2018 Ottawa consensus statement: Selection and recruitment to the healthcare professions.

Selection and recruitment into healthcare education and practice is a key area of interest for educators with significant developments in research, policy, and practice in recent years. This updated consensus statement, developed through a multi-stage process, examines future opportunities and challenges in selection and recruitment. There is both a gap in the literature around and a compelling case for further theoretical and empirical literature to underpin the development of overall selection philosophes and policies and their enactment. More consistent evidence has emerged regarding the quality of different selection methods. Approaches to selection are context-dependent, requiring the consideration of an institution's philosophy regarding what they are trying to achieve, the communities it purports to serve, along with the system within which they are used. Diversity and globalization issues continue to be critically important topics. Further research is required to explore differential attainment and explain why there are substantial differences in culturally acceptable ways of approaching diversity and widening access. More sophisticated evaluation approaches using multi-disciplinary theoretical frameworks are required to address the issues. Following a discussion of these areas, 10 recommendations are presented to guide future research and practice and to encourage debate between colleagues across the globe.

Medical professionalism frameworks across non-Western cultures: A narrative overview.

BACKGROUND: Medical professionalism is context-specific, but most literature on professionalism stems from Western countries. This study is about benchmarking of different frameworks on professionalism and interpreting the commonalities and discrepancies of understanding professionalism across different cultures. We need to study the cultural underpinning of medical professionalism to graduate future "global" practitioners who are culturally sensitive enough to recognize differences (and also similarities) of expectations of patients in various contexts. AIM: This study aims at describing culture specific elements of three identified non-Western frameworks of professionalism, as well as their commonalities and differences. METHOD: A narrative overview was carried out of studies that address professionalism in non-Western cultures in the period 2002-2014. RESULTS: Out of 143 articles on medical professionalism, only four studies provided three structured professionalism frameworks in non-Western contexts. Medical professionalism attributes in non-Western cultures were influenced by cultural values. Out of the 24 identified attributes of professionalism, 3 attributes were shared by the three cultures. Twelve attributes were shared by at least two cultures, and the rest of the attributes were unique to each culture. CONCLUSIONS: The three frameworks provided culture-specific elements in a unique conceptual framework of medical professionalism according to the region they originated from. There is no single framework on professionalism that can be globally acknowledged. A culture-oriented concept of professionalism is necessary to understand what the profession is dedicated to and to incorporate the concept into the medical students' and physicians' professional identity formation.

Health sciences and medical college preadmission criteria and prediction of in-course academic performance: a longitudinal cohort study.

High School, Aptitude and Achievement Tests have been utilized since 2002 in Saudi Arabia for the purpose of student selection to health sciences and medical colleges. However, longitudinal studies determining the predictive validity of these so-called cognitive tests for in-course performance is lacking. Our aim was to assess the predictive validity of Saudi health sciences and medical school pre-admission selection tools for in-course performance over a three year period and therefore we conducted a retrospective review of pre-admission (High School Test, Saudi Aptitude and Achievement tests) and in-course academic performance data (Grade Point Average, GPA) for all students enrolled in undergraduate Health Sciences Colleges and College of Medicine, 2007-2010. Correlation and linear regression analyses were performed for the whole cohort. Data are reported on 87 of 1,905 (4.6 %) students who applied to Health Sciences and Medical Colleges. The results indicate that in-course GPA scores in year three were significantly positively correlated with High School (r = 0.65; p < 0.05), Aptitude (r = 0.65; p < 0.05) and Achievement (r = 0.66; p < 0.05) selection test scores. Furthermore, the High School Exam was the best predictor of achievement in year three. Regression analysis revealed that 54 % of the variance in predicting academic performance is explained by the three test scores. Results confirmed our hypothesis that High School, Aptitude and Achievement tests are statistically predictive of academic performance in health sciences and medical colleges. Further longitudinal, national work is nevertheless required to determine the extent to which pre-admissions cognitive and non-cognitive tests, socio-demographic and educational process variables predict undergraduate and postgraduate achievement and performance.

The progress test as a diagnostic tool for a new PBL curriculum.

CONTEXT: The College of Medicine at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) is running a PBL-based curriculum. A progress test was used to evaluate components of the basic medical and clinical sciences curriculum. OBJECTIVE: To evaluate the performance of students at different levels of the college of medicine curriculum through USMLE-based test that focused on basic medical and clinical sciences topics. METHODS: The USMLE-based basic medical and clinical sciences progress test has been conducted since 2007. It covers nine topics, including: anatomy; physiology; histology; epidemiology; biochemistry; behavioral sciences, pathology, pharmacology and immunology/microbiology. Here we analyzed results of three consecutive years of all students in years 1-4. FINDINGS: There was a good correlation between progress test results and students' GPA. Progress test results in the clinical topics were better than basic medical sciences. In basic medical sciences, results of pharmacology, biochemistry, behavioral sciences and histology gave lower results than the other disciplines. CONCLUSIONS: Results of our progress test proved to be a useful indicator for both basic medical sciences and clinical sciences curriculum. Results are being utilized to help in modifying our curriculum.

Physicians medication prescribing in primary care in Riyadh City, Saudi Arabia. Literature review, part 1: variations in drug prescribing.

Rational prescribing is associated with improved safety in drug use, better quality of life for patients and cost-effective care. Medication prescribing is a relatively unexplored area of research in Saudi Arabia and until now most studies have been in the secondary and tertiary health care system. This paper is the first of 3 review articles that form the background for a series of 5 interconnected studies of prescribing patterns and medication errors in the public and private primary health care sectors of Saudi Arabia. A MEDLINE search was conducted to identify papers published in peer-reviewed journals over the previous 3 decades. The paper reviews variations in prescribing patterns and influences on physicians' prescribing behaviour worldwide and in Saudi Arabia.

Physicians' medication prescribing in primary care in Riyadh City, Saudi Arabia. Literature review, part 2: rational prescribing.

Unlike sub-optimal prescribing, rational prescribing, coupled with certain indicators, is associated with improved safety in drug use in terms of selecting appropriate drug for prescribing, better quality of life for patients and cost-effective care. Medication prescribing is a relatively unexplored area of research in Saudi Arabia and until now most studies have been in the secondary and tertiary health care system. This paper is the second of 3 review articles that form the background for a series of 5 interconnected studies of prescribing patterns and medication errors in the public and private primary health care sectors of Saudi Arabia. A MEDLINE search was conducted to identify papers published in peer-reviewed journals over the previous 3 decades. The paper reviews rational prescribing with its indicators, suboptimal prescribing, classification of medication errors, and how to achieve quality in health care prescribing worldwide and in Saudi Arabia.

Physicians' medication prescribing in primary care . in Riyadh City, Saudi Arabia. Literature review, part 3: prescribing errors.

Medication errors are globally huge in magnitude and associated with high morbidity and mortality together with high costs and legal problems. Medication errors are caused by multiple factors related to health providers, consumers and health system, but most prescribing errors are preventable. This paper is the third of 3 review articles that form the background for a series of 5 interconnected studies of prescribing patterns and medication errors in the public and private primary health care sectors of Saudi Arabia. A MEDLINE search was conducted to identify papers published in peer-reviewed journals over the previous 3 decades. The paper reviews the etiology, prevention strategies, reporting mechanisms and the myriad consequences of medication errors.

[Medication prescribing pattern in primary care in Riyadh City, Saudi Arabia]

Physicians' prescribing behaviour is closely linked with patient safety and this area is poorly researched in Saudi Arabia. The objective of this study was to analyse physicians' prescribing patterns and the adequacy of noted information in the primary health care sector in Riyadh city. All medication prescriptions from 5 public (n = 1182) and 5 private (n = 1200) health centres were collected by simple random sampling during 1 working day. Antibiotics were the most commonly prescribed drugs in both sectors. The mean number of drugs per prescription was 2.08 and 2.36 in the public and private sectors respectively. Information and instructions noted on prescriptions varied considerably between private and public health centres. Similarly the medication prescribing pattern differed across the 2 health settings. Primary care physicians in Saudi Arabia need continuing training to improve their prescribing practices.

Medication errors in primary care in Riyadh City, Saudi Arabia.

Medication errors can cause a variety of adverse drug events but are potentially preventable. This cross-sectional study analysed all medication prescriptions from 5 public and 5 private primary health care clinics in Riyadh city, collected by simple random sampling during 1 working day. Prescriptions for 2463 and 2836 drugs from public and private clinics respectively were examined for errors, which were analysed using Neville et al.'s classification of prescription errors. Prescribing errors were found on 990/5299 (18.7%) prescriptions. Both type B and type C errors (major and minor nuisance) were more often associated with prescriptions from public than private clinics. Type D errors (trivial) were significantly more likely to occur with private health sector prescriptions. Type A errors (potentially serious) were rare (8/5299 drugs; 0.15%) and the rate did not differ significantly between the 2 health sectors. The development of preventive strategies for avoiding prescription errors is crucial.

Determinants of physicians' medication prescribing behaviour in primary care in Riyadh City, Saudi Arabia.

This study in Saudi Arabia explored the determinants of physicians' prescribing behaviour in primary care in Riyadh city. A self-administered questionnaire designed to explore factors influencing prescribing (sociodemographic factors; practice setting; continuing education; access to educational materials; pharmaceutical company representatives; and patient factors) was completed by 87 PHC physicians. A factor analysis of 56 variables extracted 7 factors that explained 46% of the variance. Of these, 4 components positively related to perceived good prescribing behaviour could be summarized as: clinical experience of physicians; use of educational materials for continuous updating of medical knowledge; enhanced levels of continuing medical education and willingness to involve patients in decision-making; and working as a team using pharmacists for consultation and emphasizing the role of medical education. The other 3 factors derived from the analysis were less easy to interpret and may have been statistical anomalies (or measurement errors).

Predictors of quality of medication prescribing in primary care in Riyadh City, Saudi Arabia.

Identifying the indicators of good quality medication prescribing assists physicians in preventing medication errors. This study in Riyadh city aimed to examine the relationship between physicians' self-reported influences on prescribing and the quality of their prescribing, defined as the completeness and accuracy of their prescription documentation. A sample of 600 randomly selected prescriptions written by 87 physicians were rated as high or low quality. The same physicians completed a questionnaire to determine the indicators of quality prescribing. The 7 components identified with factor loadings +0.5 or -0.5 were subjected to binary logistic regression modelling. While a range of potential quality indicators of drug prescribing were identified, none of the variables underpinning the 7components/factors survived the binary logistic regression mode. More studies are needed that take into account other quality indicators of medication prescribing in Saudi Arabia.

Effectiveness of three interventions on primary care physicians' medication prescribing in Riyadh City, Saudi Arabia.

A number of strategies have been shown to improve the quality of drug prescriptions. The objective of this study was to implement and assess the effectiveness of 3 interventions on physicians' prescribing and cost containment: training physicians about quality prescribing; regulatory and administrative measures to improve rational drug prescribing; and a multi-faceted approach using 2 these strategies plus additional elements. Three public health centres, 1 for each intervention, were randomly selected; 61 physicians were trained in drug prescribing and completed a pre- and post-training questionnaire; and 100 post-intervention prescriptions from each centre were compared. All 3 interventions effectively improved the quality of drug prescriptions and the notation of drug-related information and trainees returned positive evaluations of the training course. Whether or not physicians' improvement in prescribing will be sustained is unclear and therefore subsequent follow-up evaluations are needed.

Schistosoma mansoni infection as a predictor of severe anaemia in schoolchildren in eastern Sudan.

A cross-sectional study was carried out to investigate the prevalence and risk factors for severe anaemia among schoolchildren in New Halfa, eastern Sudan. After taking age and gender, haemoglobin (Hb) levels were measured and all children were screened for malaria and intestinal parasitic infections, including schistosomiasis. Six hundred and forty (230 boys, 410 girls) schoolchildren aged 8-18 years were enrolled. The mean (SD) of the haemoglobin was 9.6 (1.7) mg/dl. One hundred and eleven (17.3%) and 33 (5.2%) children had Schistosoma mansoni infection and Hymenolepis nana infection, respectively. Five hundred and eighty (90.6%) of these children had anaemia (Hb < 12 g/dl), and 103 (16.0%) of them had severe anaemia (Hb < 8 g/dl). Girls (OR = 2.5, 95% CI = 1.1-5.3; P = 0.01) were at higher risk for severe anaemia in univariate and multivariate analyses. Schistosoma mansoni infections were associated with severe anaemia in univariate analyses only. Thus, there was a high prevalence of severe anaemia among these children. This needs to be investigated in more depth in the future, and more attention should be paid to the health of adolescent girls.

Stress and coping strategies among Arab medical students: towards a research agenda.

BACKGROUND: Research conducted in the past ten years in the area of stress and coping among Arab medical students has identified some important issues, but other significant aspects have not yet been explored. OBJECTIVES: To provide a systematic review of studies reporting on stress, anxiety and coping among Arab medical students and to identify implications for future research. METHODS: PubMed was searched to identify peer-reviewed English-language studies published between January 1998 and October 2009 reporting on stress and coping among undergraduate Arab medical students. Search strategy used combinations of the terms: Arab medical student, stress, PBL, psychological distress, depression, anxiety and coping strategies. Demographic information on respondents, instruments used, prevalence data and statistically significant associations were abstracted. RESULTS: The search identified 8 articles that met the specified inclusion criteria. Within the limited range of Arab medical students studied, studies suggest these students have a high prevalence of perceived stress, depression and anxiety, with levels of perceived psychological stress as high as those reported in the international literature for medical students of other regions of the world. Limited data were available regarding coping strategies, the impact of stress on academic performance and attrition among Arab students. No data were available regarding the impact of problem-based learning on stress and coping. CONCLUSIONS: The existing literature confirms that stress, depression and anxiety are common among Arab medical students, as for students elsewhere. Little is known about the contribution of different curricula approaches to perceived stress and what coping strategies institutions and students apply to help alleviate stress. Large, prospective, multicentre, multi-method studies are needed to identify personal and curricula features that influence stress, depression, anxiety and coping strategies among Arab students.

Determinants of effective clinical learning: a student and teacher perspective in Saudi Arabia.

CONTEXT: Graduating clinically competent medical students is probably the principal objective of all medical curricula. Training for clinical competence is rather a complex process and to be effective requires involving all stakeholders, including students, in the processes of planning and implanting the curriculum. This study explores the perceptions of students of the College of Medicine at King Abdul-Aziz Bin Saud University for Health Sciences (KASU-HS), Riyadh, Saudi Arabia of the features of effective clinical rotations by inviting them to answer the question: "Which experiences or activities in your opinion have contributed to the development of your clinical competence? This college was established in 2004 and adopted a problem-based learning curriculum. METHODS: This question was posed to 24 medical students divided into three focus groups. A fourth focus group interview was conducted with five teachers. Transcriptions of the tape-recorded focus group interviews were qualitatively analyzed using a framework analysis approach. FINDINGS: Students identified five main themes of factors perceived to affect their clinical learning: (1) the provision of authentic clinical learning experiences, (2) good organization of the clinical sessions, (3) issues related to clinical cases, (4) good supervision and (5) students' own learning skills. These themes were further subdivided into 18 sub-themes. Teachers identified three principal themes: (1) organizational issues, (2) appropriate supervision and (3) providing authentic experiences. CONCLUSION: Consideration of these themes in the process of planning and development of medical curricula could contribute to medical students' effective clinical learning and skills competency.

Criteria for a good referral system for psychiatric patients: the view from Saudi Arabia.

The development and implementation of quality referral systems reflects sound national health planning. This review appraised the data on referral systems, in particular psychiatric referrals, with special reference to Saudi Arabia. A computer search was made of relevant literature in the past 2 decades. The rate and process of referring patients through referral letters varies globally across practice settings and is initiated by an array of factors linked with health consumers, health providers and delivery systems. Referral systems, including consultation-liaison services, are an essential component of any health care organization for offering a complete range of good quality, specialized health services.

Interaction and structure induction of cell-penetrating peptides in the presence of phospholipid vesicles.

Certain short peptides, which are able to translocate across cell membranes with a low lytic activity, can be useful as carriers (vectors) for hydrophilic molecules. We have studied three such cell penetrating peptides: pAntp ('penetratin'), pIsl and transportan. pAntp and pIsl originate from the third helix of homeodomain proteins (Antennapedia and Isl-1, respectively). Transportan is a synthetic chimera (galanin and mastoparan). The peptides in the presence of various phospholipid vesicles (neutral and charged) and SDS micelles have been characterized by spectroscopic methods (fluorescence, EPR and CD). The dynamics of pAntp were monitored using an N-terminal spin label. In aqueous solution, the CD spectra of the three peptides show secondary structures dominated by random coil. With phospholipid vesicles, neutral as well as negatively charged, transportan gives up to 60% alpha-helix. pAntp and pIsl bind significantly only to negatively charged vesicles with an induction of around 60% beta-sheet-like secondary structure. With all three peptides, SDS micelles stabilize a high degree of alpha-helical structure. We conclude that the exact nature of any secondary structure induced by the membrane model systems is not directly correlated with the common transport property of these translocating peptides.

Synthesis of silver nanoparticles for the dual delivery of doxorubicin and alendronate to cancer cells.

We present the synthesis of a silver nanoparticle (AgNP) based drug-delivery system that achieves the simultaneous intracellular delivery of doxorubicin (Dox) and alendronate (Ald) and improves the anticancer therapeutic indices of both drugs. Water, under microwave irradiation, was used as the sole reducing agent in the size-controlled, bisphosphonate-mediated synthesis of stabilized AgNPs. AgNPs were coated with the bisphosphonate Ald, which templated nanoparticle formation and served as a site for drug attachment. The unreacted primary ammonium group of Ald remained free and was subsequently functionalized with either Rhodamine B (RhB), through amide formation, or Dox, through imine formation. The RhB-conjugated NPs (RhB-Ald@AgNPs) were studied in HeLa cell culture. Experiments involving the selective inhibition of cell membrane receptors were monitored by confocal fluorescence microscopy and established that macropinocytosis and clathrin-mediated endocytosis were the main mechanisms of cellular uptake. The imine linker of the Dox-modified nanoparticles (Dox-Ald@AgNPs) was exploited for acid-mediated intracellular release of Dox. We found that Dox-Ald@AgNPs had significantly greater anti-cancer activity in vitro than either Ald or Dox alone. Ald@AgNPs can accommodate the attachment of other drugs as well as targeting agents and therefore constitute a general platform for drug delivery.

Hyaluronate levels and markers of oxidative stress in the serum of Sudanese subjects at risk of infection with Schistosoma mansoni.

We showed previously that infection by Schistosoma mansoni not only triggers the production of reactive oxygen species in mouse liver but also leads to the alteration of antioxidant defences. To determine whether such events occur in humans, we measured the serum markers of oxidative stress, i.e., lipid peroxides and protein carbonyl, as well as hyaluronate levels in subjects in the Managil area of the Sudan. Grades of fibrosis were determined by ultrasonographic examination. Two groups were used as controls, one Sudanese and the other European. We found that Sudanese subjects in the endemic area differed from the control groups, both Sudanese and European, insofar as they had higher levels of the serum metabolites measured. The latter increased with the grade of fibrosis. Moreover, protein carbonyl and hyaluronic acid levels correlated positively with lipid peroxide levels. These findings indicate that oxidative stress might contribute to S. mansoni-associated pathology in man. The serum markers considered in our study, obtained by relatively simple techniques, may provide a useful biochemical index for the identification of almost asymptomatic patients who, however, are at risk of developing severe schistosomiasis.

A taxonomy of community-based medical education.

The authors propose a classification of community-based education (CBE) as it is implemented all over the world. To create this taxonomy, they used reports in the literature of 31 active programs in many locations. A CBE program is an instructional program carried out in a community context, outside the academic hospital. The authors distinguish between programs that are developed primarily to provide services to an underserved community; programs that have a research focus; and programs that have as their primary goal the (clinical) training of students. These three major types can be subdivided in six minor types, among them community development programs, health intervention programs, and simple community-exposure programs. The ultimate goal of creating the taxonomy is to contribute to the development of a theory of CBE and provide a more systematic way to study CBE. In addition, the proposed taxonomy clearly demonstrates the various ways in which medical schools, their staffs, and their students can become involved with the communities served. CBE is not a unitary concept but a set of attempts to contribute to the quality of life in a particular community and, at the same time, create conditions for students to acquire hands-on understanding of the nature of the problems to be faced in future professional practice, and to develop relevant skills. The taxonomy also enables those involved in the development of CBE programs in their medical schools to see alternative approaches, which will help them choose the approaches that fit their particular educational goals. Last, it demonstrates the intricacies involved in the implementation of CBE, in particular the complexity of building a learning environment that is productive for students and, at the same time, responsive to community needs.