Marwan Abu-Hijleh

Student-led tutorials in problem-based learning: educational outcomes and students' perceptions

The aim of this study was to examine the effectiveness of using students as tutors in a problem-based learning (PBL) medical curriculum. Ninety-one third-year medical students were divided into ten tutorial groups. The groups were randomly allocated into student-led tutorials (SLT) (five groups, n = 44 students) and faculty-led tutorials (FLT) (five groups, n = 47 students). Outcome measurements included assessment of students’ performance in tutorials individually and as a group, end-unit examinations scores, assessment of tutoring skills and identifying students’ perceptions about peer tutoring. Student tutors were perceived better in providing feedback and in understanding the difficulties students face in tutorials.Tutorial atmosphere, decision-making and support for the group leader were better in SLT compared with FLT groups. Self-assessment of student performance in SLT was not different from FLT. Student scores in the written and practical examinations were comparable in both groups. However, SLT groups found difficulties in analysis of problems presented in the first tutorial session. We conclude that the impact of peer tutoring on student performance in tutorials, group dynamics, and student achievement in examinations is positive overall. However, student tutors require special training before adopting this approach in PBL programs.

Gender-Related Differences in Learning in Student-Led PBL Tutorials

CONTEXT Male and female students behave differently in problem-based learning (PBL) tutorials. However, these differences could be partly attributed to faculty tutor behavior in male and female tutorials. OBJECTIVES This study aims to examine the gender differences in learning outcomes between medical students when peer tutors facilitate PBL tutorials. METHODS A questionnaire-based study conducted in single-gender student-led (SLT) and faculty-led (FLT) tutorials. The study involved third year medical students (n = 91) divided into ten groups (five groups each). The SLT groups consisted of 16 male and 28 female students, while the FLT group consisted of 20 male and 27 female students. Students evaluated their individual and group performance in tutorials and also skills of tutors. Student performance in end-unit examinations and their perceptions about peer tutoring were also analyzed. RESULTS A total of 290 questionnaires (response rate = 63.7%) were collected over the five-week period of the study. Although individual performance in tutorials and achievement in examinations were comparable in both groups, there was significantly higher group performance in female compared with male student-led tutorials (p < 0.01). This difference between male and female groups was not attributed to improvement in the performance of female groups, but rather to a decline in performance of the male SLT groups. In addition, both male and female students expressed facing difficulties in discussion and analysis of the problem in the first tutorial session. CONCLUSIONS Understanding the gender differences in the group behavior in student-led tutorials is important for PBL programs adopting this approach.

Undergraduate medical education in the Gulf Cooperation Council: A multi-countries study (Part 2)

Background: The Gulf Cooperation Council (GCC) countries have witnessed over the last 40 years a rapid and major social, cultural, and economic transformation. The development of medical education in the region is relatively new, dating from the late 1960s. An important goal among the medical colleges in the region is to graduate national physicians who can populate the healthcare service of each country. Aim: The aim of this study is to provide understanding of undergraduate medical education in each of the six GCC countries and the challenges that each face. Methods: This is a descriptive cross-sectional study. Fourteen senior medical faculty were requested to submit information about undergraduate medical education in their own countries, focusing on its historical background, student selection, curriculum, faculty, and challenges. Results: The information provided was about 27 medical colleges: 16 from the Kingdom of Saudi Arabia (KSA), five from the United Arab Emirates, two from the Kingdom of Bahrain, two from Sultanate of Oman, one from Kuwait and one from the State of Qatar. It was found that older colleges are reviewing their curriculum while new colleges are developing their programs following current trends in medical education particularly problem-based learning and integrated curricula. The programs as described ‘on paper’ look good but what needs to be evaluated is the curriculum ‘in action’. Faculty development in medical education is taking place in most of the regions medical colleges. Conclusion: The challenges reported were mainly related to shortages of faculty, availability of clinical training facilities, and the need to more integration with the National Health Care services. Attention to quality, standards, and accreditation is considered essential by all colleges.

The angiotensin type 1 receptor antagonist valsartan attenuates pathological ventricular hypertrophy induced by hyperhomocysteinemia in rats.

Introduction. Clinical and experimental studies have reported the role of homocysteine in ventricular hypertrophy. Activation of the reninangiotensin system mediated by angiotensin II type 1 (AT1) receptor has also been suggested to contribute to the pathogenesis of ventricular hypertrophy. There are also reports suggesting the affect of angiotensin II (Ang II) on cardiac hypertrophy is mediated by hyperhomocysteinemia. However, there is limited information on the mechanisms of the possible relationship between homocysteine and Ang II in ventricular hypertrophy. In this study we tested the hypothesis that hyperhomocysteinemia induced ventricular hypertrophy and remodelling may be mediated through activation of Ang II AT1-receptors in rats. Methods. This study was conducted on control non-treated rats (n=13), methionine-treated rats (1.5 mg/kg/day, n=18) and methionine plus oral AT1 antagonist (valsartan, 30 mg/kg/day, n=13) treated rats for 56 days. Systolic blood pressure (SBP) was determined in rats at baseline, 28 and 56 days. Echocardiography was also performed in all rats after eight weeks, and blood samples were obtained for determination of plasma tHcy. Rats were then sacrificed for histopathological and biochemical assessment of cardiac structure. Results. The SBP in the methionine-treated rats was significantly higher compared with controls and significantly lower compared with the methionine-valsartan group at 28 and 56 days (p<0.001). In addition, left ventricular wall thickness (LVWT) in the methionine-valsartan group (4.36±0.11 mm) was significantly lower compared with the methionine group (5.0±0.23 mm, p=0.03). Furthermore, cardiac collagen to total protein ratio was significantly lower in the methionine-valsartan group (2.19±0.11%) compared with the methionine group (2.64±0.08%, p=0.026). Fractional shortening (FS) was not significantly different between groups. Conclusion. Results from this study suggest that hyperhomocysteinemia-induced hypertension and ventricular hypertrophy in rats are mediated, at least partly; by Ang II activation of AT1-receptors.

Integrating applied anatomy in surgical clerkship in a problem-based learning curriculum

Little attention has been given to structured teaching of applied anatomy to senior medical students in problem-based learning (PBL) medical schools. A course named “Anatomical Principles in Surgical Practice” was introduced at the Arabian Gulf University (AGU) in 2001 for fifth- and sixth-year medical students during their surgical clerkship rotation. The course aims to emphasize, update and integrate applied anatomical concepts that are essential for surgical practice. The course consists of 15 interactive sessions held weekly to ensure topics coincide with the surgical problem-solving sessions. A questionnaire was administered to students completing their surgical rotations (n=131) seeking their perceptions about the new course during the academic years 2001, 2002 and 2003. To measure learning outcome, 70 students were also given pre- and post-tests. Positive responses were given by 85.2% of the students for course arrangement, by 92.0% for course content, by 88.3% for clinical correlation, by 95.2% for level of teaching and by 87.2% for overall judgment. The students’ mean scores in the post-test (71.7%±11.7) was significantly higher than their mean scores in the pre-test (42.3%±12.6, p<0.001). Students liked the course and reported feeling more confident in correlating anatomy with surgery during their rotations. By extending anatomical teaching into the clerkship phase, a link between basic medical and clinical sciences has been established that further enhances vertical integration within a PBL curriculum in a spiral fashion.

The prevalence of absence of the palmaris longus muscle in the Bahraini population

Absence of the palmaris longus muscle has been well documented in several populations at a prevalence rate ranging between 2.2 and 63.9% which varies according to race, sex, and side of the body. There is little documentation of the prevalence of absence of this muscle from populations in the Arabian Gulf region. We examined 1,043 subjects, 3–85 years old, from the Kingdom of Bahrain for the presence or absence of the palmaris longus muscle using the conventional test for the presence of this muscle. Statistical analyses investigated the association of muscle absence with sex, hand dominance, and laterality. The palmaris longus muscle was absent in 36.8% of subjects. Bilateral absence (19%) was more common than unilateral absence (17.9%) with preponderance in female subjects. The muscle was absent more often on the left side than the right (P = 0.003). In the right upper limbs the muscle was absent in female subjects more than male subjects (P = 0.031). This study reaffirms that there is population variation in the frequency of absence of the palmaris longus muscle. The tendon of the palmaris longus bifurcated at the wrist in 7.1% of subjects, with male subjects showing this feature more frequently than female subjects in the right hand (P = 0.037) and the left hand (P = 0.030). This has not been reported before. The clinical significance of our findings is discussed. Clin. Anat. 23:956–961, 2010.

Genetic polymorphism of the glutathione S-transferase M1 and T1 genes in three distinct Arab populations.

Deletion polymorphisms for the glutathione S-transferase (GST) gene are associated with increased risk of cancer, and are implicated in detoxifying mutagenic electrophilic compounds. GST Polymorphic variants were reported for different populations. The aim of this study was to investigate the frequencies of GSTM1 and GSTT1 null genotypes among Bahraini, Lebanese and Tunisian Arabs. GST genotyping was done by multiplex PCR-based methods. Study subjects comprised 167 Bahrainis, 141 Lebanese and 186 Tunisians unrelated healthy individuals. GSTM1 deletion homozygosity of 49.7%, 52.5% and 63.4% were recorded for Bahraini, Lebanese and Tunisians, respectively. Among Bahrainis, the prevalence of GSTT1 null homozygotes was 28.7%, while in higher rates were seen in Lebanese (37.6%) and Tunisians (37.1%). Our results indicate that there are no major differences in allelic distribution of GSTM1 and GSTT1 genes between the three Arab populations investigated except between Bahrainis and Tunisians regarding the allelic distribution of GSTM1 gene (P = 0.013). Combined analysis of both genes revealed that 14.4% of Bahrainis, 16.3% of Lebanese and 21.0% of Tunisians harbor the deleted genotype of both genes. This is the first study that addresses GST gene polymorphism in Bahraini and Lebanese Arabs, and will help genetic studies on the association of GSTM1 and GSTT1 polymorphisms with disease risks and drug effects in Arab populations.

Morphology of Anterolateral Ligament of the Knee: A Cadaveric Observation with Clinical Insight

Background. The morphology and function of anterolateral ligament (ALL) of the knee are not clearly understood even today with all the sophisticated techniques available. There have been differing descriptions of the ALL of the knee in literature, and not all of them have been named or described clearly. Aim. The present study was undertaken to provide a clear structure/relationship description on ALL. Materials and Methods. We used 24 formalin-fixed cadaveric limbs. Knee regions of the all the limbs were neatly dissected and the ALL was exposed. Its proximal and distal attachments were traced carefully. Middle portion of ALL was removed and processed for histological analysis. Results. ALL was found in one right knee (4.16%). It extended distally from the lateral femoral condyle to the lateral tibial plateau margin. Its attachment on the tibial plateau was located between head of the fibula and Gerdys tubercle. A strong connection was identified between the ALL and the periphery of the middle third of the lateral meniscus. Histological analysis of ALL confirmed the presence of true ligamentous structure in it with dense connective tissue and plenty of fibroblasts. Conclusion. The prevalence of ALL in different populations along with its clinical significance has been discussed in detail in this paper.

The place of anatomy in medical education: Guide Supplement 41.1 – Viewpoint

It is generally acknowledged that anatomy is one of the basic medical sciences which form the essential foundations for the training of doctors in the discipline of medicine. In traditional medical courses over many years, dissection has been regarded as an essential and unique feature in the study of topographical anatomy, but more recent developments in medical curricula and calls for change have challenged this approach, so that many medical students now graduate without ever dissecting the human cadaver and yet appear to be competent and adequately prepared for postgraduate training. The abandonment of dissection is symptomatic of the ongoing debate and argument about how best to teach anatomy, since presently, there is a lack of consensus and scientific evidence in this area. Interest in anatomy and dissection has varied over the passage of centuries with peaks of interest followed by decline. Are we now witnessing another decline in the scientific merit of anatomy as a subject due to its failure to evolve and adapt quickly enough? The AMEE Guide no. 41 addresses in detail the debate and ongoing arguments about how best to teach anatomy. It presents a careful review of the place of anatomy in medical education, including its history as a discipline, and how it is learned, delivered and assessed in both traditional didactic and modern integrative medical curricula (Louw et al. 2009). The Guide also discusses the current challenges and future measures that need to be addressed to ensure the continued development of anatomy as a relevant subject in any medical curriculum.

Facial Anthropometry in an Arab Population

Result: The mean inter-alar width of the nose was 35.06 mm (37.14 mm in males and 33.21 mm in females). The mean maxillary inter-canine distance was 37.96 mm (39.66 mm in males and 36.38 mm in females). The mean mouth width was 50.66 mm (52.85 mm in males and 48.63 mm in females). The maxillary inter-canine distance was 75% of mouth width; therefore, the mouth width is a reliable predictor of the maxillary intercanine distance and vice versa in the Arab population. Comparison between nationals from different GCC countries showed that Bahraini males had significantly wider mouths than Saudi Arabian males (P=0.034).