Grading reflective essays: the construct validity and reliability of a newly developed Tool- GRE-9.

BACKGROUND: The main objective of this study is to assess the construct validity and reliability of the Grading Reflective Essays-9 (GRE-9). METHODS: This study took place in a major tertiary academic medical center in Beirut, Lebanon. 104 reflective essays written by years 1-3 residents in the department of Family Medicine at the American University of Beirut Medical Center (AUBMC) were graded by 2 trained raters who independently scored the essays using GRE-9. GRE-9 scores were then correlated with scores on communication skills OSCE stations and in-training examinations to investigate, respectively, convergent and divergent validity. One of the 2 raters scored the essays twice one month apart to assess the reliability of the GRE-9 using intra rater reliability and internal consistency. RESULTS: There was a weak, non-significant correlation between GRE-9 score and In training examination (ITE) score (r = - .213, p = .395). There was a moderate, non-significant correlation between GRE-9 scores and the Objective structured clinical examination (OSCE) communication station scores (r = - .412 p = .162). The correlation coefficient between trails 1 and 2 was significant (r = .832, p = .000). Intra class correlation coefficient (ICC) analysis demonstrated almost perfect intra-rater agreement (0.819; 95% CI: 0.741-0.875) of the test ratings over time. CONCLUSIONS: GRE-9, is a short, concise, easy-to-use reliable grading tool for reflective essays that has demonstrated moderate to substantial intra-rater reliability and evidence of divergent validity. The study found non-significant correlations between reflective writing scores OSCE communication scores demonstrating a lack of relationship between reflective writing and this measure of performance.

The effect of workplace bullying on fatigue in school teachers: the moderating roles of gender and spirituality.

Workplace bullying is quite prevalent and has been linked to many health complaints. The relationship between workplace bullying and fatigue was documented in previous studies. However, knowledge on how this relationship develops with the interplaying factors of spirituality and gender was not investigated before especially among schoolteachers. The aim of this study is to explore the relationship between workplace bullying and fatigue as moderated by spirituality and gender among schoolteachers in Lebanon. This is a cross-sectional study, where 215 schoolteachers aged 18 till 64 and employed for a minimum of 6 months were recruited through systematic sampling. Six private and six public schools in Beirut participated in the study. Online questionnaires using validated scales were used. Both simple and multiple ordinal logistic regression were performed for the statistical analysis. Results showed that workplace bullying is a predictor of fatigue with an odds ratio of 2.74 and p-value 0.008. Gender was found to be an effect modifier for this relationship, mainly among females (OR 2.66, p-value 0.047) but not among males. Anxiety and depression also predicted higher levels of fatigue (OR 5.75, p-value 0.017). Spirituality did not moderate this relationship.

Evaluating a research training programme for frontline health workers in conflict-affected and fragile settings in the middle east.

BACKGROUND: Health Research Capacity Building (HRCB) is key to improving research production among health workers in LMICs to inform related policies and reduce health disparities in conflict settings. However, few HRCB programmes are available in the MENA region, and few evaluations of HRCB globally are reported in the literature. METHODS: Through a qualitative longitudinal design, we evaluated the first implementation of the Center for Research and Education in the Ecology of War (CREEW) fellowship. Semi-structured interviews were conducted with fellows (n = 5) throughout the programme at key phases during their completion of courses and at each research phase. Additional data was collected from supervisors and peers of fellows at their organizations. Data were analysed using qualitative content analysis and presented under pre-identified themes. RESULTS: Despite the success of most fellows in learning on how to conduct research on AMR in conflict settings and completing the fellowship by producing research outputs, important challenges were identified. Results are categorized under predefined categories of (1) course delivery, (2) proposal development, (3) IRB application, (4) data collection, (5) data analysis, (6) manuscript write-up, (7) long-term effects, and (8) mentorship and networking. CONCLUSION: The CREEW model, based on this evaluation, shows potential to be replicable and scalable to other contexts and other health-related topics. Detailed discussion and analysis are presented in the manuscript and synthesized recommendations are highlighted for future programmes to consider during the design, implementation, and evaluation of such programmes.

Assessing innovative approaches for global health capacity building in fragile settings in the MENA region: development of the evaluation of capacity building (eCAP) program.

BACKGROUND: Given the magnitude and frequency of conflicts in the MENA region along with their devastating impact on health responses and outcomes, there exists a strong need to invest in contextualized, innovative, and accessible capacity building approaches to enhance leadership and skills in global health. The MENA region suffers from limited (1) continued educational and career progression opportunities, (2) gender balance, and (3) skill-mix among its health workforce, which require significant attention. MAIN TEXT: The Global Health Institute at the American University of Beirut incepted the Academy division to develop and implement various global health capacity building (GHCB) initiatives to address those challenges in fragile settings across low-and middle-income countries in the MENA region. These initiatives play a strategic role in this context, especially given their focus on being accessible through employing innovative learning modalities. However, there exists a dearth of evidence-based knowledge on best practices and recommendations to optimize the design, implementation, and evaluation of GHCB in fragile settings in the MENA region. The present paper describes the development of the evaluation of capacity building program (eCAP), implemented under the Academy division, to assess the effectiveness of its initiatives. eCAP is composed of 3 phases: (1) a situational assessment, followed by (2) production of multiple case studies, and finally (3) a meta-assessment leading to model development. The goal of eCAP is not only to inform the Academy's operations, but also to synthesize produced knowledge into the formation of an evidence-based, scalable, and replicable model for GHCB in fragile settings. CONCLUSION: eCAP is an important initiative for researchers, educators, and practitioners interested in GHCB in fragile settings. Several lessons can be learned from the outcomes it has yielded so far in its first two phases of implementation, ranging from the situational assessment to the production of evaluation case studies, which are expanded on in the manuscript along with pertinent challenges.

Knowledge, attitude, and practices of complementary and alternative medicine: a survey of physicians and nurses at an academic medical center in Beirut.

The aim of this study is to assess the knowledge, attitudes, and practices of complementary and alternative medicine (CAM) among physicians and nurses at the American University of Beirut Medical Center (AUBMC) in Beirut, Lebanon. A web-based survey was emailed to 518 physicians and 423 registered nurses in all medical departments at AUBMC. Of the 94 physicians responding to the survey, 61% have never referred a patient to a CAM practitioner yet 33% reported that they would refer if available. Sixty-two percent of physicians believed that incorporating evidence-based CAM therapies will increase patient satisfaction and 66% thought that offering CAM would attract more patients. Of the 80 nurses who responded, 78.7% have never referred a patient to a CAM practitioner, yet half reported that they would likely refer if a CAM practitioner was available. Fifty-seven percent of nurses surveyed believed that offering CAM would attract more patients while 59% thought that it would increase patient satisfaction. Most nurses were uncomfortable counseling patients about CAM modalities. Favorable attitudes towards CAM were reflected by the physicians and nurses as signified by the above-average attitude means towards CAM (M = 4.01, SD = .16 and M = 3.25, SD = .59, respectively). The study findings demonstrate that despite the physicians' and nurses' limited knowledge and their discomfort in counseling on CAM, they expressed acceptability and willingness in using and incorporating CAM therapies into clinical practice at AUBMC. This is the first study conducted in Lebanon that assesses both nurses' and physicians' perspectives on the use of all CAM domains in general within the same healthcare setting. This study not only provides baseline data but also highlights the knowledge gap and learning needs among physicians and nurses with regards to CAM.

Evaluating an e-learning program to strengthen the capacity of humanitarian workers in the MENA region: the Humanitarian Leadership Diploma.

BACKGROUND: The Middle East and North Africa (MENA) region is consistently plagued with humanitarian crises while having little response capacity. Despite their obvious growing need, there exist limited educational opportunities for humanitarian workers to develop their capacity in humanitarian topics. The present study evaluates an online training program, the Humanitarian Leadership Diploma (HLD), which targeted humanitarian workers across the MENA region. METHODS: A mixed-methods design was used, comprising short and long-term quantitative and qualitative data, targeting individual and organizational-level outcomes. A total of 28 humanitarian workers across the MENA region enrolled in the program starting September 2019 until October 2020, 18 of which completed the full diploma. Short-term quantitative data such as knowledge assessments, course evaluations, and reflective commentaries were collected from all learners, whereas long-term qualitative data was collected only from those who completed the full diploma and from peers at their organizations, 6 months after completion. Data was triangulated, analyzed using qualitative content analysis, and reported as themes. RESULTS: The program was overall successful given multiple factors reported by participants such as enhanced knowledge, high satisfaction, and improved practice, with some important challenges being identified. Themes under the strengths category related to (1) online learning, (2) significance of diploma, (3) course content, (4) instructors, (5) transfer of learning into practice, and (6) personal development. Themes under the challenges category related to (1) barriers to applying changes in behavior and performance, (2) engagement and interaction, and (3) pedagogical approach. CONCLUSION: This is one of very few evaluations of locally developed and delivered online learning programs for humanitarian actors in the MENA region. The findings are especially important as they may inform researchers and humanitarian actors looking to design and deliver similar programs in the MENA region or other fragile settings. Key recommendations are discussed in the manuscript, and include to combine synchronous and asynchronous approaches, design concise course materials, limit theoretical pedagogical approaches, ensure topics are contextualized to the region, and consider continuous engagement strategies for learners.

Evaluating a capacity building program on women's health for displaced community health workers in fragile settings in Lebanon.

BACKGROUND: Displaced populations in fragile settings experience health disparities that are seldom attended to. Task-shifting, which involves training non-specialized community health workers (CHW) to deliver basic education and health services is a favorable strategy to address this problem, however very little data exist on this topic in the Middle East region. We conducted a long-term evaluation of the Women's Health Certificate delivered to Syrian refugees and host community in informal tented settlements in Lebanon under the Mobile University for Health (MUH) program. The training was delivered through a mobile classroom approach that incorporated a blended learning modality. METHODS: We collected short-term data from the 42 trained CHW (knowledge assessments and satisfaction measures) during the delivery of the intervention between March and August 2019, and long-term data (semi-structured interviews with 8 CHW and focus group discussion with 9 randomly selected community members) one year later between July and August 2020. The evaluation approach was informed by the Kirkpatrick evaluation model, and the qualitative data were analyzed using qualitative content analysis. RESULTS: Data from the CHWs and community members were triangulated, and they showed that the training enhanced access to education due to its mobile nature and provided opportunities for CHWs to engage and interact with learning material that enhanced their knowledge and favorable behaviors regarding women's health. In turn, CHWs were empowered to play an active role in their communities to transfer the knowledge they gained through educating community members and providing women's health services and referrals. Community members benefited from the CHWs and called for the implementation of more similar training programs. CONCLUSION: This is one of few studies reporting a long-term community-level evaluation of a task-shifting program on women's health among displaced populations in Lebanon. Our findings support the need to increase funding for similar programs, and to focus on delivering programs for a variety of health challenges. It is also essential to enhance the reach and length of recruitment to wider communities, to design concise, interactive, and engaging sessions, and to provide tools to facilitate circulation of learning material, and resources for referrals to health services.

Grading reflective essays: the reliability of a newly developed tool- GRE-9.

BACKGROUND: The main objective of this study is the development of a short reliable easy-to-use assessment tool in the aim of providing feedback to the reflective writings of medical students and residents. METHODS: This study took place in a major tertiary academic medical center in Beirut, Lebanon. Seventy-seven reflective essays written by 18 residents in the department of Family Medicine at the American University of Beirut Medical Center (AUBMC) were graded by 3 raters using the newly developed scale to assess the scale reliability. Following a comprehensive search and analysis of the literature, and based on their experience in reflective grading, the authors developed a concise 9-item scale to grade reflective essays through repeated cycles of development and analysis as well as the determination of the inter-rater reliability (IRR) using intra-class correlation coefficients (ICC) and Krippendorff's Alpha. RESULTS: The inter-rater reliability of the new scale ranges from moderate to substantial with ICC of 0.78, 95% CI 0.64-0.86, p < 0.01 and Krippendorff's Alpha was 0.49. CONCLUSIONS: The newly developed scale, GRE-9, is a short, concise, easy-to-use reliable grading tool for reflective essays that has demonstrated moderate to substantial inter-rater reliability. This will enable raters to objectively grade reflective essays and provide informed feedback to residents and students.

Assessment of workplace bullying: reliability and validity of an Arabic version of the Negative Acts Questionnaire-Revised (NAQ-R).

INTRODUCTION: Interest in workplace bullying has been steadily growing since the 1990s, focusing on understanding its driving factors, prevalence rates in different occupations and countries, its consequences, as well as the characteristics of the typical bully and victim. Currently, the Negative Acts Questionnaire-Revised (NAQ-R) is the most frequently used questionnaire to assess workplace bullying. Studies in the Arab world are scarce and to date the NAQ-R has not been validated in Arabic, the official or co-official language in around 25 countries in the Middle East and Asia. The aim of this study was therefore to develop an Arabic version of NAQ-R. MATERIALS AND METHODS: 447 participants aged 18-70 years were recruited through convenient sampling. Exclusion criteria were illiteracy and employment for less than 6 months. Participants were recruited from shops, banks, travel agencies and restaurants in an area in central Beirut around a tertiary care medical centre.A two-stage process was employed to translate the original version of NAQ-R to Arabic. This translated version along with validated Arabic versions of the Satisfaction with Life Scale and the Beck Depression Inventory II were distributed to participants. RESULTS: A 14-item two-factor NAQ-R, with subscales of person-related and work-related bullying, was supported. Reliability coefficients for total and subscale scores of the NAQ-R ranged from 0.63 to 0.90. The Arabic NAQ-R had good concurrent validity as indicated by significant correlations with depression and satisfaction with life (p < 0.05). CONCLUSION: NAQ-R was translated to Arabic and adapted. The results revealed acceptable levels of reliability and construct validity. As for the underlying factor structure, it needs to be further supported.