apparent contradiction between simulations and experiments, and we concluded that the occurrence of unwanted reflections in the HDC is the source of the apparent failure of FPM. We thereafter solved the problem of reflections by using a single-directional illumination source and showed that FPM can image photonic crystals with a period below the Rayleigh resolution limit.

The Impact of Patient Online Access to Computerized Medical Records and Services on Type 2 Diabetes: Systematic Review.

BACKGROUND: Online access to computerized medical records has the potential to improve convenience, satisfaction, and care for patients, and to facilitate more efficient organization and delivery of care. OBJECTIVE: The objective of this review is to explore the use and impact of having online access to computerized medical records and services for patients with type 2 diabetes mellitus in primary care. METHODS: Multiple international databases including Medline, Embase, CINAHL, PsycINFO and the Cochrane Library were searched between 2004 and 2016. No limitations were placed on study design, though we applied detailed inclusion and exclusion criteria to each study. Thematic analysis was used to synthesize the evidence. The Mixed Methods Appraisal Toolkit was used to appraise study quality. RESULTS: A search identified 917 studies, of which 28 were included. Five themes were identified: (1) disparities in uptake by age, gender, ethnicity, educational attainment, and number of comorbidities, with young men in full-time employment using these services most; (2) improved health outcomes: glycemic control was improved, but blood pressure results were mixed; (3) self-management support from improved self-care and shared management occurred especially soon after diagnosis and when complications emerged. There was a generally positive effect on physician-patient relationships; (4) accessibility: patients valued more convenient access when online access to computerized medical records and services work; and (5) technical challenges, barriers to use, and system features that impacted patient and physician use. The Mixed Methods Appraisal Toolkit rated 3 studies as 100%, 19 studies as 75%, 4 studies as 50%, and 1 study scored only 25%. CONCLUSIONS: Patients valued online access to computerized medical records and services, although in its current state of development it may increase disparities. Online access to computerized medical records appears to be safe and is associated with improved glycemic control, but there was a lack of rigorous evidence in terms of positive health outcomes for other complications, such as blood pressure. Patients remain concerned about how these systems work, the rules, and timeliness of using these systems.

Impact of Information Technology-Based Interventions for Type 2 Diabetes Mellitus on Glycemic Control: A Systematic Review and Meta-Analysis.

BACKGROUND: Information technology-based interventions are increasingly being used to manage health care. However, there is conflicting evidence regarding whether these interventions improve outcomes in people with type 2 diabetes. OBJECTIVE: The objective of this study was to conduct a systematic review and meta-analysis of clinical trials, assessing the impact of information technology on changes in the levels of hemoglobin A1c (HbA1c) and mapping the interventions with chronic care model (CCM) elements. METHODS: Electronic databases PubMed and EMBASE were searched to identify relevant studies that were published up until July 2016, a method that was supplemented by identifying articles from the references of the articles already selected using the electronic search tools. The study search and selection were performed by independent reviewers. Of the 1082 articles retrieved, 32 trials (focusing on a total of 40,454 patients) were included. A random-effects model was applied to estimate the pooled results. RESULTS: Information technology-based interventions were associated with a statistically significant reduction in HbA1c levels (mean difference -0.33%, 95% CI -0.40 to -0.26, P<.001). Studies focusing on electronic self-management systems demonstrated the largest reduction in HbA1c (0.50%), followed by those with electronic medical records (0.17%), an electronic decision support system (0.15%), and a diabetes registry (0.05%). In addition, the more CCM-incorporated the information technology-based interventions were, the more improvements there were in HbA1c levels. CONCLUSIONS: Information technology strategies combined with the other elements of chronic care models are associated with improved glycemic control in people with diabetes. No clinically relevant impact was observed on low-density lipoprotein levels and blood pressure, but there was evidence that the cost of care was lower.

Mechanical properties of hydrated electrospun polycaprolactone (PCL) nanofibers.

Polycaprolactone (PCL) nanofibers are a promising material for biomedical applications due to their biocompatibility, slow degradation rate, and thermal stability. We electrospun PCL fibers onto a striated substrate with 12 µm wide ridges and grooves and determined their mechanical properties in an aqueous solution with a combined atomic force/inverted optical microscopy technique. Fiber diameters, D, ranged from 27 to 280 nm. The hydrated PCL fibers had an extensibility (breaking strain), εmax, of 137%. The Young's modulus, E, and tensile strength, σT, showed a strong dependence on fiber diameter, D; decreasing steeply with increasing diameter, following empirical equations E(D)=(4.3∙103∙e-D51nm+1.1∙102) MPa and σT(D)=(2.6∙103∙e-D55nm+0.6∙102) MPa. Incremental stress-strain measurements were employed to investigate the viscoelastic behavior of these fibers. The fibers exhibited stress relaxation with a fast and slow relaxation time of 3.7 ± 1.2 s and 23 ± 8 s and these experiments also allowed the determination of the elastic and viscous moduli. Cyclic stress-strain curves were used to determine that the elastic limit of the fibers, εelastic, is between 19% and 36%. These curves were also used to determine that these fibers showed small energy losses (<20%) at small strains (ε < 10%), and over 50% energy loss at large strains (ε > 50%), asymptotically approaching 61%, as Eloss=61%·(1-e-0.04*ε). Our work is the first mechanical characterization of hydrated electrospun PCL nanofibers; all previous experiments were performed on dry PCL fibers, to which we will compare our data.

Dementia Knowledge Among Primary Healthcare Physicians in Riyadh, Saudi Arabia.

INTRODUCTION: Dementia poses a significant healthcare challenge globally, and healthcare providers must have adequate knowledge about its diagnosis, management, and support services. By assessing the knowledge level of primary care physicians in Riyadh, we can identify potential gaps and areas for improvement in dementia care, ultimately enhancing patient outcomes and quality of life. This study holds promise in shedding light on the current state of dementia knowledge among primary healthcare physicians in Riyadh and offering insights into strategies to enhance dementia care in this region. METHODS: This cross-sectional questionnaire-based study was conducted from the first of June 2023 to the end of December 2023 in Riyadh, Saudi Arabia. A validated questionnaire was used to assess physicians' knowledge, attitude, and practice toward dementia. RESULTS: A total of 151 physicians completed the questionnaires. The majority were male (55%), below 30 years of age (88.1%), and family medicine residents (84.8%). Most (74.8%) recognized old age as the most significant risk factor; an overwhelming majority of participants (98.7%) could not identify the minimum course of treatment to judge a medication's effectiveness. The average score of correct responses (7.74 ∓ 4.11) was equivalent to 38.7%. Furthermore, the average correct responses were significantly different among the different job levels of the participants. CONCLUSIONS: The findings of this study highlight a lack of knowledge among primary care physicians regarding dementia, emphasizing the crucial importance of physician education in this area. Additionally, the results strongly indicate the need for emphasis on dementia education within the undergraduate medical curriculum, family medicine curriculum, and physician training programs. By addressing these educational gaps, we can better equip physicians to provide optimal care and support for individuals with dementia, ultimately improving patient care and quality of life.

Overconfidence, Time-on-Task, and Medical Errors: Is There a Relationship?

Background: Literature suggest that physicians' high level of confidence has a negative impact on medical decisions, and this may lead to medical errors. Experimental research is lacking; however, this study investigated the effects of high confidence on diagnostic accuracy. Methods: Forty internal medicine residents from different hospitals in Saudi Arabia were divided randomly into two groups: A high-confidence group as an experimental and a low-confidence group acting as a control. Both groups solved each of eight written complex clinical vignettes. Before diagnosing these cases, the high-confidence group was led to believe that the task was easy, while the low-confidence group was presented with information from which it could deduce that the diagnostic task was difficult. Level of confidence, response time, and diagnostic accuracy were recorded. Results: The participants in the high-confidence group had a significantly higher confidence level than those in the control group: 0.75 compared to 0.61 (maximum 1.00). However, neither time on task nor diagnostic accuracy significantly differed between the two groups. Conclusion: In the literature, high confidence as one of common cognitive biases has a strong association with medical error. Even though the high-confidence group spent somewhat less time on the cases, suggesting potential premature decision-making, we failed to find differences in diagnostic accuracy. It is suggested that overconfidence should be studied as a personality trait rather than as a malleable characteristic.

Assessment of Arabic Web-Based Knowledge About Root Canal Treatment: An Infodemiologic Study.

BACKGROUND: Root canal treatment (RCT) is a vital dental procedure aimed at preserving tooth function and minimizing infection. Access to accurate and comprehensive information about RCT is crucial for informed decision-making. With the increasing reliance on the Internet for health-related information, it is essential to evaluate the quality and readability of web-based RCT content, particularly in Arabic-speaking regions. METHODS: This study conducted an extensive web search using three major search engines (Google, Yahoo, and Bing) to identify Arabic-language websites providing information on RCT. Inclusion criteria required websites in Arabic with comprehensive RCT content. Quality assessment employed the DISCERN instrument, JAMA benchmarks, and Health on the Net (HON) assessment tools, while readability was assessed using Flesch Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Flesch Reading Ease (FRE) metrics. RESULTS: Out of 152 websites included, the majority were affiliated with university/medical centers (56.58%) and non-profit organizations (28.29%). Quality assessment revealed that the mean DISCERN score was 2.82, indicating moderate quality. Only one website achieved a high DISCERN score. JAMA benchmarks showed limited compliance, with only two websites meeting all criteria. The HON code was found on only five websites. Readability analysis indicated that most websites were reasonably easy to read by the general population. CONCLUSION: This study highlights the significant gap in the quality and reliability of web-based health information related to RCT in Arabic. While the majority of websites examined in this study did not meet established quality standards, there is a clear need for improvements in the accuracy and comprehensiveness of online resources. Patients seeking information on RCT should exercise caution and consider consulting healthcare professionals for trustworthy guidance. Further research should explore strategies to enhance the quality of web-based health information and expand the scope of evaluation to ensure that individuals have access to reliable resources for making informed decisions about their dental health.

Evaluation of Mental Foramen and Mandibular Canal Course and Location in an Emirati Subpopulation.

INTRODUCTION AND AIMS: Violations of the mandibular canal (MC) and mental foramen (MF) and subsequent injuries to their neurovascular bundle have been reported after surgical and nonsurgical dental procedures. Besides using advanced technologies such as cone-beam computed tomography (CBCT), clinicians should be aware of the anatomy and location of MC and MF in different populations. This study aims to describe the morphologic characteristics of the MF, MC, and its intrabony location in relation to the apices of mandibular posterior teeth in an Emirati subpopulation using CBCT. METHODS: A total of 3700 CBCT scans were screened, and 154 scans that met the inclusion and exclusion criteria were randomly selected. The scans were assessed using 3-dimensional multiplanar imaging for the following structures: the location of MF and the MC course, its intrabony location, and its relationship to the apices of the mandibular posterior teeth. The data were analysed statistically using SPSS software. RESULTS: The MC ran lingually and inferiorly at the posterior region and became more buccal and superior towards the MF. The distal root of the mandibular second molar was found to be the closest root to the MC (2.06 ± 1.83 mm). Moreover, the most common location of the MF was distal to the contact area between the 2 premolars (0.83 ± 1.84 mm) with a significant negative correlation to age (with and increase in age, the MF moves distally). The distance between the root apices and the MC was statistically significantly affected by age (positive correlation) and gender (male patients had a greater distance). CONCLUSIONS: The common course of the MC is lingual and inferior posteriorly and becomes more buccal and superior towards the MF, which is located mostly between the mandibular first and second premolars. Furthermore, the distal root of the mandibular second molar is the closest to the MC and has a positive relationship with age.

The Mechanical Properties of Blended Fibrinogen:Polycaprolactone (PCL) Nanofibers.

Electrospinning is a process to produce versatile nanoscale fibers. In this process, synthetic and natural polymers can be combined to produce novel, blended materials with a range of physical, chemical, and biological properties. We electrospun biocompatible, blended fibrinogen:polycaprolactone (PCL) nanofibers with diameters ranging from 40 nm to 600 nm, at 25:75 and 75:25 blend ratios and determined their mechanical properties using a combined atomic force/optical microscopy technique. Fiber extensibility (breaking strain), elastic limit, and stress relaxation times depended on blend ratios but not fiber diameter. As the fibrinogen:PCL ratio increased from 25:75 to 75:25, extensibility decreased from 120% to 63% and elastic limit decreased from a range between 18% and 40% to a range between 12% and 27%. Stiffness-related properties, including the Young's modulus, rupture stress, and the total and relaxed, elastic moduli (Kelvin model), strongly depended on fiber diameter. For diameters less than 150 nm, these stiffness-related quantities varied approximately as D-2; above 300 nm the diameter dependence leveled off. 50 nm fibers were five-ten times stiffer than 300 nm fibers. These findings indicate that fiber diameter, in addition to fiber material, critically affects nanofiber properties. Drawing on previously published data, a summary of the mechanical properties for fibrinogen:PCL nanofibers with ratios of 100:0, 75:25, 50:50, 25:75 and 0:100 is provided.

Evaluation of learning environment of different family medicine programs, Jeddah-KSA, 2021.

Background: A supportive educational climate in which learners are educated and monitored is a significant determinant of the medical trainees' performance and progress and eventually contributes to better patient care. Therefore, residents' training programs need to be assessed and incorporated according to the views and expectations of the candidates. The objectives of this research are to compare and evaluate the learning environment of Family Medicine (FM) programs in Jeddah and make practical recommendations for improvement of the learning environment. Methods: A descriptive causal-comparative study was designed at FM programs in Jeddah, Saudi Arabia during January, and February 2021, including all residents from R1 to R4. A Postgraduate Hospital Educational Environment Measure (PHEEM) questionnaire was used in this study. The overall score and the three domains were calculated. Results: Two hundred and eighty-three questionnaires were distributed, and 262 were completed and collected, making a response rate of 92.6%. Females represented were 150 (57.3%), and males were 112 (42.7%). The study shows that 78 (29.8%) of the residents reported that the learning environment was excellent, and 154 (58.8%) described it as a more positive than the negative environment, whereas 29 (11.1%) described it as having a lot of problems. Out of 160 maximum scores, the highest total score (127) was observed among residents at the National Guard program, whereas the lowest score (108) was in the FM joint program, P < 0.001. Conclusion: Evaluation of the training programs is an essential component of quality assurance procedures. The satisfaction of the FM residents at different programs in Jeddah, Saudi Arabia, is better than reported previously, but however, further improvement is warranted. Juniors and residents of the National Guard program were more satisfied than their peers. We recommend low score items should have special consideration from high authorities and ongoing evaluation of the FM training program for further improvement of the learning environment.

Legal and Bioethical Educational Module in Saudi Board of Emergency Medicine: A Qualitative Need Assessment".

Purpose: Medical malpractice is a leading cause of morbidity and mortality worldwide, negatively affecting healthcare systems, communities, and providers. Although physicians value legal knowledge, their understanding of medical law is limited. Integrating medical law and ethics into medical school curriculums can develop a practitioner's decision-making skills, critical thinking abilities, and ethical judgment. The Saudi Board of Emergency Medicine (SBEM) is a residency training program governed by the Saudi Commission for Health Specialties (SCFHS), which aims to improve healthcare quality and patient safety in Saudi Arabia. This study explored stakeholders' perceptions regarding implementing a legal and bioethical education module in the SBEM curriculum. Methods: Nineteen participants (seven program directors and 12 trainees) from the different training centers around the kingdom (from Riyadh, Jeddah, and eastern province) have been included in the study. Thirty minutes to one-hour face-to-face and virtual (zoom-based) structured interviews have been done. Each interview was audio-recorded and transcribed verbatim. Then, data have been analyzed using a grounded theory constant comparative approach to develop categories, central themes, and a descriptive model. Results: Four themes have emerged from the data, including planning and executing the current bioethical and legal educational activities in the SBEM, the current teaching methods and guiding resources for the bioethical and legal subjects, the assessment methods used to evaluate the trainees' comprehension of bioethical and legal topics and the opinions regarding integrating bioethical and legal education module with the current curriculum of the SBEM. Conclusion: The study found that the current educational initiatives for legal and bioethical topics in SBEM are insufficient. There are no clear learning objectives, study guides, or combined practices for trainees to develop safe approaches when faced with ethical and legal challenges. A comprehensive protocol with required competencies and dedicated educators may help trainees understand Islamic ethics and jurisprudence principles for delivering culturally sensitive and patient-centered care. Further studies and needs assessments are recommended.

Effect of total fasting hours on the overall quality of recovery after surgery: An observational study.

Context: Preoperative fasting is one of the pre-requisite for patients undergoing a surgery. Despite clear instructions, patients frequently fast for extended periods before elective surgeries. Longer periods of fasting may cause discomfort, thirst, hunger, and other physiological problems. Aims: To assess the quality of postoperative recovery among adult patients having different preoperative fasting hours by using the postoperative Quality of Recovery40 (QoR40) score. Settings and Design: This was an observational study that was conducted for adult patients undergoing elective surgery during four weeks between 19th September and 13th October 2022 at Security Forces Hospital Riyadh, Kingdom of Saudi Arabia. Methods and Material: We excluded pediatric patients, patients undergoing spine or neurosurgery, emergency cases, or local anesthesia cases. Non-probability convenient sampling technique was used in this study. The postoperative quality of recovery-40 (QoR-40) questionnaire was distributed among 200 patients. Statistical Analysis Used: All analyses were performed with Statistical Package for the Social Sciences software (SPSS) v25. Descriptive statistics (frequency, percentage, median, and IQR) were used for the questionnaire's variables. The difference between the variables was analyzed using Kruskal-Wallis, and a P value <0.05 was considered statistically significant. Results: Out of 200 patients, 172 patients responded but 16 responses were excluded. A total of 156 adult patients' responses were included in this study. The majority were female (53%), 31% were older than 45 years. More than 50% of patients reported fasting for more than 6 hours for drinking and more than 8 hours for eating. On the positive scale, the comfort score was significantly affected by the fasting hours for drinking (P value = 0.045). On the negative scale of the questionnaire, the emotions were significantly affected by fasting hours for both drinking (P value = 0.027) and eating (P value = 0.043). Conclusions: The study results showed better comfort for patients with lesser fasting hours for drinking. Moreover, the results strongly suggest the need of following the fasting guidelines without prolonging the fasting duration. However, further studies with larger sample sizes are recommended.

Endometrioid Adenocarcinoma within an Endometriotic Cyst in the Mesosalpinx: A Case Report and Review of the Literature.

Endometriosis-related neoplasms may arise within endometriotic cysts of organs of the female genital tract or other organ systems. Herein, we present a case of endometrioid adenocarcinoma arising within an endometriotic cyst in the mesosalpinx. A 27-year-old single female presented to the clinic with a history of right hypochondrial pain. Pelvic MRI revealed a bulky uterus with three intramural uterine fibroids and a complex cyst in the mesosalpinx. The excised cyst showed predominantly confluent growth of relatively well-defined glands resembling proliferative-phase endometrium in a background of endometriosis. The tumor was diagnosed as endometrioid adenocarcinoma within an endometriotic cyst, pathologic stage pT1a. She was referred to the oncology team, where a positron emission tomography scan showed unremarkable results. Although these neoplasms have been reported in various locations within the female genital tract, endometrioid adenocarcinoma arising from endometriosis in the mesosalpinx is seldom reported.