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.

Diversity in Mission Statements and Among Students at US Medical Schools Accredited Since 2000.

Importance: Diversity in the physician workforce improves patient care and decreases health disparities. Recent calls for social justice have highlighted the importance of medical school commitment to diversity and social justice, and newly established medical schools are uniquely positioned to actively fulfill the social mission of medicine. Objective: To identify diversity language in the mission statements of all medical schools accredited since 2000 and to determine whether the presence of diversity language was associated with increased diversity in the student body. Design, Setting, and Participants: Cross-sectional study of public websites conducted between January 6, 2023, and March 31, 2023. Qualitative content analysis of mission statements was conducted using a deductive approach. Eligible schools were identified from the 2021-2022 Medical School Admission Requirements and American Medical Colleges and American Association of Colleges of Osteopathic Medicine websites. Each school's publicly available website was also reviewed for its mission and student body demographics. All United States allopathic and osteopathic medical schools that have been accredited and have enrolled students since 2000. Exposure: Content analysis of medical school mission statements. Main Outcomes and Measures: Prevalence of diversity language in medical school mission statements and its association with student body racial diversity. Data were analyzed in 5-year groupings: 2001 to 2005, 2006 to 2010, 2011 to 2015, and 2016 to 2020). Results: Among the 60 new medical schools (33 [55%] allopathic and 27 [45%] osteopathic; 6927 total students), 33 (55%) incorporated diversity language into their mission statements. In 2022, American Indian or Alaska Native individuals accounted for 0.26% of students (n = 18), Black or African American students constituted 5% (n = 368), and Hispanic or Latinx individuals made up 12% (n = 840). The percentage of schools with diversity language in their mission statements did not change significantly in schools accredited across time frames (60% in 2001: mean [SE], 0.60 [0.24] vs 50% in 2020: mean [SE], 0.50 [0.11]). The percentage of White students decreased significantly over the time period (26% vs 15% students in 2001-2005 and 2016-2020, respectively; P < .001). No significant differences were observed in student body racial or ethnic composition between schools with mission statements that included diversity language and those without. Conclusions and Relevance: In this cross-sectional study of US medical schools accredited since 2000, diversity language was present in approximately half of the schools' mission statements and was not associated with student body diversity. Future studies are needed to identify the barriers to increasing diversity in all medical schools.

Medical Student Experiences and Perceptions of ChatGPT and Artificial Intelligence: Cross-Sectional Study.

BACKGROUND: Artificial intelligence (AI) has the potential to revolutionize the way medicine is learned, taught, and practiced, and medical education must prepare learners for these inevitable changes. Academic medicine has, however, been slow to embrace recent AI advances. Since its launch in November 2022, ChatGPT has emerged as a fast and user-friendly large language model that can assist health care professionals, medical educators, students, trainees, and patients. While many studies focus on the technology's capabilities, potential, and risks, there is a gap in studying the perspective of end users. OBJECTIVE: The aim of this study was to gauge the experiences and perspectives of graduating medical students on ChatGPT and AI in their training and future careers. METHODS: A cross-sectional web-based survey of recently graduated medical students was conducted in an international academic medical center between May 5, 2023, and June 13, 2023. Descriptive statistics were used to tabulate variable frequencies. RESULTS: Of 325 applicants to the residency programs, 265 completed the survey (an 81.5% response rate). The vast majority of respondents denied using ChatGPT in medical school, with 20.4% (n=54) using it to help complete written assessments and only 9.4% using the technology in their clinical work (n=25). More students planned to use it during residency, primarily for exploring new medical topics and research (n=168, 63.4%) and exam preparation (n=151, 57%). Male students were significantly more likely to believe that AI will improve diagnostic accuracy (n=47, 51.7% vs n=69, 39.7%; P=.001), reduce medical error (n=53, 58.2% vs n=71, 40.8%; P=.002), and improve patient care (n=60, 65.9% vs n=95, 54.6%; P=.007). Previous experience with AI was significantly associated with positive AI perception in terms of improving patient care, decreasing medical errors and misdiagnoses, and increasing the accuracy of diagnoses (P=.001, P<.001, P=.008, respectively). CONCLUSIONS: The surveyed medical students had minimal formal and informal experience with AI tools and limited perceptions of the potential uses of AI in health care but had overall positive views of ChatGPT and AI and were optimistic about the future of AI in medical education and health care. Structured curricula and formal policies and guidelines are needed to adequately prepare medical learners for the forthcoming integration of AI in medicine.

Representation in Health Professions Education: Striving for an Inclusive Health Professions Education Community.

Author representation and inclusivity in health professions education (HPE) scholarship is receiving increasing attention in academic medicine, with multiple articles calling for greater equity related to gender, geographic, and institutional affiliations. Despite journal efforts to seek diversity, authors from high-income English-speaking countries are the most highly represented in HPE scholarship. Less attention, however, has been focused on the openness of medical education scholars, themselves, to engaging in international collaborations with authors and institutions from low-and-middle income countries. This eye-opener is inspired by the authors' personal experiences in HPE scholarship from an international medical educator perspective and advocates for the creation of an open and inclusive multinational medical education community. We offer suggestions that can help create opportunities for networking, collaboration, and promoting a sense of belonging among HPE scholars worldwide. As researchers, journal editors and associate editors, and faculty in HPE programs, we can work together to create a welcoming and accommodating environment that embraces non-dominant voices and perspectives, with the ultimate goal of achieving diversity and equity in HPE scholarship.

Clinical characteristics of patients with mpox infection in the United Arab Emirates: a prospective cohort study.

OBJECTIVES: The study aims to explore the risk factors, clinical characteristics, and outcomes of mpox infection in Abu Dhabi, United Arab Emirates (UAE). METHODS: A prospective cohort study was conducted at two communicable disease centers in Abu Dhabi, UAE and patients admitted with confirmed mpox infections between May 01, 2022 and December 31, 2022 were included in our study. RESULTS: A total of 176 mpox patients were admitted, of which 93% (n = 164) were men and mean age was 30.4 ± 7 years. Individuals presented with mucocutaneous lesions, most commonly on the genital and anal regions (n = 157; 89%). Only 70 (39.8%) gave a history of sexual exposure. The most common systemic symptoms reported were fever (n = 91; 52%), exanthema (n = 92; 52%), and inguinal lymphadenopathy (n = 60; 34%). Median timeframe from systemic symptoms to appearance of lesions was 4 days (interquartile range 4-6 days). Complications were observed in seven (4%) participants; two (1.1%) individuals developed conjunctivitis, four (2.3%) patients developed penile edema, and one (0.6%) case of myocarditis was reported. In 60% (n = 106) of patients, a potential source of sexual exposure was not identified. CONCLUSION: The clinical characteristics of mpox cases in the UAE are similar to those in other countries. However, cultural and religious factors likely prevent patient disclosure of sexual exposure and symptoms, contributing to the limited information about the disease in the Middle East.

Tuition Costs of Master's of Health Professions Education Programs: A Cross-Sectional Analysis.

PURPOSE: The increasing professionalization of medical education during the past 2 decades has ushered in an era in which formal degrees, particularly master's of health professions education (MHPE), have become important for career advancement in medical education. Although tuition costs can pose a substantial barrier for many seeking advanced degrees in health professions education, data on tuition associated with these programs are lacking. This study examines the accessibility of pertinent cost-related information available to prospective students and the variability of costs among programs worldwide. METHOD: The authors conducted an Internet-based, cross-sectional study, augmented with emails and direct contact with educators, to extract tuition-related data for MHPE programs between March 29, 2022, and September 20, 2022. Costs were converted to an annual total within each jurisdiction's currency and converted to U.S. dollars on August 18, 2022. RESULTS: Of the 121 programs included in the final cost analysis, only 56 had publicly available cost information. Excluding programs free to local students, the mean (SD) total tuition cost was $19,169 ($16,649), and the median (interquartile range) cost was $13,784 ($9,401- $22,650) (n = 109). North America had the highest mean (SD) tuition for local students ($26,751 [$22,538]), followed by Australia and New Zealand ($19,778 [$10,514]) and Europe ($14,872 [$7,731]), whereas Africa had the lowest ($2,598 [$1,650]). The region with the highest mean (SD) tuition for international students was North America ($38,217 [$19,500]), followed by Australia and New Zealand ($36,891 [$10,397]) and Europe ($22,677 [$10,010]), whereas Africa had the lowest ($3,237 [$1,189]). CONCLUSIONS: There is substantial variability in the geographic distribution of MHPE programs and marked differences in tuition. Incomplete program websites and limited responsiveness from many programs contributed to a lack of transparency regarding potential financial implications. Greater efforts are necessary to ensure equitable access to health professions education.

Interventions to support medical trainee well-being when dealing with patient death: a scoping review protocol.

INTRODUCTION: Existing literature demonstrates that medical students and residents experience complex emotions and substantial grief after patient deaths. Over time, this can lead to burnout and depression and adversely impact patient care. In response, medical schools and training programmes worldwide have developed and implemented interventions to help medical trainees to better cope with patient deaths. This manuscript provides a scoping review protocol that aims to systematically identify and document the published research reporting on the implementation or delivery of interventions to support medical students and residents/fellows in dealing with patient death. METHODS AND ANALYSIS: A scoping review will be conducted following the Arksey-O'Malley five-stage scoping review method and the Scoping Review Methods Manual by the Joanna Briggs Institute. English language interventional studies published through 21 February 2023, will be identified in the following databases: MEDLINE, Scopus, Embase, Psych Info, Cochrane Database of Systematic Reviews, CINAHL and ERIC. Two reviewers will screen titles and abstracts and then independently screen full-text articles for inclusion. Two reviewers will assess the methodological quality of included studies using the Medical Education Research Study Quality Instrument. After extraction, data will be narratively synthesised. Experts in the field will be consulted to ensure the feasibility and relevance of the findings. ETHICS AND DISSEMINATION: Ethical approval is not required as all data will be collected from published literature. The study will be disseminated through publication in peer-reviewed journals and presentation at local and international conferences.

Estimation of health literacy levels in patients with cardiovascular diseases in a Gulf country.

INTRODUCTION: Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. In the United Arab Emirates (UAE), the prevalence of deaths associated with CVD is higher than the global average, and the incidence of premature coronary heart disease is 10-15 years earlier than in Western nations. In patients with CVD, inadequate health literacy (HL) is significantly associated with poor health outcomes. The goal of this study is to assess HL levels among patients with CVD in the UAE to develop effective health system strategies for disease prevention and management. METHODS: A nationwide cross-sectional survey to assess HL levels in patients with CVD was conducted between January 2019 and May 2020 in the UAE. The association between health literacy level with patient age, gender, nationality, and education was determined using the Chi-Square test. The significant variables were further analyzed by ordinal regression. RESULTS: Of 336 participants (86.5% response rate), approximately half 51.5% (173/336) of the respondents were women, and 46% (146/336) of them attained high school level of education. More than 75% (268/336) of the participants were above the age of 50 years. Overall, 39.3% (132/336) of respondents possessed inadequate HL, and 46.4% (156/336) and 14.3% (48/336) demonstrated marginal and adequate HL, respectively. Inadequate health literacy was more prevalent among women, as compared to men. Age was significantly associated with HL levels. Participants under age 50 had higher adequate HL levels 45.6% (31/68), (95% CI (3.8-57.4), P < 0.001). There was no correlation between education and health literacy levels. CONCLUSION: The inadequate HL levels found in outpatients with CVD is a major health concern in the UAE. To improve population health outcomes, health system interventions, including targeted educational and behavioral programs for the older population are necessary.

Health literacy levels in patients with type 2 diabetes in an affluent Gulf country: a cross-sectional study.

OBJECTIVES: To identify health literacy levels in patients with type 2 diabetes mellitus in the United Arab Emirates (UAE). INTERVENTION: Nationwide cross-sectional survey. SETTING AND PARTICIPANTS: Individuals with type 2 diabetes mellitus attending outpatient diabetes clinics in all emirates of the UAE were surveyed between January 2019 and May 2020. Out of 832 patients approached, 640 met the inclusion criteria and agreed to participate. OUTCOME VARIABLES: The outcome variable of interest was the health literacy level, which was measured using the Eastern-Middle Eastern Adult Health Literacy 13 Questionnaire. The association of health literacy level with age, gender and education was conducted using the Χ2 test. RESULTS: Only 11% of respondents had adequate health literacy levels. Age and education were directly correlated with health literacy levels. Patients under age 50 years had statistically significant higher rates of marginal (106 of 238, 44.5%) and adequate literacy (67 of 238, 28.2%, p<0.001) than the older population. Participants with bachelor's or postgraduate degrees also had significantly higher adequate health literacy levels (24 of 79, 30.4%, p<0.001). CONCLUSIONS: The low health literacy levels found in outpatients with diabetes may be a major challenge to optimising diabetes care in the UAE. In addition to health services strategies, targeted educational and behavioural interventions for the older population and those with less formal education are necessary.

Promoting physician-patient language concordance in undergraduate medical education: a peer assisted learning approach.

BACKGROUND: Verbal communication plays an important role in the patient-physician relationship. Research shows that language concordance, when a healthcare professional communicates fluently in the patient's preferred language, contributes to patient satisfaction and improves healthcare outcomes. Yet, many medical schools worldwide, including most institutions in the Arab world, use English as the language of instruction. As a result, students lack confidence and feel unprepared to communicate effectively with the local population. This manuscript describes the development, implementation and early perceptions of an Arabic language program for medical students in the United Arab Emirates. METHODS: In 2020, the learning communities at Khalifa University College of Medicine and Health Sciences launched a pilot program implementing a Peer Assisted Learning (PAL) framework to teach Arabic medical terminology and language to both native and non-native Arabic speaking medical students. A web-based survey was administered to the first two cohorts of students to assess satisfaction with the classes and the program's impact on students' communication skills during clinical encounters. RESULTS: Early perceptions of the program were very positive, with 43/48 students (89.6%) reporting that they used the information during home visits and clinical rotations, and 42 students (87.5%) admitting that the classes made them feel more comfortable in communicating with the Arabic speaking local patient population. CONCLUSION: This paper explores a new educational approach to address the challenge of language barriers in healthcare. A feasible, low cost program using peer assisted learning can improve students' comfort in communicating with patients in the local language.

The Gendered Work/Role of Program Directors in International Graduate Medical Education.

Healthcare organizations offer numerous clinical and academic leadership pathways for physicians, among which the position of program director (PD) is considered to be a prominent educational leadership role. As PDs are instrumental in the recruitment and training of the next generations of physicians, PD gender distribution can affect the present and future of a medical specialty. This study offers a dialectical perspective in understanding how international PDs negotiate gendered understanding of their work/role by using the framework of Relational Dialectics Theory 2.0. Thirty-three interviews of PDs from Qatar, Singapore, and the United Arab Emirates were conducted and, using contrapuntal analysis, the competing discourses of meanings of gender in the PD work/role were examined. Competing discourses where structural, cultural, and professional meanings of gender were interrogated revealed inherent multiple meanings of how gender is understood in PD work/roles. In making sense of these meanings of gender, PDs express dilemmas of traditional gender binaries of masculine/feminine work/role meanings to explain the term in different ways in their everyday organizational and cultural struggles. The findings have implications for PD recruitment and retention in teaching hospitals.

Development of an acute medical unit to optimize patient flow and early discharges in a tertiary care hospital in the United Arab Emirates.

BACKGROUND: Hospitals worldwide are seeing an increased number of acute admissions, with resultant emergency department (ED) crowding and increased length of stay (LOS). Acute Medical Units (AMUs) have developed throughout the United Kingdom and other Western countries to reduce the burden on EDs and improve patient flow. Limited information is available on AMUs in the Middle East. The purpose of this study is to describe the development of the first AMU in the United Arab Emirates (UAE) for general medical patients and its impact on LOS, early discharges, ED boarders, and readmission rates. METHODS: We established a consultant-led AMU in a tertiary hospital in the UAE. A retrospective comparative review of all general medical admissions to the AMU between August 1, 2020 and December 31, 2020 and all admissions to the traditional medical wards between August 1, 2019 and December 31, 2019 was conducted. RESULTS: The average LOS reduced from 10 to 5 days (95% CI [4.14-6.25], p < 0.001) after the introduction of AMU. Early discharges increased by 22%. The number of outliers and number of patients boarding in ED reduced significantly (111 in 2019 vs. 60 in 2020, p < 0.05; 938 in 2019 vs. 104 in 2020, p < 0.001 respectively), with a decrease in ED waiting time from 394 min to 134 min (95% CI [229.25-290.75], p < 0.001). There was no increase in 30-day readmission rates. CONCLUSION: Restructuring the system of care can reduce LOS, overcome discharge barriers and improve patient flow. Similar units can be developed in hospitals throughout the UAE and the region to reduce LOS and improve patient flow through acute care units.

Medical Resident Awareness of Predatory Journal Practices in an International Medical Education System.

INTRODUCTION: Learning research methodology is increasingly becoming an essential part of graduate medical education worldwide, with many regulatory and accreditation bodies requiring residents to participate in scholarship. Research methodology workshops have become a standard part of medical curricula; however, there is limited data on how much training on journal selection and the publication process trainees receive. The alarming growth of predatory journals has made it increasingly difficult for researchers, especially trainees and early career physicians, to distinguish these publications from reputable journals. The purpose of this study is to assess the knowledge of reputable and predatory publishing practices amongst medical trainees in an international medical education setting in the United Arab Emirates. METHODS: A survey on credible journal practices based on the 'Think. Check. Submit' initiative was sent to all graduate medical education trainees at two large academic medical centers in Abu Dhabi, United Arab Emirates. Descriptive statistics were used to tabulate variable frequencies. RESULTS: Over half of the 160 respondents reported receiving prior research methodology training and 42.5% had at least one publication. The majority of the trainees selected impact factor and the quality of the peer-review process as characteristics of reputable journals. Ambiguous editorial board and rapid publication process were recognized as characteristics of predatory journals by >65% of trainees, however, 95% of all trainees were unaware of Beall's list or other resources to help select a journal for publication. 15.2% of trainees who received unsolicited emails from publishers submitted their manuscripts to the unfamiliar journals, citing peer recommendation and pressure to publish from their training programs as reasons. CONCLUSION: Trainees in the United Arab Emirates were mostly unaware of reputable publication practices and are vulnerable to publishing in predatory journals. Policy and educational reform are necessary to maintain the credibility and integrity of the scientific process.

Health literacy in a high income Arab country: A nation-wide cross-sectional survey study.

INTRODUCTION: Health literacy is a powerful predictor of health outcomes, but remains a global challenge. There is a paucity of published data and limited understanding of the health literacy of patients in the Middle East. The purpose of this study was to assess the patient health literacy levels in the United Arab Emirates (UAE) and identify associated demographic characteristics. METHODS: A cross-sectional survey of adult patients attending public and private hospitals and primary care clinics was conducted across the UAE between January 2019 and May 2020. Chi-square test was used to analyze the association between health literacy and demographic variables. Ordinal regression was adopted to analyze the data for statistically significant independent variables. RESULTS: 2349 of 2971 patients responded (79% response rate). Slightly less than one-quarter (23.9%) of patients surveyed demonstrated adequate health literacy. Over a third of women respondents (31.7%) possessed adequate health literacy, as compared to only 13% of men surveyed (p<0.001). Participant age was significantly (p<0.001) associated with health literacy levels, with approximately 50% of participants above age 50 years (51-75 years) demonstrating inadequate health literacy. Education was also positively correlated with health literacy. Adequate health literacy levels were twofold higher (30.5%, p<0.001) in patients with high school education, as compared to patients without secondary education. CONCLUSIONS: The high proportion of patients with inadequate health literacy in our study confirms that the health literacy deficit is a challenge in the UAE. Targeted interventions are needed to improve health literacy, particularly for older individuals, to optimize healthcare utilization and improve individual and population health outcomes.