Challenges Facing Medical Residents' Satisfaction in the Middle East: A Report From United Arab Emirates.

UNLABELLED: PHENOMENON: Medical residents' satisfaction with the quality of training for medical residency training specialists is one of the core measures of training program success. It will also therefore contribute to the integrity of healthcare in the long run. Yet there is a paucity of research describing medical residents' satisfaction in the Middle East, and there are no published studies that measure the satisfaction of medical residents trained within the United Arab Emirates (UAE). This makes it difficult to develop a quality residency training program that might meet the needs of both physicians and society. APPROACH: The authors designed a questionnaire to assess medical residents' satisfaction with the Dubai residency training program in order to identify insufficiencies in the training, clinical, and educational aspects. The survey was a self-report questionnaire composed of different subscales covering sociodemographic and educational/academic profile of the residents along with their overall satisfaction of their training, curriculum, work environment, peer teamwork, and their personal opinion on their medical career. FINDINGS: Respondents showed a substantial level of satisfaction with the residency training. The vast majority of residents (80%, N = 88) believe that their residency program curriculum and rotation was "good," "very good," or "excellent." Areas of dissatisfaction included salary, excessive paperwork during rotations, and harassment. INSIGHTS: This is the first report that studies the satisfaction of medical residents in all specialties in Dubai, UAE. Our findings provide preliminary evidence on the efficiency of different modifications applied to the residency program in UAE. To our knowledge, there has not been any previous study in the Middle East that has analyzed this aspect of medical residents from different specialties. The authors believe that this report can be used as a baseline to monitor the effectiveness of interventions applied in the future toward improving residency training programs in this region.

Three years experience with forward-site mass casualty triage-, evacuation-, operating room-, ICU-, and radiography-enabled disaster vehicles: development of usage strategies from drills and deployments.

OBJECTIVE: Delineation of the advantages and problems related to the use of forward-site operating room-, Intensive Care Unit (ICU)-, radiography-, and mass casualty-enabled disaster vehicles for site evacuation, patient stabilization, and triage. SETTING: The vehicles discussed have six ventilated ICU spaces, two ORs, on-site radiography, 21 intermediate acuity spaces with stretchers, and 54 seated minor acuity spaces. Each space has piped oxygen with an independent vehicle-loaded supply. The vehicles are operated by the Dubai Corporate Ambulance Services. Their support hospital is the main trauma center for the Emirate of Dubai and provides the vehicles' surgical, intensivist, anesthesia, and nursing staff. The disaster vehicles have been deployed 264 times in the last 5 years (these figures do not include deployments for drills). INTERVENTIONS: Introducing this new service required extensive initial planning and ongoing analysis of the performance of the disaster vehicles that offer ambulance services and receiving hospitals a large array of possibilities in terms of triage, stabilization of priority I and II patients, and management of priority III patients. PRELIMINARY RESULTS: In both drills and in disasters, the vehicles were valuable in forward triage and stabilization and in the transport of large numbers of priority III patients. This has avoided the depletion of emergency transport available for priority I and II patients. CONCLUSIONS: The successful utilization of disaster vehicles requires seamless cooperation between the hospital staffing the vehicles and the ambulance service deploying them. They are particularly effective during preplanned deployments to high-risk situations. These vehicles also potentially provide self-sufficient refuges for forward teams in hostile environments.

A framework for physician activity during disasters and surge events.

OBJECTIVES: Delineation of the problem of physician role during disaster activations both for disaster responders and for general physicians in a Middle East state facility. SETTING: The hospital described has 500 medical-surgical beds, 59 intensive care unit beds, eight operating rooms (ORs), and 60 emergency room (ER) beds. Its ER sees 150,000 presentations per year and between 11 and 26 multitrauma cases per day. Most casualties are the result of industrial accidents (50.5 percent) and road traffic accidents (34 percent). It is the principle trauma center for Dubai, UAE. The hospital is also the designated primary regional responder for medical, chemical, and biological events. Its disaster plan has been activated 10 times in the past 3 years and it is consistently over its bed capacity. INTERVENTIONS: A review of the activity of physicians during disaster activations revealed problems of role identification, conflict, and lack of training. Interventions included training nonacute teams in reverse triaging and responder teams in coordinated emergency care. Both actions were fostered and controlled by a Disaster Control Centre and its Committee. RESULTS: Clear identification of medical leadership in disaster situations, introduction of a process of reverse triage to meet surge based on an ethical framework, and improvement of flow through the ER and OR. CONCLUSIONS: Reverse triage can be made to work in the Middle East despite its lack of primary healthcare infrastructure. Lessons from the restructuring of responder teams may be applicable to the deployment to prehospital environments of hospital teams, and further development of audit tools is required to measure improvement in these areas.