Exploring Perceptions and Practices of Interprofessional Shared Decision-Making Education in Palliative Care Settings

Background

Palliative care teams provide support to patients and their caregivers during terminal illness, which requires interprofessional collaboration. One of the foundational skills is to assist patients with decision-making. This can be facilitated through interprofessional shared decision-making (IP-SDM). So far, IP-SDM education frameworks have only been used to a limited extent in the area of palliative care.

Aim

This study aims to explore perceptions and practices of faculty members, health professionals, and students toward IP-SDM education in palliative care and to indicate associated factors to implement an IP-SDM in undergraduate health professions education in palliative care settings.

Methods

We used a cross-sectional study design in which the data was obtained via an online self-administered questionnaire adapted from existing validated tools. The questionnaire was distributed to faculty members and health professionals (n = 125) and students (n = 334) at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The sampling technique was a non-probability convenience sampling. Bivariate statistics, such as independent sample t-tests, one-way ANOVA, correlation coefficient, and linear multiple regression were conducted.

Findings

The response rate was 54% (85 faculty members and health professionals and 164 students). Perceptions on IP-SDM did not differ between participants. From those who had previous experience with IP-SDM, the mean practices score was slightly higher for faculty members and health professionals (M = 83.1, SD = 15.9) than for students (M = 74.1, SD = 11.5), which was significant (p < 0.05). Factors such as gender, age, discipline, nationality, level of education, years of study, and previous experience that were associated with perceptions and practices were varied among participants.

Conclusion

The findings show high levels of perception with low levels of practice of IP-SDM in palliative care. Other factors that could be associated with the topic should be addressed in further studies.

The Analysis of Job Satisfaction of Health Practitioners in Saudi Arabia: Determinants and Strategic Recommendations for Health Workforce Planning

BACKGROUND

Job satisfaction plays an important foundation in the health system to deliver high-quality care services to patients. Job satisfaction describes the inside feeling of workers about their jobs whether they like it or not. Job satisfaction of health practitioners is considered an essential factor that affects their efficiency, well-being, and mental health.

AIM

This research study is part of an integrated research aiming to understand the determinants of a revised Workforce Planning Strategy in Saudi Arabia, in close relevance to the demand and supply side in Saudi Arabia.

RESULTS

This study showed that males were significantly more satisfied than females in relation to specialty, organization, and overall global score. There is also evidence for a significant association between age groups and job satisfaction. Older health practitioners had a higher level of satisfaction than younger ones. Regarding nationality, we found that Saudi health practitioners were less satisfied in all aspects, while non-Saudi (Arab) healthcare practitioners were the most satisfied in all aspects except city happiness.

CONCLUSION

Our study found statistically significant differences that medicine and surgery practitioners are the most satisfied professionals and the least satisfied are dentist practitioners. Health practitioners with more than five years of experience were significantly the most satisfied.

Employment Rate of Newly Certified Healthcare Specialists in Saudi Arabia: A Survey-Based Study

Background This study aimed to assess and compare the employment rates of medical and dental specialists across different regions of Saudi Arabia from 2011 to 2019. Methodology With the aid of the Saudi Commission for Health Specialties, the national survey was sent via email to 12,000 healthcare postgraduates who obtained their board certificate within the period 2011-2019. It contained several questions regarding demographics, specialty, employment, satisfaction, and, finally, challenges and obstacles they faced during their job-seeking experience. Results Of the 723 respondents, almost 655 (90.7%) were employed. The employment rate of medical specialists (n = 605, 90.7%) was higher than dental specialists (n = 50, 89.3%). Nevertheless, 96% (n = 48) of dental employees were working at a specialty of their specified qualification, while only 93.7% (n = 562) of medical employees did. Regarding the month of their employment, the month of October (15.25%) had the highest employment rate for medical specialists; however, for a dental specialist, August (18%) had the highest employment rate. However, 64.5% of the respondents admitted that they faced challenges during their job-seeking experience, with few available positions being the most common obstacle for both medical and dental specialists. Conclusions Our survey confirms that medical and dental specialists in Saudi Arabia are facing delays in entering the workforce, which vary by region and specialty. It also sheds light on the reasons for these gaps, with limited job opportunities being a major issue for both groups. For career advancement, it is essential to identify these obstacles and develop a strategy to overcome them, such as involving the private sector.

Attitudes and Perceptions of Health Leaders for the Quality Enhancement of Workforce in Saudi Arabia

BACKGROUND AND AIM

Besides the unique exposure and experience of health leaders in facing challenges and overcoming them, and the relatively fewer articles relating to the perception of health leaders in workforce quality enhancement, health leadership plays a crucial role in redirecting the workforce, increasing job satisfaction, professional development, and burnout prevention. Thus, this study aimed to understand the current healthcare workforce quality and future expectations from the attitudes and perceptions of health leaders.

METHODS

A qualitative research was carried out using semi-structured interviews consisting of 24 different questions. Participants of the study were healthcare leaders from different backgrounds and governmental institutions. All interviews were recorded, transcribed, and then analyzed using thematic analysis via the N-Vivo program.

RESULTS

Eleven participants were involved in the study, with one female and ten males. A thematic analysis and N-Vivo program yielded 5 main themes: (1) workforce competency, (2) health transformation, (3) leadership, (4) workforce planning, and (5) healthcare quality, with 22 emerging sub-themes. Moreover, participants responded with different attitudes and perceptions.

CONCLUSION

Health leaders are satisfied with the current direction of workforce competency and planning, yet fragmentation of the system and poor accessibility may need further enhancement. Furthermore, misutilization of services and the uncertainty of the future and talent pool are potential barriers for capability building. Moreover, with the existing gap in the workforce, health leaders believe that privatization and corporatization may have a positive effect. Aside from that, Saudization with the current plan of having a minimum standard of accepting non-Saudis in certain areas might benefit in maintaining competition and enriching experience. However, catching up with further research in healthcare quality in Saudi Arabia is needed because of the ongoing health transformation.

Detection of renal anomalies using antenatal and postnatal ultrasound: The consanguinity factor

INTRODUCTION

Antenatal ultrasound (US) is considered the gold standard tool to detect fetal anomalies during the antenatal period. However, its highly operator dependent and maybe affected with other variables. The aim of this study to compare discrepancy between antenatal and postnatal US diagnosis of congenital anomalies of the kidney and urinary tract (CAKUT) and to evaluate the incidence of parent's consanguinity among those patients at King Abdulaziz Medical City - Western Region (KAMC-WR), as it may help changing the current practiced guidelines and applied protocols.

METHODS

This is an observational, retrospective, cross-sectional study, conducted at the Maternal Fetal Medicine Unit at KAMC-WR, reviewing antenatally detected CAKUT between the years 2009 and 2014. Utilizing the congenital anomalies database and using multiple databases collected the data. A data sheet was completed and divided into four sections, which consist of maternal data, antenatal data, delivery, and postnatal data. The analysis was performed using Statistical Package for Social Sciences program (Armonk, NY: IBM Corp).

RESULTS

We included 137 fetuses with renal anomalies in our study, with 17% perinatal mortality rate, and 13% loss of follow-up. Abnormal amniotic fluid was detected in 32%, and bilateral anomalies presented in 41% and it was most commonly seen in male fetuses. Added to that, 41% of the fetuses were product of consanguineous marriage and 11% had a history of other child with renal anomalies. However, the rate of discrepancy between antenatal and postnatal renal US findings was 24%. Finally, the most common anomaly found antenatally and confirmed postnatally was hydronephrosis disease spectrum (60.6%).

CONCLUSION

There is a significant association between children with CAKUT and parents' consanguinity. Furthermore, the discrepancy rate for the detection of CAKUT between antenatal and postnatal US in our study was comparable to other international studies. Further prospective studies are recommended in this field for further understanding.

Faculty Members’ Perspective on Virtual Interviews for Medical Residency Matching during the COVID-19 Crisis: A National Survey

During the COVID-19 pandemic, conducting face-to-face medical residency interviews was challenging due to infection prevention precautions, social distancing, and travel restrictions. Virtual interviews were implemented by the Saudi Commission for Health Specialties (SCFHS) as an alternative process for residency matching while striving to maintain the same quality standards. This national survey was conducted to assess the satisfaction and perceptions of faculty members’ virtual interview performance in the assessment for the medical training residency programs. Among the participating 173 faculty members, 34.1% did not have previous experience with video-conferencing. The Zoom application was the most commonly used platform (65.9%). Most (89.6%) of the faculty perceived virtual interviews as “adequate” platforms on which the candidates could express themselves, while almost half of the faculty (53.8%) agreed that virtual interviews allowed them to accurately reach an impression about the candidates. Overall, 73.4% of faculty felt comfortable ranking the virtually interviewed candidates. We conclude that the acceptance of participating faculty members in the first Saudi medical residency training matching cycle virtual interviewing event was well-perceived. This study provides evidence for future application and research of virtual interviews in residency candidates’ assessment, especially after the pandemic crisis resolves.

Remote interviews for medical residency selection during the initial COVID-19 crisis: a national survey

BACKGROUND

Medical training programs candidate's interview is an integral part of the residency matching process. During the coronavirus disease 2019 (COVID-19) pandemic, conducting these interviews was challenging due to infection prevention restrains (social distancing, namely) and travel restrictions. E-interviews were implemented by the Saudi Commission for Healthcare Specialties (SCFHS) since the matching cycle of March 2020 to hold the interviews in a safer virtual environment while maintaining the same matching quality and standards.

AIM

This study was conducted to assess the medical training residency program applicants' satisfaction, stress, and other perspectives for the (SCFHS) March 2020 Matching-cycle conducted through an urgently implemented E-interviews process.

METHOD

A cross-sectional, nationwide survey (Additional file 1) was sent to 4153 residency-nominated applicants to the (SCFHS) March 2020 cycle.

RESULTS

Among the 510 candidates who responded, 62.2% applied for medical specialties, 20.2% applied for surgical specialties, and 17.6% applied for critical care and emergency specialties. Most respondents (61.2%) never had previous experience with web-based video conferences. Most respondents (80.2%) used the Zoom application to conduct the current E-interviews, whereas only 15.9% used the FaceTime application. 63.3% of the respondents preferred E-interviews over in-person interviews, and 60.6% rated their experience as very good or excellent. 75.7% of the respondents agreed that all their residency program queries were adequately addressed during the E-interviews. At the same time, 52.2% of them agreed that E-interviews allowed them to represent themselves accurately. 28.2% felt no stress at all with their E-interviews experience, while 41.2% felt little stressed and only 8.2% felt highly stressed. The factors that were independently and inversely associated with applicants' level of stress with E-interviews experience were their ability to represent themselves during the interviews (p = 0.001), cost-savings (p < 0.001), their overall rating of the E-interviews quality (p = 0.007) and the speed of the internet connection (p < 0.006).

CONCLUSION

Videoconferencing was implemented on an urgent basis during the COVID-19 pandemic in the medical residency application process in Saudi Arabia. It was perceived as an adequate and promising tool to replace in-person interviews in the future. Applicants' satisfaction was mainly driven by good organization, cost-saving, and their ability to present themselves. Future studies to enhance this experience are warranted.

Effectiveness and Preparedness of Institutions' E-Learning Methods During the COVID-19 Pandemic for Residents' Medical Training in Saudi Arabia: A Pilot Study

Background: Under the urgent circumstances of the COVID-19 pandemic, higher education institutions of an international scale have resorted to online education methods, exclusive or not. Among those, medical institutions are under double pressure, fighting the pandemic's effects and, at the same time providing efficient clinical training to their residents. The main aim of the study is to evaluate the preparedness of the educational institutions for the e-learning platform transition for the delivery of medical training and also to evaluate the overall satisfaction level of the participants with their e-learning experience. Methods: This is an observational cross-sectional study design. The survey's sample included 300 medical students and residents of multiple training levels and specialties, coming from more than 15 different cities of Saudi Arabia. Filling the questionnaire required specific inclusion criteria and all obtained data were secured by the Saudi Commission of Health specialty. The main objective was to evaluate the quality of e-learning methods provided by medical universities. For the collection of the data, Survey Monkey software was used and the analysis was conducted with SPSS. Results: The study found that the frequency of digital education use increased by ~61% during the coronavirus crisis, while almost 9 out of 10 residents have used some e-learning platform. It was reported that before the pandemic, participants' online training was deemed to be rather ineffective, given the rate of 3.65 out of 10. However, despite the increase in e-learning use after COVID-19, many obstacles arose duringcthe adaptation process. According to our survey: lectures and training sessions were not conducted as per the curriculum (56.33%); both students and instructors' academic behavior and attitude changed (48.33%); engagement, satisfaction, and motivation in class were rated low (5.93, 6.33, and 6.54 out of 10 accordingly), compared to the desired ones. Still, participants accredited e-learning as a potential mandatory tool (77.67%) and pinpointed the qualifications that in their opinion will maximize educational impact. Conclusion: The study concluded that innovative restructuring of online education should be based on defined critical success factors (technical support, content enhancement, pedagogy etc.) and if possible, set priority levels, so that a more permanent e-learning practice is achievable. Also our study confirmed that students were overall satisfied with the e-learning support of the training method.

Knowledge, Attitude, and Willingness Toward Kidney Donation Among Health Sciences Students at King Saud Bin Abdulaziz University

Background: End-stage renal disease, as one of the most serious and major health problems, does not have many treatment options available. One of the best treatment modalities used to cure this debilitating disease is kidney transplantation. However, with the continuous increase in number of patients diagnosed with it, there is not enough supply of the organ. The aim of our study is to assess knowledge about, attitude toward, and willingness to donate kidney among health science students at King Saud bin Abdulaziz University in comparison to the general population in Jeddah and to investigate the factors that play a role on their willingness.

Methods: This is an observational, analytical, cross-sectional study design conducted in 2019. Two target populations were included: King Saud bin Abdulaziz University for Health Sciences students and the general population in Jeddah. Data were collected via a self-administered, close-ended, structured, and previously validated questionnaire that contained 39 items divided into four sections. SPSS program version 22 was used in data analysis.

Results: Out of 685 surveyed participants, 179 (26.1%) were willing to donate their kidney, with students showing a higher rate of willingness (N = 101; 32.3%) than the general population (N = 78; 21%). However, only 46 (6.7%) out of the total population hold an organ donor card. In bivariate analysis, it was found that knowledge significantly associated with a higher rate of willingness among the student population than the general population, while positive beliefs were associated with increased willingness in the general population than students. Positive attitude appeared to play a role in higher willingness among the general population and student population.

Conclusion: There is a low perception of awareness regarding kidney donation in both populations of this study. The willingness rate of health science students at King Saud bin Abdulaziz University and the general population was low when compared with other studies conducted internationally.

Challenges and Obstacles Faced by Trainee Female Physicians: An Integrative Research on Gender Discrimination, Stress, Depression and Harassment

This study's purpose is to assess the challenges and obstacles faced by female trainee physicians and suggest solutions that could resolve these issues and improve their performance. The study utilized an observational, analytical, cross-sectional design based on a self-administered open-ended and validated questionnaire which was distributed to 133 recruited female resident trainees of medical units in Jeddah, Saudi Arabia. The findings of the study revealed that 52% female trainees experienced gender discrimination, mostly (65%) by their superiors, while 40% were regularly harassed. About half (53%) of the interviewees were severely depressed, resulting in their reconsidering their career in medicine. A total of 14% thought of suicide, while four planned to end and five had attempted to end their life. However, only eight (6%) participants officially reported the cases of harassment to the accountable superiors. Half of them felt neglected by the healthcare administration, and one-fourth (24%) were underachieving in their studies and work. The study concluded that work dissatisfaction, limited clinical correspondence, high depression, burnout, stress and drop-out rates-all deriving from common gender discrimination-compose the alarming and complex challenges that female trainee residents in Jeddah of various levels and specialties have to face.

Improving access to care for children with cancer through implementation of an electronic referral system (IMPACT): A single-center experience from Saudi Arabia

BACKGROUND

Delayed access to cancer care has been associated with childhood cancer death. Improving timely access to cancer care is the first important step in the cancer treatment journey. We introduced an electronic referral system (e-RS) to improve timely access to cancer care. This study aimed to assess the impact of implementing an e-RS on timely access to cancer care.

METHODS

A retrospective cross-sectional study of pediatric oncology patients selected through a consecutive nonprobability sampling technique was performed to determine the turnaround time (TAT) of children with cancer diagnosed 12 months before and after implementation of the e-RS. TAT was defined as time in hours from referral to approval for admission.

RESULTS

Of the 326 pediatric oncology patients diagnosed between January 2014 and December 2015, 59.9% were male and 40.1% were female. Median age for both sexes was 5.0 years (interquartile range [IQR]: 2.5-9.0 years). Among these, 98.2% were Saudi nationals. Hematological malignancies accounted for 50.6% of referrals and 16.6% had lymphoma. The median TAT of the manual referral system (m-RS) and e-RS was 18 h (IQR: 2-25 h) and 2 h (IQR: 1-16 h; P = .0001), median length of hospital stay during first admission was 11 days versus 9 days (P = .14), and death events occurred in 11 patients versus zero patients referred using the m-RS versus e-RS (P = .003), respectively.

CONCLUSION

The introduction of an e-RS was associated with more rapid processing of pediatric patients for cancer treatment and fewer patient deaths during the initial evaluation and treatment during that time period.

An Experimental Study On Usefulness Of Virtual Reality 360° In Undergraduate Medical Education

PURPOSE

Various smartphone-based virtual reality (VR) applications allow the users to view 360° videos of real or simulated places. A 360° VR is captured with a special camera that simultaneously records all 360° of a scene unlike the standard video recording. An experimental study was conducted where 4th-year medical students participated in a workshop.

PATIENTS AND METHODS

The study was conducted at College of Medicine (COM-J), King Saud bin Abdul-Aziz University for Health Sciences (KSAU-HS) in Jeddah, Saudi Arabia. 360° VR videos including, pre-briefing and debriefing sessions were held for the experimental group, whereas group two (control group) was provided with the interactive lecture. A total of 169 undergraduate medical students attend the 4th year at the College of Medicine (KSAU-HS) Jeddah.

RESULTS

The response rate was 88% for 169 participants, 57 (VR) and 112 (conventional method). The majority of students (93%) thought that VR can be used in medical education. Post-MCQs score (out of 20) was significantly higher in the VR group, when compared to the conventional group (17.4+2.1 vs 15.9+2.9, p-value <0.001). The OSCE score was also better with the VR group (12.9+4.1 vs 9.8+4.2, p-value <0.001). Overall rating of VR satisfaction experience showed a mean of 7.26 of 10.

CONCLUSION

VR provides a rich, interactive, and engaging educational context that supports experiential learning-by-doing. In fact, it raises interest and motivation for student and effectively supports knowledge retention and skills acquisition.

Patients' attitudes towards the participation of medical students in clinical examination and care in Western Saudi Arabia

Background and Objectives:

Patients are essential for the acquisition and development of medical students clinical skills for their tasks. The study aimed to identify factors that influence patients’ attitudes towards the involvement of medical students in clinical examination and care in Western Saudi Arabia.

Methods:

A cross-sectional study using self-administered questionnaire was conducted among Saudi and non-Saudi patients at two university hospitals in Jeddah, Western Saudi Arabia. Information sought included demographic characteristics (age, gender, educational level, job, income, and marital status); patients’ attitude and comfort level towards different types of students’ involvement; factors influencing patients’ cooperation with medical students (students’ level of training, manner, skills, and attire. All these were assessed on a five-point Likert scale. Data was entered and analyzed using SPSS v 19.

Results:

Four hundred and seventeen adult patients participated. Fifty-one percent indicated a positive attitude towards involving medical students in clinical examination and care. Female and young patients (<45 years old) were more likely to be negative in their attitude and be less comfortable towards involving medical students in their care. The highest overall mean comfort score was with medical students taking history followed by observations and less invasive examination. Patients’ mean confidence scores regarding students’ attire were the highest for female traditional attire and for scrub suit for males.

Conclusion:

Of the influential factors that could affect patients’ willingness to cooperate with medical students, clinical skills followed by manner and level of training ranked first. Ensuring that students mastered specific procedures before coming into direct contact with patients using patient simulators, for example, would improve patients’ acceptance of student participation.

Emphysematous pyelonephritis: Is nephrectomy warranted?

INTRODUCTION

Emphysematous pyelonephritis (EPN) is associated with high mortality rate, up to 25%. There is still conflicting reports regarding the most appropriate management, conservative versus nephrectomy.

OBJECTIVE

To describe the outcome of patients with EPN.

METHODS

We retrospectively reviewed the medical records of patients diagnosed with EPN by computed tomography from three tertiary institutes in Jeddah, Saudi Arabia. Type of management was classified as conservative and surgical. The conservative includes medical and minimally invasive procedures, such as percutaneous drainage and nephrostomy. The surgical which is nephrectomy. The outcome observed was preservation of the kidney function or patient's life.

RESULTS

A total of 10 patients were included (9 females and 1 male), median age was 55 years and 63% were diabetic. The most common presentation was flank pain (100%), fever (75%), and vomiting (63%). The most common organism isolated was Escherichia coli. Nephrectomy was not associated with increased survival rate, while conservative management was associated with a good outcome, less morbidity (not dialysis-dependent).

CONCLUSION

Nephrectomy was not associated with high survival rate. Patients managed conservatively had a better overall performance and better survival. This study will add to other studies, which are encouraging conservative management.