Establishment of an Accelerated Doctor of Family Medicine Program at Unaizah College of Medicine, Qassim University, Kingdom of Saudi Arabia.

Primary health care is well known to be the cornerstone for the health of the society. Furthermore, efficient health care at the secondary and tertiary levels is entirely dependent on effective primary health care. The Kingdom of Saudi Arabia (KSA) is currently building up a rigorous primary health care system with a large number of well-equipped primary health care centers. However, there is an acute shortage of Saudi family physicians throughout the country; both in urban and rural areas. There is no evidence in the literature supporting the relatively long 7 years' traditional duration of medical programs in the KSA. Rather, several US and Canadian medical schools have established accelerated programs in Internal Medicine and Family Medicine with graduates comparable with those of the traditional curricula in terms of standardized tests, initial resident characteristics, and performance outcomes. In response to the challenges the KSA is facing in primary health care, Unaizah College of Medicine at Qassim University is proposing to establish an accelerated Doctor of Family Medicine Program that would run for total duration of 6 years. Herein, we describe a concise outline of this program.

The need for national medical licensing examination in Saudi Arabia.

BACKGROUND: Medical education in Saudi Arabia is facing multiple challenges, including the rapid increase in the number of medical schools over a short period of time, the influx of foreign medical graduates to work in Saudi Arabia, the award of scholarships to hundreds of students to study medicine in various countries, and the absence of published national guidelines for minimal acceptable competencies of a medical graduate. DISCUSSION: We are arguing for the need for a Saudi national medical licensing examination that consists of two parts: Part I (Written) which tests the basic science and clinical knowledge and Part II (Objective Structured Clinical Examination) which tests the clinical skills and attitudes. We propose this examination to be mandated as a licensure requirement for practicing medicine in Saudi Arabia. CONCLUSION: The driving and hindering forces as well as the strengths and weaknesses of implementing the licensing examination are discussed in details in this debate.

Therapeutic efficacy of hysterosalpingography with special reference to application of hydrostatic pressure during the procedure.

BACKGROUND: In the majority of infertile females, cause lies within the fallopian tubes. The causes for tubal obstruction include tuabal endometriosis, chlamydial and tuberculous infections, salpingitis, due to previous tubal approach, previous tubal pregnancy, peritubal adhesions due to previous appendicectomy, ovarian, uterine or adnexal operations. Other less important but easily treatable significant causes include tubal obstruction due to debris, fine adhesions or even unexplained tubal spasm. The later group can be managed with selective fallopian tube catheterization. Proximal tubal obstruction is seen in 10-20% of HSG examinations. The purpose of this study was to treat the infertility due to proximal fallopian tube obstruction with application of hydrostatic pressure during hysterosalpingography (HSG) technique. METHODS: A study of consecutive hundred women of 18-30 years (mean age=24 years) who were clinically suspected of proximal fallopian tube obstruction (FTO) or unexplained infertility were included in this study. Women with other organic causes were excluded from the study. All the selected women underwent for HSG examination within 10 days of the menstrual cycle (3-4 days after the bath) by applying 10 days rule and with the application of hydrostatic pressure using water soluble contrast medium during the procedure. Women with successful opening of fallopian tubes (47%) after the application of hydrostatic pressure were followed for 3-6 months for the pregnancy. RESULTS: The fallopian tubes were patent in 57 (57%) women and appeared obstructed in 43 (43%) females (33 unilateral and 10 bilateral). With application of hydrostatic pressure during HSG technique, 25 (47%) fallopian tubes in 22 women reveal prompt opening while 28 tubes in 21 women remain blocked. The rate of successful conception was observed in 6 (24%) women within 3-6 months after the procedure. CONCLUSION: Application of hydrostatic pressure during the HSG examination offers a promising technique for the management of minimal proximal fallopian tube obstructions due to debris, fine adhesions and even in unexplained tubal spasm. Therefore, being minimally invasive and cost-effective, this technique may be adopted in all the suspected proximal fallopian tube obstruction or unexplained infertility, especially prior to selective fallopian tube catheterization (FTC), laparoscopy and laparotomy.

Food signs in radiology.

OBJECTIVE: Certain diseases show classic radiological signs that resemble various types of food items like fruits, meat, vegetables, eggs, bakery, grocery and confectionary items. In this article various food signs are discussed and correlated with the various food items in a pictorial way. The objective of this pictorial essay is to provide the information and learn the characteristic radiological signs resembling various food items. These food signs are easy to recognize and allows a confident diagnosis on the basis of imaging findings alone or can narrow down the differential diagnosis.

Comparison of an integrated problem-based learning curriculum with the traditional discipline-based curriculum in KSA.

OBJECTIVE: To compare the integrated problem-based learning (PBL) curriculum of the third year medical students of KSU at the Al-Qaseem campus with the traditional discipline-based teaching curriculum of students of Riyadh campus. DESIGN: A comparative cross-sectional study. PLACE AND DURATION OF STUDY: Al-Qaseem and campuses of King Saud University (KSU). A structured questionnaire was used for comparing the students of third year at both campuses of KSU. The student's learning behaviours and their liking for teaching methodologies was evaluated from March to June 2003. SUBJECTS AND METHODS: There were 138 3rd year students of Riyadh campus (59 females and 79 males) and 65, of Al-Qaseem campus (17 females and 48 males) (N = 203). Fifty-eight percent of students' at Al-Qaseem campus went to the library two or more times compared to 3.4% of the Riyadh campus (P = 0.000), 18.5% of Al-Qaseem campus used Journals (P = 0.000), and 86% did self-learning (P = 0.000), which was much higher than the students' at Riyadh campus. RESULTS: Almost 75% students at Al-Qaseem campus were satisfied with their system of education compared to 20% at Riyadh campus (P = 0.000). Sixty-nine percent students at Al-Qaseem campus answered problem-solving questions correctly versus 7.25% of the students at Riyadh campus. The students of both campuses liked group teaching almost equally and thought it makes them remember better. The Al-Qaseem campus students liked PBL, clinical skills lab, tutorials, and also lectures delivered at the college. CONCLUSION: PBL improved the students' usage of learning resources, problem-solving abilities and they were satisfied with their learning and the curriculum.

Ultrasound guided fine needle aspiration using 25G needle as a new technique for a wide range of pathological conditions.

OBJECTIVE: This study is to report on the use of 25 gauge (G) needle in ultrasound (US) guided fine needle aspiration (FNA), as a new technique for a wide range of pathological conditions, and to assess the yield of positive tissue material and the complications compared to those reported in the literature using larger needles. METHODS: One hundred and seventy-two patients presented consecutively at King Saud University Teaching Hospitals, Kingdom of Saudi Arabia, during the period 2000 to 2002, with various pathological conditions, underwent US guided FNA using 25G needle. The adequacy of the tissue obtained, and the pathological outcome were tabulated. The patients were discharged in the same day and followed for 4-6 weeks for complications. RESULTS: Adequate tissue was obtained from 165 (96%) patients. Seven (4.1%) patients had to be examined twice, to obtain a sufficient sample. The 172 patients also included 14 patients (8.1%) who had repeated procedure on the request of the clinician, who needed confirmation of the pathological diagnosis. Adequate sampling was obtained in the first attempt in 89%, in liver problems, and in other regions, and 86.8% in lung problems. The percentages of diagnostic categories revealed by the cytological analysis are similar to those obtained by other larger fine needles. CONCLUSION: No complications have been encountered. The technique can safely be repeated if the amount is inadequate or diagnosis is inconclusive, to reach 100% correct sampling. The results of positive findings are comparable to other studies using larger needles. The use of 25G needle is recommended for use under ultrasound guidance.

Cigarette smoking behavior among male secondary school students in the Central region of Saudi Arabia.

OBJECTIVE: This study was conducted to examine the smoking habits among male secondary school students in Al-Qassim, Kingdom of Saudi Arabia (KSA) and to assess their knowledge and attitudes towards smoking. METHODS: This cross-sectional study was conducted in Al-Qassim region, KSA during March 2003. Randomly selected was 14 out of 110 government male secondary schools. In the sample section, care was taken to represent urban and rural communities. In urban areas, 8 schools with the largest number of students were selected. This is in addition to 3 schools, which were the only schools with special education on Islamic, Commercial and Technical programs. In the rural areas the 3 most distant schools were included in the sample. Data were obtained through self-administered questionnaires that contained questions on personal background, smoking behavior, knowledge and attitude towards cigarette smoking. A total of 2203 students responded to the questionnaires with 83% response rate. RESULTS: Of the studied group, 606 (29.8%) were current smokers and among these 83.7% started smoking at the age of 15 years or less. Technical and commercial secondary school students had higher prevalence of the habit of smoking than those in general and Islamic secondary schools. It was found that the more pocket money received by the students, the higher was the prevalence of smoking. The most common reason given for cigarette smoking behavior (CSB) was the influence of friends (63.5%). Family factor, especially the brother's smoking habit (24.8%) was also important. Most of the students knew that smoking is harmful to their own health (89.3%), and to others (73.9%). The association between smoking and lung cancer was 84.3%, 80.9% for chest disease and 78.2% for heart disease, while the relation to other diseases was less known. CONCLUSION: We conclude that onset of smoking in the young is alarming. This is of immense importance in formulating health education strategies, which should be directed towards pupils, teachers and parents. The religious aspect should also be an integral part of such programs.

Acquired Intercostal Arteriovenous Fistulas: Transesophageal Doppler Echocardiographic Diagnosis.

Acquired intercostal arteriovenous fistulas are recognized complications of traumatic injuries. In this article, transesophageal Doppler echocardiographic findings in a patient with posttraumatic acquired intercostal arteriovenous fistulas are presented. The findings have been confirmed by angiography. The demonstration of intercostal arteriovenous fistulas by transesophageal Doppler echocardiography has not been reported before. (ECHOCARDIOGRAPHY, Volume 13, November 1996)