Reprioritizing current research trends in medical education: A reflection on research activities in Saudi Arabia

Abstract

Background: There are numerous national efforts to determine and develop research priorities of medical education in Saudi Arabia. These priorities were first proposed in 2010 by “Dr Al-Khuli’s Chair for Developing Medical Education in Saudi Arabia”. The proposed priority domains were: curriculum, students, faculty, and quality assurance and accreditation.

Aim: To investigate publications in medical education at the national and international levels in areas relating to these proposed priorities.

Methods: Electronic search within PubMed database for papers relating to each domain of priority was conducted at national and international levels in the last three years, using the same keywords as the priority domains, but only confined to undergraduate medical education.

Results: Out of 3145 articles retrieved when searching with keyword as broad as “undergraduate medical curriculum” only 81 articles worldwide and 3 articles from Saudi Arabia were dealing with curriculum related issues as a whole. Further search on the sub-domains “effective strategies to manage undergraduate curriculum” and “undergraduate medical education models”, resulted in the retrieval of few articles worldwide and none from Saudi Arabia. At the national level, there were 63 publications from Saudi Arabia that were either course (topic)-specific or could not be classified under the four domains specified by Dr Al-Khuli’s Chair.

Conclusion: Research activities in medical education in Saudi Arabia in the last 3 years showed diversity and lack of focus in the research priorities. Efforts of academic and research centers should continue to monitor and encourage these activities toward achieving the recommended priorities.

Introduction

Medical education, nationally and internationally, is witnessing numerous changes in the fields of curriculum, innovations in instructional methods, assessment, and issues related to accreditation. At the national level, there is an increased interest in medical education not only due to pressure from accreditation bodies, but also due to the rapid expansion in the number of medical schools to meet the demand of all stakeholders, including the community (Bin Abdulrahman et al. 2013). Recent advances in Saudi medical education resulted in the creation of many private and Governmental medical colleges across the country. Currently, there are 32 medical colleges in Saudi Arabia, nine of them are private and the number is on the rise (Abdulghani et al. 2013). Majority of these colleges have created departments of medical education or units to maintain and improve the quality of their educational activities. This has created a great demand to look into research priorities in the field of medical education.

With this in mind, back in 2010, the scientific committee of “Dr Al-Khuli’s Chair for Developing Medical Education in Saudi Arabia” at Al-Imam Mohammad Bin Saud Islamic University conducted multiple workshops and focus groups with many national experts in medical education to come up with a list of research priorities in medical education. Research priorities related to four domains in medical education were recommended: curriculum, students, faculty, and quality assurance and accreditation (Al-Shafei et al. 2013).

Table

Practice points

There are numerous efforts to develop research priorities of medical education in Saudi Arabia. Priorities were proposed in 2010 by Dr Al-Khuli’s Chair for Developing Medical Education. A search within PubMed database was conducted at two levels. Results showed diversity and lack of focus. It is important to promote a culture of educational research and scholarship of teaching.

This was followed by the Third Saudi International Medical Education Conference (SIMEC 2012) that was held in Saudi Arabia and was hosted by the College of Medicine at Al-Imam Mohammad Ibn Saud Islamic University in Riyadh from 22 to 26 April 2012. This conference covered all areas of medical education but the focus was mainly on the following five major themes: trends in curriculum planning and development; teaching and learning; assessment; accreditation; and innovation in medical education. Other research priorities were also covered in the form of research papers and presentations (Al-Shafei et al. 2013). It was noticeable, that research papers presented at the conference were not able to address the themes that were recommended by Al Khouli’s Chair or even those that were predetermined to be the main themes of the conference. This was evident when a panel of world renowned medical education experts chose the top 10 research ideas from the vast array of e-posters, short communications, and other forms of research presented at the meeting. Many of the top 10 papers only dealt with assessment, teaching, and learning. The rest covered a wide array of medical education topics. This study was initiated to investigate publications in medical education at the national and international levels in areas relating to the aforementioned priorities.

Methods

Three years after prioritizing research questions by Dr Al-Khuli’s Chair for Developing Medical Education in Saudi Arabia we looked at the published studies relating to the recommended domains in the last three years. For this purpose, a search within PubMed database for papers relating to each domain was conducted at two levels. Hence, the keywords reflected the priority domains mentioned above; i.e., curriculum, students, faculty, and quality assurance and accreditation. Level 1 dealt with research papers worldwide; and Level 2 dealt with papers that emerged from Saudi Arabia.

All retrieved articles were reviewed manually and articles that were not directly related to medical education (e.g., dealing with patient education or with prevalence of certain diseases in medical students), were excluded. The remaining articles were categorized under four medical education domains.

The search for local publications included more domains, such as teaching and learning and assessment as many articles could not be categorized under the aforementioned four domains.

Results

Surprisingly, our search showed a lack of focus and diversity in research themes in the published articles especially at the national level. Articles related to curriculum were not dealing with issues like curriculum development or strategies for curriculum management; rather, many described the introduction of certain courses at a micro-level. Out of 3145 articles retrieved when searching for keywords as broad as “undergraduate medical curriculum” only 81 articles worldwide and three articles from Saudi Arabia were dealing with curriculum related issues as a whole (Table 1).

Table 1. Summary of the search results within the PubMed database for papers published worldwide and from Saudi Arabia between October 2010 and December 2013; relating to research domains prioritized by Dr Al-Khuli’s Chair for Developing.

Domain	Research question	Total world-wide published articles	Papers published from Saudi Arabia
Curriculum	1. undergraduate medical curriculum	3145	35
	Non-course (topic) specific)	81	3
	Undergraduate medical curriculum [ti] AND strategies*	2	0
	Undergraduate medical curriculum [tiab] AND strategies**	5	0
	Undergraduate medical curriculum [tiab] AND models	4	0
	2. undergraduate medical curriculum and Saudi Medical Schools	17	17
	3. core learning objectives and medical education (Non-course specific)	3	0
	4. core competencies and medical education (Non-course specific)	14	0
Faculty	Faculty recruitment, retention, selection, and promotion: Different combinations	11	3
	Faculty development and medical education	55 (many reviews)	4
Students	Student admission and performance in medical schools (different combinations)	50	11
Quality Assurance and Accreditation	Saudi National Commission for Academic Accreditation & Assessment	3	3
Within the above domains but are course (topic specific)		Too many	45
Others (not related to the above domains)		Too many	18

Medical Education in Saudi Arabia (Adapted from Al-Shafei et al. 2013).

*[ti] = Title search.

**[tiab] = Title/Abstract search.

Answering specific questions raised by Dr Al-Khuli’s Chair, such as dealing with effective strategies to manage undergraduate curriculum or undergraduate medical education models resulted in the retrieval of fewer articles worldwide and none from Saudi Arabia. For example; searching for “Undergraduate medical curriculum [ti] AND strategies” as keywords retrieved two articles. Searching for “Undergraduate medical curriculum [tiab] AND strategies” as keywords retrieved five articles. Searching for “Undergraduate medical curriculum [tiab] AND models” as keywords retrieved four articles. At the national level, there were 63 publications from Saudi Arabia that were course (topic) specific (i.e. leading to non-generalizable results) or could not be classified under the four domains specified earlier. Mostly, these articles investigated institutional practices without investigating in specific domains. Many papers relating to curriculum discussed integration of PBL to the curriculum, with a limited scope. There were very few articles related to students’ stress and educational environment and learning styles. Faculty-related issues were poorly investigated; only three articles dealt with accreditation. One article discussed difficulties related to faculty research output. Many articles discussed teaching, learning, and assessment. It is noteworthy that medical educators in Saudi Arabia tackled areas that are considered either new or desolate before; e.g., stress and depression among medical students, sleep and academic performance, educational environment and self directed learning, how to assess professional behavior within the curriculum, and evaluation of the role of social media in medical education.

Discussion

It is evident that research in medical education continues to be of insufficient quantity and quality despite the progress that has taken place over the past two decades. Albert and colleagues (2007) believe that the working conditions of researchers, budgetary restraints in financing research in medical education, and the conception of research in the medical environment were the main obstacles to the advancement of medical education research. Two principal means for improving research are presented: intensifying collaboration between PhD’s and clinicians, and encouraging the diversification of perspectives brought to bear on research in medical education (Albert et al. 2007).

Perhaps, learning from the Netherland’s experience in this regard is useful. With regards to the quantity of publications in the medical education literature, the Netherlands rank second among countries in Europe and fourth worldwide over the past years, related to the journals with highest impact factors (Jaarsma et al. 2013). The authors believe that the establishment of the Netherlands Association for Medical Education with its mission to stimulate research and development of education, annual conferences, courses on research in medical education, chairs in medical education qualified to graduate PhD students, and a general open and critical national culture of enquiry may have added to this success.

In the Kingdom of Saudi Arabia; it is clear that many academic and research bodies encourage medical education research activities. Academic and research centers, including Dr Al-Khuli’s Chair, should take a leading role in monitoring medical education research activities in Saudi Arabia and probably encourage research towards achieving the recommended local priorities. It is evident, three years after prioritizing research areas in medical education by Dr Al-Khuli’s Chair that those priorities are still valid especially at the national and international level. Although, the quantity of these activities in Saudi Arabia is relatively acceptable but the lack of focus and non-generalizability of the findings are of concerns. The key might be in the establishment of multi-center research centre and to conduct focus groups with those who are interested in conducting research in medical education in specific and well defined areas that fit well under those priorities, so that new research ideas could be generated.

Encouraging and involving undergraduate medical students in conducting research will lead to the development of their cognitive and professional abilities and will likely to promote their success (Fechheimer et al. 2011; Thiry et al 2012).

Their engagement and participation in research activities will also likely promote the development of a “culture” of scientific medical research among them and will lead to the development of their research interest and skills after graduation (Reinders et al. 2005). Undergraduate medical students have shown an outstanding ability to initiate excellent researches, organize, and participate in national and international meetings and even develop students-led scientific journals (Alfaro-Toloza & Olmos-de-Aguiera 2013).

Despite all recognized benefits of the research for undergraduate medical students, measures should be taken to overcome expected obstacles that could minimize their involvement. Formation of support groups and mentoring of students could offer a significant support and showed encouraging outcomes (Kardash 2000; Alamodi et al. 2014). High-quality student-led researches have been and will hopefully continue to be presented locally at the annual scientific research meetings organized by the Saudi Ministry of Higher Education. Continuation of such efforts that support and encourage student-led research will promote scientific research activities, in general, and in the areas of medical education specifically.

It is also important to promote a culture of educational research and scholarship of teaching. Measure to take might include; educational leadership programs, faculty development, the teaching scholars program, the establishment of the office of educational research and development, the establishment of academy of medical educators, a Fellowship in medical education research, collaborative research, and extramural grants.

Notes on contributors

AKEF OBEIDAT, MD, PhD, Associate Professor of Anatomy & Medical Education, Vice Dean, Quality Assurance and Accreditation, College of Medicine, Alfaisal University, Riyadh, KSA.

ALI IBRAHIM ALHAQWI, ABFM, FRCGP (UK), PhD (MedED), Associate Professor, Department of Medical Education, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, KSA.

HAMZA MOHAMMAD ABDULGHANI, MBBS, DPHC, ABFM, FRCGP (UK), MMed Ed Associate Professor, Department of Medical Education, College of Medicine, King Saud University, Riyadh, KSA.

The publication of this supplement has been made possible with the generous financial support of the Dr Hamza Alkholi Chair for Developing Medical Education in KSA.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.