Components of effective letters of recommendation: A cross-sectional survey of academic faculty.

INTRODUCTION: Conventional merit-based criteria, including standardized test scores and grade point averages, have become less available to residency programs to help distinguish applicants, making other components of the application, including letters of recommendation (LORs), important surrogate markers for performance. Despite their impact on applications, there is limited published data on LORs in the international setting. METHODS: A cross-sectional survey of academic faculty was conducted between 9 January 2023 and 12 March 2023 at two large academic medical centers in the United Arab Emirates. Descriptive statistics were used to tabulate variable frequencies. RESULTS: Of the 98 respondents, the majority were male (n = 67; 68.4%), Western-trained (n = 66; 67.3%), mid-career physicians (n = 46; 46.9%). Most respondents (n = 77; 78.6%) believed that the purpose of an LOR was to help an applicant match into their desired program. Letters rarely included important skills, such as leadership (n = 37; 37.8%), applicant involvement in research (n = 43; 43.9%), education (n = 38; 38.8%), or patient advocacy (n = 30; 30.6%). Most faculty (n = 81; 82.7%) were not familiar with standardized letters of recommendation. Only 7.3% (n = 7) of respondents previously received training in writing LORs, but 87.7% (n = 86) expressed an interest in this professional development opportunity. CONCLUSION: There is variability in perceptions and practices related to LOR writing in our international setting, with several areas for improvement. Given the increasing importance of LORs to a candidate's application, faculty development is necessary.

Teaching Social Determinants of Health in Undergraduate Medical Education: A Longitudinal Curricular and Experiential Program in the United Arab Emirates.

ABSTRACT: Social determinants of health (SDH) have a major impact on illness and wellness. However, research shows a lack of training on SDH in both undergraduate and postgraduate medical education, with studies confirming that the social needs of patients are not routinely identified or addressed by health care professionals in clinical practice. The medical education community is currently working to incorporate SDH into undergraduate training but has had limited guidance regarding educational topics, modes of teaching, and evaluation criteria in this domain. This article describes the evolution, process, and structure, along with student perceptions, lessons learned, and future directions, of an SDH educational program in the United Arab Emirates. Using the Institute of Medicine's behavioral and social science knowledge domains as a framework, the program includes a didactic component with workshops, reflective practice training, and an experiential component that integrates home visits with social activities in collaboration with community partners. The program began in 2019. To date, 114 students have completed the didactic sessions and at least 1 year of the experiential component. Student surveys and reflective narratives reveal positive perceptions of the program and improved SDH knowledge, skills, and attitudes.

Reliability and validity of the Arabic version of the Consultation and Relational Empathy (CARE) measure.

PURPOSE: Empathy is the ability to communicate an understanding of an individual's subjective experience. It plays a vital role in the physician-patient relationship and improves clinical outcomes. This increases the importance of measuring and studying empathy in the clinical setting. The Consultation and Relational Empathy (CARE) is a 10-item questionnaire that measures patient assessment of physician's empathy in primary care. To our knowledge, there are no validated measures of empathy in the clinical setting in Arabic. This study aims at validating the CARE in Arabic. METHODS: Data collection took place between October 2019 and February 2020. A total of 220 patients completed the questionnaire which consisted of the 10 CARE items, participants' opinions regarding the importance of each item, demographic information, and information about the consultation. The reliability and validity of the Arabic CARE were measured using Cronbach alpha, item-total correlations, and factor analysis. Construct validity was measured based on the overall patient satisfaction, and their satisfaction with the length of the consultation. RESULTS: High Cronbach alpha and item-total correlation reveal the internal consistency and homogeneity of the Arabic version. Our findings showed significant positive correlations between CARE score and each of the characteristics: overall satisfaction with the consultation, duration of the consultation, patients' satisfaction with consultation duration and whether they would recommend the doctor to others. CONCLUSION: The Arabic version of the CARE measure appears to be valid and reliable. It is available for use in research, education, and assessment of physicians' empathy.

Physicians' empathy levels in a primary care setting: perceptions of patients and their physicians, a qualitative study.

BACKGROUND: The physician-patient relationship is a crucial element in successful medical care. Empathy is the ability to understand an individual's subjective experience yet remain as an observer. It plays a major role in establishing a good physician-patient relationship. OBJECTIVE: The aim of this study was to evaluate the perspectives of patients and their corresponding emergency physicians regarding physicians' empathy levels and to extract themes that both patients and their doctors considered as important for an empathic encounter. METHODS: This is a qualitative study conducted at a Middle Eastern tertiary care centre Emergency Department (ED) using in-depth semi-structured interviews administered to each participating patient and his/her corresponding ED physician. Empathy-related themes were identified using inductive thematic analysis. RESULTS: This study shows that both patients and physicians believe in the importance of empathy in the ED based on four major themes: emotions, interpersonal skills, time and chief complaint. Time and the chief complaint were perceived as barriers by physicians, but not by their patients. CONCLUSIONS: A gap lies in the expressive communication phase of empathy between the two groups. The four major themes retrieved could form the basis of an empathy measure in the medical encounter in Lebanese and similar settings.

Systems thinking: advancing health advocacy training; a perspective from junior family physicians in the Middle East.

Healthcare systems are becoming increasingly complex. Physicians are expected to be agents of change to meet the growing health needs. In the Middle East, young family doctors are subtly creating a space for advocacy. Recognising the need for compulsory advocacy training in undergraduate medical curricula, allows health workers and students a concrete exposure to social determinants of health by carrying out clinical encounters from the hospital setting to outpatient dispensaries in underprivileged areas. At the community level, they organise mobile clinics and engage in collaborative initiatives to provide primary healthcare services to vulnerable populations. To be successful, advocacy practice and training should move towards systems thinking. Family doctors need to engage and collaborate with other stakeholders within the healthcare system and understand the dynamics of the relationships between them. This empowers their role in national health agendas, especially those related to universal health coverage (UHC). Future physicians and all members of primary care teams need to partner with people outside their discipline; the idea of interdisciplinary and interprofessional collaboration should be integrated into their schooling and all forms of vocational training.