Evaluation of the learning environment of urology residency training using the postgraduate hospital educational environment measure inventory

Saleh Binsaleh,1 Abdulrahman Babaeer,2 Abdullah Alkhayal,2 Khaled Madbouly3 1Division of Urology, Department of Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Department of Urology, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 3Department of Urology, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia Objectives: The educational environment plays a crucial role in the learning process. We aimed to evaluate the educational-environment perceptions of Saudi urology residents using the postgraduate hospital educational environment measure (PHEEM) inventory, and to investigate associations of their perception with stages of residency program, regions of Saudi Arabia, and main sectors of the health care system. Methods: We used PHEEM to measure the educational environment of Saudi urology residents. Respondents' perception was compared regarding different levels of residency training, regions of Saudi Arabia, and sectors of the health care system. Internal reliability of the inventory was assessed using Cronbach's alpha coefficient. Results: Out of 72 registered residents, 38 (53%) completed the questionnaire. The residents did not perceive their environment positively (77.7±16.5). No significant differences in perception were found among residents of different program stages or Saudi regions. Residents from different health care sectors differed significantly regarding the total PHEEM score (P=0.024) and the teaching subscale (P=0.017). The inventory showed a high internal consistency with Cronbach's alpha of 0.892. Conclusion: Saudi urology residents perceived the educational environment as less than satisfactory. Perception of the educational environment did not change significantly among different stages of the program or different regions of Saudi Arabia. However, some sectors of the health care system are doing better than others.    Keywords: educational environment, PHEEM, residency program, resident

Necrotizing Urethritis due to Aerococcus urinae

A 49-year-old male presented to the emergency with hematuria and pain in the shaft of the penis for one day. The patient was found to be in a state of shock. The shaft of the penis and the scrotum were swollen and tender. No skin necrosis was observed and no crepitus was palpable. Serum white count (WBC) was 29.5 × 103/μL. A CT scan showed gas in the corpus spongiosum. Antibiotics were started with IV metronidazole, vancomycin, and piperacillin/tazobactam. Metronidazole was then replaced by clindamycin. Exploration was performed but no necrotic tissue was identified. Cystourethroscopy revealed dusky looking urethra. A suprapubic tube and a urethral catheter were placed in the bladder. WBC trended down to 13.9 × 103/μL on the fourth postoperative day. Urine culture grew Aerococcus urinae and blood cultures grew Alpha Hemolytic Streptococcus. On the sixth day, the patient was feeling worse and WBC increased. MRI revealed absent blood flow to the corpus spongiosum. Urethroscopy revealed necrosis of the urethra. Urethrectomy was performed via perineal approach. The patient immediately improved. The patient was discharged on the sixth postoperative day to continue ampicillin/sulbactam IV every 6 hours for a total of 4 weeks from the day of urethrectomy

Quality of life tools among patients on dialysis: A systematic review

Introduction:  The universal increase in obesity and diabetes has increased the chronic kidney disease (CKD) rate. In 2017, almost 800 million individuals suffered from CKD worldwide. Kidney dialysis becomes necessary as the disease progresses. Dialysis negatively impacts CKD patients' quality of life (QoL). It causes several complications that affect patients' physical, social, psychological, and spiritual aspects of life. This systematic review aims to identify condition-specific tools used to assess CKD patients' quality of life on dialysis. Material and Methods: A systematic literature search was conducted to investigate studies using QoL tools among patients on dialysis from February 2000 to June 2023. The search was conducted in several databases and followed the PRISMA guidelines. The focus was to identify tools that capture intrinsic factors, such as spiritual subdomains, rather than extrinsic factors, such as environmental subdomains. Results: The review identified five studies and seven dialysis-specific tools for assessing the QoL of CKD patients on dialysis. The physical domain was the most assessed, followed by the psychological and social domains. Fatigue, muscle weakness, sleep disorders, and pain were identified as the most common concerns in the physical domain. Conclusion: Dialysis negatively impacts all aspects of QoL in CKD patients. This review can guide clinicians in understanding the disease and treatment burden by identifying the most appropriate tools for assessing the QoL of adult CKD patients undergoing dialysis. There is a need for further studies to explore the detrimental effects of CKD treatment and better understand its impact on patients' QoL

Looking to our Past to Re-Envision our Future: A Co/Authoethnographic Study of Teacher Candidate Supervision across International Contexts

This self-study tells the story of two international teacher education doctoral students and one faculty member as they embarked upon a co/autoethnography as a way to collectively explore experiences with and conceptualization of teacher candidate supervision across international contexts. Data collection included written autobiographical narratives, audio-recordings of reflective conversations, and various artifacts. By sharing our narratives and engaging in reflective conversations about these experiences, we gained insight into our histories in relation to the term supervision. Understanding each other’s pasts and contexts helped us gain a window into how our experiences influenced our beliefs about supervision. Specifically, we saw connections in relation to what influenced us to become teachers, relationships and the context for supervision, and the function of supervision. Our past narratives became a lens to study how we currently view supervision. This realization pushed us to develop a new vision of supervision informed by both our past experiences and our current knowledge and experiences. This study has implications for both teacher educator-doctoral student preparation and teacher educator professional development