SimUniversity at a distance: a descriptive account of a team-based remote simulation competition for health professions students.

BACKGROUND: SimUniversity competition is an innovative Society in Europe for Simulation Applied to Medicine (SESAM) initiative which has existed since 2014, with the aim of creating opportunities for undergraduate healthcare students to take part in a formative educational experience on an international platform. The main educational focus is on promoting non-technical skills such as leadership, situation awareness, decision making, communication, and assertiveness, but also clinical reasoning within a team. In preparation for the 2021 virtual conference, the team designed a new methodology to meet the same mission, and yet be offered remotely. MAIN TEXT: In this article, we describe the way in which we transformed the SimUniversity competition activity from face to face to a remote simulation. We relied on Zoom as the main communication technology to enable the distance component and followed the key elements of pre-briefing, simulation, and debriefing with the students being onsite together in one location and the faculty and simulator technologists in distant locations. Thirty-eight medical and nursing students formed 8 teams from 7 different countries. Two participating teams were based in Germany and one in Italy, Belgium, the Netherlands, Romania, Portugal, and Syria. Each team consisted of between 4 and 5 members and was self-selected to consist of either medical students alone or medical and nursing students together. The SimUniversity faculty team was composed of 5 physician educators, one nurse educator, one paramedic simulation technologist, and one industry simulation technologist. The faculty members facilitated each simulation synchronously in Zoom, while being based in different geographical locations within Europe (Germany, Switzerland, and the Netherlands) and the Middle East (Qatar and Lebanon). CONCLUSION: We conclude that assuming there is access to adequate internet connectivity and minimal technical setup, conducting a remote simulation with virtual debriefing is achievable in supporting team-based learning, particularly when learners and/or faculty members are in distant locations. While the authors do not recommend this method to be superior to a face-to-face experience, we propose this model to be an alternative method to consider when educators are faced with imposed restrictions such as what we faced during the COVID-19 pandemic. We discuss lessons learned and highlight other potential benefits that this method may provide, to consider even when the restrictions are lifted.

Culpability, blame, and stigma after pregnancy loss in Qatar.

BACKGROUND: Following a miscarriage many women report feeling guilty and culpable for what has happened particularly when aspects of societal blame and stigma are involved. This research investigated the impact of cultural context on the experience of miscarriage. In particular, it focused on how elements of stigma and blame are linked to notions of miscarriage etiology and risk among Qatari women. METHODS: The research used an ethnographic approach. The data was collected over 18 months of fieldwork in Qatar, using semi-structured face to face interviews, and participant observation. A purposive sample of 40 women (primary participants) who had recently miscarried, participated in the study. Potential subjects were initially identified in the Women's Hospital and were consented, and then interviewed in Arabic either in the hospital or at their preferred location. The interviews were audio recorded, transcribed and translated into English. Additional key interviews were performed with 20 secondary participants related to the miscarriage cohort including family members and husbands. Inductive thematic analysis of content was performed manually to extract themes. RESULTS: Two main themes emerged from the material looking specifically at miscarriage aftermaths: rhetorics of blame, self-blame and feelings of guilt; and miscarriage attitudes. Overall society is sympathetic and miscarriage is seen as normal and not particularly worrying, but understood to be upsetting to women. However, findings suggest there is some ambivalence around blame, culpability and stigma applied to miscarriage; some participants perceived miscarriage as a relatively normal and common event, whereas, others felt that miscarriage is resounding stigma and shame. CONCLUSION: Miscarriage aftermaths are embedded in social, cultural and religious frameworks in relation to notions of risk and causation. Attention should be paid to ensure women and those around them are given appropriate and robust information about miscarriage causation to deflect discourses of blame that may be employed and reduce harm to women who suffer miscarriage.

Perceived Preparedness of Health Care Students for Providing Cardiovascular Disease Risk Assessment and Management.

Early assessment and management of risk factors is known to have significant impact in preventing cardiovascular disease (CVD) and its associated burden. Cardiovascular disease risk assessment and management (CVDRAM) is best approached by teamwork across health care professionals. This study aimed at assessing health care students' (HCSs) knowledge about the parameters needed for estimating CVD risk, their self-assessed preparedness/confidence and perceived barriers for the provision of CVDRAM services through a survey administered to third and fourth year pharmacy, medical, and nursing students in Qatar. Although all student cohorts achieved similar knowledge scores, less than half (n = 38, 47%) were able to identify all of the six main risk factors necessary to estimate absolute CVD risk, and a third (32%) were unable to identify total cholesterol as an independent risk factor necessary to estimate CVD risk. Training on the use of CVD risk assessment tools differed among the three student cohorts. All student cohorts also perceived similar levels of preparedness in CVDRAM. However, pharmacy students reported the highest preparedness/confidence with the use of the latest CVDRAM guidelines. The majority of statements listed under the barriers scale were perceived by the students as being moderate (median score = 3). Poor public acceptance or unawareness of importance of estimating CVD risk was the only barrier perceived as a major by nursing students. Future integration of interprofessional educational (IPE) activities in the CVDRAM curricula of HCSs may be a suitable strategy to minimize barriers and foster collaborative practice for the provision of CVDRAM services in Qatar.

Causal explanations of miscarriage amongst Qataris.

BACKGROUND: Despite its commonality, there is a paucity of literature on miscarriage in non-Western societies. In particular, there is little understanding of how people ascribe cause to miscarriage. This research sought to gain an in-depth understanding of notions of miscarriage causality and risk amongst Qataris. METHODS: The study adopted an exploratory descriptive qualitative approach and collected data during 18 months of ethnographic research in Qatar, including semi-structured interviews. The sample includes 60 primary participants (20 pregnant women and 40 women who had recently miscarried), and 55 secondary participants including family members, health care providers, religious scholars and traditional healers. Informed consent was obtained from all participants. Primary participants were interviewed in Arabic. The interviews were audio recorded, transcribed and translated into English. Data was analysed using an inductive thematic approach, which involved identification and application of multiple codes to different text segments. Data were encoded manually and examined for recurrences across the data set. Similar quotations were grouped into subcategories and further categorized into main themes. RESULTS: A number of key themes emerged, revealing Qatari women attributed miscarriages to a number of factors including: supernatural forces, such as God's will and evil eye; lifestyle, such as physical activities and consuming particular substances; medical conditions, such as diabetes; and emotional state, such as stress, and emotional upset. Resting, avoiding stress and upset, maintaining healthy diet, and spiritual healing (ruqyah) are seen as a means to avoid miscarriage. CONCLUSION: Practices and beliefs around miscarriage are embedded in social, cultural, religious and medical frameworks. Understanding the socio-cultural context and understandings of explanatory theories can enhance health care providers' understandings, resulting in improved communication and care.

Medical educators working abroad: a pilot study of educators' experiences in the Middle East.

Medical education is now a global enterprise, with many medical educators working internationally, either for short or longer periods or even permanently. In parallel, many medical schools are now involved in collaborations and partnerships with schools in other countries. With this in mind, we set out to explore what motivates, supports and inhibits medical educators who wish to or might work outside their "home country". This article reports on the pilot stage (in specific organizational contexts in Middle East) of a longitudinal project aimed at canvassing medical educators on a broader global scale, using reflective accounts and a questionnaire survey. The findings from this pilot study raise interesting issues about the lived experience of medical educators who have chosen to work in a different culture from their own. Respondents identify many advantages around skills, personal and professional development. Three main issues emerged in terms of educators' experiences: the academic environment, medical practice in a different cultural context and personal matters. Adapting to the local culture, gender segregation and the impact on learning and teaching was an overarching factor. We introduce an explanatory framework to explain the development of international educator identity, a cyclical process in which, through experiences and reflection, individual world views and perspectives are continually modified and developed. This pilot study tested the methodologies and developed a new conceptual model that will be used in a wider study across different cultures.

Medical Students Learning Communication Skills in a Second Language: Empathy and expectations.

OBJECTIVES: Communications skills (CS) training for medical interviewing is increasingly being conducted in English at medical schools worldwide. In this study, we sought to identify whether Arabic-speaking medical students experienced difficulty with the different components of the CS training that were conducted in English. METHODS: Individual third-year preclinical medical students (N = 45) were videotaped while interviewing simulated patients. Each student assessed his/her performance on a 13-item (5-point scale) assessment form, which was also completed by the tutor and other students in the group. RESULTS: Of the 13 components of their CS training, tutors awarded the lowest marks for students' abilities to express empathy, ask about patients' feelings, use transition statements, ask about functional impact, and elicit patients' expectations (P <0.001). CONCLUSION: The expression of empathy and the ability to elicit patients' feelings and expectations are difficult to develop in medical students learning CS in a second language.

Focus groups findings reveal barriers to teaching communication skills to medical students.

BACKGROUND: In December 2002, 74 medical students in the second preclinical years at the American University of Beirut (AUB) attended a workshop on basic communication skills (CS). The students watched video clips which demonstrated different communication skills and stages of the consultation, and role-played to try out ways they could improve the consultation. Their familiarity with the skills taught was assessed at the beginning of the workshop, immediately afterwards, and again six months later. There was a significant improvement noted immediately after the intervention but this apparent gain was lost at six months. METHOD: Sixteen students, who attended the workshop, also attended two focus group discussions which were aimed to assess student recall of the communications skills workshop, and explore ways in which the students thought the knowledge gained could be maintained. RESULTS: In general students thought that lack of exposure to patients at the time when the CS course was held, and a lack of consistency in CS coupled with poor faculty CS role modeling hindered their ability to maintain and practice good CS. CONCLUSIONS: Teaching CS may be more effective if medical students are taught these skills when they are exposed to patients on a regular basis, and the training is maintained throughout the clinical years. However, more emphasis should be on reminding faculty members of their role as teachers and good communicating role models to students through workshops and seminars.

Impact of a communication skills audiovisual package on medical students' knowledge.

INTRODUCTION: Over the last decade more emphasis is being put on teaching communication skills (CS). Use of videos and role-play was suggested to improve CS. This article will present the impact of an audiovisual package on promoting the knowledge of medical students in CS. METHODS: Seventy-five second year medical students--distributed into eight groups led by four facilitators--critiqued a video clip immediately before and after the introduction of a communication skills audiovisual package. The skills taught included opening the interview, questioning, facilitation, clarification, reflection, confrontation, summarizing, and preparation of the patient for the physical exam. The students, also, role-played the reviewed scenario. The students' pre- and post-intervention responses were analyzed using a standardized grading form. RESULTS: There was a significant improvement in students' knowledge (p < 0.000) after the introduction of the intervention in all the CS taught except closed ended questioning. This improvement was consistent among the four facilitators. CONCLUSION: Reviewing video scenarios and role-playing improved the knowledge in core communication skills among second-year medical students assessed by a video-based written examination.

Locus of control moderates the relationship between headache pain and depression.

The aim of the current study was to triangulate qualitative and quantitative data in order to examine in greater detail the relationship between self-reported headache pain severity, depression and coping styles. Psychosocial scales, headache characteristic scales and in-depth interviews were administered to 71 adults with the diagnosis of primary headache. Regression analyses with the scales showed that greater self-reported headache pain severity was associated with higher levels of depression. A high internal locus of control weakened the relationship between the headache severity and depression variables. The qualitative data supported the relationship between pain severity and internal locus of control and, in addition, revealed that perceived efficacy of pharmacologic intervention might be a related factor. The results suggested that stronger coping skills might reduce depression among headache sufferers.

Post-graduation migration intentions of students of Lebanese medical schools: a survey study.

BACKGROUND: The international migration of physicians is a global public health problem. Lebanon is a source country with the highest emigration factor in the Middle East and North Africa and the 7th highest in the World. Given that residency training abroad is a critical step in the migration of physicians, the objective of this study was to survey students of Lebanese medical schools about their intentions to train abroad and their post training plans. METHODS: Our target population consisted of all students of Lebanese medical schools in the pre-final and final years of medical school. We developed the survey questionnaire based on the results of a qualitative study assessing the intentions and motives for students of Lebanese medical schools to train abroad. The questionnaire inquired about student's demographic and educational characteristics, intention to train abroad, the chosen country of abroad training, and post-training intention of returning to Lebanon. RESULTS: Of 576 eligible students, 425 participated (73.8% response rate). 406 (95.5%) respondents intended to travel abroad either for specialty training (330 (77.6%)) or subspecialty training (76 (17.9%)). Intention to train abroad was associated with being single compared with being married. The top 4 destination countries were the US (301(74.1%)), France (49 (12.1%)), the United Kingdom (31 (7.6%)) and Canada (17 (4.2%)). One hundred and two (25.1%) respondents intended to return to Lebanon directly after finishing training abroad; 259 (63.8%) intended to return to Lebanon after working abroad temporarily for a varying number or years; 43 (10.6%) intended to never return to Lebanon. The intention to stay indefinitely abroad was associated male sex and having a 2nd citizenship. It was inversely associated with being a student of one of the French affiliated medical schools and a plan to train in a surgical specialty. CONCLUSION: An alarming percentage of students of Lebanese medical schools intend to migrate for post graduate training, mainly to the US. A minority intends to return directly to Lebanon after finishing training abroad.

Involvement of general practice (family medicine) in undergraduate medical education in the United Kingdom.

We describe the changes in the development and delivery of undergraduate medical education in the United Kingdom as it moved from being exclusively hospital based to one that is increasingly led and delivered by academic departments of general practice (GP), GP teachers, and hospitalists guided by the General Medical Council. We describe the impact of this change on GP teachers, medical students, and patients. The Kings Medical Firm in the Community and The Cambridge Community-based clinical course have been examples of innovation in undergraduate GP teaching and illustrate some of the strengths and challenges of delivering undergraduate medical teaching in the community.

Graduates of Lebanese medical schools in the United States: an observational study of international migration of physicians.

BACKGROUND: As healthcare systems around the world are facing increasing physician shortages, more physicians are migrating from low to high income countries. As an illustrative case of international migration of physicians, we evaluated the current number and historical trends of Lebanese medical graduates (LMG) in the US, and compared their characteristics to those of US medical graduates (USMG) and other international medical graduates (IMG). METHODS: We evaluated the number of LMG using the 2004 the American Medical Association Physicians' Professional Data (AMA-PPD) and then compared it to the number of graduates of other countries. We evaluated the historical trends using the 1978-2004 historical files of the AMA-PPD. We analyzed the characteristics of all LMG and compared them to a random sample of 1000 USMG and a random sample of 1000 IMG using the 2004 AMA-PPD. RESULTS: In 2004, there were 2,796 LMG in the US, constituting 1.3% of all IMG. Compared to other foreign countries contributing to the US physician workforce, Lebanon ranked 2nd after adjusting for country population size (about 4 million) and 21st overall. About 40% of those who graduated from Lebanese medical schools in the last 25 years are currently active physicians in the US. Since 1978, the number of LMG in the US showed a consistent upward trend at a rate of approximately 71 additional graduates per year. Compared with USMG and IMG, LMG were more likely to work in medical research (OR = 2.31; 95% Confidence Interval (CI) = 1.21; 4.43 and OR = 2.63; 95% CI = 1.34; 5.01, respectively) and to be board certified (OR = 1.43; 95% CI = 1.14; 1.78 and OR = 2.04; 95% CI = 1.65;2.53, respectively) and less likely to be in family practice (OR = 0.14; 95% CI = 0.10; 0.19 and OR = 0.18; 95% CI = 0.12; 0.26, respectively). CONCLUSION: Given the magnitude and historical trends of migration of LMG to the US, further exploration of its causes and impact is warranted. High income countries should consider the consequences of their human resources policies on both low income countries' and their own healthcare systems.

Why are you draining your brain? Factors underlying decisions of graduating Lebanese medical students to migrate.

In the context of a worldwide physician brain drain phenomenon, Lebanon has the highest emigration factor in the Middle East and North Africa. In this manuscript we aim to identify and develop a conceptual framework for the factors underlying the decisions of graduating Lebanese medical students to train abroad. We conducted two focus groups and seven semi-structured individual interviews with 23 students. In the deductive analysis (based on the push-pull theory), students reported push factors in Lebanon and pull factors abroad related to five dimensions. They focused predominantly on how training abroad provides them with a competitive advantage in an oversaturated Lebanese job market. An inductive analysis revealed the following emerging concepts: repel factors abroad and retain factors locally; societal expectations that students should train abroad; marketing of abroad training; and an established culture of migration. The marketing of abroad training and the culture of migration are prevalent in the academic institutions.

Communication skills in a Lebanese medical school: from movie theaters to medical classrooms.

BACKGROUND: Communication skills are widely taught in US medical schools, but in Lebanon, such teaching is in its infancy. METHODS: At the American University of Beirut, we piloted a communication skills teaching package using video scenarios in Arabic. A total of 150 second-year medical students addressed eight communication issues in a 3-hour multi-method workshop that included watching and discussing video clips and role-playing. RESULTS: Students evaluated the sessions positively for relevancy, quality of video clips, teaching methods, and usefulness for future practice. CONCLUSIONS: This interactive, role-playing workshop proved highly acceptable to Arab students and has been permanently incorporated into the curriculum.

Factors influencing the choice of specialty among medical students in Lebanon.

STATEMENT OF THE PROBLEM: We focus on graduating students from two medical schools in Lebanon to identify the proportions who select primary care careers, to highlight factors that are considered when making a career choice, and to compare these among primary care (PC) and non-primary care (NPC) candidates. METHODS: Anonymous self-administered questionnaire was used to assess student demographics, chosen career, and perceived level of importance concerning 27 career influencing factors using a 5-point Likert scale. RESULTS: 127 (97%) students responded. 53 (42%) students selected primary care. 20 (61%) of the females were in the primary care group. Among all, the most important factors scored (3.30 to 3.06) represent: "intellectual opportunities", "match of personal interest and skills" and "helping and social responsibilities". Least important factors scored (1.96 to 1.13) and represent: "encouragement/role models", "clerkships and courses", and "residency issues". "Diversity in diagnosis and treatment" and "emphasis on patient education and prevention" were significantly higher for the primary care career groups (p = 0.001, p = 0.001) and "working with new technology" significantly more important (p = 0.001) for the non-primary care group. CONCLUSION: Among the students surveyed "intellectual opportunities", "match of personal interest and skills" and "helping and social responsibilities" were the most important criteria reported to influence their choice of career in medicine.

Osteitis pubis: an unusual postpartum presentation.

INTRODUCTION: Osteitis pubis is a poorly understood and uncommon disorder rarely associated with spontaneous delivery. CASE REPORT: We present a case consistent with osteitis pubis that followed a normal vaginal delivery and where symptoms developed earlier than ever previously reported. DISCUSSION: The potential benefit of low molecular heparin is discussed.

Changes in health-related attitude and self-reported behaviour of undergraduate students at the American university of Beirut following a health awareness course.

UNLABELLED: The importance of the university as a setting for health promotion is increasingly being acknowledged. Part of this health promoting function includes curricular offerings to increase health awareness. However, there is a dearth of systematic evaluations of such courses. OBJECTIVE: To evaluate the impact of a university level "Health Awareness" course on attitudes and behaviours of undergraduates enrolled in the course. METHODS: A self-administered survey was used to assess attitude and self-reported behaviour of students at the beginning and end of the course. Paired analysis of means compared responses at pre and post assessments for groups of items within a particular health topic. Cross tabulations of stage of change at pre and post assessment indicated movement related to tobacco use, exercise, and nutrition. RESULTS: Results indicated an improvement of at least 20% from pretest score in four out of eleven health topic areas, and of 10-20% in an additional five topical areas. In addition, movement in a health promotive direction along the stages of change was evident for smoking, eating fruits and vegetables, and exercise. DISCUSSION: The results presented herein are encouraging and indicate support for the impact of a health awareness class on knowledge, attitude, and behaviour of undergraduate students. The two topical areas that did not show improvements between pre and post assessment were those (i). for which students already scored high at pre assessment, or (ii). which the course did not tackle specifically. Conclusions to be drawn are limited by several factors inherent in the design of this evaluation. Future evaluation should include a larger number of students and a comparison group.