Effective teaching in medical schools guiding principles

Clinical teachers have high qualifications in their specialty, but some of them do not have training, or proficiency in teaching, and education. Therefore, they may face the challenge of effective teaching in their daily practice. The objective of this study is to present some basic guiding principles for novices and expert academic health professionals. An overview from the perspective of the authors on critical fields in education was conducted. Seventeen principles [supported by one or more relevant examples] are discussed. To improve the quality of their teaching practice, academic health professionals need to study the pedagogy of education, and to seek feedback from colleagues who have already studied and practiced the principles of learning and teaching

practical discussion to avoid common pitfalls when constructing multiple choice questions items

This paper is an attempt to produce a guide for improving the quality of Multiple Choice Questions [MCQs] used in undergraduate and postgraduate assessment. Multiple Choice Questions type is the most frequently used type of assessment worldwide. Well constructed, context rich MCQs have a high reliability per hour of testing. Avoidance of technical items flaws is essential to improve the validity evidence of MCQs. Technical item flaws are essentially of two types [i] related to testwiseness, [ii] related to irrelevant difficulty. A list of such flaws is presented together with discussion of each flaw and examples to facilitate learning of this paper and to make it learner friendly. This paper was designed to be interactive with self-assessment exercises followed by the key answer with explanations

Evaluation of three instructional methods of teaching for undergraduate medical students, at King Saud university, Saudi Arabia

There is an international move from traditional curriculum towards the learner - centered, and patient-oriented curriculum. In spite of its advantages, problem-based learning requires a larger number of teaching staff and space. This study was done to compare the problem-based learning [PBL], lectures and modified PBL methods. Thirty-three fifth year medical students who were taking the Family Medicine rotation participated in the study at the College of Medicine, King Saud University. Three instructors participated in the teaching of three topics to the three groups of students. Students acted as control for themselves across the three instructional methods, namely; lectures, PBL and modified PBL. The main outcomes were students' recall of knowledge, problem solving skills and topic comprehension. In the initial assessment, there was a significant difference in favor of PBL and the modified PBL regarding comprehension of the topic as tested by the short answer questions [p = 0.0001], problem solving skills as tested by the modified essay question [p = 0.002]. Non-significant results were observed at the second stage of assessment. The modified PBL method was the preferred one for 39% of the students, followed by the PBL [36%] and lastly the lectures [25%].This empirical study suggests some advantages for the PBL method and the modified PBL over the lecture method. Larger studies are needed to confirm our results of this important issue as the modified PBL is an affordable option for schools that can not meet the staff and space requirements of the PBL curriculum

Prevalence and pattern of alternative medicine use: the results of a household survey

Alternative medicine [AM] encompasses all forms of therapies that fall outside the mainstream of medical practice. Its popularity is on the increase. Because previous surveys were limited and not generalizable, we estimated the prevalence, pattern and factors associated with use of AM in the community. A multistage cluster cross-sectional household survey was conducted among Saudi residents of the Riyadh region. Data were collected in 2003 by trained interviewers from primary health care centers using a specially designed questionnaire. Of 1408 individuals participating in the study, 39% were men. The mean [ +/- SD] age for the study population was 35.5 [ +/- 13.9] years. Sixty-eight percent of the respondents had used AM during the last 12 months. The Holy Quran as a therapy was the most frequently used AM [50.3%], followed by honey [40.1%], black seed [39.2%] and myrrh [35.4%]. The health belief model was found to be the most important determinant of AM use. Factors independently associated with AM use included perceived failure of medical treatment, the perceived success of AM, a preference for natural materials, and long appointment intervals to see physicians. There is a high prevalence of AM use in the Riyadh region and the most important determinant of AM use was the perceived failure of medical treatment. The study results call for intensive health education campaigns in the media addressing wrong beliefs regarding AM and modern medicine. The popularity of AM in this community should alert decision makers to look at the difficult accessibility to the health system

Teaching evidence-based medicine in a Saudi medical school: a pilot study

The teaching of Evidence Based Medicine [EBM] has been increasingly integrated into curricula at both undergraduate and postgraduate medical education. The aims of this paper were to: i] describe King Saud University [KSU] experience of teaching EBM for medical students ii] explore students' satisfaction with the module, their practice of what was learned and obstacles faced. Six months after completing the module, a self-administered questionnaire was distributed to 43 female students. The majority [> 90%] of the students found the EBM module helpful in their clinical practice and favored it's inclusion in the FM rotation. About 38% of students found difficulty in searching the literatures for information and only 45% practiced EBM in other clinical rotations. The majority of the students [78%] found that the six weeks' duration was enough for the module. About 77.5% of the students thought that EBM was important for their career. It is reassuring to find the students satisfied with the EBM module. In view of the students' difficulty in literature searching and lack of practice in other clinical rotations which are going in common with others recommendations; it is suggested that EBM teaching to take place earlier in the medical school curriculum and to involve different specialties in it's teaching

Outpatient management of type 2 diabetic patients: a review of evidence-based literature

Diabetes mellitus is a common, serious, and treatable disease. Good control is associated with fewer complications. The impact of the disease on the patient, family and the community psychologically and physically is staggering. This paper aims to update the reader on certain issues related to the management of diabetes. Recent criteria for the diagnosis are presented followed by non-pharmacological and pharmacological management, glycemic monitoring, prevention, continuity of diabetes care and the control of co-morbidities. Throughout, as far as possible, the best available evidence was used

criteria and analysis of good multiple choice questions in a health professional setting

Assessment of health workers as students and professionals has a profound impact on their learning and is an essential safety valve before certification. It is used for their training, their placement, their certification, and their promotion. The multiple choice question MCQ type of tests represents one of the most important examination tools that is commonly used in this assessment. The MCQs can be reliable, valid, and cost-effective in assessing medical knowledge. This paper portrays the different purposes of assessment in the medical field. The paper discusses in detail the criteria of a good assessment tool. Interpretation of MCQ test results is the final section of the paper

prevalence of abnormal results of annual investigations among diabetic patients with different risk factors

The basic theme of this study was to promote the use of risk approach and encourage selectivity in requesting laboratory investigations. The objective was to estimate the proportion of abnormal results obtained from routinely requested annual investigations among the whole study population, and the odds ratios of abnormal test results among patients with certain risk factors. Patients and A total of 459 diabetic patients aged 12 years and over, attending the primary care clinics of a university hospital in Riyadh, Saudi Arabia, were included in the study. In this cross-sectional study, analysis of the association between patients' demographic characteristics and clinical findings [independent variables], and the results of the annual investigations were conducted. A multiple logistic regression analysis was carried out to identify certain independent variables associated with abnormal investigations. The proportion of patients who had abnormal electrocardiogram [ECG] was 23%, chest x-ray [CXR] 26%, and liver function test [LFT] 9%. High systolic blood pressure [BP] and age were found to be important determinants of abnormal ECG and CXR. Patients who had high systolic BP [>140 mm Hg] were found to be 2.39 times more likely to have abnormal ECG [OR=2.39], and their odds ratio of abnormal CXR was 2.33. Furthermore, for each 10-year increment in age, there was a 43% increased likelihood of abnormal ECG and 29% increase of abnormal CXR. Smokers were nine times more likely to have abnormal LFT [OR=9.26, 95% CI=2.29 to 37.5]. The disease duration and obesity were not found to have an independent association with the possibility of having abnormal results. The study results led to some tentative suggestions on guidelines for clinicians in their decision either to request annual investigations for all diabetic patients, or to restrict some investigations to certain groups of patients. This was discussed and compared with the findings from the literature and other authorities' recommendations

Audit of prescribing patterns in Saudi primary Health care: what lessons can be learned?

The prescription of drugs is one of the most important factors in the rising costs of health services. The lack of proven benefit, and the definite cost and side effects of many prescriptions, have been found in many studies. The aim of the present study is to assess the prescribing pattern of primary health care [PHC] physicians in Riyadh city, the capital of Saudi Arabia. Patients and Prescriptions issued from eight PHC centers over two weeks [six months apart] were analyzed. The health centers were randomly selected to represent the geographical parts of Riyadh city. A total of 17,067 prescriptions were analyzed. The most frequently prescribed drugs were antihistamines [25%], paracetamol [20.3%] and antibiotics [14.7%]. Upper respiratory tract infection [URTI] was the diagnostic label used on more than half of the prescriptions. On the other hand, drugs for chronic illnesses such as diabetes mellitus [DM] and hypertension were written in a minority of the prescriptions. Antibiotics were prescribed for 26% and antihistamines for 28% of patients with URTI. Although it is well known that a large proportion of patients seen in PHC have a significant psychological or psychiatric disorder, no diagnoses of mental disorders were made. There is a pressing need for education of both patients and doctors regarding the benefit of treatment and control of chronic illnesses, and the limited contribution that the doctor or an antibiotic can make to many self-limiting conditions like URTI. Doctors should be educated on more appropriate and cost-effective prescribing. The detection and management of psychological disorders need special emphasis