Browsing by Author "Zary, Nabil"

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Applications and Challenges of Implementing Artificial Intelligencein Medical Education: Integrative Review
(2019-05) Zary, Nabil
Background: Since the advent of artificial intelligence (AI) in 1955, the applications of AI have increased over the years within a rapidly changing digital landscape where public expectations are on the rise, fed by social media, industry leaders, and medical practitioners. However, there has been little interest in AI in medical education until the last two decades, with only a recent increase in the number of publications and citations in the field. To our knowledge, thus far, a limited number of articles have discussed or reviewed the current use of AI in medical education. Objective: This study aims to review the current applications of AI in medical education as well as the challenges of implementing AI in medical education. Methods: Medline (Ovid), EBSCOhost Education Resources Information Center (ERIC) and Education Source, and Web of Science were searched with explicit inclusion and exclusion criteria. Full text of the selected articles was analyzed using the Extension of Technology Acceptance Model and the Diffusions of Innovations theory. Data were subsequently pooled together and analyzed quantitatively. Results: A total of 37 articles were identified. Three primary uses of AI in medical education were identified: learning support(n=32), assessment of students’ learning (n=4), and curriculum review (n=1). The main reasons for use of AI are its ability to provide feedback and a guided learning pathway and to decrease costs. Subgroup analysis revealed that medical undergraduates are the primary target audience for AI use. In addition, 34 articles described the challenges of AI implementation in medical education; two main reasons were identified: difficulty in assessing the effectiveness of AI in medical education and technical challenges while developing AI applications. Conclusions: The primary use of AI in medical education was for learning support mainly due to its ability to provide individualized feedback. Little emphasis was placed on curriculum review and assessment of students’ learning due to the lack of digitalization and sensitive nature of examinations, respectively. Big data manipulation also warrants the need to ensure data integrity. Methodological improvements are required to increase AI adoption by addressing the technical difficulties of creating an AI application and using novel methods to assess the effectiveness of AI. To better integrate AI into the medical profession,measures should be taken to introduce AI into the medical school curriculum for medical professionals to better understand AI algorithms and maximize its use.
Assessment as Learning in Medical Education: Feasibility and Perceived Impact of Student-Generated Formative Assessments
(2022-07) Lakhtakia, Ritu; Otaki, Farah; Alsuwaidi, Laila; Zary, Nabil
Background: Self-regulated learning (SRL) is gaining widespread recognition as a vital competency that is desirable to sustain lifelong learning, especially relevant to health professions education. Contemporary educational practices emphasize this aspect of undergraduate medical education through innovative designs of teaching and learning, such as the flipped classroom and team-based learning. Assessment practices are less commonly deployed to build capacity for SRL. Assessment as learning (AaL) can be a unique way of inculcating SRL by enabling active learning habits. It charges students to create formative assessments, reinforcing student-centered in-depth learning and critical thinking. Objective: This study aimed to explore, from the learners’ perspectives, the feasibility and perceived learning impact of student-generated formative assessments. Methods: This study relied on a convergent mixed methods approach. An educational intervention was deployed on a cohort of 54 students in the second year of a 6-year undergraduate medical program as part of a single-course curriculum. The AaL intervention engaged students in generating assessments using peer collaboration, tutor facilitation, and feedback. The outcomes of the intervention were measured through quantitative and qualitative data on student perceptions, which were collected through an anonymized web-based survey and in-person focus groups, respectively. Quantitative survey data were analyzed using SPSS (IBM), and qualitative inputs underwent thematic analysis. Results: The students’overall score of agreement with the AaL educational intervention was 84%, which was strongly correlated with scores for ease and impact on a 5-point Likert-type scale. The themes that emerged from the qualitative analysis included prominent characteristics, immediate gains, and expected long-term benefits of engagement. The prominent characteristics included individuals’ engagement, effective interdependencies, novelty, and time requirements. The identified immediate gains highlighted increased motivation and acquisition of knowledge and skills. The expected long-term benefits included critical thinking, problem solving, and clinical reasoning. Conclusions: As a form of AaL, student-generated assessments were perceived as viable, constructive, and stimulating educational exercises by the student authors. In the short term, the activity provided students with a fun and challenging opportunity to dive deeply into the content, be creative in designing questions, and improve exam-taking skills. In the long term, students expected an enhancement of critical thinking and the inculcation of student-centered attributes of self-regulated lifelong learning and peer collaboration, which are vital to the practice of medicine
Assessment of Clinical Information Quality in Digital Health Technologies: International eDelphi Study
(2022-12) Zary, Nabil
Background: Digital health technologies (DHTs), such as electronic health records and prescribing systems, are transforming health care delivery around the world. The quality of information in DHTs is key to the quality and safety of care. We developed a novel clinical information quality (CLIQ) framework to assess the quality of clinical information in DHTs. Objective: This study explored clinicians' perspectives on the relevance, definition, and assessment of information quality dimensions in the CLIQ framework. Methods: We used a systematic and iterative eDelphi approach to engage clinicians who had information governance roles or personal interest in information governance; the clinicians were recruited through purposive and snowball sampling techniques. Data were collected using semi structured online questionnaires until consensus was reached on the information quality dimensions in the CLIQ framework. Responses on the relevance of the dimensions were summarized to inform decisions on retention of the dimensions according to prespecified rules. Thematic analysis of the free-text responses was used to revise definitions and the assessment of dimensions. Results: Thirty-five clinicians from 10 countries participated in the study, which was concluded after the second round. Consensus was reached on all dimensions and categories in the CLIQ framework: informativeness (accuracy, completeness, interpretability, plausibility, provenance, and relevance), availability (accessibility, portability, security, and timeliness), and usability (conformance, consistency, and maintainability). A new dimension, searchability, was introduced in the availability category to account for the ease of finding needed information in the DHTs. Certain dimensions were renamed, and some definitions were rephrased to improve clarity. Conclusions: The CLIQ framework reached a high expert consensus and clarity of language relating to the information quality dimensions. The framework can be used by health care managers and institutions as a pragmatic tool for identifying and forestalling information quality problems that could compromise patient safety and quality of care.
Contextual Conversational Agent to Address Vaccine Hesitancy: Protocol for a Design-Based Research Study
(2022-08) Zidoun, Youness; Kaladhara, Sreelekshmi; Powell, Leigh; Nour, Radwa; Al Suwaidi, Hanan; Zary, Nabil
Abstract: Background: Since the beginning of the COVID-19 pandemic, people have been exposed to misinformation, leading to many myths about SARS-CoV-2 and the vaccines against it. As this situation does not seem to end soon, many authorities and health organizations, including the World Health Organization (WHO), are utilizing conversational agents (CAs) in their fight against it. Although the impact and usage of these novel digital strategies are noticeable, the design of the CAs remains key to their success. Objective: This study describes the use of design-based research (DBR) for contextual CA design to address vaccine hesitancy. In addition, this protocol will examine the impact of DBR on CA design to understand how this iterative process can enhance accuracy and performance. Methods: A DBR methodology will be used for this study. Each phase of analysis, design, and evaluation of each design cycle inform the next one via its outcomes. An anticipated generic strategy will be formed after completing the first iteration. Using multiple research studies, frameworks and theoretical approaches are tested and evaluated through the different design cycles. User perception of the CA will be analyzed or collected by implementing a usability assessment during every evaluation phase using the System Usability Scale. The PARADISE (PARAdigm for Dialogue System Evaluation) method will be adopted to calculate the performance of this text-based CA. Results: Two phases of the first design cycle (design and evaluation) were completed at the time of this writing (April 2022). The research team is currently reviewing the natural-language understanding model as part of the conversation-driven development (CDD) process in preparation for the first pilot intervention, which will conclude the CA’s first design cycle. In addition, conversational data will be analyzed quantitatively and qualitatively as part of the reflection and revision process to inform the subsequent design cycles. This project plans for three rounds of design cycles, resulting in various studies spreading outcomes and conclusions. The results of the first study describing the entire first design cycle are expected to be submitted for publication before the end of 2022. Conclusions: CAs constitute an innovative way of delivering health communication information. However, they are primarily used to contribute to behavioral change or educate people about health issues. Therefore, health chatbots’ impact should be carefully designed to meet outcomes. DBR can help shape a holistic understanding of the process of CA conception. This protocol describes the design of VWise, a contextual CA that aims to address vaccine hesitancy using the DBR methodology. The results of this study will help identify the strengths and flaws of DBR’s application to such innovative projects.
Conversational Agents in Health Education:Protocol for a Scoping Review
(2022) Al Suwaidi, Hanan; Powell, Leigh; Nizam, Mohammed Zayan; Nour, Radwa; Zidoun, Youness; Sleibi, Randa; Warrier, Sreelekshmi Kaladhara; Zary, Nabil
Background: Conversational agents have the ability to reach people through multiple mediums, including the online space, mobile phones, and hardware devices like Alexa and Google Home. Conversational agents provide an engaging method of interaction while making information easier to access. Their emergence into areas related to public health and health education is perhaps unsurprising. While the building of conversational agents is getting more simplified with time, there are still requirements of time and effort. There is also a lack of clarity and consistent terminology regarding what constitutes a conversational agent, how these agents are developed, and the kinds of resources that are needed to develop and sustain them. This lack of clarity creates a daunting task for those seeking to build conversational agents for health education initiatives. Objective: This scoping review aims to identify literature that reports on the design and implementation of conversational agents to promote and educate the public on matters related to health. We will categorize conversational agents in health education in alignment with current classifications and terminology emerging from the marketplace. We will clearly define the variety levels of conversational agents, categorize currently existing agents within these levels, and describe the development models, tools, and resources being used to build conversational agents for health care education purposes. Methods: This scoping review will be conducted by employing the Arksey and O’Malley framework. We will also be adhering to the enhancements and updates proposed by Levac et al and Peters et al. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews will guide the reporting of this scoping review. A systematic search for published and grey literature will be undertaken from the following databases: (1) PubMed, (2) PsychINFO, (3) Embase, (4) Web of Science, (5) SCOPUS, (6) CINAHL, (7) ERIC, (8) MEDLINE, and (9) Google Scholar. Data charting will be done using a structured format. Results: Initial searches of the databases retrieved 1305 results. The results will be presented in the final scoping review in a narrative and illustrative manner. Conclusions: This scoping review will report on conversational agents being used in health education today, and will include categorization of the levels of the agents and report on the kinds of tools, resources, and design and development methods used.
COVID-19 vaccine hesitancy: A narrative review of four South Asian countries
(2022) Ennab, Farah; Zary, Nabil; Nawaz, Faisal A.
Objectives: Vaccine hesitancy remains a global issue, especially within poverty-stricken countries where there’s an interplay of financial and nonfinancial barriers. This narrative review aims to understand attitudes and behaviors toward COVID-19 vaccination in four South Asian countries and make context-specific recommendations to vaccine program drivers and decision-makers. Methods: A search was conducted using PubMed and Science Direct, and CINHAL from January 2020 up to May 2022 restricted to the English language for terms: “Afghanistan” OR “Pakistan” OR “India” OR “Bangladesh” in combination with “COVID-19 vaccine” and other related terms. All articles were initially included, and those with relevance were included in the synthesis of this paper. Results: A narrative review was performed for this study. Our narrative review included a total of eighteen studies with a sample size (n = 223–5,237) averaging about 1,325 participants per study conducted. The studies included revealed public hesitancy to receive the COVID-19 vaccine ranging from 6.3 to 56.2% with an average of 31.63% across all eighteen studies. Several reasons were linked to this observation in these four South Asian countries, and the predominant ones included: Insufficient information provided to the general public about the side effects of the vaccines, concerns regarding vaccine safety, and skepticism of vaccine efficacy. Conclusion: Vaccine hesitancy is a global problem within the context of COVID-19, and issues regarding equity, misinformation, and poverty in South Asian countries makes it di cult to meet goals for herd immunity. Policymakers and governments should aim toward financial and non-financial incentives to drive the public toward vaccination.
Diagnostic Markers of User Experience, Play, and Learning for Digital Serious Games: A Conceptual Framework Study
(2019-07-16) Zary, Nabil
Background: Serious games for medical education have seen a resurgence in recent years, partly due to the growth of the video game industry and the ability of such games to support learning achievements. However, there is little consensus on what the serious and game components in a serious game are composed of. As a result, electronic learning (e-learning) and medical simulation modules are sometimes mislabeled as serious games. We hypothesize that one of the main reasons is the difficulty for a medical educator to systematically and accurately evaluate key aspects of serious games. Objective: This study aimed to identify markers that can evaluate serious games and distinguish between serious games, entertainment games, and e-learning. Methods: Jabareen’s eight-phase framework-building procedure was used to identify the core markers of a serious game. The procedure was modified slightly to elicit “diagnostic criteria” as opposed to its original purpose of a conceptual framework. Following the identification of purported markers, the newly developed markers were tested on a series of freely available health care serious games—Dr. Game Surgeon Trouble, Staying Alive, and Touch Surgery—and the results were compared to the published test validity for each game. Results: Diagnostic criteria for serious games were created, comprising the clusters of User Experience (UX), Play, and Learning. Each cluster was formed from six base markers, a minimum of four of which were required for a cluster to be considered present. These criteria were tested on the three games, and Dr. Game Surgeon Trouble and Staying Alive fit the criteria to be considered a serious game. Touch Surgery did not meet the criteria, but fit the definition of an e-learning module. Conclusions: The diagnostic criteria appear to accurately distinguish between serious games and mediums commonly misidentified as serious games, such as e-learning modules. However, the diagnostic criteria do not determine if a serious game will be efficacious; they only determine if it is a serious game. Future research should include a much larger sample of games designed specifically for health care purposes.
Digital Health for Supporting Precision Medicine in Pediatric Endocrine Disorders: Opportunities for Improved Patient Care
(2021) Zary, Nabil
Abstract: Digitalization of healthcare delivery is rapidly fostering development of precision medicine. Multiple digital technologies, known as telehealth or eHealth tools, are guiding individualized diagnosis and treatment for patients, and can contribute significantly to the objectives of precision medicine. From a basis of “one-size-fits-all” healthcare, precision medicine provides a paradigm shift to deliver a more nuanced and personalized approach. Genomic medicine utilizing new technologies can provide precision analysis of causative mutations, with personalized understanding of mechanisms and effective therapy. Education is fundamental to the telehealth process, with artificial intelligence (AI) enhancing learning for healthcare professionals and empowering patients to contribute to their care. The Gulf Cooperation Council (GCC) region is rapidly implementing telehealth strategies at all levels and a workshop was convened to discuss aspirations of precision medicine in the context of pediatric endocrinology, including diabetes and growth disorders, with this paper based on those discussions. GCC regional investment in AI, bioinformatics and genomic medicine, is rapidly providing healthcare benefits. However, embracing precisionmedicine is presenting some major new design, installation and skills challenges. Genomic medicine is enabling precision and personalization of diagnosis and therapy of endocrine conditions. Digital education and communication tools in the field of endocrinology include chatbots, interactive robots and augmented reality. Obesity and diabetes are a major challenge in the GCC region and eHealth tools are increasingly being used for management of care. With regard to growth failure, digital technologies for growth hormone (GH) administration are being shown to enhance adherence and response outcomes. While technical innovations become more affordable with increasing adoption, we should be aware of sustainability, design and implementation costs, training of HCPs and prediction of overall healthcare benefits, which are essential for precision medicine to develop and for its objectives to be achieved.
Effect of introducing interprofessional education concepts on students of various healthcare disciplines: a pre-post study in the United Arab Emirates
(2022-07) Zaher, Shroque; Otaki, Farah; Zary, Nabil
Background: The value of inter professional education (IPE) in nurturing healthcare professionals, and in shaping their professional identities, and their attitudes towards interdisciplinary teamwork and collaboration is established in the literature. IPE is an emerging concept in the Middle East and North Africa (MENA) region and is new to the United Arab Emirates (UAE). To date, the applicability and feasibility of IPE and of the corresponding collaborative practice in MENA countries remain largely unexamined. Purpose: To investigate the effect of one of the first experiences of IPE in the UAE, which was purposefully designed in alignment with the principles of the Situated Learning Theory (SLT), on the readiness for inter professional learning and collaboration among students of various healthcare disciplines in the UAE. Methods: A pre-post intervention quantitative research design was adopted for this study. The intervention focused on communication skills, and consisted of 2 tailor-made case-based scenarios. A total of 90 students (40 medical, 16 nursing, 16 pharmacy, and 18 physiotherapy), spread across two sessions (1 session per academic year across 2 academic years), took part in the IPE intervention. Readiness for Inter professional Learning Scale (RIPLS) was used as the pre- and post- intervention assessments; aggregate data was analyzed using SPSS. Results: Of those who participated in the intervention (across both rounds), 77 participants responded to the preassessment (85. 6%) and 84 responded to the post-assessment (93. 3%). The IPE intervention under investigation signifcantly increased the level of readiness to engage in cross-disciplinary learning and collaboration among participating health professions’ students. In terms of the subscales, the participants’ openness to engage in teamwork was raised and their professional identity was fostered. Yet, no statistical significance around clarity of roles and responsibilities was detected. Conclusion: The findings of this study encourage other universities in the MENA region to adopt IPE to improve future health professionals’ capacity to develop shared understanding and mutual respect within cross-disciplinary teams. This, ultimately, feeds into improved quality of care and patient outcomes.
Elements that underpin the design, development and evaluation of social media health interventions. A Scoping Review Protocol
(2021) Nizam, Mohammed Zayan; Powell, Leigh; Zary, Nabil
Background: Social media use has grown tremendously over the years. Given the volume of people on social media and the amount of information being exchanged, it is perhaps unsurprising that social media is being used to promote health interventions. There exists an opportunity for social media-driven health interventions to make a positive impact on health. There is a need to explore the current state of this field, including the platforms being used, models of design, models of behavior change, and evaluation that underpin social media health interventions. This scoping protocol will help to inform those who wish to develop such health interventions. Objective: The main objective of this scoping review protocol is to map the landscape of health interventions disseminated through social media. In addition to which we aim to understand what models of design, models of behavior change, and evaluation underpin social media health interventions. Methods: The methodological framework for this review is guided by Arksey and O’Malley and enhancements by Levac et al. and Peters et al. We will search relevant literature from 9 databases (1) PubMed, (2) PsychINFO, (2) Embase, (4) Web of Science, (5) SCOPUS, (6) CINAHL, (7) ERIC, (8) MEDLINE, (9) Google Scholar. The literature will be screened by at least two reviewers in two stages 1) Title/Abstract screening against the eligibility criteria; eligible articles will then undergo full text screening. Data will be charted using the data charting tool developed by the authors. Results: The results of this study will be presented in the final scoping review in two sections. The first section will describe the search strategy and study selection process and will contain the PRISMA flow chart. The second section will provide key details pertaining to the review objective and question. Conclusions: Our scoping review will provide insights into the use of social media in the field of health intervention. Using social media to drive health interventions is an emerging way of reaching diverse audiences. This scoping review provides an opportunity to explore the current state of the field and help to inform others who wish to enter into the space of social mediadriven health interventions to improve health outcomes.
Exploring the value of the learners perception of teaching effectiveness in informing faculty development needs: A mixed-methods study
(2020) Otaki, Farah; Hassan Khamis, Amar; AlGurg, Reem; Davis, Dave; Zary, Nabil
Abstract: The evaluation of a faculty development intervention needs to start at the outset, and not as an afterthought. Moreover, it is important to evaluate the degree to which the predefined impact is attained as a result to the learning and development opportunity. This calls for the engagement of the ultimate receivers: the students, who are wellpositioned to identify gaps in the teaching performance of their own instructors. Accordingly, this mixed-methods study aims at shedding light on a Continuous Quality Improvement system where feedback from undergraduate and postgraduate students is assembled to pinpoint faculty development needs, based on which professional development opportunities are devised. Data was extracted from an annual survey that evaluates the students’ satisfaction. Qualitative data was thematically analysed, and quantitative data was analysed using SPSS. The qualitative analysis resulted in six categories of recommendations, that were fit into two themes: dynamic between the instructors and students, and organization and delivery of the program. As for the quantitative analysis, the students indicated opportunities for improvement in the following two areas: student academic advising process (55.17%), and communication between instructors and students (50.59%). The study concluded that there is added value in capturing and effectively assembling the learners’ perception of faculty performance. It raises the reliability of the implemented evaluation framework, and has the potential of improving the rigor of faculty development initiatives.
Feasibility and Educational Value of Clinical Cases Generated Using Large Language Models
(2024-08) Berbenyuk, Anna; Powell, Leigh; Zary, Nabil
Abstract In medical education, case-based learning (CBL) is a fundamental method for training healthcare professionals across different levels of expertise. This approach hinges on using authentic or fabricated clinical cases to bridge the gap between theoretical knowledge and its practical application. It fosters active engagement and knowledge application among learners in healthcare domains. While creating effective cases demands substantial clinical understanding and time investment, the integration of Generative Artificial Intelligence (AI) presents a promising solution to this challenge. AI can efficiently analyze extensive medical data to generate diverse and realistic clinical scenarios, continuously updating case content based on emerging medical literature and guidelines. This study explores AI-generated cases' feasibility and educational value in continuing medical education, focusing on COVID-19 scenarios tailored for the MENA region. Results indicate the potential of AI-generated cases to foster engagement and critical thinking among learners, suggesting their suitability for different levels of education. This study highlights the advantages of integrating AI into CBL and emphasizes the need for future efforts to tackle obstacles and facilitate its successful adoption.
Identification of Key Factors for Optimized Healthcare Services: A Protocol for a Multi-phase Study of the Dubai Vaccination Campaign
(2022) Faroun, Hayette; Zary, Nabil; Gad, Kareem; Al Suwaidi, Hanan
Background: Mass vaccination of the global population against the novel coronavirus (COVID-19) posed multiple challenges, including effectively administering millions of doses in a short period of time while ensuring public safety and accessibility. The Government of Dubai launched a mass campaign in December 2020 to vaccinate all its citizens and residents, targeting the population over the age of 18 against COVID-19. The vaccination campaign involved a transformation of multiple commercial spaces into mass vaccination centers (MVCs) across the city of Dubai, the largest of which was the Dubai One Central (DOC) Vaccination Center. It was operational between 17 January 2021 and 27 January 2022. Objective: The multi-phase research study aims to empirically explore the opinions of multiple healthcare stakeholders, elicit the key success factors that can influence the effective delivery of emergency healthcare services such as COVID-19 MVCs, and explore how these factors relate to one another. Method: To understand more about the operations of the Dubai One Central vaccination center, the study follows a multi-phase design divided into two main sections. The study is conducted by the Institute for Excellence in Health Professions Education (ieHPE) at Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) between December 2021 and January 2023. To elicit the key success factors that contributed to the vaccination campaign administered at DOC, the research team conducted 30 semi-structured interviews (SSI) with a sample of staff and volunteers who worked at the DOC vaccination center. Stratified random sampling was used to select the participants, and the interview cohort included representatives from the management team, team leaders, administration and registration team, vaccinators, and volunteers. A total of 103 people were invited to take part in the research study and 30 people accepted to participate in the SSI interviews. To validate the participation of various stakeholders, the second phase analytically investigated one’s subjectivity through Q-methodology and empirically investigating the opinions obtained from the research participants during phase 1. Results: As of July 2022, 30 semi-structured interviews were conducted with the research participants. The expected results from the project's first phase will be the identification of key success factors, enablers, and barriers of the design and operation of the Covid-19 vaccination center at DOC. While the expected results from the study's second phase will identify patterns of similarities and differences in the ranking of the Q-sets. The final set of results from this dataset will quantitatively interpret the common answers amongst participants and the correlation between the selected success factors relating to the study. Conclusions: The study will provide a comprehensive two-phase approach to obtaining the key success factors that can influence the delivery of high-quality healthcare services such as emergency services launched during a global pandemic. The study's findings will be translated into key factors that could support designing future healthcare services utilizing evidence-based practice. In line with future plans, a study will use data, collected through the One Central vaccination center, to develop a simulation model outlining the process of the customer journey and center workflow.
Imagining the Future of Learning in Healthcare: The GAME 2019 #FuturistForum
(2021) Zary, Nabil
Abstract: The GAME 2019 #FuturistForum involved an exchange of ideas and perspectives on the future of learning in healthcare and necessary evolutions to sustain future health systems. This event allowed for reflection and discourse around a) what medical learning or learning in healthcare may look like 10–15 years from now, b) how technology would impact that evolution, and c) what collaborative roles distinct stakeholders would play. Seventy-five (75) key stakeholders, experts from various fields, participated in the two-day event. Four multifaceted themes were uncovered from the qualitative analysis, which are: learning will be lifelong and outcome-based, the health system will follow a preventive care model, technology will be an enabler of evolution in education and health systems, and that multi-level collaboration will support and sustain future progress. Future implications, exacerbated by the ongoing COVID-19 pandemic, and study limitations are described.
An Inquiry-Based Distance Learning Tool for Medical Students Under Lockdown (“COVID-19 Rounds”): Cross-Sectional Study
(2023) Akhras, Aya; ElSaban, Mariam; Selvan, Varshini Tamil; Alzaabi, Shaika Zain; Senok, Abiola; Zary, Nabil; Ho, Samuel B
Background: The COVID-19 pandemic presented significant challenges to both clinical practice and the delivery of medical education. Educators and learners implemented novel techniques, including distance learning and web-based rounds, while trying to stay updated with the surge of information regarding COVID-19 epidemiology, pathogenesis, and treatment. Hence, we designed and implemented a technologically enhanced course called “COVID-19 Rounds” to educate students about the rapidly evolving pandemic. Objective: The objectives of this study are to describe a technologically enhanced course called “COVID-19 Rounds” and evaluate the following: (1) student satisfaction and program usefulness in achieving preset objectives, (2) perceived improvement in literacy regarding the pandemic, and (3) the impact of student engagement by designing infographics and initiating COVID-19–related research projects. Methods: This is a cross-sectional study measuring the impact of the implementation of the web-based “COVID-19 Rounds” course. This program included web-based clinical experiences with physicians on actual rounds in COVID-19 wards in the hospital, weekly updates on evolving data and new research, and engagement in student-led projects. The study population included 47 fourth-year medical students at the Mohamed Bin Rashid University of Medicine and Health Sciences in Dubai, the United Arab Emirates, who attended the course. We designed and administered a 47-item survey to assess student satisfaction, program usefulness, impact on knowledge, and student engagement. Data were collected at the end of program delivery via Microsoft Forms. Results: In total, 38 (81%) out of 47 fourth-year medical students participated in this study. The final course evaluation revealed an overall high satisfaction rate, with a mean rating of 3.9 (SD 0.94) on the 5-point Likert scale. Most students were satisfied with the course format (27/38, 71%), organization (31/38, 82%), and the learning experience (28/38, 74%) that the course offered. The course was particularly appreciated for offering evidence-based talks about aspects of the pandemic (34/38, 90%), providing weekly updates regarding emerging evidence (32/38, 84%), and enhancing understanding of the challenges of the pandemic (34/38, 90%). Satisfaction with distance learning was moderate (23/37, 62%), and a minority of students would have preferred an in-person version of the course (10/37, 27%). Student engagement in the course was high. All students participated in small group presentations of infographics of pandemic-related topics. Perceived advantages included conciseness and visual appeal, and disadvantages included the lack of detail and the time-consuming nature of infographic design, especially for students with no prior design experience. After the course ended, 27 (57%) students began research projects. This resulted in 6 abstracts presented at local meetings and 8 scientific papers published or submitted for publication. Conclusions: This inquiry-based adaptive approach to educating medical students about updates on COVID-19 via web-based learning was successful in achieving objectives and encouraging engagement in research. However, shortcomings of the course related to the lack of in-person teaching and clinical activities were also highlighted.
Introducing the 4Ps Model of Transitioning to Distance Learning: A convergent mixed methods study conducted during the COVID-19 pandemic
(2021) Otaki, Farah; Zaher, Shroque; Du Plessis, Stefan; Lakhtakia, Ritu; Zary, Nabil; Inuwa, Ibrahim M.
Abstract: Significant concern has been raised regarding the effect of COVID-19 on medical education. This study aimed to shed light on the distance learning experiences of medical students and their instructors at the Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) in Dubai, United Arab Emirates. A convergent mixed methods approach was utilized. Qualitative and quantitative data was collected using a survey of closed-ended followed by open-ended questions. The percentage of the total average of satisfaction among stakeholders was 76.4%. The qualitative analysis led to developing the 4Ps Model of Transitioning to Distance Learning, which encapsulates four interrelated themes. It would be helpful to leverage the lessons learned to tailor blended medical programs with a reasonable me´lange of experiences. The study also contributes to the mixed methods research by showcasing a means of adapting it to evaluate critical situations reliably and rapidly.
Making clinical teaching visible-A time and motion study of hospital rounds in undergraduate medical teaching
(2024-08) Kilian, Paddy; Alshehabi, Nagam; Othman, Malek; Mahmoud, Anan; Preez, Leon du; Zary, Nabil; Ho, Samuel
Abstract Background: Teaching medical students in the clinical setting is frequently perceived as a demanding commitment by attending physicians. There is a paucity of data measuring the duration and efficacy of teaching during clinical rounds. Aim: The aim of this study was to assess both the quantity and quality of clinical teaching time dedicated to medical students on hospital ward rounds. Methods: A cross-sectional direct structured observational study was conducted during the morning rounds of attending physicians involved in teaching undergraduate medical students at three different clinical facilities in three different specialties. A validated observational tool was used by four observers to record teaching time and quality indicators. Results: In terms of teaching duration, it was observed that 25% of the total morning round time was allocated to teaching. However, this measure varied widely between different physicians and specialties. As for teaching quality, actions categorized as active teaching by the teachers were observed in 19% of the interactions observed per round, while active learning by the students was observed in 17% of the interactions per round. Teacher high-cognition interactions were similarly observed in 23% of actions per round, while student high-cognition interactions occurred in 16% of actions per round. Internal Medicine tended to score higher than both Pediatrics and Surgery in terms of percentage teaching time as well as percentage of active teaching observed per round. Using liberal criteria, rounds characterized overall as predominantly active or high-cognition by both teachers and students were observed in only 21% of the total number of rounds observed. Conclusion: These results indicate that the percentage of teaching time during ward rounds is highly variable, and that round teaching generally consists of passive and low-cognition interactions. Future work is needed to train clinical faculty to achieve a desired level of teaching quality, and to determine if there are any changes in teaching time commitments and student outcomes.
Medical Students’ Perception and Perceived Value of Peer Learning in Undergraduate Clinical Skill Development and Assessment: Mixed Methods Study
(2021) Alzaabi, Shaikha; Nasaif, Mohammed; Hassan Khamis, Amar; Otaki, Farah; Zary, Nabil; Mascarenhas, Sharon
Background: The effectiveness of peer learning in clinical skill development is well recognized and researched, given the many benefits gained such as enhanced learning, alleviation of the burden on faculty, and early development of teaching skills for future doctors. However, little is known in terms of its effectiveness as an assessment tool and the extent to which peer assessment can be relied upon in the absence of faculty support. Objective: This study was conducted to assess medical students’ perception toward peer learning, which is based on self-regulated learning as a tool of assessment, and to compare peer evaluation with faculty evaluation of clinical skill performance. Methods: A cohort of 36 third-year medical students were exposed to peer learning (same-level) in clinical skills education for 3 months. A convergent mixed methods approach was adapted to collect data from 3 sources, namely, students’ perception of peer learning, performance scores, and reflective observational analysis. A 5-point Likert-type scale was used to assess students’ (n=28) perception on the value of peer learning. The students were asked to assess their peers by using a preset checklist on clinical skill performance, and scores were compared to faculty assessment scores. Reflective observational data were collected from observing video recordings of some of the peer learning sessions. The findings from all 3 sources were integrated using joint display analysis. Results: Out of 28 students, 25 students completed the survey and 20 students perceived peer learning as valuable in clinical skills education. The mean score of peer assessment was higher than that of faculty assessment. There was a significant difference in student performance between supervised teaching and peer learning groups (P=.003). Most students focused on the mastery of skill with little attention to the technique’s quality. Further, students were unable to appreciate the relevance of the potential clinical findings of physical examination. Conclusions: Peer learning in clinical skills education, based on self-regulated learning, empowers students to develop a more responsible approach toward their education. However, peer assessment is insufficient to evaluate clinical skill performance in the absence of faculty support. Therefore, we recommend that peer learning activities be preceded by supervised faculty-taught sessions.
Profiling of Learners in Medical Schools as a Move Toward Precision Education: Protocol for a Scoping Review
(2022) Salman, Hira; Powell, Leigh; Alsuwaidi, Laila; Nair, Bhavana; Tegginmani, Shakeel Ahmed; Mohamadeya, Jalal; Zary, Nabil
Background: Academic experiences seek to get the best out of learners, maximizing performance and developing the skills and competencies needed to foster lifelong learning. The more personalized and tailored the academic experience among learners, the better the outcome. Precision education is a novel approach to research and practice, which is concerned with identifying and tailoring education to the precise needs of the learner. An emerging area of precision education is using data to develop learner profiles for a better understanding of individual learners relative to the characteristics and competencies of lifelong learners. Objective: This scoping review aims to identify literature that reports on profiling learners within medical schools. Our review, as described in this paper, will describe the characteristics being measured, the methods and data sources used to generate profiles, and the resulting profiles that emerge. This review aims to provide guidance to those supporting medical school learners on the current state of learner profiling. Methods: This scoping review will use the Population, Concept, and Context framework, published by Joanna Briggs Institute, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The search strategy was developed in collaboration with a library specialist. An initial search was conducted in PubMed, ERIC, Google Scholar, Cochrane, CINAHL, and SCOPUS. Data will be extracted, and 2 authors will undertake the screening procedure using the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews checklist. Results: The database searches yielded 166 results, and title and abstract screening of 135 extracted articles is currently underway after eliminating 31 duplicates. We anticipate the scoping review to be completed in the first week of October 2022. The final scoping review will present the findings in a narrative and pictorial fashion. Conclusions: This review will help guide scholars looking to understand the current state of learner profiling within medical schools.
Rapid Transformation from Face to Face to Virtual Simulation During the SARS-CoV-2 Pandemic: Impact on the Simulation Process during "The Little Room of Horrors"
(2023-11) Mascarenhas, Sharon; Sudhir, Meghana; Al Suwaidi, Hanan Sulaiman; Alfroukh, Jalal; Zary, Nabil
Abstract: Objective: 1. To explore the feasibility of a rapid transformation from face to face to virtual simulation and its impact on the simulation process 2. To explore the efficacy of a rapid transformation from face to face to virtual simulation and its impact on the simulation process. Methods: The simulation process (preparation, pre-briefing, simulation, and debriefing) was investigated for feasibility and efficacy from the perspective of the educators and students. This study took place very early in the pandemic, thus highlighting the speed at which it needed to be conducted and acknowledging the limitations of technology at the time. The faculty (n = 3) involved in the virtual simulation experiment and year one medical students(n = 61) were invited to participate in the study voluntarily. The module chosen for this study was the Introduction to the Practice of Medicine, where the students were introduced to the concept of patient safety using simulation-based education. The "Little Room of Horrors" - is a simulation based educational session emphasising the importance of patient safety. Students were taken into a simulated medical ward that demonstrated common hospital-based errors. The learners were timed and asked to identify and document as many patient safety hazards as possible. The semi structured questionnaire was analysed using descriptive statistics and thematic analysis. Results: The Educator's perspective reflected that virtual simulation was technologically dependent and had limitations during debriefing but was also a sustainable and portable standardised process. The student's perspective revealed that the objectives were met, and the session helped them support the theory previously learned. The average rating was 4.09 on a 5-point scale. Innovation: When resources of the simulation center like space, mannikins, and faculty cannot be accessed for reasons like social distancing during a pandemic, virtual simulation was developed and used as a feasible alternative for our students without impacting the learning objectives. Conclusion: This study demonstrates the use of virtual simulation as a valuable option for teaching when face to face simulation is challenging or not possible.