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Zoaib Habib Tharwani,1 Prince Kumar,1 Yumna Salman,1 Zarmina Islam,1 Shoaib Ahmad,2 Mohammad Yasir Essar3 1Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan; 2District Head Quarters Teaching Hospital, Faisalabad, Pakistan; 3Kabul University of Medical Sciences, Kabul, AfghanistanCorrespondence: Mohammad Yasir Essar, Email yasir.essar@gmail.comAbstract: Typhoid, and its extra drug resistant form which is highly prevalent Pakistan, is increasing the burden on healthcare through multiple factors. These range from lack of sanitation, the collapsing economy, and poor access to clean drinking water which have made it arduous for the government and various other organizations in containing it. With the COVID-19 pandemic, treatment of typhoid became a challenge as focus was driven towards limiting the COVID-19 spread, and hence preferential use of antibiotics such as azithromycin may limit future empirical antibiotic therapy for typhoid. Socioeconomic disparities and geographical as well as demographic barriers further limit access to appropriate typhoid management. Lastly, illiteracy and self-medication with antibiotics may predispose Pakistan to another outbreak of typhoid. These concerns, although largely unaddressed effectively, need immediate action. Previously, the government and international organizations have made efforts to control the spread through the introduction of TCV as a part of EPI and awareness, additional improvements are needed. These include: improving access to telemedicine in rural areas, extensive vaccination programs, and routine awareness programs especially in schools.Keywords: typhoid, COVID-19, water sanitation, healthcare, vaccine, Pakistan

الملخص: أهداف البحث: إن طرق التدريس التقليدية ليست بالكفاءة المرجوة بسبب عدم قدرتها على تعزيز التعلم النشط. وإن اعتبار المشاركة النشطة من قبل المتعلمين يساعد على تعزيز التجربة التعليمية. بالإضافة إلى ذلك، فقد ثبت أن التغذية الراجعة البناءة تحفز على التعلم النشط. تهدف هذه الدراسة إلى قياس تأثير التدخلات باستخدام التعلم النشط والتغذية الراجعة على الأداء الأكاديمي لطلاب الطب. طرق البحث: أُجريت هذه الدراسة الاستطلاعية متعددة المراحل على طلاب الطب في منهج علم الأجنة من خلال التعلم السلبي (٩٠ طالبا)، والتعلم المتكامل النشط (٨٠ طالبا)، وأخيرا بالتعلم النشط مع التغذية الراجعة الفاعلة (٨٥ طالبا) على مدى ثلاث سنوات متتالية. وقد تمت مقارنة درجات الطلاب خلال التقييمات المستمرة والختامية مع الدرجات النهائية. بالإضافة إلى ذلك، تم تحليل آراء الطلاب باستخدام استبانة. النتائج: شارك في هذا البحث ٢٥٥ طالبا. أظهرت آراء الطلاب اختلافات ملحوظة. وكان هناك اتجاه إيجابي نحو التدخلات من خلال التعلم النشط والتغذية الراجعة. زادت المشاركة النشطة للطلاب من ٢٤٪ إلى ٦٩٪ وأخيرا إلى ٧٢٪ خلال ثلاث سنوات. وكان لديهم الدافع لحضور المحاضرات كما اتضح من مشاركة ٢٨٪ و٧٠٪ و٨٢٪ على التوالي. كما كانت هناك زيادة كبيرة في الدرجات الأكاديمية خلال الثلاث سنوات. الاستنتاجات: تؤكد هذه الدراسة فاعلية التعلم النشط والتغذية الراجعة على الأداء الأكاديمي لطلاب الطب. وبالتالى يمكن إدراج نهج تعليمي للتعلم المتكامل النشط متبوعا بالتغذية الراجعة في المناهج الطبية. Abstract: Objectives: Didactic time-honoured teaching pedagogies carry a low educational impact due to their inability to foster active learning. Active participation from learners is considered to enhance their learning experience. Furthermore, constructive feedback has been found to facilitate active learning. This study aims to measure the impact of interventions via the use of active learning and feedback on the academic performance of medical students. Methods: We conducted an observational multi-stage prospective study of the medical students undertaking embryology courses via passive learning (90 students), active integrated learning (80 students), and finally, with active learning and effective feedback (85 students) over three successive years. The students' grades in the formative and summative assessments were compared with their end-of-course grades. Additionally, the students’ perceptions about the courses were analysed using a self-constructed questionnaire. Results: A total of 255 students participated in this research. The observed frequencies of the students’ responses showed significant variations in their responses to all the statements (X2, p

Abstract Background Interprofessional education (IPE) encompasses integration, communication, mutual trust and shared decision-making with a common goal of improved patient care and safety. Despite its crucial role, IPE has not gained its anticipated popularity. This study aims to determine the impact of an online educational intervention about IPE on medical, dental and health sciences students in the University of Sharjah (UoS). Methods This quasi-experimental research was conducted in three phases; a pre-intervention phase where the Readiness for Interprofessional Learning Scale (RIPLS) inventory was administered online to the medical, dental and health sciences students of UoS; an intervention phase where an online workshop was organized via Microsoft Teams®; and a post-intervention phase where RIPLS was used to gather the students’ attitudes towards IPE. The independent t test was used to compare the responses between genders and junior and senior students. A paired sample t test was used to determine the impact of the intervention on the students’ understandings and attitudes about IPE. Results Out of 800 invited students, 530 students responded to the pre-intervention RIPLS survey. A comparison of the pre-post intervention for the RIPLS subscales of teamwork and collaboration, professional identification, and professional roles showed a significant improvement of students’ attitudes with p-values 0.03, 0.00 and 0.00, respectively. All workshop moderators scored a median of 4 or 5 to the essential elements of IPE during intervention except for a median of 3 for group dynamics. Conclusion The present data, derived from the application of a brief online educational intervention, underpins the readiness and positive attitudes of undergraduate medical students towards IPE. The positive impact of online intervention necessitates the development of a structured and unified IPE curriculum to enhance the receptiveness and application of IPE in the medical field.

BackgroundNumerous clinical and experimental observations have alluded to the substantial anti-neoplastic role of vitamin D in breast cancer (BC), primarily by inducing apoptosis and affecting metastasis. Tumor progression and resistance to chemotherapy have been linked to vasculogenic mimicry (VM), which represents the endothelial-independent formation of microvascular channels by cancer cells. However, the effect of vitamin D on VM formation in BC has not been thoroughly investigated. This study examined the impact of 1α,25-dihydroxyvitamin D3 (calcitriol), the active form of vitamin D, on the expression of major factors involved in BC migration, invasion, and VM formation.Experimental MethodsPublicly available transcriptomic datasets were used to profile the expression status of the key VM markers in vitamin D-treated BC cells. The in silico data were validated by examining the expression and activity of the key factors that are involved in tumor progression and MV formation in hormone-positive MCF-7 and aggressive triple‐negative MDA-MB-231 BC cells after treatment with calcitriol.Results and DiscussionsThe bioinformatics analysis showed that tumor VM formation-enriched pathways were differentially downregulated in vitamin D-treated cells when compared with control counterparts. Treatment of BC cells with calcitriol resulted in increased expression of tissue inhibitors of metalloproteinases (TIMPs 1 and 2) and decreased content and gelatinolytic activity of matrix metalloproteinases (MMPs 2 and 9). Furthermore, calcitriol treatment reduced the expression of several pro-MV formation regulators including vascular endothelial growth factor (VEGF), tumor growth factor (TGF-β1), and amphiregulin. Eventually, this process resulted in a profound reduction in cell migration and invasion following the treatment of BC cells with calcitriol when compared to the controls. Finally, the formation of VM was diminished in the aggressive triple‐negative MDA-MB-231 cancer cell line after calcitriol treatment.ConclusionOur findings demonstrate that vitamin D mediates its antitumor effects in BC cells by inhibiting and curtailing their potential for VM formation.

Abstract Background High-quality patient care is a complex phenomenon that requires collaboration among healthcare professionals. Research has shown that Interprofessional Education (IPE) carries promise to improve collaborative work and patient care. So far, collaboration among various health professionals remains a challenge. Very few focus group discussions to determine the medical students’ readiness and positive attitudes towards IPE have been reported from the Arabian context. Methods A two-staged sequential mixed methods study was conducted among medical, dental, pharmacy, and health sciences students of the University of Sharjah United Arab Emirates. The perspectives of students toward IPE and collaborative practice were first gathered by administering a validated instrument, Readiness for Interprofessional Learning Scale (RIPLS). This was followed by focused group discussions. A quantitative as well as a qualitative data analysis was performed. Results This study cohort included 282 students. All respondents showed readiness to adopt IPE as all statements of the RIPLS inventory scored high median scores. All participants showed positive attitudes and readiness towards IPE. Three main domains of themes were generated from focus group discussions; prior knowledge, need for IPE framework and its implementation. Information workload, lack of clarity and less focused teaching pedagogies of IPE were considered as perceived barriers. Conclusion This study demonstrated a substantial agreement of medical and health sciences students towards readiness and perceived effectiveness of IPE. Educators are urged to embed new IPE programs into existing curricular frameworks, which can potentially enhance collaborative learning and improve quality of patient care.

الملخص: أهداف البحث: على الرغم من شعبيتها، لم تُظهر الأدبيات ما يكفي من الأدلة التي يمكن أن تثبت صحة تأثير التعلم بمساعدة الأقران على التعلم الفعال للطلاب. يهدف هذا التحليل البعدي إلى التحليل الكمي لفاعلية التعلم بمساعدة الأقران في التعليم الطبي. طرق البحث: تم البحث في قواعد البيانات المختارة باستخدام مصطلحات الشبكة” مساعدة الأقران“ و”التعلم“ أو ”التعلم الفعال“ أو ”استراتيجيات التعلم“ أو ” توجيه الأقران“ أو ”تعليمات الأقران“ لإيجاد دراسات تشمل النص الكامل باللغة الإنجليزية مع معلومات قبل وبعد الدراسة. بعد بروتوكول منهجي، اخترنا ١١ مقالا للتحليل النهائي. وتم إجراء التحليل البعدي باستخدام برنامج المراجعة الإدارية ٥.٣ من مكتبة كوكرين، وتم عرض المخرجات النهائية على شكل مخطط غابي. النتائج: أظهرت النتائج فاعلية كبيرة للتعلم بمساعدة الأقران؛ فرق المتوسط المعياري ١.٢٦ مع فاصل ثقة ٠.٥٨ إلى ١.٩٤. أظهر اختبار كوكرين Q مستوى الأهمية ٥٪ كما تم قياسه بواسطة مربع كاي ٤٤٩.٤٦. إلى جانب ذلك، كانت نتائج اختبار I2 مهمة (٩٨٪). تتحقق قيمة Z بمقدار ٣.٦٥ من فاعلية التعلم بمساعدة الأقران. الاستنتاجات: أظهر هذا البحث أنه يمكن استخدام التعلم بمساعدة الأقران كأداة تعليمية قيمة في المجال الطبي. يمكن للتدخلات التعليمية في المناهج الدراسية وإدراجها في استرتيجيات التعلم بواسطة الأقران أن تعزز خبرة التعلم لطلاب الطب. Abstract: Objective: Despite the popularity of peer-assisted learning (PAL), existing literature has not shown enough evidence that can validate its impact on students' active learning. This meta-analysis aims to quantitatively analyse the effectiveness of PAL in medical education. Methods: We searched selected databases using the Medical Subject Headings (MeSH) terms ‘peer-assisted’, ‘learning’, ‘active learning’, ‘teaching strategy’, ‘peer mentoring’, and ‘peer instructions’ for full-text English language studies with a pre-post design. Following a systematic protocol, we selected 11 articles for final analysis. A meta-analysis was done using Review Manager (RevMan) 5.3 from Cochrane Training and the final output was presented by a forest plot. Results: The results showed a significant effectiveness of PAL; notably, there was a standardised mean difference of 1.26 with a confidence interval of 0.58–1.94. The Cochran's Q test showed a 5% level of significance as measured by Chi2 = 449.46. Besides, the results of the I2 test were significant (98%); moreover, a z value of 3.65 validated the effectiveness of PAL. Conclusion: This research has shown that PAL can be used as a valuable learning tool in the medical field. Educational interventions in curricula for incorporating PAL strategies can potentially enhance the learning experience of the medical students.

Introduction: A compassionate and patient-centered care leads to improved clinical outcomes. Promoting empathy and compassion of medical students is a forerunner of their well-being, emotional stability, and a patient-centered care. However, there is slender evidence about best educational interventions that can inculcate empathy and compassion skills. Our objective was to conduct a systematic review of research evaluating the associations between spectrum, effectiveness, frequency of teaching modalities and their outcomes on compassion and empathy to highlight best practices.Methods: We searched the Web of Science, PubMed, Scopus, and EBSCO Host on 22nd July 2020. We adapted our search strategy from a previously published systematic review on education for compassion and empathy. Selected studies were required to have used unique educational interventions for promoting empathy and compassion of medical students. The research questions were based on Participants (medical students), Intervention (empathy and/or compassion related teaching), Comparison, and Outcome.Results: We analyzed 24 articles from the initial yield of 2,861. Twenty-two were quantitative studies with a mean of 12.8 on MERSQI. Twelve were randomized controlled trials while 5 measured outcomes with single group pre- and post-tests. There was no association found between duration, frequency and complexity of an educational intervention and its effectiveness. Twenty used multimodality curricula, and of those 18 reported statistically significant positive improvement in empathy, while 3 of 4 single modality were effective. Only three studies looked for long-term effects of educational interventions. Fourteen studies evaluated Kirkpatrick's level one (self-reported knowledge), 2 level three (behavior), and 6 level four (patient outcomes). We identified six major educational constructs of teaching empathy and compassion; communication, mindfulness, early clinical exposure, technology-enhanced learning, comics and arts and culture.Discussion: Our review couldn't identify a standard teaching construct in place and highlighted that different teaching tools carry similar impact in promoting compassion and empathy and a sustainable program rather than a single training activity is essential.

Background: Vitamin D deficiency associates with high risk of breast cancer (BRCA) and increased cellular iron. Vitamin D exerts some of its anti-cancer effects by regulating the expression of key iron regulatory genes (IRGs). The association between vitamin D and cellular iron content in BRCA remains ambiguous. Herein, we addressed whether vitamin D signaling exerts a role in cellular iron homeostasis thereby affecting survival of breast cancer cells.Methods: Expression profile of IRGs in vitamin D-treated breast cancer cells was analyzed using publicly available transcriptomic datasets. After treatment of BRCA cell lines MCF-7 and MDA-MB-231 with the active form of vitamin D, labile iron content, IRGs protein levels, oxidative stress, and cell survival were evaluated.Results: Bioinformatics analysis revealed several IRGs as well as cellular stress relates genes were differentially expressed in BRCA cells. Vitamin D treatment resulted in cellular iron depletion and differentially affected the expression of key IRGs protein levels. Vitamin D treatment exerted oxidative stress induction and alteration in the cellular redox balance by increasing the synthesis of key stress-related markers. Collectively, these effects resulted in a significant decrease in BRCA cell survival.Conclusion: These findings suggest that vitamin D disrupts cellular iron homeostasis leading to oxidative stress induction and cell death.

الملخص: الساركومات الشحمية خلف الصفاق مجموعة غير متجانسة من أورام اللحمة المتوسطة. لهذه الأورام تنوّع واسع من الأصناف الفرعية النسيجية التي تظهر بأعراض غامضة. نستعرض رجلا يبلغ من العمر ٧٥ عاما مصابا بفقدان الشهية وفقدان للوزن بلغ ٧ كجم مع محيط بطني متزايد خلال الأسابيع الستة الماضية. أظهر التصوير المقطعي المحوسب للبطن والحوض كتلة كبيرة ملأت كامل البطن تقريبا. بعد التشاور مع مجلس الأورام متعدد التخصصات، تم إجراء عملية استئصال كاملة للورم. بالإضافة إلى ذلك، تمت إزالة الكلية اليسرى وجزء من الحجاب الحاجز الأيسر. كانت قياسات الورم ٣٥x ٢٩ x ٢٠.٥سم ووزنه ١١.٦ كجم. أكد التقرير النسيجي أنها ساركومة شحمية ذات درجة تباين متدنية مع قلة من الخلايا الدهنية غير الطبيعية والخلايا المنتجة للدهون، مع وجود مكونات الخلايا المغزلية والمتعددة الأشكال والغضروفية. تعافى المريض دون مضاعفات وبقي مستقرا أثناء زيارة المتابعة. نبلغ عن هذه الحالة كي يتخذ غير المبالي تدابير جراحية استثنائية في التعامل مع مثل هذه الأورام الصلبة أثناء العملية الجراحية، حيث يصعب التعامل مع هذه الأورام الصلبة بسبب الغزو الموضعي والمجاور الذي يستلزم عادة الاستئصال الكامل. Abstract: Retroperitoneal liposarcomas are a heterogeneous group of mesenchymal tumours that have a wide spectrum of histological subtypes and vague clinical presentations. Herein, we present the case of a 75-year-old man with anorexia, weight loss of 7 kg, and a growing abdominal circumference within a span of 6 weeks. Computed tomography of the abdomen and pelvis showed a large mass that filled almost the entire abdominal cavity. After consultation with a multidisciplinary tumour board, en bloc resection of the tumour was performed. In addition, the left kidney and a part of the left diaphragm were removed. The tumour measured 35 × 29 × 20.5 cm and weighed 11.6 kg. The histological report confirmed low-grade dedifferentiated liposarcoma with scarce atypical adipocytes, lipoblasts containing spindle cell, pleomorphic, and chondroid components. The patient had uneventful recovery and remained stable during the follow-up period. We report this case to highlight the need for customized surgical oncological measures in the treatment of solid abdominal tumours due to locoregional invasion that usually necessitates en bloc resection. الكلمات المفتاحية: ساركومة دهنية, الساركومة العملاقة خلف الصفاق, كتلة بطنية, فريق متعدد التخصصات, جراحة, Keywords: Abdominal mass, Giant retroperitoneal sarcoma, Liposarcoma, Multidisciplinary team, Surgery

الملخص: أهداف البحث: لقد أظهرت الدراسات المنشورة أن بعض المقيِّمين يضعون درجات نجاح لطلاب طب ما كان ينبغي لهم في حقيقة الأمر أن ينجحوا. فشل أعضاء هيئة التدريس هذا في ترسيب الطلاب ضعاف الأداء من الممكن أن يسيء إلى سمعة البرامج المهنية، سواء كان في الحقل الطبي أو خارجه. في الوقت نفسه، يصبح الطلاب الضعفاء أطباء غير أكفاء وبالتالي يعرِّضون المجتمع الذي يخدمونه للخطر. كان الدافع وراء إجراء هذه المراجعة المنهجية هو تحديد العوائق التي تمنع أعضاء هيئة التدريس من ترسيب طلاب الطب المتعثرين. طرق البحث: تم البحث في قواعد بيانات مدلاين، وسكوبس، ومكتبة وايلي على الإنترنت، ومكتبة كوكرين، وأوفد، وتَيلر وفرانسس، وسِنال، ورابط سبرنجر، وبروكويست وشبكة أي اس أي للمعرفة، تم البحث فيها باستخدام عناوين الموضوعات الطبية (مصطلحات ''مش”) التالية: ''ترسيب عضو هيئة التدريس '' و'' ترسيب الطلاب'' و''العجز عن الترسيب'' أو ''التقييم''. تم تنسيق البيانات وتحليل النتائج. النتائج: أظهر هذا البحث وجود وفرة من الحواجز لدى أعضاء هيئة التدريس تساهم في منعهم من الترسيب، مثل مخاوف أعضاء هيئة التدريس من الإجراءات القانونية، وعمليات الطعن، والتوتر من ترسيب الطلاب، ونقص المعرفة بالتوثيق المناسب، وعدم توافر مكاتب الدعم والموارد لأعضاء هيئة التدريس، وغياب التوجيهات الإدارية، وإجراءات الفصل المعقدة، التي تثني عضو هيئة التدريس عن ترسيب الطلاب. الاستنتاجات: ينبغي على برامج تطوير أعضاء الهيئة التدريسية في المؤسسة والورش التدريبية أن تيسر تعليم المشرفين والمقيِّمين على التقييم المتكرر والتوثيق المنتظم لتقييم المتدرب. كما نؤكد على ضرورة توفير المشورة القانونية في حالة الطعن ودعم ذوي الاختصاص من قبل مكتب الموارد والدعم. Abstract: Objectives: Literature has shown that some assessors assign passing grades to medical students who, in fact, should not have passed. This inability of the faculty to fail underperforming students can jeopardise the reputation of professional programs, be it in the medical field or beyond. Simultaneously, weak students become incompetent physicians and, thus, endanger the community they serve. The impetus for conducting this systematic review was to identify barriers to faculty in failing struggling medical students. Methods: The databases of MEDLINE, Scopus, Wiley online library, Cochrane library, OVID, Taylor and Francis, CINAHL, Springer link, ProQuest, and ISI Web of knowledge were searched using Medical Subject Headings (MeSH) terms ‘Faculty failure’ AND ‘Failing students’ AND ‘Failure to fail’ OR ‘Assessment’. The data were synthesised, and the results were analysed. Results: This search showed a wealth of barriers to faculty contributing to a ‘failure to fail’ such as their concerns about legal action and an appeals process; the stress of failing students; a lack of knowledge about proper documentation; unavailability of support, resources, and offices for faculty; absence of administrative guidelines; and complex dismissal procedures discouraging the faculty from failing students. Conclusion: Institutional faculty development programs and training workshops should facilitate the education of supervisors and assessors for timely evaluation and regular documentation of trainee assessment. The provision of legal advice in cases of appeal and professional support by the resource and support office is emphasised. الكلمات المفتاحية: التقييم, ترسيب أعضاء هيئة التدريس, ترسيب الطلاب, العجز عن الترسيب, التعليم الطبي, Keywords: Assessment, Faculty failure, Failing students, Failure to fail, Medical education

Background Medical professionalism education intends to produce virtuous and humanistic healthcare professionals who demonstrate perseverance and professional integrity. However, today’s medicine has embodied a mammoth transformation of medical practice towards sns and the digital realm. Such paradigm shift has challenged the medical professional’s values, behaviors, and identities, and the distinct boundaries between personal and professional lives are blurred. This study aims to develop a framework for healthcare professionals coping with the challenges of medical professionalism in the digital realm. Methods We followed a systematic approach for the development of a framework about e-professionalism. Qualitative data was collected from a systematic review and a delphi study, while quantitative data was collected by administering a validated questionnaire social networking sites for medical education (snsme). Subsequently, categorization of the selected data and identifying concepts, deconstruction and further categorizing concepts (philosophical triangulation), integration of concepts (theoretical triangulation), and synthesis and resynthesis of concepts were performed. Results The initial process yielded six overlapping concepts from personal, professional, character (implicit) and characteristic (explicit) domains: environment, behavior, competence, virtues, identity, and mission. Further integration of data was done for the development of the medical education e-professionalism (meep) framework with a central concept of a commitment to mission. The mission showed deep connections with values (conformity, beneficence, universalism, and integrity), behaviours (communication, self-awareness, tolerance, power), and identity (reflection, conscientiousness, self-directed, self-actualization). The data demonstrated that all medical professionals require updated expertise in sns participation. Conclusion The meep framework recognises a mission-based social contract by the medical community. This mission is largely driven by professional values, behaviors and identity. Adherence to digital standards, accountability, empathy, sensitivity, and commitment to society are essential elements of the meep framework.

أهداف البحث: على الرغم من وضوح مفهوم التعليم المتداخل بين التخصصات في البلدان المتقدمة، إلا أنه لا ينظر له بشكل موحد في البلدان النامية. تهدف هذه الدراسة إلى قياس مواقف أعضاء هيئة تدريس التخصصات الصحية تجاه التعليم المتداخل بين التخصصات وقياس الاختلافات المهمة المحتملة في الخصائص الديموغرافية لأعضاء هيئة التدريس وجاهزيتهم لدمج هذا التعليم المتداخل بين التخصصات في المناهج الحالية. طرق البحث: أجريت هذه الدراسة العشوائية البسيطة بواسطة توزيع استبانة مقياس جاهزية التعلم المتداخل بين التخصصات عشوائيا على ٢٠٠ عضو هيئة تدريس بالكليات الصحية في جامعة الدمام وجامعة طيبة في المملكة العربية السعودية. أجري الاستطلاع ورقيا بجامعة الدمام وعبر الإنترنت بجامعة طيبة. النتائج: متوسط الدرجة لجمع البنود (ماعدا- بند واحد) لمقياس جاهزية التعلم المتداخل بين التخصصات كانت مرتفعة (٣.٤ > المتوسط). وكانت هناك اختلافات ذات دلالة إحصائية بين الجنسين في القضايا المتعلقة بدور التعليم المتداخل بين التخصصات في تعزيز فهم الطلبة لحدود دورهم المهني، وكذلك في حاجة طلاب التخصصات الصحية للتعلم مع بعضهم. كما كانت هناك فروق ذات دلالة إحصائية بين استجابة أعضاء هيئة التدريس من جامعة الدمام وجامعة طيبة فيما يتعلق بتصورهم لدور التعليم المتداخل بين التخصصات في تعزيز التفكير الإيجابي عن غيرهم من المتخصصين في التخصصات الصحية. وكذلك اعتقادهم بأهمية عاملي الثقة والاحترام بين المهن في تحقيق نتائج ناجحة. أظهرت نتائج مقارنة مواقف أعضاء هيئة التدريس من مختلف الفئات العمرية وجود فروقات ذات دلالة إحصائية نحو التعليم المتداخل بين التخصصات يعتبر الإناث وأولئك الذين تتراوح أعمارهم بين ٤١ و ٥٠ عاما التعليم المتداخل بين التخصصات أكثر إيجابية من غيرهم. الاستنتاجات: أظهرت هذه الدراسة مواقف إيجابية لأعضاء هيئة تدريس التخصصات الصحية في كلا الجامعتين نحو التعليم المتداخل بين التخصصات. وقد توفر هذه النتائج المشجعة حافزا للانخراط المحتمل لأعضاء هيئة التدريس في الكليات الصحية السعودية في تقديم التعليم المتداخل بين التخصصات عند تطبيقه.

Due to the multi-dimensional characteristics of professionalism, no single assessment modality has shown to reliably assess professionalism. This review aims to describe some of the popular assessment tools that are being used to assess professionalism with a view to formulate a framework of assessment of professionalism in medicine. In December 2015, the online research databases of MEDLINE, the Educational Resources Information Center (ERIC), Elton Bryson Stephens Company (EBSCO), SCOPUS, OVID and PsychINFO were searched for full-text English language articles published during 2000 to 2015. MeSH terms “professionalism” AND “duty” AND “assessment” OR “professionalism behavioural” AND “professionalism– cognitive” were used. The research articles that assessed professionalism across medical fields along with other areas of competencies were included. A final list of 35 articles were selected for this review. Several assessment tools are available for assessing professionalism that includes, but not limited to, mini clinical evaluation exercise, standardised direct observation of procedural skills, professionalism mini-evaluation exercise, multi-source feedback and 360 degree evaluation, and case based discussions. Because professionalism is a complex construct, it is less likely that a single assessment strategy will adequately measure it. Since every single assessment tool has its own weaknesses, triangulation involving multiple tools can compensate the shortcomings associated with any single approach. Assessment of professionalism necessitates a combination of modalities at individual, interpersonal, societal, and institutional levels and should be accompanied by feedback and motivational reflection that will, in turn, lead to behaviour and identity formation. The assessment of professionalism in medicine should meet the criteria of validity, reliability, feasibility and acceptability. Educators are urged to enhance the depth and quality of assessment instruments in the existing medical curricula for ensuring validity and reliability of assessment tools for professionalism.

Background: Historically, operating room (OR) has always been considered as a stand-alone trusted platform for surgical education and training.However, concerns about financial constraints, quality control, and patient safety have urged the surgical educators to develop more cost-effective, surgical educational platforms that can be employed outside the OR. Furthermore, trained surgeons need to regularly update their surgical skills to keep abreast with the emerging surgical technologies. This research aimed to explore the value of currently available modern surgical tools that can be used outside the OR and also elaborates the existing laparoscopic surgical training programs in world-class centers across the globe with a view to formulate a blended and unified structured surgical training program. Materials and Methods: Several data sources were searched using MeSH terms “Laparoscopic surgery” and “Surgical training” and “Surgical curriculum” and “fundamentals of endoscopic surgery” and “fundamentals of laparoscopic surgery” and “Telementoring” and “Box trainer.” The eligibility criteria used in data extraction searched for original and review articles and by excluding the editorial articles, short communications, conference proceedings, personal view, and commentaries. Data synthesis and data analysis were done by reviewing the initially retrieved 211 articles. Irrelevant and duplicate and redundant articles were excluded from the study. Results: Finally, 12 articles were selected for this systematic review. Data results showed that a myriad of cutting-edge technical innovations have provided modern surgical training tools such as the simulation-based mechanical and virtual reality simulators, animal and cadaveric labs, telementoring, telerobotic-assisted surgery, and video games. Surgical simulators allow the trainees to acquire surgical skills in a tension-free environment without supervision or time constraints. Conclusion: The existing world-renowned surgical training centers employ various clusters of training tools that essentially endeavor to embed the acquisition of knowledge and technical skills. However, a unified training curriculum that may be accepted worldwide is currently not available.

Evolution of the synthetic strategy that culminated in the first total syntheses of the structurally unique plectosphaeroic acids B (2) and C (3) is described. The successful enantioselective route to (+)-2 and (+)-3 proceeds in 6 and 11 steps from the known hexahydro-2H-pyrazinopyrrolo[2,3-b]indole-1,4-dione 39, which in turn is available in enantiomerically pure form by chemical synthesis. The central challenge in this synthesis endeavor was uniting the hexahydro-2H-pyrazinopyrrolo[2,3-b]indole-1,4-dione and cinnabarinic acid fragments of these marine alkaloids. Critical for achieving this successful C-N bond formation was the use of an iodocinnabarinic acid diester in which the amino group was masked with two Boc substituents, a Cu(I) carboxylate complex and the weak base KOAc. The highly congested C-N bond generated in this coupling, in conjunction with the delicate nature of the densely functionalized coupling partners, provided a striking testament to the power of modern copper-mediated amination methods. Two approaches, one stereoselective, for introducing the methylthio substituents of (+)-plectosphaeroic acid B were developed. The epitrisulfide ring of (+)-plectosphaeroic acid C was formed by ring expansion of an epidisulfide precursor.

Abstract Background Empathy is an essential core competency for future doctors. Unfortunately, the medical curriculum is infamously known to burn out aspiring doctors, which may potentially lead to a decline in empathy among medical students. This research was planned to understand the evolution of empathic approaches among students across the curriculum using the Interpersonal reactivity index (IRI) as a benchmark at the Royal College of Surgeons in Ireland - Medical University of Bahrain (RCSI-MUB) and University of Sharjah (UoS). Methods We adopted a cross-sectional design and administered an online survey to the medical students of RCSI-MUB and UoS using a modified version of the IRI along with its three subscales of empathic concern (EC), perspective taking (PT), and personal distress (PD). To identify intra- and inter-institutional variations in empathy scores, the Analysis of Variance (ANOVA) was performed separately for each institution and with both institutions combined. A two-way ANOVA was conducted for the comparison between years and institutions. For the subscale analysis of EC, PT, and PD, we used one-way ANOVA for significant differences between years at both institutions. For the gender-effect analysis, t-test was performed to examine the differences in total IRI scores at both institutions combined and at each institution separately. Additionally, an Analysis of Covariance (ANCOVA) was done to identify the influence of gender on empathy scores. Results A total of 140 students from both institutions participated in this study. We found a fluctuating pattern of empathy scores without a clear trend across the years. The sub-scales of EC, PD, and PT across academic years at both institutions showed significant differences within the EC at RCSI-MUB (p = 0.003). No significant differences were identified across other years from both institutions. There were significant differences between empathy scores from RCSI-MUB and UoS for EC (p = 0.011). Additionally, a pronounced interaction effect between year and institution was observed for PT (p = 0.032). The gender-wise analysis showed that female students had higher empathy scores than males (p = 0.004). The ANCOVA for IRI score results revealed a p-value of 0.023, indicating that gender plays a crucial role in empathy levels among medical students. The ANCOVA results revealed a p-value of 0.022 in the EC subscale. Conclusion Our study unveiled intricate patterns in empathy development among medical students across years and genders at RCSI-MUB and UoS. These congruences and dissimilarities in empathy scores signal a subjective understanding of empathy by medical students. The disparities in understanding may encourage medical educators to embed empathy in standard medical curricula for better healthcare outcomes.

Securing computers is crucial to prevent data breaches, identity theft, and financial losses. Virus incursions disrupt operations, causing downtime and costly repairs. Protective measures, including anti-virus software and cybersecurity practices, maintain network integrity and reduce the spread of malware. Combining robust cybersecurity with green computing strategies ensures efficient energy usage and sustainable network environments, safeguarding against viruses while contributing to both security and environmental goals In this study, we explore the dynamic behaviors of a modified version of the computer virus model and elucidate the connection between its parameters and network attributes. We employ Banach’s and Schaefer’s fixed-point theorems to assess the existence and uniqueness of solutions of the suggested model. Furthermore, we establish sufficient conditions for Ulam–Hyers stability within the envisioned computer virus model. To analyze solution trajectories and the impact of various input factors on computer virus dynamics, we utilize an efficient numerical technique, providing insight into the relationships between model parameters and enabling the design of networks that minimize the risk of virus outbreaks under various bifurcation conditions.

Abstract Simulation in healthcare, empowered by big data analytics and artificial intelligence (AI), has the potential to drive transformative innovations towards enhanced interprofessional collaboration (IPC). This convergence of technologies revolutionizes medical education, offering healthcare professionals (HCPs) an immersive, iterative, and dynamic simulation platform for hands-on learning and deliberate practice. Big data analytics, integrated in modern simulators, creates realistic clinical scenarios which mimics real-world complexities. This optimization of skill acquisition and decision-making with personalized feedback leads to life-long learning. Beyond clinical training, simulation-based AI, virtual reality (VR), and augmented reality (AR) automated tools offer avenues for quality improvement, research and innovation, and team working. Additionally, the integration of VR and AR enhances simulation experience by providing realistic environments for practicing high-risk procedures and personalized learning. IPC, crucial for patient safety and quality care, finds a natural home in simulation-based education, fostering teamwork, communication, and shared decision-making among diverse HCP teams. A thoughtful integration of simulation-based medical education into curricula requires overcoming its barriers such as professional silos and stereo-typing. There is a need for a cautious implantation of technology in clinical training without overly ignoring the real patient-based medical education.

OBJECTIVES Leadership within medical academic institutions often adheres to hierarchical structures, relying on factors like seniority and context, with limited focus on leadership development. This study aims to develop a structured framework by examining the traits, aspirations, and pre-requisites of academic leaders within medical school faculties. METHODS A cross-sectional study collected input from regular medical faculty and those in leadership roles through an online questionnaire, followed by quantitative and qualitative analyses. Data was curated, analyzed, and triangulated to establish subdomains, domains, and themes for the framework. RESULTS Among 229 respondents, 121 held formal academic leadership roles, the remaining 108 were regular medical faculty. And 92% of regular faculty cited lack of experience and training as significant barriers to effective leadership. Both groups agreed on the need for intensive leadership training, as 85% of leaders and 66% of regular faculty lacked formal academic leadership training. The concept of affiliative leadership was favored by 45% of leaders. Qualitative analysis and subtheme triangulation led to the development of the 6 Es Framework for Leadership in Academic Medicine (FLAM). This framework encompasses: ethics (accountability and role modeling), education (structured curriculum and training), envision (clear path and talent identification), engagement (structural foundation and attainable goals), empowerment (fostering passion), and encouragement (financial incentives). CONCLUSION This research reinforces the necessity of structured leadership development in academic medicine. The unique attributes of the 6Es FLAM have the potential to enhance leadership in this field.

Abstract Background Healthcare systems rely on well-trained family medicine physicians who can offer continuous quality services to their communities and beyond. The American Academy of Family Physicians and the World Organization of Family Doctors recommend that medical curricula should have adequately supervised education and training of the learners in family medicine during their preclinical and clinical placements. However, some medical schools don’t have a comprehensive family medicine program to prepare graduates who can meet the community needs. This work aims to report the essential steps for the development, implementation, and evaluation of the family medicine program at the College of Medicine at the University of Sharjah in United Arab Emirates. Methods We used the Kern’s 6-step model to describe the development, implementation, and evaluation of the family medicine program. This includes problem identification, needs assessment, goals setting, educational strategies, implementation, and evaluation. During 2014–2022, we longitudinally collected essential information about the family medicine program from different stakeholders including the feedback of clinical coordinators, adjunct clinical faculty, and medical students at the end-of-clerkship. All responses were analysed to determine the effective implementation and evaluation of the family medicine program. Results Over the course of 8 academic years, 804 medical students, 49 adjunct clinical faculty and three College of Medicine faculty participated in the evaluation of the family medicine program. The majority of respondents were satisfied with various aspects of the family medicine program, including the skills gained, the organisation of program, and the variety of clinical encounters. The medical students and adjunct clinical faculty suggested the inclusion of e-clinics, faculty development program, and the expansion of more clinical sites for the effectiveness of the family medicine program. Conclusions We report a successful development, implementation, and evaluation of the family medicine program in United Arab Emirates with a positive and impactful learning experience. More attention should be paid towards a suitable representation of family medicine program in the medical curriculum with focused and targeted educational plans for medical students.

Background There has been an alarming surge in the usage of social networking sites (SNSs) by healthcare professionals (HCPs) without adherence to the principles of professionalism. The widespread use of SNSs in medical practices has been coupled with reports of breaches of professional behaviors. Despite the benefits of SNSs, skepticism prevails about a clearly defined role for SNSs within medicine based upon the core principles of professionalism. Thus, there is a need to understand the manifestations of professionalism in the digital context, classically known as e-professionalism. This study systematically examines HCPs’ perceptions of e-professionalism to advance a thorough understanding of e-professionalism.Methods This concept analysis was performed using the principle-based approach of Penrod and Hupcey. In January 2023, we searched the databases of PubMed and ISI Web of Science for English-language articles specific to ‘e-professionalism’ in the medical field. The final selected research corpus of 63 articles was analyzed in this study.Results A comprehensive analysis of the selected articles highlighted that e-professionalism is an epistemologically mature and distinct concept by a standard definition. However, inconsistencies in conceptual meanings were reported due to varied interpretations despite digital literacy. The pragmatic utility showed a lack of sound methodological and philosophical paradigms. Perhaps the rapid technological advancements and manifestations have hampered linguistic maturity. However, logically, e-professionalism is perceived as an extension of conventional professionalism but with a focus on a distinct framework with a set of attributes to be digitally relevant.Conclusion This study identifies a scarcity of research about the collective perspective of essential stakeholders, underpinning the need to further explore e-professionalism due to its emerging complex nature within the digital context. There is also a recognition that a framework is essential to guide future HCPs to yield a profound understanding and to provide remediation strategies in the rapidly advancing medical field in digital realm.

Existing public sector management literature requires an empirical examination of the relationship between change readiness, organizational agility, and public value-driven innovation performance. Moreover, how organizational structure moderates these relationships in the public sector context is still being determined. This study aims to address this gap by collecting data from 421 top management respondents working in public services in the United Arab Emirates. The hypotheses are tested using a structural equation model. The study's findings confirm that change readiness positively influences organizational agility and reveals the positive effects of organizational agility on public value-driven innovation performance in public service organizations. Additionally, this study highlights that change readiness directly affects public value-driven innovation performance. Simultaneously, organizational structure (formalization and centralization) affects the relationships between change readiness and public value-driven innovation performance, and organizational agility and public value-driven innovation performance. Finally, this study shows that organizational structure (centralized and formalized) impacts the relationship between change readiness and organizational agility. This study contributes substantially to the existing knowledge on the relationships between change readiness, organizational agility, organizational structure, and public value-driven innovation performance.