evolving educational environment in a medical school undergoing curricular change in the United Arab Emirates

College of Medicine, Gulf Medical University, United Arab Emirates, underwent a curricular change from a discipline-based to an organ system-based integrated curriculum. The long term effect of this change on the educational environment was unknown. Hence we aimed to compare perceptions of three consecutive batches of second year students about their educational environment [EE] in the new curriculum. The Dundee Ready Education Environment Measure [DREEM] questionnaire was distributed to a total of 140 second year students of Batches 2008, 2009 and 2010 at the beginning of their academic year. Collected data was transferred to SPSS 21 version and the total, domain and individual statement scores were assessed with Kruskal-Wallis and Wilcoxon rank sum tests. The mean DREEM score for all the three batches was 123/200 with significantly higher scores [p < 0.001] for Batch 2008 [135/200] than for Batch 2009[116/200] or Batch 2010 [120/200]. Significantly higher scores in all domains [excepting the domain Students' academic self-perceptions] and certain individual statement scores were also observed for Batch 2008 compared to the other two batches. There was hardly any difference in all the scores between the genders. The curricular overload, the authoritarian leaning of the teachers, a lack of a support system for students who experienced stress, and diminishing interest levels of the students, which had been rated low by Batches 2009 and 2010, emerged as areas that warranted remedial development. Some improvements detected in 2010 were the assessment strategies, the student-centered teaching and the students' social interactions. The mean DREEM score for all the three batches [123/200] signified a positive EE over the previous three years. There was no difference between the genders in their perceptions of the EE over the three years. Individual item analyses identified the areas of strengths and remedial interventions for the institution

Prescribing patterns in the orthopedics outpatient department in GMC hospital, Ajman, United Arab Emirates

Information on the utilization patterns of drugs in the Orthopedics outpatient department [OPD] were lacking in Gulf Medical College Hospital [GMCH]. Hence, we aimed to investigate the prescribing patterns in the Orthopedics outpatient department [OPD] of GMCH. The study was a hospital based observational [record based] study carried out over one year period. The prescriptions of all new patients visiting the Orthopedic OPD of GMCH hospital were critically analyzed using a predetermined criterion. Prescriptions of 623 patients were randomly selected for analysis. The majority patients were South -East Asians or Arab males, aged between 26-35 years and had insurance coverage. The median number of drugs per prescription was 3 [range 5]. Low backache was the most common reason for attending the OPD. Non-steroidal anti-inflammatory drugs [NSAIDs] and muscle relaxants were the most commonly prescribed drug group. Fixed dose combinations accounted for around 17% of the prescriptions. All the drugs were prescribed by their brand names Absence of department name on the prescriptions were also observed. The prescribing pattern in the orthopedic outpatient department in GMC Hospital was generally rational. The most commonly prescribed drugs included were Nonsteroidal anti-inflammatory drugs and fixed dose combinations were observed in many of the prescription

Development of the AMEET questionnaire, an instrument measuring faculty members' perceptions of their educational environment

The educational environment experienced by teachers involves all conditions affecting teaching and learning activities. Faculty perceptions of their educational environment are important not only for themselves but also for students. As no instrument exists to assess viewpoints of faculty, we aimed to develop and validate the Assessment of Medical Education Environment by Teachers [AMEET] questionnaire. A modified Delphi technique was used to generate items for the inventory. A small group of experts [a medical education expert and four teaching faculty] assisted in defining a preliminary list of items through literature review and group discussions. Sixteen international consenting panel members graded [0 - not necessary, 1- desirable, 2- important, 3- absolutely essential] and modified the initial statements or suggested new statements [Round 1], In Round 2, the panel graded the new statements and reconsidered their previous responses. Subsequently, statements with median scores < /= 1 were excluded. Responses for new statements were reconsidered and final inclusion of each statement was indicated through agreement in Round 3. A pilot test enabled evaluation of validity and reliability of the instrument. Fifty statements were generated initially for the preliminary inventory. The panel members modified and graded the fifty statements and suggested five new statements via Round 1. The new statements were graded; responses to previous fifty statements were reconsidered and three statements with median scores < 1 were removed following Round 2. Agreement was finally sought for inclusion of 52 statements and two statements were subsequently deleted as panel agreement was < 75% for each of them. The 50-item questionnaire was refined to its final version with six domains and piloted with 62 faculties. A Cronbach's Alpha of 0.94 was obtained. The AMEET questionnaire is a valid, highly reliable and practically useful instrument to assess faculty members' perceptions of educational environment

Utilization of complementary and alternative medicine by parents for their children: a cross sectional study in Ajman, UAE

The study aimed to determine the utilization pattern of Complementary and Alternative Medicine [CAM] by parents for their children in Ajman, UAE. This cross sectional study was carried out among parents attending Parent-Teachers meeting at schools in Ajman, UAE. Self-administered questionnaires were distributed among the parents after obtaining consent. The questionnaire included demographic characteristics of parent [Age, gender, educational qualification, nationality] and child [age, gender] and details of utilization pattern [type of CAM, route of therapy, indication]. Descriptive and inferential statistics performed using SPSS-20; p value < 0.05 considered significant. Total of 136 parents participated [Fathers 32.6%; Mothers 67.6%]. Their age ranged between 20-55 years. Asians constituted 30.4% and Arab ethnicity 53.6% of total. About 57.2% of the parents were graduates. About 31.2% parents had one child, 30.4%- two children and 38.4% had three or more children. CAM use among their children was reported by 73[53.6%] parents. It was noted that parent who used CAM for the first child 73[53.6%], also reported to use CAM in their subsequent children [2nd, 311 child-7 1[52.2%] each]. Indications for use were gastrointestinal disorders, respiratory disorders, fever, and dermatological conditions. CAM therapies used in descending frequency were herbal medicine, dietary supplements, prayer, homeopathy and massage therapy. Based on ethnic groups, utilization frequency was similar among Asians, Arabs and other groups [50%, 53%, and 59% respectively]. Similarly, utilization frequency was similar among parents with school education, graduation and post- graduation [50%, 54.4%, and 53.8% respectively]. CAM was recommended by family members in 48% of the responders. About 47% parents reported good 30% excellent results with CAM in their children. In accordance to previous reports from the Middle East, herbal medicine was the common CAM therapies in the study. Utilization of CAM by parents for their children was similar in different ethnic groups and parents with different levels of education

Parents' opinion about the use of complementary and alternative medicine for their children: a cross sectional study in Ajman, UAE

The use of Complementary and Alternative Medicine [CAM] has increased over recent years. Little is known about the parent opinion regarding the use of CAM for children. This study aimed to identify the parent opinion about the use of CAM for their children and the most important source of information on CAM. A cross sectional study was carried out over a period of 12 months, including parents attending Parent-Teachers meeting in the schools in Ajman, UAE. A self- administered validated, pilot tested questionnaire was used as a tool. Informed consent was taken from participants before enrolment in the study. Analysis was performed using the SPSS-20. Descriptive statistics and inferential statistics performed [Z test] and p values < 0.05 was considered significant. The study includs 136 parents who are most frequently females [67%], less than 40 years age [54%], Non-Arabs [65%], holding Diploma/ Bachelor or higher degree [76%], and having 2 children [61%]. Although about 79% of the parents reported that it is safe/very safe to use CAM for children [89% of CAM user vs. 28.5% of CAM non-user, z=5.1, P < 0.001], however, about 46% of them are not using CAM, and the most common reason stated was that the modern medicine is more effective [42%]. Family is the most frequent source of information for CAM [57%]. The use of CAM for other children is recommended either alone by 49% [n=66] or to be used in combination with other conventional medicine by25% [n=34] of the parents. Most of the parents reported that the use of CAM for children is safe/ very safe. However, the opinion differed significantly among the parents who used CAM for their children as compared to those who did not

Faculty perceptions of the educational environment at the college of medicine, Gulf Medical University

College of Medicine, Gulf Medical University [C0M] underwent a curricular change from a discipline-based to an organ system-based integrated curriculum. As information about the viewpoints of faculty regarding this change was not available, we aimed to ascertain the faculty members' perceptions of the educational environment at CoM and investigate any differences in perceptions based on socio-demographic characteristics. Following a pilot test, the self-administered Assessment of Medical Education Environment by Teachers [AMEET] questionnaire was answered by teaching faculty of MBBS 2012-2013. The total, domain and individual statement scores were expressed as Median [range]. Scores were compared among groups using Wilcoxon Rank sum test. The median total score of the sample was 136 [range: 108] out of a possible maximum of 200. The highest median domain scores were for Teachers' Perceptions of Teaching and Teachers' Professional Self-Perceptions, whereas the lowest domain scores were for Teachers' Perceptions of Students. The individual item analyses identified the teaching- learning activities, learning atmosphere, collaborative atmosphere and professional self-perceptions as strengths of our college while the preparedness of students, levels of student stress, learning atmosphere in the hospital and support system for stressed faculty were areas necessitating improvement. The median total, domain and individual item scores of the non-clinical faculty were found to be significantly higher than those of the clinical faculty. The female faculty also gave significantly higher scores to the domain Teachers' Perceptions of Teaching [p < 0.05]. There were no significant differences in the median total and domain scores based on teaching experience and faculty positions. The educational environment in the organ system-based integrated curriculum was generally perceived positively by the faculty although a few areas of concern were highlighted. The results of our study give important feedback to curriculum planners and administrative leaders for necessary remedial actions

Nasobronchial allergies among university students in Ajman, United Arab Emirates

The prevalence of wheezing and allergies among the population in Arab countries are on a rise due to urbanization that resulted in substantial environmental changes. The prevalence of respiratory symptoms is about 14% among school children but data on adolescent groups in the Gulf region are lacking. Hence, this study aimed to assess the prevalence of wheezing and bronchial asthma among undergraduate students of Gulf Medical University. A cross-sectional study was conducted among undergraduate students of Gulf Medical University using a self-administered questionnaire for data collection. The demographic data, the wheezing and bronchial asthma characteristics and family history were collected and analyzed using SPSS version 19. Of the total of 255 students that were included, 120 [47%] had allergic rhinitis and 31 [12.2%] bronchial asthma. A total of 71 [27.8%] had symptoms of wheezing [females were 66% and males 34%; African [24%] and Pakistani [22.5%] nationals]. Of the 71 students, 41 [57.7%] students experienced 1-3 episodes during the previous year, 13 [18.3%] and had episodes limiting their speech. Exercise-induced wheezing was experienced by 62 [24.3%] participants. The wheezing episodes were most frequent in January and March. A positive family history of wheezing was reported by 29[40.8%] of the students. 40.8% students reported that wheezing interfered with their daily and extra-curricular activities. Bronchial asthma and allergic rhinitis had a positive association with family history [p<0.05]. Allergic rhinitis was frequent among Pakistani, African and Emirati nationals. Symptoms of asthma and allergic rhinitis had significantly affected the quality of life of the students. Strong family history was also noted for allergic rhinitis and bronchial asthma. Asthma was associated with a high rate of allergic rhinitis symptoms. The prevalence of asthma in this study is within the reported prevalence ranges from UAE and many other parts of the world

Nasobronchial allergies among university students in Ajman, UAE

Objective: The prevalence of wheezing and allergies among the population in Arab countries are on a rise due to urbanization that resulted in substantial environmental changes. The prevalence of respiratory symptoms is about 14% among school children but data on adolescent groups in the Gulf region are lacking. Hence, this study aimed to assess the prevalence of wheezing and bronchial asthma among undergraduate students of Gulf Medical University

Materials and Methods: A cross-sectional study was conducted among undergraduate students of Gulf Medical University using a self-administered questionnaire for data collection. The demographic data, the wheezing and bronchial asthma characteristics and family history were collected and analyzed using SPSS version 19

Results: Of the total of 255 students that were included, 120 [47%] had allergic rhinitis and 31 [12.2%] bronchial asthma. A total of 71 [27.8%] had symptoms of wheezing (females were 66% and males 34%; African [24%] and Pakistani [22.5%] nationals). Of the 71 students, 41 [57.7%] students experienced 1-3 episodes during the previous year, 13 [18.3%] and had episodes limiting their speech. Exercise-induced wheezing was experienced by 62 [24.3%] participants. The wheezing episodes were most frequent in January and March. A positive family history of wheezing was reported by 29[40.8%] of the students. 40.8% students reported that wheezing interfered with their daily and extra-curricular activities. Bronchial asthma and allergic rhinitis had a positive association with family history [p<0.05]. Allergic rhinitis was frequent among Pakistani, African and Emirati nationals. Symptoms of asthma and allergic rhinitis had significantly affected the quality of life of the students

Conclusion: Strong family history was also noted for allergic rhinitis and bronchial asthma. Asthma was associated with a high rate of allergic rhinitis symptoms. The prevalence of asthma in this study is within the reported prevalence ranges from UAE and many other parts of the world

Faculty outlook towards animal experiments in postgraduate medical education

Animal experiments form an essential component of postgraduate medical education in the discipline of Pharmacology. In this context, the present study aimed to assess the perceptions of Pharmacology faculty members in South Indian medical colleges regarding the use of animals in postgraduate training. A cross-sectional survey was done among 70 Pharmacology faculty in 15 South Indian medical colleges. A validated pre-tested 27-statement, 5-domain questionnaire was used to collect the data. Data were analyzed using SPSS 19 version. Categorical variables were described by frequencies and percentage. With 52 faculty members responding to the content validated questionnaire, the response rate was 84.3%. The analysis of results revealed that the majority of the faculty members agreed with statements about the advantages and some disadvantages of animal experiments. About 88% stated that animal experiments should be conducted in the program. The majorities were also aware of alternatives to animal experiments and agreed that animal experiments should be continued with a reduction in the number or with refinement of the use of animals in spite of the availability of alternatives. The majority of faculty members of South Indian medical colleges, who took part in our study, support animal use in postgraduate courses in spite of being aware of their drawbacks and the availability of alternatives. Hence, in view of the trend to "Replace, Reduce and Refine" animal use, greater awareness is needed regarding the utilization of alternatives to animal experiments in postgraduate medical education

Prevalence of allergies among university students in Ajman, UAE

Urbanization and globalization in UAE has resulted into drastic environmental changes and increase in the allergens present in the environment and the prevalence of allergies. Hence, this study aimed to assess the prevalence of allergies among undergraduate students of Gulf Medical University. This cross-sectional survey was carried out among undergraduate students of Gulf Medical University. A self administered questionnaire was used as research instrument for data collection. The demographic data and the allergy characteristics were collected and analyzed using SPSS version 19. descriptive and inferential statistics were performed. A total of 255 students [33.3% males and 66.7% females] were included. The commonest allergies among the students were allergic conjunctivitis [104 [40.8%]], allergic dermatitis [89[34.9%]], dust allergies [58 [22%]] and eczema in [38 [14.9%]]. A positive family history of allergies was reported by 62 [24.3%] for allergic dermatitis and 33 [12.9%] for allergic conjunctivitis. Allergies associated with pollen, food and drugs were less frequent allergy. Students with allergies reported interference with their daily activities, and academic, social and extra-curricular activities. Overall higher proportion of students had allergies especially among the African and Pakistani students. Adequate preventive strategies should be initiated to crumb this rising prevalence of allergies

Qualitative insights into the nurses' knowledge and experience of polypharmacy in Ajman, UAE

The specter of polypharmacy is an ever increasing problem. Nurses play a functional role in assisting patients to understand the dangers of polypharmacy. Nurses' knowledge and their experience of polypharmacy in their nursing practice are determined in the study. Nurses working in Gulf Medical College Hospital and Research Centre, Ajman, United Arab Emirates participated in this cross-sectional study during March to May 2011. A self-administered structured questionnaire was used to obtain data. Chi-square test was performed to find the association between sociodemographic characteristics and the variables under study using PSAW software. A total of 105 nurses [92 female; 13 male] participated. The definition of polypharmacy was correctly identified by only 45.7% nurses. Elderly was identified as the most common age group in whom polypharmacy is practiced. 66.7% of the nurses acknowledge their non-awareness of rational and irrational polypharmacy. Non-awareness of rationality of polypharmacy was similar between genders and all three groups of clinical experience. The common reasons given for practice of polypharmacy included use of multiple drugs to manage multiple disease conditions. 66% identified the elderly population as the common age group exposed to polypharmacy, while 22.9% nurses opined that it is common in all age groups. Working knowledge of rational polypharmacy is essential among the nursing community to reduce the practice of polypharmacy

Nurses opinion on the negative attributes of polypharmacy in patient safety, in Ajman, UAE

The negative attributes of polypharmacy should be known by nurses while reviewing and administering medications. We studied the nurses' opinion on the negative attributes of polypharmacy. Nurses working in a tertiary care teaching hospital participated in this cross-sectional study, conducted over 3 months, by responding to a self-administered questionnaire. Chi-square test was used to analyze association between socio-demographic characteristics and items in the study. A value of p<0.05 was considered statistically significant. Increased drug interactions scored the highest [98.1%], followed by increased adverse drug effects [81.9%] among the negative effects of polypharmacy. No difference was observed in the opinions between male and female nurses or among nurses of varying duration of nursing experience. Nurses with 5-10 years of experience opined increase in non-compliance to prescribed medication regimen and increase in financial burden also as negative attributes. There is a lacuna in the knowledge about ill effects of polypharmacy among nurses, which can be filled in by Continuing educational programs and workshops

Reporting of adverse drug reactions: a study among clinicians

Adverse drug reactions [ADRs] are an important public health problem. Serious ADRs lead to morbidity and mortality and considerable economic burden on the society and healthcare systems. Only 6-10% of all ADRs are reported. Spontaneous reporting of ADRs enhances detection of serious, unexpected and unusual ADRs. Health care professionals play an integral role in the success of the safety surveillance of drugs. This study aimed to investigate knowledge, practice and factors affecting ADR reporting among clinicians. A cross sectional study was carried out among all the clinicians of Gulf Medical College Hospital and Research Centre [GMCHRC] irrespective of their gender, specialization and experience. A validated self-administered questionnaire was used to assess the knowledge, practice and factors influencing ADR reporting. The questionnaire was distributed among clinicians during their duty hours, who were given adequate time to fill in the forms. The filled in self-administered questionnaire was returned by only 42 clinicians. The 42 clinicians included in the study comprised more than 50% males, had a mean age 36 +/- 8 years and represented a multi-ethnic population of varying clinical experience. The most frequent ADR the clinicians had come across was rashes. The commonly implicated drugs were antibiotics and analgesics. With regard to ADR reporting, the majority of the clinicians correctly identified which of the ADRs had to be reported and the individuals who can report ADRs. Very few clinicians had reported ADRs to the Pharmacovigilance Centre. The common factor discouraging reporting of ADR was that most clinicians did not know how to report ADRs [71%]. A majority of the clinicians were willing to undergo training on this aspect. The study revealed the existence of under-reporting of ADRs, but also the willingness of clinicians to be trained in ADR reporting and thus contributing to the Pharmacovigilance program