Abdulaziz Boker

The need for national medical licensing examination in Saudi Arabia

BackgroundMedical education in Saudi Arabia is facing multiple challenges, including the rapid increase in the number of medical schools over a short period of time, the influx of foreign medical graduates to work in Saudi Arabia, the award of scholarships to hundreds of students to study medicine in various countries, and the absence of published national guidelines for minimal acceptable competencies of a medical graduate.DiscussionWe are arguing for the need for a Saudi national medical licensing examination that consists of two parts: Part I (Written) which tests the basic science and clinical knowledge and Part II (Objective Structured Clinical Examination) which tests the clinical skills and attitudes. We propose this examination to be mandated as a licensure requirement for practicing medicine in Saudi Arabia.ConclusionThe driving and hindering forces as well as the strengths and weaknesses of implementing the licensing examination are discussed in details in this debate.

Postoperative complications of pediatric dental general anesthesia procedure provided in Jeddah hospitals, Saudi Arabia

BackgroundReview of post-operative morbidity reports for pediatric dental care under general anesthesia (GA) show great variations. Until now, no morbidity data has been available to estimate the safety of pediatric patients under GA for dental rehabilitation in Saudi Arabia. The purposes of this study were to (1) investigate post-operative complications associated with dental care under GA and (2) correlate morbidity reports with patients characteristics, dental procedures, and hospital protocol.MethodsStudy sample included 90 children attending GA for dental treatment at major governmental hospitals in Jeddah. Data were collected from every patient on three occasions, intra-operatively at the operating room, and post-operatively via phone calls in the first and third days after operation.ResultsResults showed that 99% of the children had one or more complaints in the first day in contrast to only 33% in the third day. Inability to eat (86%), sleepiness (71%), and pain (48%) were the most common complaints in the first day, followed by bleeding (40%), drowsiness (39%), sore throat (34%), vomiting (26%), psychological changes (24%), fever (21%), cough (12%), and nausea (8%). A great significant complaints reduction was reported by the third post-operative day. Age, gender, admission type of the patients and GA duration were the factors that showed a significant relationship with post-operative complaints.ConclusionPost-operative morbidity was common, but mostly of mild severity and limited to the first day. Hospital staff efforts should be directed to control commonly reported postoperative complaints.

Use of Airtraq, C-Mac, and Glidescope laryngoscope is better than Macintosh in novice medical students' hands: A manikin study

Background and Aim: Obtaining patent airway is a crucial task for many physicians. When opportunities to practice intubations on patients are really limited, skill gaining methods are needed. We conducted a study among novice 6th year medical students to assess their ability to intubate the trachea in normal airway in manikin using four airway tools. Setting and Design: Prospective, cohort study conducted at simulation center of university-based, tertiary care hospital. Methods: Fifty medical students performed either oral or nasal tracheal intubation using the following four intubating tools: C-Mac videolaryngoscope, Glidescope, and Airtraq in comparison with regular Macintosh laryngoscope. Intubation time, visualization of glottic opening, ease of intubation, satisfaction of participants, incidence of dental trauma, and the need for optimization manoeuvres′ use among different airway tools were recorded. Results: In oral intubation, Airtraq was better than others in regard to intubation time, glottic opening, ease of intubation, and the need for external laryngeal pressure application, followed by Glidescope, C-Mac, and finally Macintosh laryngoscope (P<0.001). Airtraq and Glidescope associated with less dental trauma than C-Mac and Macintosh. In nasal route, fastest intubation time was reported with Airtraq followed by Glidescope, C-Mac, and lastly Macintosh. Airtraq, Glidescope, and C-Mac were similar to each other and better than the Macintosh in regard to ease of intubation, satisfaction, and number of attempts (P≤0.008). Conclusions: New devices like Airtraq, Glidescope, and C-Mac are better than the regular Macintosh when used by novice medical students for oral and nasal intubation on manikin.

Integration of simulation in postgraduate studies in Saudi Arabia: The current practice in anesthesia training program

The educational programs in the Saudi Commission for Health Specialties are developing rapidly in the fields of technical development. Such development is witnessed, particularly in the scientific areas related to what is commonly known as evidence-based medicine. This review highlights the critical need and importance of integrating simulation into anesthesia training and assessment. Furthermore, it describes the current utilization of simulation in anesthesia and critical care assessment process.

Perceptions of Medical Students in King Abdulaziz University about Teaching and Learning Modalities; Comparative Cross Sectional Study between Traditional and System-based Curriculum@@@إدراك طلاب كلية الطب جامعة الملك عبدالعزيز لأنواع التعليم والتعلم (دراسة مقطعية مقارنة بين المنهج التقليدي والمنهج المطور)

The undergraduate curriculum of the Medical School-King Abdulaziz University, Saudi Arabia was a traditional one (it was teacher centered, discipline-based, and hospital-based with no options or elective modules). In 2006-2007, the Medical School adopted a new system-based curriculum. This study was constructed to compare the perceptions of students of both, the traditional and new curricula to identify the problem areas that should be remediated. A comparative cross-sectional study was carried out with the third- and fourth-year students at 2008/2009. A questionnaire was distributed to the third-year students who were enrolled in the new system-based curriculum (n = 227 response rate was 80%) and to the fourth-year students who were enrolled in the old curriculum (n = 217 response rate was 76%). For the third-year students, the total mean scores of all the studied domains were significantly higher compared with the fourth year students except for the fourth domain (library and electronic learning resources), which showed an insignificant difference between the two groups. Perceptions of students who experienced the system-based curriculum are significantly higher than those who had experienced the traditional ones; however, the overall score is still low. Therefore, there is a great need for improvement.

New scale to improve inter-examiner reliability during oral exam

METHODS After obtaining the IRB approval, five faculty members and ten residents participated in the end-of-year promotion exam. Each of the two examiner teams (two or three examiners each) examined all residents in two Structured Oral Examination (SOE) scenarios. Each examiner assigned independently a score for each resident performance based on the predetermined scale. The scale ranged from 55 which represent extremely poor performance to 65 which corresponds to outstanding performance, with the grade of 60 signifying an average performance at the expected level of training. Each of the marks in the scale has clear description in three domains (knowledge, Organization, and Communications and expression) in addition to general description category. Correlation between each member of the examiner teams and between score of each candidate mark and their final written mark were determined. Pearson correlation (pair-wise deletion) was used for analysis.