Physicians' professionalism from the patients' perspective: a qualitative study at a single-family practice in Saudi Arabia.

INTRODUCTION: Professionalism is a crucial component of medical practice. It is a culturally sensitive notion that generally consists of behaviors, values, communication, and relationships. This study is a qualitative study exploring physician professionalism from the patients' perspective. METHODS: Focus group discussions with patients attending a family medicine center attached to a tertiary care hospital were carried out using the four gates model of Arabian medical professionalism that is appropriate to Arab culture. Discussions with patients were recorded and transcribed. Data were thematically analyzed using NVivo software. RESULTS: Three main themes emerged from the data. (1) In dealing with patients, participants expected respect but understood delays in seeing physicians due to their busy schedules. In communication, participants expected to be informed about their health conditions and to have their questions answered. (2) In dealing with tasks, participants expected proper examination and transparency of diagnosis, but some expected the physician to know everything and did not appreciate them seeking outside opinions. They expected to see the same physician at every visit. (3) In physician characteristics preferences, participants preferred friendly smiling physicians. Some cared about the outer appearance of the physician whereas others did not. DISCUSSION/CONCLUSIONS: The findings of the study explained only two themes of the four gates model namely dealing with patients and dealing with tasks. Cultural competence and how to benefit from patients' perceptions to be an ideal physician should be incorporated into the process of physicians' training.

Stress coping strategies among medical students and trainees in Saudi Arabia: a qualitative study.

BACKGROUND: Stress is very common among medical students and trainees. Chronic stress has multiple negative mental and physical health consequences. This study explores medical students and interns' stressors and their coping strategies. METHODS: This is a qualitative study involving four focus group discussions with final year medical students (8 males, 10 females) and medical interns (8 males, 7 females). The study was conducted between October 2017 and January 2018 in the premises of a large medical school in Riyadh. After verbatim transcription, framework thematic analysis of the data was performed using NVivo software. RESULTS: Promoting the reward feeling of the medical profession was seen as an active stress-coping strategy among medical students. Planning and time management was seen by some participants as stressful while others felt it was a stress-coping strategy. The perception of stress among medical students was seen as a normal feeling. Avoiding discussions on medical matters, building relationships with the other sex and smoking were reported as avoidant stress-coping strategies. CONCLUSION: Medical students and interns are still struggling to achieve healthy stress-coping strategies. There is a great need for stress management programs to help fostering the students' coping skills.

The relationship between study skills and depressive symptoms among medical residents.

BACKGROUND: The cost of depression among residents is staggering as it extends into the quality and safety of patient care. Finding an explanation to resident depression by investigating the associated factors is therefore important. Study skills can be a possible factor, and a clear gap in the literature exists in this regard. We sought to investigate the relationship between depressive symptoms among residents and their study skills. METHODS: This was a correlational study and a non-probability sample of 240 residents completed the Beck Depression Inventory II (BDI-II) and the Study Skills Inventory (SSI). Chi-square test was used to compare different categorical variables, while student t-test and ANOVA for continuous data. Pearson's correlation coefficient was performed to find the relationship between depressive symptoms and study skills and the association that these measures have with the demographic variables. RESULTS: Overall, 186 residents (76%) filled out the questionnaire. The SSI total score was found to have a significant negative association with the BDI-II depression score (Pearson correlation = - 0.447and p < 0.000). No significant association was found between the total SSI score and the residents' sex, age, marital status, smoking status, training years or specialties. CONCLUSION: Poor study skills were found to be correlated with higher depressive symptoms. Future studies are required to develop a deeper understanding of this relationship and reconfigure the approach to study skills for the well-being of the future physicians.

The pattern of social media use and its association with academic performance among medical students.

BACKGROUND: There are concerns that the use of social media (SM) among medical students could affect academic performance. The objectives of the study were to investigate the pattern and reasons for SM use and their association with academic performance. METHODS: A stratified random sample, frequency distribution and comparison of categorical variables with Chi-square and Fisher exact tests were used. RESULTS: Of the 97% who responded, 98% used SM. The most popular were Whatsapp (87.8%), You tube (60.8%) and Twitter (51.8%) for general use; while You tube (83.5%), Whatsapp (35.5%) and Twitter (35.3%) for learning. For general use, there was a significant higher number of visits to You tube and Facebook among male students, while the reverse was true for Instagram and Path. Around 71% visited SM >4 times/day and 55% spent 1-4 hours/day. The main reasons for SM use were entertainment (95.8%), staying up-to-date with news (88.3%), and socializing (85.5%); for academic studies (40%). There was no significant association between Grade Point Average and the frequency of daily SM use or use during lectures. CONCLUSIONS: While almost all the students used SM, only a minority used them for academic purposes. SM use was not associated with academic performance.

Health professions' students have an alarming prevalence of depressive symptoms: exploration of the associated factors.

BACKGROUND: There is a need to better understand the depression phenomenon and to clarify why some students become depressed and others don't. The purpose of this study was to compare the prevalence of depressive symptoms among health professions' (HP) students, and to explore the association between socio-demographic factors (e.g. year of study, discipline, gender) and depressive symptoms. METHODS: In this descriptive-analytic, cross-sectional study, stratified proportionate sampling strategy was used to select the study sample during the academic year 2012-2013. The students from four health professions' schools situated within a large, public university located in Riyadh, Saudi Arabia were screened for depressive symptoms using the 21-item Beck Depression Inventory (BDI II). Chi-square test, student t-test and ANOVA were used to compare different categorical variables. RESULTS: The overall response rate was 79.0 %, the highest among dental students 86.1 %, and lowest among nursing (49.7 %). The overall prevalence rate of depressive symptoms was 47.0 %; it was highest among dentistry students (51.6 %), followed by medicine (46.2 %), applied medical sciences (AMS) (45.7 %) and lowest among nursing students (44.2 %). A statistically significant association was found between the presence and severity of depressive symptoms on one hand and the female gender (p = 0.000) and year of study on the other hand. CONCLUSION: This study seems to indicate an alarming rate of depressive symptoms. Female gender, dentistry, the third year for all schools and fifth year for medicine and dentistry have the highest association with depressive symptoms. Future studies may be needed to explore further the reasons and explanations for the variation in the prevalence of depressive symptoms among these groups. The factors that deserve exploration include curricular variables and personal factors such as the students' study skills.

Student centered curricular elements are associated with a healthier educational environment and lower depressive symptoms in medical students.

BACKGROUND: Any curriculum change is essentially an environmental change; therefore there is a need to assess the impact of any change in the curriculum on the students' perception of the Educational Environment (EE) and psychological well-being. The objectives of the current study are to (i) compare the EE perceptions of medical students studying in a System Based Curriculum (SBC) with those studying in a traditional curriculum (ii) compare the rate of depressive symptoms among the same students studying in both types of curricula (iii) determine whether there is a difference in the EE perception and depressive symptoms based on gender and year of study. METHODS: A cross sectional survey was conducted in a Saudi Medical School from 2007-2011, a period in which the school transitioned from a traditional to a SBC. A bilingual version of the Dundee Ready Educational Environment Measure (DREEM) inventory was used for measuring the EE; the Beck Depression Inventory (BDI II) was used for screening of depressive symptoms. A separate demographic questionnaire was also used. Mean scores and percentages were calculated. Continuous variables were summarized as means and standard deviation. For comparison of means, the effect size and student t test (with significance level of <0.05) were used. The percentages of the categorical data were compared using chi square test. RESULTS: The mean total DREEM score of positive perception of the EE in the SBC students was significantly higher (better) than the traditional curriculum students (p < 0.01) with an effect size of 0.472. The mean total score on the BDI-II inventory for depressive symptoms was higher (sicker) 21.3 among the female traditional curriculum students than 16.7 among the male traditional curriculum students and the difference was statistically significant (p = 0.001). The BDI score of the female SBC students (14.7) was significantly lower (healthier) than the female traditional curriculum students (21.3). No similar change was noted for the male students. CONCLUSION: The current study adds to the advantages of the SBC indicating not only healthier EE for both genders but also healthier emotional well-being for female students only.

Evaluation of Continuing Professional Development Program for Family Physicians.

OBJECTIVES: To evaluate the King Saud University Continuing Professional Development (CPD) Program for Family Physicians in relation to the Convenience, Relevance, Individualization, Self-Assessment, Interest, Speculation and Systematic (CRISIS) criteria. METHODOLOGY: A descriptive study was conducted at King Saud University (KSU) in Riyadh, Saudi Arabia. The authors used the six strategies of Convenience, Relevance, Individualization, Self-Assessment, Interest, Speculation and Systematic (CRISIS) for evaluation. The program was independently analyzed by the three authors using CRISIS framework. The results were synthesized. The suggestions were discussed and agreed upon and documented. RESULTS: The results indicate that KSU-CPD program meets the CRISIS criteria for effective continuing professional development and offers a useful approach to learning. The course content covers specific areas of practice, but some shortcomings were found that need to be improved like self assessment area and individual learning needs analysis. CONCLUSION: This program is suitable for Family Physicians, as it is well planned and utilizes most of the principles of CRISIS, but there is still room for improvement. Designing a program for general practitioners using hybrid model that offers a blend of e-learning as well as face-to-face learning opportunities would be an ideal solution.

Assessing the Validity of Health Messages Used by the Saudi Public in WhatsApp.

Objective: WhatsApp is the most frequently used social media platform in Saudi Arabia. Inaccurate information could negatively impact public health. The number of studies worldwide investigating health-related misinformation in social media increased steadily, with limited data from Arabic-speaking communities. This study aimed to estimate the validity and safety of Arabic-language health information messages circulated on WhatsApp and identify the different categories of these messages based on their credibility. Participants and Methods: A descriptive, analytical cross-sectional study was conducted from February to April 2021. A total of 374 students were randomly selected from the common first preparatory year college at King Saud University in Riyadh, Saudi Arabia, and participated by sharing up to three health-related WhatsApp messages per student that they or their relatives had recently read. Four board-certified physicians reviewed and classified the messages based on their credibility and sources. Results: 282 students provided 326 messages (1.2 messages per student). Most messages (86%) had either invalid or inaccurate content, and 83.7% came from unknown sources. Only 26 messages (8%) of the total were written by trusted scientific sources. Most of the messages from unknown sources or unqualified persons were either invalid or invalid, with potential health risks for the public, and the difference from trusted sources was statistically significant. Conclusion: This study showed a high percentage of inaccurate and invalid health-related messages on WhatsApp. Invalid messages with potential health risks were authored mostly by unknown sources or unqualified persons. Most health messages written by trusted authorities and qualified persons were valid. Trusted scientific authorities should thus be more active in public education on social media platforms. They should advise their communities on how to discern the validity of such messages. More efforts are needed to guide patients from where to obtain accurate and valid health information.

Faculty development on item writing substantially improves item quality.

The quality of items written for in-house examinations in medical schools remains a cause of concern. Several faculty development programs are aimed at improving faculty's item writing skills. The purpose of this study was to evaluate the effectiveness of a faculty development program in item development. An objective method was developed and used to assess improvement in faculty's competence to develop high quality test items. This was a quasi experimental study with a pretest-midtest-posttest design. A convenience sample of 51 faculty members participated. Structured checklists were used to assess the quality of test items at each phase of the study. Group scores were analyzed using repeated measures analysis of variance. The results showed a significant increase in participants' mean scores on Multiple Choice Questions, Short Answer Questions and Objective Structured Clinical Examination checklists from pretest to posttest (p < .0005). The effect sizes were 1.38, 3.84 and 2.20 for Multiple Choice Questions, Short Answer Questions and Objective Structured Clinical Examination, respectively. This study emphasizes that items written by faculty without faculty development are generally lacking in quality. It also provides evidence of the value of faculty development in improving the quality of items generated by faculty.

Anxiety and depression symptoms among medical residents in KSA during the COVID-19 pandemic.

OBJECTIVES: Medical residents' direct contact with patients with COVID-19 places them at high risk of psychological disturbance. This study aimed to estimate the prevalence of depression and anxiety symptoms, and their relationship with the COVID-19 pandemic among medical residents in KSA. METHODS: A cross-sectional study was conducted between January and March of 2021. The Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7) were used to screen for depressive disorders and generalized anxiety disorder, respectively. RESULTS: A total of 533 medical residents participated in the study; 52% were men, and 58% were single. Most residents had direct contact with one or more patients with COVID-19. The prevalence of depression and anxiety symptoms was 65.8% and 58.3%, respectively. The study revealed that gender was a risk factor for diagnosis with COVID-19 among residents: male residents were diagnosed with COVID-19 to a greater extent than female residents. In addition, being a nonsmoker rather than a smoker was associated with a higher risk of COVID-19 diagnosis. A multivariate regression analysis revealed that gender (female) and residency level (R5) were independently associated with anxiety symptoms. Similarly, the independent correlates of depression symptoms were gender (female) and specialty (family medicine). CONCLUSION: A high prevalence of depression and anxiety symptoms was found among medical residents trained in KSA. The rates were significantly higher among female than male residents.

Does professionalism change with different sociodemographic variables? A survey of Arab medical residents.

BACKGROUND: Medical professionalism reflects the commitment of physicians to their patients, society, themselves, and the profession. The study examined residents' attitudes towards professionalism and how these attitudes vary among the different demographic groups, namely gender, specialty, and year of residency. METHODS: A proportionate random sampling strategy was used to select the study sample. Medical residents from six specialties at a large tertiary care teaching facility were invited to participate in an online survey. The survey used the modified Learners Attitude of Medical Professionalism Scale (LAMPS), which consists of five domains: respect, excellence, altruism, duty/accountability, and integrity. Chi-square, Student t-test, one-way ANOVA, factorial ANOVA, and post hoc analysis were used to examine the attitudinal differences towards professionalism among the different demographic factors. RESULTS: The overall response rate was 82.7%. Overall, the residents' self-reported attitudes towards professionalism was positive. The highest score was for the "respect" domain (4.61), and the lowest was for "altruism" (3.67). No significant association was found between the mean scores and the three studied variables, namely, gender, specialty (surgical/nonsurgical), and level (senior/junior). CONCLUSIONS: No significant differences were observed in the overall attitude towards professionalism among the residents regarding their year of residency, gender, and specialty. The low altruism score and absence of improvement of the total score regarding the residents' increasing experience in the profession are concerns that need remedial action. Therefore, we suggest that future research look for possible explanations by using multi-institutional surveys that explore not only the residents' attitudes, but also the trainers' attitudes and practice, work situations, the hidden curriculum, and culture. Key messagesAttitudes towards professionalism among different demographic groups of residents do not show similar variations as has been reported in the literature, albeit in different sociocultural contexts.The low altruism score and absence of improvement of the total score as the residents gained more experience in the profession are concerns that need remedial action.A longitudinal study involving more than one institution for both residents and their faculty members to compare faculty scores with those of residents, while controlling for specialty and gender, may help elucidate the factors affecting attitudes towards professionalism and suggest possible means of addressing unfavourable attitudes.

Stress and its effects on medical students: a cross-sectional study at a college of medicine in Saudi Arabia.

Medical education is perceived as being stressful, and a high level of stress may have a negative effect on cognitive functioning and learning of students in a medical school. This cross-sectional study was conducted to determine the prevalence of stress among medical students and to observe an association between the levels of stress and their academic performance, including the sources of their stress. All the medical students from year one to year five levels from the College of Medicine, King Saud University, were enrolled in the study. The study was conducted using Kessler10 psychological distress (K10) inventory, which measures the level of stress according to none, mild, moderate, and severe categories. The prevalence of stress was measured and compared with the five study variables, such as gender, academic year, academic grades, regularity to course attendance, and perceived physical problems. The response rate among the study subjects was 87% (n=892). The total prevalence of stress was 63%, and the prevalence of severe stress was 25%. The prevalence of stress was higher (p<0.5) among females (75.7%) than among males (57%) (odds ratio=2.3, chi2=27.2, p<0.0001). The stress significantly decreased as the year of study increased, except for the final year. The study variables, including being female (p<0.0001), year of study (p<0.001), and presence of perceived physical problems (p<0.0001), were found as independent significant risk factors for the outcome variables of stress. Students' grade point average (academic score) or regularity to attend classes was not significantly associated with the stress level. The prevalence of stress was higher during the initial three years of study and among the female students. Physical problems are associated with high stress levels. Preventive mental health services, therefore, could be made an integral part of routine clinical services for medical students, especially in the initial academic years, to prevent such occurrence.

Primary care healthcare policy implementation in the Eastern Mediterranean region; experiences of six countries: Part II.

Background: Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available.Objectives: This paper describes and analyses the health systems of Algeria, Kuwait, Morocco, Saudi Arabia, Jordan and Iraq to PHC.Methods: Data were collected during a workshop at the Wonca East Mediterranean Regional Conference in 2018. Academic family physicians (FP) presented their country; using the Wonca framework of 11 PowerPoint slides, with queries of the country demographics, main health challenges, and the position of PHC in the health system.Results: The six countries had achieved a significant improvement in populations' health but currently face challenges of health financing, a small number of certified FPs, difficulties in accessing services and bureaucratic procedures. Primary concerns were the absence of a family practice model, brain drain and immigration of FPs. Countries differed in building a coherent policy.Conclusion: Priorities should be focused on: developing PHC model in Eastern Mediterranean region with advocacy for community-based PHC to policymakers; capacity building for strengthening PHC-oriented health systems with FP specialty training and restrict practising to fully trained FPs; engage communities to improve understanding of PHC; adopt quality and accreditation policies for better services; validation of the referral and follow-up process; and, develop public-private partnership mechanisms to enhance PHC for UHC.

Patterns and determinants of stress among consultant physicians working in Saudi Arabia.

BACKGROUND: Physicians experience several work-related stressors that have been mounting up in recent decades. This study aimed to examine perceived stress and its risk factors and consequences among consultant physicians in Saudi Arabia. METHODS: A cross-sectional study was conducted from November 2014 to March 2015 among physicians who were assigned rank of consultant. The stress level was assessed using perceived stress scale (PSS). RESULTS: A total of 582 consultants participated. The average age was 46.9±7.9 years, 71% were males, 56% were Saudi, 15% were smokers, and 68% slept ≤6 hours per night. The median PSS score was 17 (interquartile range of 14-21), which represented 44% of maximum possible PSS score. The upper tertile of PSS score (represents a high stress level) was significantly associated with being younger, female, and Saudi. The majority (85%) considered job environment to be stressful and ~50% attributed that to a high workload and a noncooperative administration. In the year preceding this study, half of consultants frequently contemplated or even worked toward changing their medical institutes or even moving to work outside Saudi Arabia because of perception of a stressful working environment. Over the previous year, encountering life stressors, considering job environment as stressful and experiencing passive suicidal ideation, were significantly associated with higher levels of stress. In multivariate analysis, the following factors were independently associated with stress: female gender (odds ratio [OR]=2.41, 95% CI 1.58-3.70) and perceived stressful working environment (OR=3.66, 95% CI 1.87-7.17). CONCLUSION: Consultant physicians in Saudi Arabia experience moderate to high levels of perceived stress that are relatively comparable to physicians worldwide. A significant association was found between stress levels and both female gender and perception of a stressful working environment. Further studies are required to assess physician-based interventions and organization-directed approaches to management of stress among physicians.

Stress and coping among consultant physicians working in Saudi Arabia.

BACKGROUND: Exposure to stressful working conditions without adequate stress-coping strategies may lead to stress and even psychiatric morbidity. There are a dearth of studies on stress-coping strategies among consultant physicians in the Arabian Gulf. OBJECTIVES: Determine stress-coping strategies among consultants in Saudi Arabia and the relationship of strategies to level of stress. DESIGN: Analytical cross-sectional study. SETTINGS: Conducted between November 2014 and March 2015 among physician consultants registered at the Saudi Commission for Health Specialties. SUBJECTS AND METHODS: Text messages were used to directly ask consultants to complete an online questionnaire. MAIN OUTCOME MEASURES: The 28-item Brief COPE inventory and the Perceived Stress Scale. SAMPLE SIZE: 582. RESULTS: The consultants were largely males (71%) and Saudi (56%), and their mean age was 46.9 (7.9) years. Adaptive stress-coping strategies were more frequently used than maladaptive stress-coping strategies (68% versus 49%). Stress levels were positively correlated with maladaptive stress-coping strategies (r=0.41, P less than .001) and negatively correlated with adaptive stress-coping strategies (r=-0.09, P=.026). Religion was the most frequently reported stress-coping strategy (79.6%) while alcohol drinking or substance use was the least frequently reported stress-coping strategy (28.0%). Females used both adaptive and maladaptive stress-coping strategies more than males (P=.002 and P less than .001, respectively). Stress management education/training was positively associated with frequent use of adaptive stress-coping strategies. CONCLUSIONS: Physician consultants generally cope well with work stressors. Nevertheless, there is still a critical need for stress management programs targeting consultants in order to further improve coping strategies. LIMITATIONS: The low response rate may negatively impact the validity and the generalizability of the current findings. The cross-sectional study design precluded the finding of any causal association. CONFLICT OF INTEREST: None.

Validation of a new study skills scale to provide an explanation for depressive symptoms among medical students.

BACKGROUND: Medical students are faced with enormous academic demands that may influence their emotional wellbeing. The high rate of depression among medical students and its negative impact is an impetus to find explanation for the factors associated with it. Study skills that students possess might be such a factor. The current tools for the assessment of the study skills may have certain limitations, particularly for different cultural settings. OBJECTIVES: This study aimed to develop and validate a Study Skills Inventory (SSI), and to investigate the relationship between the students' study skills and the extent (severity) of depressive symptoms, measured using the validated tool. METHOD: The first version of the SSI was developed through expert consensus. The inventory was then administered to a randomly selected group of medical students. Confirmatory factor analysis was conducted for the internal validity. External validation was conducted by comparing the results of the SSI with the "Approaches and Study Skills Inventory for Students" (ASSIST). After validation, the correlation between the SSI total score with the Beck Depression Inventory II (BDI-II) total score was investigated using the Pearson correlation coefficient. The means of the total study skills scores for each severity category of depression were compared using ANOVA. RESULTS: A total of 23 items, representing five sub-scales, were included in the inventory. Based on 372 student responses (response rate of 93%), the five-factor solution explained a cumulative variance of 52% and Cronach alpha was 0.84. The SSI total score had a significant negative association with the BDI-II depression score (Pearson correlation of -.348** and P<0.0001). CONCLUSION: This study showed evidence for acceptable reliability and validity of the newly developed SSI. Poor study skills were found to correlate with higher depressive symptoms. This association needs confirmation in future research and could open a new door for better understanding of student depression.

Towards evidence-based medical education in Saudi medical schools.

(EBME) [corrected] is an attitude of mind that entails the creation of a culture in which teachers think critically about what they are doing, look at the best evidence available and on this basis, make decisions about their teaching practice, and subsequently, undertake the necessary revision and change. More medical schools have opened in Saudi Arabia in the last few years than have existed over the last three decades. Currently, the education of health professionals is based on assumption and traditions and rarely on research findings. Medical teaching has evolved from being opinion-based to evidence-based and the art of teaching is rapidly becoming the 'science' of teaching. The need for evidence in our teaching and medical education practices is as important as it is in assessing a new therapy. This approach to education is not only associated with better results in terms of better learning, from the side of the students (the consumers), but also has a wider impact on patient care and the community. Moreover, in this age of accountability, litigations and quality assurance, the need for BEME becomes greater. Some suggestions to implement BEME in Saudi Arabia have been put forward and these are the training of medical education professionals in the use the existing information systems, and disseminating information through the creation of a BEME journal (secondary publication) that publishes a critically appraised summary of medical education articles that are both valid and of immediate clinical use.

Prevalence of sleep problems and habits in a sample of Saudi primary school children.

BACKGROUND: Sleep problems in children vary not only with age, but also with ethnic and sociocultural background. No research has been conducted to assess sleep problems in Saudi elementary school children. This study surveyed parents (or guardians) abouttheir elementary school children's sleep to assess the prevalence of certain sleep problems. METHODS: The study population comprised boys and girls attending regular public elementary schools in all grades and was conducted during springtime of the year 1999. A questionnaire inquiring about demographic data, specific sleep problems and habits and home environment was distributed and completed bythe parents or guardians. RESULTS: A total of 1012 complete questionnaires were included in the analysis. The sample comprised 511 boys (50.5%) and 501 girls (49.5%). The mean age was 9.5+/-1.9 years, ranging from 5 to 13 years. Daytime fatigue was the most prevalent sleep problem (37.5%) followed by bedtime resistance (26.2%), difficulty rising in the morning during weekdays (20.7%), and sleep-onset delay (11.8%). Cosleeping with parents was reported in 12.4% of children. The study revealed some differences between boys and girls. Napping during the daytime was reported in 40.8% of children. CONCLUSION: The study showed that sleep problems are prevalent among Saudi elementary school children. Moreover, the study shed some light on sleep habits and practices in this age group in Saudi Arabia, like the high prevalence of daytime napping.

A One-Day Dental Faculty Workshop in Writing Multiple-Choice Questions: An Impact Evaluation.

Long training workshops on the writing of exam questions have been shown to be effective; however, the effectiveness of short workshops needs to be demonstrated. The aim of this study was to evaluate the impact of a one-day, seven-hour faculty development workshop at the College of Dentistry, King Saud University, Saudi Arabia, on the quality of multiple-choice questions (MCQs). Kirkpatrick's four-level evaluation model was used. Participants' satisfaction (Kirkpatrick's Level 1) was evaluated with a post-workshop questionnaire. A quasi-experimental, randomized separate sample, pretest-posttest design was used to assess the learning effect (Kirkpatrick's Level 2). To evaluate transfer of learning to practice (Kirkpatrick's Level 3), MCQs created by ten faculty members as a result of the training were assessed. To assess Kirkpatrick's Level 4 regarding institutional change, interviews with three key leaders of the school were conducted, coded, and analyzed. A total of 72 course directors were invited to and attended some part of the workshop; all 52 who attended the entire workshop completed the satisfaction form; and 22 of the 36 participants in the experimental group completed the posttest. The results showed that all 52 participants were highly satisfied with the workshop, and significant positive changes were found in the faculty members' knowledge and the quality of their MCQs with effect sizes of 0.7 and 0.28, respectively. At the institutional level, the interviews demonstrated positive structural changes in the school's assessment system. Overall, this one-day item-writing faculty workshop resulted in positive changes at all four of Kirkpatrick's levels; these effects suggest that even a short training session can improve a dental school's assessment of its students.