Abdullatif Al-Khal

Clinician-educators in emerging graduate medical education systems: description, roles and perceptions

Objectives To describe clinician-educators (CEs) in new graduate medical education (GME) systems and characterize perception of preparedness, roles and rewards, and factors affecting job satisfaction and retention. Methods A cross-sectional survey of all CEs of institutions using competency-based GME and accredited by the Accreditation Council for Graduate Medical Education-International (ACGME-I). Results 274 of 359 eligible participants (76.3%) responded, representing 47 residency programs across 17 specialties. CEs were predominantly married men aged in their 40s, employed at their current institution 9.3 years (±6.4 years). CEs judged themselves competent or expert in teaching skills (91.5%), trainee assessment (82%) and mentoring (75%); less so in curriculum development (44%) and educational research skills (32%). Clinical productivity was perceived by the majority (62%) as the item most valued by their institutions, with little or no perceived value for teaching or educational efforts. Overall, 58.3% were satisfied or very satisfied with their roles, and 77% expected to remain in academic medicine for 5 years. A strong negative correlation was found between being a program or associate program director and likelihood of staying in academic medicine (aOR 0.42; 0.22 to 0.80). Conclusions In the GME systems studied, CEs, regardless of country or programme, report working in environments that value clinical productivity over educational efforts. CEs feel competent and prepared for many aspects of their roles, have positive attitudes towards teaching, and report overall job satisfaction, with most likely to remain in academic medicine. As medical training advances internationally, the impact on and by CEs requires ongoing attention.

Multi-indication Pharmacotherapeutic Multicriteria Decision Analytic Model for the Comparative Formulary Inclusion of Proton Pump Inhibitors in Qatar

PURPOSE The formulary inclusion of proton pump inhibitors (PPIs) in the government hospital health services in Qatar is not comparative or restricted. Requests to include a PPI in the formulary are typically accepted if evidence of efficacy and tolerability is presented. There are no literature reports of a PPI scoring model that is based on comparatively weighted multiple indications and no reports of PPI selection in Qatar or the Middle East. This study aims to compare first-line use of the PPIs that exist in Qatar. The economic effect of the study recommendations was also quantified. METHODS A comparative, evidence-based multicriteria decision analysis (MCDA) model was constructed to follow the multiple indications and pharmacotherapeutic criteria of PPIs. Literature and an expert panel informed the selection criteria of PPIs. Input from the relevant local clinician population steered the relative weighting of selection criteria. Comparatively scored PPIs, exceeding a defined score threshold, were recommended for selection. FINDINGS Weighted model scores were successfully developed, with 95% CI and 5% margin of error. The model comprised 7 main criteria and 38 subcriteria. Main criteria are indication, dosage frequency, treatment duration, best published evidence, available formulations, drug interactions, and pharmacokinetic and pharmacodynamic properties. Most weight was achieved for the indications selection criteria. Esomeprazole and rabeprazole were suggested as formulary options, followed by lansoprazole for nonformulary use. The estimated effect of the study recommendations was up to a 15.3% reduction in the annual PPI expenditure. Robustness of study conclusions against variabilities in study inputs was confirmed via sensitivity analyses. IMPLICATIONS The implementation of a locally developed PPI-specific comparative MCDA scoring model, which is multiweighted indication and criteria based, into the Qatari formulary selection practices is a successful evidence-based cost-cutting exercise. Esomeprazole and rabeprazole should be the first-line choice from among the PPIs available at the Qatari government hospital health services.

Implementing and tailoring a western-developed communication skills training program for graduate medical trainees in Qatar.

In 2009, the Accreditation Council for Graduate Medical Education launched an international branch (ACGME-I). In July 2012, Hamad Medical Corporation (HMC) in Qatar was the second international organization to receive institutional accreditation. The evolution of the ACGME into an international organization leads to the need to understand how to effectively build upon educational programs developed in western cultures while still being attentive to important cultural differences and local needs of international programs. Harden1 delineated three ways of approaching curriculum in international medical education: (1) local educators build a local curriculum; (2) a curriculum built in one country is exported to another; or (3) a transnational curriculum is developed with a strong international basis and attention to local students’ needs. All three approaches may be used by ACGME-I accredited institutions. Communication skills training (CST) programs are of particular interest since the key concept of communication crosses many of the competencies and milestones. Yet communication, perhaps more than other competencies, is subject to differences in interpretation and cultural norms.2 For example, a communication competency such as “Create and sustain a relationship that is therapeutic for patients and supportive of their families”3 may be applied differently in international graduate medical education programs where the role of the family in healthcare is central.2 Important cultural differences notwithstanding, we began this project believing that there were more cross-cultural similarities than differences in healthcare communication skills. Thus, rather than develop a new program, we chose to tailor and implement a western model of CSTin graduate medical education in Qatar.Much has been published internationally on CST for medical students, graduate medical trainees and practicing physicians.4-6 Best practices for teaching communication skills are well-established,7 focusing on facilitator-guided, experiential work.8,9 Research on these programs generally show positive evaluations of such interventions and demonstrate skills uptake as measured with Standardized Patients (SPs). However, most published work about CST has been from western countries. Implementing a CST program in Qatar was innovative as we introduced a western-based curriculum. This is significant as previous educators have questioned whether an experiential role play approach would work in non-western countries.10 The primary purpose of this paper is to report on our experience tailoring and implementing a western-developed CST program in Qatar. Components of training Setting HMC is Qatar’s not-for-profit public healthcare system, consisting of eight public hospitals and other healthcare services, with 19 residency training programs, 14 of which are ACGME-I accredited. Residents and fellows are mandated to complete the CST course during their training.

Improving influenza vaccination rates of healthcare workers: a multipronged approach in Qatar

We assessed whether an influenza vaccination (IV) campaign was effective at increasing vaccination rate in healthcare workers (HCWs) in 2 hospitals in Doha, Qatar that had no mandatory IV policy. The campaign comprised promotional, educational and vaccine delivery interventions; a dedicated IV team; telephone hotline; free IV with improved access, leadership involvement; incentives; group educational sessions; and reporting/tracking activities. During the 2014/15 influenza season, IV rates according to hospital and HCW category were calculated and compared with the 2 seasons before the intervention. The combined mean rate for IV for both hospitals increased for 2014/15 (64.3%) compared with 2013/14 (37.2%) and 2012/13 (28.4%). There was increased IV uptake among doctors and nurses at each hospital, and the IV rate for the 2 hospitals (59.1 and 69.5%) were higher than in 2013/14 (21.1% and 53.2%) and 2012/13 (17.2% and 39.6%). The findings highlight the importance of improving IV rates among HCWs in hospitals with no mandatory vaccination policies through multicomponent interventions.

Contextualizing the Physician Charter on Professionalism in Qatar: From Patient Autonomy to Family Autonomy.

BACKGROUND The Physician Charter on medical professionalism has been endorsed by professional organizations worldwide, yet it is unclear if this Western framework of professionalism is applicable in non-Western countries. OBJECTIVE This study examines how physicians practicing in a Middle Eastern context perceive the terms, principles, and commitments outlined in the charter. METHODS In May 2013, the authors conducted 6 focus groups with 43 clinician-educators practicing at Hamad Medical Corporation in Doha, Qatar, to discuss the applicability of the Physician Charter in a local context. The research team coded and analyzed transcripts to identify sociocultural influences on professionalism. RESULTS Participants generally expressed agreement with the applicability of the charters principles to physician professionalism in Qatar. However, 3 contextual factors (religious beliefs and practices, family-centered decision making, and multinationality) complicated the application of the core principles of patient autonomy and social justice. Islamic beliefs reinforced the importance of professional values such as altruism, but presented a barrier to the principle of self-determination for female patients. The family-centered culture in Qatar called for enlarging the scope of patient-centered decision making to include the patients family. Qatars multinational population prompted debate over equal treatment and how to conceptualize and implement the principle of social justice. CONCLUSIONS Several sociocultural contexts influence the conceptualization of the principles of medical professionalism in Qatar. The findings suggest that contextual factors should be considered when developing or adopting a professionalism framework in an international setting and context.

Burnout and sources of stress among medical residents at Hamad Medical Corporation, Qatar.

This study aimed to describe the experiences of stress and burnout and sociodemographic factors associated with dimensions of stress among medical residents at Hamad Medical Corporation, Qatar. Medical residents participating in a stress management course were asked to complete an anonymous survey. The survey included demographic questions, the Abbreviated Maslach Inventory, and 4 open-ended questions on experiences with stress. Of the 150 residents participating in the stress management course, 142 responded to the survey, listing an average of 2.2 types of stressors, with workload and workplace relationships as the most frequent. They listed an average of 3.1 coping strategies, most frequently seeking out social support and entertainment. Responses indicated low depersonalization, high personal accomplishment, high satisfaction with medicine and high emotional exhaustion. Training to improve coping and reduce burnout is recommended.