Competencies for Successful Middle Managers in Healthcare and Medical Education

The Kingdom of Saudi Arabia (KSA) and the Kingdom of Bahrain (KB) are currently in the process of the rapid transformation of health care to a self-sustained autonomous system. Middle managers play a pivotal role in achieving this goal. The aim of this study is to develop a feasible, reliable, and valid scale for measuring the leadership and managerial competencies of MM in KSA and KB. Zhou’s (2019) conceptual framework using a mixed-method approach was followed. After procuring ethical clearance from concerned authorities and informed consent from all the participants (n = 27), semi-structured interviews were conducted across three groups: Top Management (TM), Middle Management comprising of Middle Managers (MM), and Lower Management (LM) for the creation of items for the scale, which were later approved by five experts. Two hundred two participants from medical education (ME) and health care (HC) responded to the new scale. Cronbach\u27s alpha and exploratory and confirmatory factor analysis were performed to confirm internal consistency and validity. The model fit was adequate with a good GFI (0.90), TLI (0.96), and RMSEA (0.06). Seven major themes emerged from the thematic analysis, while a structural model with three inter-related constructs—“professionalism and problem solving,” “team management and adaptation,” and “time management and expertise” were recognized based on factor analysis. Both TM and LM identified the ability to motivate (70.8%) as comprising one of the most significant characteristics of MM. TM also indicated that concern and consideration of subordinates (68.8%) were important. LM considered being active (71.6%) as important for MM. Interestingly, MM had scored these attributes lower, illustrating the different ways in which MM is perceived across the three levels of management. Importantly, MM acknowledged concern for employee well-being, relationship, communication, and being active as crucial competencies, representing a mix of all competencies identified by the three levels of management. The “Leadership and Managerial Competency Scale for Middle Managers in Gulf Region (LMCS-MM Gulf Region)” developed under this study reflects what people in the three levels of management (lower, middle, and top) across ME and HC value in a (hypothetical) middle manager. This scale has several implications for the selection, training, and appraisal of MM in ME and HC. This dissertation is available in open access at AURA (https://aura.antioch.edu) and OhioLINK ETD Center (https://etd.ohiolink.edu)

A Comparison Study of Communication Skills between General Surgery and General Practice Residents on First-time Patient Visits

Background: There is little published research about differences in doctor-patient communication of different specialties. Accordingly, we compared doctor-patient communication skills in two different specialties, general surgery (GS) and general practice (GP). Methods: Twenty residents training at the Bahrain Defence Force Hospital (10 men and 10 women; mean age 28 years; 10 GS and 10 GP) participated in 200 patient first visit consultations. The consultations were video-recorded and analysed by four trained observers using the MAAS Global scale. Results: 1) Internal consistency reliability of the MAAS Global (> 0.91) and Ep2 = 0.84 for raters was high, 2) GP residents spent more time (12 minutes) than GS residents (7 minutes), in the visits, 3) There were several differences on the MAAS Global items between GP and GS residents (GS > GP, p < 0.05 on history taking, diagnosis and medical aspects; GP > GS, p < 0.05 on information giving), and 4) The present participants performed well compared to normative samples as well as to criterion-referenced cut-off scores. The general level of communication skills in both specialties, however, was ‘unsatisfactory’ and ‘doubtful’, as it is for normative samples. Conclusion: Excellent doctor-patient communication is essential but does not appear to receive the amount of attention that it deserves in practice settings. There are some differences between specialties as well as unsatisfactory communication skills for both specialties, since residents from both programs spent less time than recommended on each consultation. Our findings emphasize the need to improve the communication skills of physicians in general and for surgeons in particular.

Measurement of Impairment among Children with Attention Deficit Hyperactivity Disorder as Part of Evaluating Treatment Outcome

Objectives: This study assesses the impairment and treatment outcome of children with attention deficit hyperactivity disorder (ADHD) in an outpatient child psychiatry clinic, using multiple sources, including the Children Global Assessment Scale (C-GAS). Methods: A total of 20 children, aged 4 to 16 years, were recruited serially in 2010 from the Child Psychiatric Unit of the Psychiatric Hospital, Manama, Bahrain. The children received a diagnosis of ADHD using the Diagnostic and Statistical Manual of Mental Disorders Text Revision (DSM-IV-TR). The children were assessed with the C-GAS by a blinded investigator, initially at the beginning of the treatment and then one year later. Results: The parents of the patients reported improvement in all cases; the improvement in impairment after one year, assessed using the C-GAS, was significant for all of the cases (P = 0.001) and low for those with comorbidity (P = 0.07). Conclusion: Measurement of improvement using the C-GAS was a suitable method of collecting data, and hence should be included in routine clinical practice for both ADHD diagnosis and outcome measurement

Multisource feedback to assess pediatric practice: a systematic review

Introduction: The assessment and maintenance of competence for pediatricians has recently received increased attention. The aim of the present study was to investigate further the use of multisource feedback for assessing pediatricians in practice. Methods: A systematic literature review was conducted using the electronic databases EMBASE, PsycINFO, MEDLINE, PUBMED, and CINAHL for English-language articles. Results: 762 articles were identified with the initial search and 756 articles were excluded for a total of six studies that met the inclusion criteria for this systematic review. Internal consistency reliability was reported in five studies with α > 0.95 for both subscales and full scales. Generalizability was also reported in two studies with Ep2 generally > 0.78. These adequate Ep2 coefficients were achieved with different numbers of raters. Evidence for content, criterion-related (e.g., Pearson’s r) and construct validity (e.g., principal component factor analysis) was reported in all 6 studies. Conclusion: Multisource feedback is a feasible, reliable, and valid method to assess pediatricians in practice. The results indicate that multisource feedback system can be used to assess key competencies such as communication skills, interpersonal skills, collegiality, and medical expertise. Further implementation of multisource feedback is desirable

A Comprehensive Fluid-Solid Interaction Analysis of Finite Journal Bearings

As key elements in plenty of rotating machinery, the elastohydrodynamic performance of journal bearings should be carefully checked in light of the design and operating parameters considered. This first part of the current study aims to numerically analyse the operation of journal bearings under alignment conditions. In the fluid-solid interaction analysis conducted, the lubricant flow field is solved using the finite volume method. Based on finite elements strategy, a structural analysis is then implemented to the solid bearing using the pressure distribution computed earlier on its inner surface. A wide range of operating conditions has been considered including the eccentricity ratio (0.1≤ε≤0.9), bearing length-diameter ratio (0.8≤L/D≤2), and rotation speed (4,000≤N≤10,000 rpm). Three principal categories of operational quantities have inspected, namely; the lubricant pressure distribution, overall performance parameters, and structural aftereffects. Among all the parameters examined, the eccentricity ratio is the most influential one on the performance of journal bearings. As it increases with applying heavier loads, a significant rise occurs in each of the friction force, power loss, stress levels, and deformation on the inner surface of the bearing. The bearing length and rotation speed, on the other hand, affect the bearing performance as well, but to a less extent

A Comprehensive Fluid-Solid Interaction Analysis of Finite Journal Bearings

As key elements in plenty of rotating machinery, the elastohydrodynamic performance of journal bearings should be carefully checked in light of the design and operating parameters considered. This first part of the current study aims to numerically analyse the operation of journal bearings under alignment conditions. In the fluid-solid interaction analysis conducted, the lubricant flow field is solved using the finite volume method. Based on finite elements strategy, a structural analysis is then implemented to the solid bearing using the pressure distribution computed earlier on its inner surface. A wide range of operating conditions has been considered including the eccentricity ratio (0.1≤ε≤0.9), bearing length-diameter ratio (0.8≤L/D≤2), and rotation speed (4,000≤N≤10,000 rpm). Three principal categories of operational quantities have inspected, namely; the lubricant pressure distribution, overall performance parameters, and structural aftereffects. Among all the parameters examined, the eccentricity ratio is the most influential one on the performance of journal bearings. As it increases with applying heavier loads, a significant rise occurs in each of the friction force, power loss, stress levels, and deformation on the inner surface of the bearing. The bearing length and rotation speed, on the other hand, affect the bearing performance as well, but to a less extent

Adrenal Cyst Presenting as Hepatic Hydatid Cyst

Introduction. Although adrenal cysts are uncommon, the incidence rate is increasing with the advances in radiological technologies. The incidental detection of adrenal cysts nowadays has become more frequent as a result of the increase usage of high quality imaging modalities. Adrenal cysts originate from the adrenal gland and can be classified into either true or pseudocyst. Presentation of Case. In this report, we described an adrenal cyst of endothelial type, in a 30-year-old lady who was mistakenly diagnosed to have a hydatid cyst both clinically and by imaging. Discussion. Although adrenal cysts are uncommon, the incidence rate is increasing with the frequent use of various high quality radiological technologies. Adrenal cyst should be considered in the differential diagnosis when dealing with upper abdominal cysts. The size of the adrenal cyst can vary from a few millimeters up to 50 cm in diameter. Most of the adrenal cysts are unilateral, while 8%–15% of those cysts do present bilaterally. The majority of cases are diagnosed between the 3rd and 5th decades. Conclusion. Although most of the adrenal cysts are benign in nature, surgical excision is advisable especially when the cysts are greater than 5 cm in diameter and in the case of suspecting malignancy