Rolina Al-Wassia

Using patients’ charts to assess medical trainees in the workplace: A systematic review

Abstract Objectives: The objective of this review is to summarize and critically appraise existing evidence on the use of chart stimulated recall (CSR) and case-based discussion (CBD) as an assessment tool for medical trainees. Methods: Medline, Embase, CINAHL, PsycINFO, Educational Resources Information Centre (ERIC), Web of Science, and the Cochrane Central Register of Controlled Trials were searched for original articles on the use of CSR or CBD as an assessment method for trainees in all medical specialties. Results: Four qualitative and three observational non-comparative studies were eligible for this review. The number of patient-chart encounters needed to achieve sufficient reliability varied across studies. None of the included studies evaluated the content validity of the tool. Both trainees and assessors expressed high level of satisfaction with the tool; however, inadequate training, different interpretation of the scoring scales and skills needed to give feedback were addressed as limitations for conducting the assessment. Conclusion: There is still no compelling evidence for the use of patient’s chart to evaluate medical trainees in the workplace. A body of evidence that is valid, reliable, and documents the educational effect in support of the use of patients’ charts to assess medical trainees is needed.

Outcomes of Saudi Arabian Patients With Nasopharyngeal Cancer Treated With Primarily Neoadjuvant Chemotherapy Followed by Concurrent Chemoradiotherapy

Purpose Nasopharyngeal cancer (NPC) is the most common head and neck cancer in Saudi Arabia. This study reports the locoregional disease control and survival outcomes in patients with NPC treated in King Abdulaziz University Hospital. Methods Patients treated for NPC between June 2007 and October 2014 were retrospectively reviewed. Demographic information, clinicopathologic variables, and chemotherapy data were collected and analyzed. Cumulative survival and disease control rates were calculated by Kaplan-Meier product-limit actuarial method. Results Thirty-nine patients with NPC were reviewed. Thirty-five (90%) patients received definitive radiotherapy (RT) and four (10%) had palliative RT. Mean prescribed dose for definitive RT was 68 Gy (range, 60 to 70.2 Gy), delivered with mean doses per fraction of 1.9 Gy (range, 1.8 to 2.1 Gy). After a median follow-up of 15 months (range, 1 to 84 months), 22 (63%) patients who underwent definitive RT were disease free and 13 (37%) were still with disease. During this period, seven (18%) patients died of the disease; five (13%) of them received definitive RT. After 2 years’ follow-up, the actuarial estimate rates were: 85.7% for local control, 91.4% for nodal control, and 85.7% for distant control. Conclusion Our study showed a disease with clinical behavior similar to what has been observed in East and Southeast Asia. Further it explored the neoadjuvant chemotherapy approach in treating NPC with results that are comparable to literature. However, little is known about the molecular pathogenesis of this disease in this region, and further research integrating clinical and molecular biomarkers is required.

Cultural challenges to implementation of formative assessment in Saudi Arabia: An exploratory study

Abstract Background/Purpose: This study investigates challenges that students and faculty face to implement assessment for learning; and the activities, capabilities, enablers, and indicators which could impact performance. Method: The study is a mixed methods research, cross-sectional, exploratory study. The study was organized through two phases of data collection and analysis (QUAL → quan). Based on qualitative focus group discussions (FGD), we first gathered data through field notes. Later, we engaged in analysis using techniques drawn from qualitative data including categorization, theme identification, and connection to existing literature. Based on this analysis, we developed a questionnaire that could provide quantitative measures based on the qualitative FGD. We then administered the questionnaire, and the quantitative data were analyzed to quantitatively test the qualitative findings. Twenty-four faculty and 142 students from the 4th and 5th clinical years participated voluntarily. Their perception of FA and the cultural challenges that hinder its adoption were evaluated through a FGD and a questionnaire. Results: The mean score of understanding FA concept was equal in faculty and students (p = 0.08). The general challenge that scored highest was the need to balance work and academic load in faculty and the need to balance study load and training and mental anxiety in students. There was no difference between faculty and students in perceiving “learning is teacher-centered” (p = 0.481); and “past learning and assessment experience” (p = 0.322). There was a significant difference between them regarding interaction with opposite gender (p <0.001). Students showed higher value as regards the “gap between learning theories and assessment practice”, “grade as a priority”, and “discrimination by same faculty gender”. Conclusion: The authors suggested a “Framework of Innovation in Endorsing Assessment for Learning”. It emphasizes a holisitic approach through all levels of the System: Government, Accreditation Bodies, Policy makers; Institution, and Classroom levels.

Optimization of Craniospinal Irradiation for Pediatric Medulloblastoma Using VMAT and IMRT.

Purpose: Intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) provide highly conformal target radiation doses, but also expose large volumes of healthy tissue to low-dose radiation. With improving survival, more children with medulloblastoma (MB) are at risk of late adverse effects of radiotherapy, including secondary cancers. We evaluated the characteristics of IMRT and VMAT craniospinal irradiation treatment plans in children with standard-risk MB to compare radiation dose delivery to target organs and organs at risk (OAR). Patients and Methods: Each of 10 children with standard-risk MB underwent both IMRT and VMAT treatment planning. Dose calculations used inverse planning optimization with a craniospinal dose of 23.4 Gy followed by a posterior fossa boost to 55.8 Gy. Clinical and planning target volumes were demarcated on axial computed tomography images. Dose distributions to target organs and OAR for each planning technique were measured and compared with published dose-volume toxicity data for pediatric patients. Results: All patients completed treatment planning for both techniques. Analyses and comparisons of dose distributions and dose-volume histograms for the planned target volumes, and dose delivery to the OAR for each technique demonstrated the following: (1) VMAT had a modest, but significantly better, planning target volume-dose coverage and homogeneity compared with IMRT; (2) there were different OAR dose-sparing profiles for IMRT versus VMAT; and (3) neither IMRT nor VMAT demonstrated dose reductions to the published pediatric dose limits for the eyes, the lens, the cochlea, the pituitary, and the brain. Conclusions: The use of both IMRT and VMAT provides good target tissue coverage and sparing of the adjacent tissue for MB. Both techniques resulted in OAR dose delivery within published pediatric dose guidelines, except those mentioned above. Pediatric patients with standard-risk MB remain at risk for late endocrinologic, sensory (auditory and visual), and brain functional impairments.

Daily setup uncertainty analysis for craniospinal irradiation using helical tomotherapy

PURPOSE Setup deviations of a craniospinal irradiation (CSI) patient cohort previously treated with helical tomotherapy were used to derive the optimal planning target volume (PTV) margin for CSI patients treated in the supine position. METHODS AND MATERIALS The daily setup shifts of 27 CSI tomotherapy patients as determined using pretreatment megavoltage computed tomography verification for a total of 454 fractions were evaluated. Translational displacements in the mediolateral (ML), craniocaudal (CC), and anteroposterior (AP) directions were used to assess the systematic and random setup errors, and to derive the PTV margin required when daily image guidance is unavailable. RESULTS The individual patient mean shifts and the corresponding standard deviations in the ML, CC, and AP directions were -0.5 ± 2.1 mm, 1.0 ± 2.7 mm, and 0.7 ± 1.1 mm, respectively. The random errors in the corresponding directions were 1.9 mm, 1.9 mm, and 2.2 mm. The PTV margins required in the absence of daily imaging were 3.7 mm to the right, 4.7 mm to the left, 4.4 mm inferior, 6.4 mm superior, 1.6 mm posterior, and 3.0 mm anterior. CONCLUSIONS The current PTV margin of 3.0 mm is sufficient to ensure clinical target volume coverage for CSI tomotherapy patients treated with daily megavoltage computed tomography imaging. When pretreatment verification imaging is not used to lower the setup uncertainty, a larger PTV margin of up to 6.4 mm in the CC direction will be needed.

Patterns, knowledge, and barriers of mammography use among women in Saudi Arabia

Objectives: To assess mammography utilization and knowledge, and to determine barriers associated with mammography utilization among Saudi women. Methods: We conducted a cross-sectional survey in 5 main geographic regions of Saudi Arabia from February 2015 to May 2015. The sample comprised women aged ≥40 years. Associations between socio-demographic factors and mammography use were tested using chi-square test. Predictors of mammography use were assessed by logistic regression. Results: A total of 3,245 women were surveyed, with 40% reporting ever having a mammogram. As indicated by the univariable analyses, older age (≥60 years), being single or divorced, having <2 children, not completing high school, and having a family history (hx) of breast cancer were significantly associated with never having a mammogram. Participants of older age (odds ratio [OR] 51-60 versus 41-50 = 0.6, 95% CI: 0.5-0.7 and OR >60 versus 41-50 = 0.5, 95% CI: 0.3-0.8), and divorced (OR divorced versus married = 0.6, 95% CI: 0.5-0.8] were less likely to have had a mammogram, while participants with no family hx of breast cancer (OR no family hx versus family hx = 1.5, 95% CI: 1.3-1.8)were more likely to have had a mammogram. Conclusion: Mammography utilization and knowledge are low in Saudi Arabia. Increasing the awareness of breast cancer screening through educational programs could help women overcome existing barriers and misconceptions.