Impact of Patient-Centered and Self-Care Education on Diabetes Control in a Family Practice Setting in Saudi Arabia.

Background: Diabetes mellitus is a chronic and complex medical disease that leads to significant morbidity and mortality. Patient-centered diabetes education that emphasizes active patient involvement, self, and shared care constitutes a substantial and essential component of the comprehensive diabetes management approach. Objectives: To assess the impact of patient-centered diabetes education sessions on the prescribed treatment plan in controlling diabetes and other related cardiovascular risk factors. Methods: In a pre-experimental pretest-posttest one group study design, all referred patients with type 2 diabetes (T2DM) to the diabetes educator clinic (n = 130 patients) during the period of 6 months from January to July 2021 were subjected to multiple and consecutive patient-centered diabetes education sessions, based on the framework published by the Association of Diabetes Care and Education Specialties (ADCES), in addition to their usual treatment plan. Demographic, social, and biological data were obtained at the baseline, three months, and six months after the intervention. Nonparametric Friedman and Cochran's Q tests for related samples were applied to examine the impact of this educational intervention on glycosylated hemoglobin (HbA1c) and other associated cardiovascular risks. The results of 130 patients with T2DM showed a significant reduction of mean systolic blood pressure "SBP" (p = 0.015), glycosylated hemoglobin (HbA1c) (p < 0.001), fasting blood sugar "FBS" (p < 0.001), total cholesterol (p < 0.001), low-density lipoprotein (p < 0.001), and triglyceride (p < 0.001), and significant rise of mean high-density lipoprotein (p = 0.011). At three and six months after the intervention, 43% and 58% of patients showed improved HbA1c levels. The mean HbA1c was reduced from 10.2% at the beginning of the study to 8.7% (p < 0.001) after six months. Moreover, a significant reduction in the prevalence of obesity (p = 0.018), high FBS (p = 0.011), and high SBP (p = 0.022) was detected. Conclusions: This study showed a considerable positive impact of diabetes education and patient-centered care on optimizing glycemic and other cardiovascular risk control. The needs of certain patients with T2DM should be addressed individually to achieve the best possible outcomes. Further research is needed to explore the long-term benefits of this intervention.

Does physician distraction lead to diagnostic and management errors? An exploratory study in the primary care setting.

OBJECTIVES: There is an increasing concern about diagnostic errors and their impact on patient safety. Physicians' diagnostic ability is significantly undermined by certain distractions that can carry potential negative consequences such as diagnostic and management errors. This study aimed to examine the effects of distracting factors for physicians during consultation and their consequent effects on diagnostic accuracy and disease or condition management. METHODS: Family medicine residents at a major training hospital in KSA were randomly assigned to two groups of simulated patients: one group with patients with distracting features and another group with patients without distracting features (the control group). Both groups encountered six simulated patients with different clinical conditions or diseases. The consultation time, accuracy of diagnosis, appropriateness of management, number of outlines of treatment, and simulated patient satisfaction were measured for both groups. RESULTS: A total of 70 simulated physician-patient encounters were conducted with 35 residents. Consultation time was significantly longer for encounters with patients with distracting features, which had a mean time of 7.43 min, compared with encounters with non-distracting patients, which had a mean time of 4.4 min (p value < 0.0001). There were no significant statistical differences in accuracy of diagnosis, appropriateness of management, or patient satisfaction between the two groups. However, residents recommended a higher number of outlines of treatment for patients with distracting features (2.96 for distracting patients versus 2.46 for non-distracting patients; p < 0.011). CONCLUSION: Distracting factors are associated with prolonged consultation time among physicians. Although this study did not demonstrate any effects of distracting factors on accuracy of diagnosis or disease management, these factors are still concerning, especially in complex clinical situations and situations where there is lack of reflective practice. The effects of distracting factors should be minimized to ensure patient safety.

Patient's Desire and Preference for Provision of Information Toward Greater Involvement in Shared Care.

OBJECTIVES: To determine the perceptions of patients on whether they receive sufficient information about their medical problems, their preferences to obtain information, and factors that may influence their preferences. DESIGN AND SETTINGS: Cross-sectional, questionnaire-based study conducted in a primary health-care center affiliated with the National Guard Hospital, Riyadh, Saudi Arabia. PATIENTS AND METHODS: Patients attending the center between October and December 2010 were interviewed using a questionnaire developed to meet the objectives of the study. RESULTS: A total of 245 patients participated in the study. The mean (±standard deviation) age of the participants was 43 (±16) years. Reported cases of dyslipidemia, diabetes mellitus, and hypertension among participants were 42%, 39%, and 31%, respectively. A minority of the participants indicated that they had a sufficient knowledge of their medical problems. The vast majority of the patients (92%) indicated that their preference to be informed about available treatment options and the plan for their future treatment. However, only 38% indicated that they had been told about the available treatment options, and less than half (48%) were informed about their future treatment plan. The proportion of male patients who preferred to know the treatment plan for their medical problems was significantly more than that of females (P < 0.001); nevertheless, female participants perceived that they had been better informed about their treatment plan than the male participants (P = 0.003). CONCLUSION: This study demonstrates that patients receive information about their medical problems much less than their expectations. Measures to promote patient education and their involvement in shared care process should be considered and implemented to minimize serious health outcomes.

Shared clinical decision making. A Saudi Arabian perspective.

OBJECTIVES: To determine preferences of patients regarding their involvement in the clinical decision making process and the related factors in Saudi Arabia.   METHODS: This cross-sectional study was conducted in a major family practice center in King Abdulaziz Medical City, Riyadh, Saudi Arabia, between March and May 2012. Multivariate multinomial regression models were fitted to identify factors associated with patients preferences.  RESULTS: The study included 236 participants. The most preferred decision-making style was shared decision-making (57%), followed by paternalistic  (28%), and informed consumerism (14%). The preference for shared clinical decision making was significantly higher among male patients and those with higher level of education, whereas paternalism was significantly higher among older patients and those with chronic health conditions, and consumerism was significantly higher in younger age groups. In multivariate multinomial regression analysis, compared with the shared group, the consumerism group were more likely to be female [adjusted odds ratio  (AOR) =2.87, 95% confidence interval [CI] 1.31-6.27, p=0.008] and non-dyslipidemic (AOR=2.90, 95% CI: 1.03-8.09, p=0.04), and the paternalism group were more likely to be older (AOR=1.03, 95% CI: 1.01-1.05, p=0.04), and female (AOR=2.47, 95% CI: 1.32-4.06, p=0.008).  CONCLUSION: Preferences of patients for involvement in the clinical decision-making varied considerably. In our setting, underlying factors that influence these preferences identified in this study should be considered and tailored individually to achieve optimal treatment outcomes.

Learning outcomes and tutoring in problem based-learning: how do undergraduate medical students perceive them?

OBJECTIVES: To explore opinions of undergraduate medical students regarding learning outcomes of the instructional strategy of Problem Based Learning (PBL). In addition their views were sought about the role of tutors and qualities of effective tutors. METHOD: This was a cross-sectional, questionnaire based study which was conducted in two colleges of Medicine, Central region, Saudi Arabia during the period of 1st of April to 30(th) June 2012. RESULTS: One hundred seventy four undergraduate medical students participated in this study. Seventy percent of participants have indicated that PBL strategy contributed to the development of their knowledge, presentation skills, team work abilities, and accepting criticism from other colleagues. Regarding the tutors' role in PBL tutorials, majority of the participants (75%) indicated that this role is essential, nevertheless, only 58% of students indicated that this role is clear and well identified. Sixty three percent of participants preferred a member role in the PBL tutorials and 80 percent of participants preferred both content and process expert tutors in the PBL tutorials. Significant statistical difference was noted between the views of students and their schools, gender, and study phase. CONCLUSION: Majority of the participants believed that PBL had a positive impact on the development of their cognitive, personal and teamwork skills. The view of the students in this study and the available evidence suggest that tutor should have both qualities; content and process expertise, in order to have the best outcomes from the PBL tutorials.

Development of the clinical learning evaluation questionnaire for undergraduate clinical education: factor structure, validity, and reliability study.

BACKGROUND: Teaching and learning of clinical skills for undergraduate medical students usually takes place during the clinical clerkship. Therefore, it is of vital importance to ensure the effectiveness of the rotations within this clerkship. The aims of this study were to develop an instrument that measures the effectiveness of the clinical learning environment, to determine its factor structure, and to find first evidence for the reliability and validity of the total scale and the different factors. METHODS: The Clinical Learning Evaluation Questionnaire (CLEQ) is an instrument, consisting of 40 items, which have been developed after consideration of the results of a qualitative study that investigated the important factors influencing clinical learning, both from the perspective of students, as well as teachers. Results of relevant literature that investigated this issue were also incorporated in the CLEQ. This instrument was administered to a sample of students (N = 182) from three medical colleges in Riyadh city, the capital of Saudi Arabia. The factor structure of the CLEQ (Principal component analysis, Oblimin rotation) and reliability of the factor scales (Cronbach's α) were determined. Hypotheses concerning the correlations between the different factors were tested to investigate their convergent and divergent validity. RESULTS: One hundred and nine questionnaires were returned. The factor analysis yielded six factors: F1 Cases (8 items), F2 Authenticity of clinical experience (8 items), F3 Supervision (8 items), F4 Organization of the doctor-patient encounter (4 items), F5 Motivation to learn (5 items), and F6 Self awareness (4 items). The overall internal consistency (α) of the CLEQ was 0.88, and the reliabilities (Cronbach's α) of the six factors varied from .60 to .86. Hypotheses concerning the correlations between the different factors were partly confirmed, which supported the convergent validity of the factors, but not their divergent validity. Significant differences were found between the scores of the students of the three different schools on the factors Supervision and Organization of patient-doctor encounter. CONCLUSIONS: The results of this study demonstrated that CLEQ is a multidimensional and reliable instrument. It can be utilized as an evaluation tool for clinical teaching activities, both by educators as well as students. Further research is needed into the validity of the CLEQ.

Cigarette smoking among female students in five medical and nonmedical colleges.

OBJECTIVES: This study was conducted to determine the prevalence of smoking, knowledge about the ill effects of smoking on health, and the influence of family members' smoking habits among Saudi female students. METHODS: This is a type of cross-sectional study. A sample of 1,070 female students was selected by a nonrandom and convenient sampling method from five colleges (Medicine, Business and Administration, Computer Sciences, Education, and Languages and Translation) of King Saud University, Riyadh, Saudi Arabia. A self-administrated questionnaire was used to determine the personal, social, and educational characteristics of the respondents. In addition, questions about their smoking types, status, duration of smoking, knowledge about the ill effects of smoking, daily cigarette consumption, and reasons for quitting smoking were included. RESULTS: The students' response rate was 85%. The prevalence of current smoking was 4.3% and 5.6% for cigarettes and water-pipes, respectively, whereas 3.9% of the participants were ex-smokers. The prevalence of current smoking was highest in the College of Business and Administration (10.81%) and lowest in the College of Medicine (0.86%). The majority (77%) of the smokers' parents (current and ex-smokers) were also smokers. More than half (54%) of the smokers started their smoking habit for entertainment, and 44.4% of the participants did not know that smoking causes serious health problems. The most common factors for quitting smoking were health concerns (54%), religious beliefs (29%), and parent's advice (17%). CONCLUSION: The study concludes that the prevalence of smoking varies in different subject streams and that family and friends have a great influence on individuals starting or stopping smoking. Extensive health education programs are needed to educate young women on the health hazards of smoking and help stop them from smoking.

Importance and process of feedback in undergraduate medical education in Saudi Arabia.

Feedback is an essential element in the process of students' learning and development. This study aimed to explore the views of medical students regarding the importance and process of feedback in their medical education. A cross-sectional questionnaire-based study was conducted in our college of medicine. The questionnaire included questions to assess the students' views about the importance and the need of feedback in the learning process and whether feed-back should follow certain or all forms of assessment. In addition, the questionnaire contained questions that aimed to explore students' views about the contents and process of feedback. One hundred and eighty-six male medical students participated in this study. While the majority of students (85%) indicated that feedback was important for their learning and expressed their need for regular feedback during their study, only about 20% of them indicated receiving regular feed-back. Senior students perceived that they received feedback less frequently than their junior colleagues' (P <0.05). The majority of the participants expressed their interest into receiving an immediate feedback after their summative and formative assessment. Students think that feedback should be balanced and include a suggested plan for their future learning process. Senior students showed a higher preference to have feedback that also contained points related to their strengths more than juniors. Students also indicated their preference to have one-to-one and written feed-back more than feedback that was conveyed in groups and verbally. These issues are of high importance and should be considered for planning and implementing an effective feedback system.

Sleep disorder among medical students: relationship to their academic performance.

BACKGROUND: Medical students are exposed to a significant level of pressure due to academic demands. Their sleep pattern is characterized by insufficient sleep duration, delayed sleep onset, and occurrence of napping episodes during the day. OBJECTIVE: To examine the prevalence of sleep disorder among medical students and investigate any relationship between sleep disorder and academic performance. METHODS: This is a cross-sectional self-administered questionnaire-based study. The participants were medical students of the first, second, and third academic years. The Epworth Sleepiness Scale (ESS) was also included to identify sleep disorder and grade point average was recorded for academic performance. RESULTS: There were 491 responses with a response rate of 55%. The ESS score demonstrated that 36.6% of participants were considered to have abnormal sleep habits, with a statistically significant increase in female students (p = 0.000). Sleeping between 6-10 h per day was associated with normal ESS scores (p = 0.019) as well as the academic grades ≥ 3.75. Abnormal ESS scores were associated with lower academic achievement (p = 0.002). CONCLUSION: A high prevalence of sleep disorder was found in this group of students, specifically female students. Analysis of the relationship between sleep disorder and academic performance indicates a significant relationship between abnormal ESS scores, total sleeping hours, and academic performance.