Amal Hussein

Using team-based learning to prepare medical students for future problem-based learning

Background: The original concept of problem-based learning (PBL) was built upon an acceptance that its participants would be of a more mature age, and with personal and potential qualities that would equip them for problem solving as part of their learning process. However, despite global acceptance for the use of PBL in medical and health sciences education, and knowledge of the diverse background of students about to embark upon PBL, structured programs preparing medical students for such an educational activity are not common. Aim: The primary aim of this study is to describe the experience in adopting and adapting an educational approach analogous to PBL, team-based learning (TBL), in preparing medical students to later study in a PBL environment and secondarily, to measure the students’ reaction to this experience. Methods: At the University of Sharjah, 363 students were enrolled over four semesters in the ‘Introduction to Medical Sciences Education (IMSE)’ course. They were divided into groups of 25–27 students per class, where their learning was facilitated through a TBL approach. The course was evaluated both quantitatively and qualitatively and appropriate statistical analysis was applied to their responses. Results: Out of 363 students, 304 (84%) responded to a 28-item closed-ended questionnaire. Their mean scores and consensus measurements indicated a high degree of students’ satisfaction. Eighty-two students (65%) responded to the open-ended questions providing 139 comments. Content analysis of the responses supported the quantitative results. Conclusion: This study demonstrated a high degree of students’ satisfaction from the course in acquiring skills preparing them for future PBL. Although this represents an evaluation of the TBL effects upon the early exposures to PBL, TBL was considered to be a feasible, efficient and cost-effective educational approach in preparing the students for their new educational experience.

The Prevalence and Correlates of Depressive Symptoms among Arab Women in a Primary Health Care Setting

Background: Depression is one of most common mental illnesses in the world, with a high prevalence in primary health care settings. Some research has been conducted in the Arab region, but this research has been limited. This study investigated the prevalence of depression in a primary health care setting in the United Arab Emirates as well as possible socio-demographic and stressful life event correlates of depression. Methods: Arabic versions of the Beck Depression Inventory (BDI), a Stressful Life Events Inventory, and socio-demographic form were used for the study. Data were collected from 224 Arab women, aged 18 and above, in the primary health care centers of Sharjah, using a convenience sampling method. Results: Approximately 33% of women were found to be either moderately (14.7%) or severely (18%) depressed. The following socio-demographic variables were found to be correlated with scores on the BDI (p < .05): marital status (being single, widowed or divorced), working status (working full- or part-time), and family income (lower family income). The number of stressful life events that a woman had experienced in the past year was also correlated with depression. Conclusions: Depressive symptoms are common in women attending primary health care centers in the Emirate of Sharjah. Stressful life events, in particular, are related to the level of depressive symptoms experienced by these women. It will be important to consider the social, psychological, and economic variables that impact emotional health in the region. This research is considered to be an initial step in developing prevention and intervention programs to address the mental health needs of Arab women.

High prevalence of diabetes among migrants in the United Arab Emirates using a cross-sectional survey

In 2011, the United Arab Emirates (UAE) had the 10th highest diabetes prevalence globally, but this was based on data that excluded migrants who comprise 80% of the population. This study assessed diabetes prevalence across the UAE population. A random sample of migrants was recruited from the visa renewal centers. Data were collected using interviews, anthropometric measurements and fasting blood for glucose, lipids and genetic analyses. 2724 adults completed the questionnaires and blood tests. Of these, 81% were males, 65% were ≤40 years old and 3% were above 60 years. Diabetes, based on self-report or fasting plasma glucose ≥7.0 mmol/l, showed a crude prevalence of 15.5%, of whom 64.2% were newly diagnosed. Overall age- and sex-adjusted diabetes prevalence, according to the world mid-year population of 2013, was 19.1%. The highest prevalence was in Asians (16.4%) and non-Emirati Arabs (15.2%) and lowest in Africans and Europeans (11.9%). It increased with age: 6.3% in 18–30 years and 39.7% in 51 to 60 years. Lower education, obesity, positive family history, hypertension, dyslipidemia, snoring, and low HDL levels, all showed significant associations with diabetes. The high diabetes prevalence among migrants in the UAE, 64% of which was undiagnosed, necessitates urgent diabetes prevention and control programs for the entire UAE population.

Diabetes risk score in the United Arab Emirates: a screening tool for the early detection of type 2 diabetes mellitus

Objective The objective of this study was to develop a simple non-invasive risk score, specific to the United Arab Emirates (UAE) citizens, to identify individuals at increased risk of having undiagnosed type 2 diabetes mellitus. Research design and methods A retrospective analysis of the UAE National Diabetes and Lifestyle data was conducted. The data included demographic and anthropometric measurements, and fasting blood glucose. Univariate analyses were used to identify the risk factors for diabetes. The risk score was developed for UAE citizens using a stepwise forward regression model. Results A total of 872 UAE citizens were studied. The overall prevalence of diabetes in the UAE adult citizens in the Northern Emirates was 25.1%. The significant risk factors identified for diabetes were age (≥35 years), a family history of diabetes mellitus, hypertension, body mass index ≥30.0 and waist-to-hip ratio ≥0.90 for males and ≥0.85 for females. The performance of the model was moderate in terms of sensitivity (75.4%, 95% CI 68.3 to 81.7) and specificity (70%, 95% CI 65.8 to 73.9). The area under the receiver-operator characteristic curve was 0.82 (95% CI 0.78 to 0.86). Conclusions A simple, non-invasive risk score model was developed to help to identify those at high risk of having diabetes among UAE citizens. This score could contribute to the efficient and less expensive earlier detection of diabetes in this high-risk population.

Setting and maintaining standards in multiple choice examinations: Guide supplement 37.3--practical application.

An important challenge in medical education is setting standards for cut off passing scores for medical students’ examinations. As assessment drives learning, making accurate pass/fail decisions largely affects the effectiveness of medical education programmes. Failing competent students or passing incompetent ones is an error which could have serious implications to the community, student, and institution. Several methods for standards-setting have been effectively described in the recent AMEE Guide in Medical Education (Bandaranayake 2008); the most widely used is the Angoff method (Goodwin 1999) which is considered as an absolute and item-centered standard-setting method (Downing et al. 2006; Van Nijlen & Janssen 2008). The main problems with this method are related to the selection of judges and conceptualization of what a borderline student is (Downing et al. 2006; Verheggen et al. 2008). The Hoftsee method is referred to as a compromise method between the absolute and the relative standards (Norcini 2003). It takes into consideration both the judges’ decisions about the minimum and maximum acceptable passing scores and failure rates and the distribution of the students’ scores on an exam (De Gruijter 1985). Although this method is easy to implement, its application might be limited to occasional use only (Norcini 2003). The standard error of measurement (SEM) has been used for making confident and defensible decisions about the borderline students (Norcini 2000). This statistical measure defines confidence intervals, around individual scores, that are thought to contain the true scores. The Angoff method has been compared to other standard-setting methods, such as Nedelsky (Chang 1999) and contrasting-groups method (Van Nijlen & Janssen 2008). It was found to produce higher cut off scores than the Nedelsky (Chang 1999). Several studies have recommended and emphasized the need for further research to refine and improve defensibility of standard-setting procedures (Goodwin 1999; Hays et al. 2008). In the United Arab Emirates, the University of Sharjah, College of Medicine adopted, since its inception in 2004, a problem-based learning (PBL) integrated curriculum. The medical programme is of 5 years duration, divided into two phases. Phase one includes years 1, 2, and 3 ‘‘Preclerkship’’ and phase two includes years 4 and 5 ‘‘Clerkship.’’ An examination blueprint is prepared to guide the identification of what should be assessed, expected performance and assessment tools to be used. According to the university regulations, a student must achieve a minimum aggregate score from all types of assessment of 70% in order to pass a unit, clerkship or a year. This cut off point is historic and arbitrary. The current practice at the College of Medicine is to use Angoff as the standard-setting procedure for all written examinations and adjust the Angoff-based scores to the university cut off passing score of 70%. In this study, we aimed to compare pass/fail decisions made on examination results scores of medical students using three standard-setting methods Angoff, Hofstee and SEM. We compared the degree of agreement between the three identified cut off scores; and the implications of applying each method on numbers of students who failed or would fail.