SACM - United Kingdom
Permanent URI for this collectionhttps://drepo.sdl.edu.sa/handle/20.500.14154/9667
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Item Restricted Novel Approaches to the Assessment and Management of Granulomatous Lymphocytic Interstitial Lung Disease (GLILD)(University College London, 2024) Bintalib, Heba; Hurst, John; Burns, SiobhanIntroduction: Granulomatous-lymphocytic interstitial lung disease (GLILD) is generally considered a manifestation of systemic immune dysregulation occurring in up to 20% of people with common variable immunodeficiency disorders (CVID). GLILD is associated with increased morbidity and mortality and presents a significant diagnostic and management challenge. There is a lack of evidence-based guidelines of GLILD despite its clinical significance. This thesis aimed to bridge knowledge gaps, offering new insights and methods to improve GLILD assessment and management. Methods: Several methods are employed. First, an international research prioritization exercise was conducted based on methodology developed by the James Lind Alliance. Subsequently, a systematic review was undertaken to summarise the current literature on diagnostic approaches in GLILD. Additionally, a national data analysis focusing on non-infectious complications (NICs) in CVID patients with and without GLILD was conducted to assess the variation in clinical features and the risk factors associated with this condition. Moreover, a clinicians survey was conducted to evaluate the current practice regarding lung biopsy in the work up of GLILD. A retrospective analysis was undertaken to assess three treatment regimens at our centre. Finally, a prospective study was conducted to evaluate the utility of the 6-minute walk test (6MWT) in GLILD. Results: The international research prioritization exercise identified key areas for future research. The systematic review suggested that high-resolution computed tomography (HRCT) and lung biopsy were required for definitive diagnosis of GLILD, emphasizing the need for standardized diagnostic criteria. In the CVID cohort with NICs, chronic lung diseases, particularly GLILD, were predominant, with lymphadenopathy associated with GLILD. The clinician survey underscored the complexity of diagnosing GLILD and highlighted varied opinions on the necessity and effectiveness of lung biopsies. Treatment outcomes varied, with corticosteroids demonstrating inducing remission but presenting challenges in long-term management, while mycophenolate showed promise in disease stabilization and corticosteroid sparing. Functional assessments, particularly the 6MWT and the King's Brief Interstitial Lung Disease (K-BILD) questionnaire, were valuable measures with good reproducibility in GLILD patients. Conclusion: This thesis contributes significantly to the understanding and management of GLILD in CVID. By addressing critical research priorities, elucidating diagnostic challenges, evaluating treatment modalities, and integrating functional assessments. Our findings inform clinical practice and guide future research. Ultimately, our efforts aim to improve patient outcomes and promote international collaboration.14 0Item Restricted Investigating Computer Aided Assessment of Mathematical Proof by Varying the Format of Students’ Answers and the Structure of Assessment Design by STACK(University of Edinburgh, 2024-03-18) Alarfaj, Maryam Khalid H; Sangwin, ChristopherStudents are increasingly being expected to use Computer Aided Assessment (CAA) systems as support for traditional courses. Assessing a full mathematical proof in an educational context and providing feedback and other outcomes to students is currently well beyond the capabilities of CAA systems. One possible approach to assessing students’ answers has been to break up larger tasks into smaller individual steps to which automatic assessment can then be applied. However, the method of marking depends on the format of a mathematical response. This thesis aims to investigate the effectiveness of different formats in computer aided assessment of mathematics. A format effect occurs when the format of an exercise affects the rate of successful outcomes of the exercise. Having established the need to study the format effect when writing mathematical arguments particularly online, I consider three formats for writing open-ended questions: two-column, typing, and Separated Concerns. The first of three studies explored the impact of the two-column format in writing simple mathematical arguments. In conducting this research, I developed a coding scheme to describe and analyse the structure of individual mathematical arguments. The second study focused on the difference and the format effects between uploading handwritten and typing in writing mathematical responses. Another outcome of this study is to provide a further application of using the coding scheme on analysing students’ arguments. The third study focused on updating STACK potential response tree based on Separated Concerns. STACK is a System for Teaching and Assessment using a Computer algebra Kernel, is an open source computer aided assessment system for mathematics, and other STEM subjects. Separated Concerns is a phrase used to describe materials in which potential misconceptions are addressed directly. In this study, I focused exclusively on students’ responses, and misconceptions in learning proof by induction using STACK. Mathematical induction is used as a vehicle to illustrate the idea of Separated Concerns. The main goal of the third study is to understand how engagement with learning materials packaged into online quizzes to replace live lectures, a “lecture quiz”, related to success on the weekly assessed quiz, and the course total. A second goal of the third study is to explore the common mistakes made by students when using online materials to prepare for mathematical induction. This study also illustrates how to use research to update the algorithms which assess students’ answers, known as “STACK potential response trees”, in questions written to support learning mathematical induction based on Separated Concerns.64 0Item Restricted Assessment of Clinical Competence: Implementation of the Objective Structured Clinical Examination (OSCE) in Saudi Medical Schools(University of Leeds, 2023-02-08) Almisnid, Khaled; Homer, MatthewAssessment of clinical skills is essential in determining the competency of health professionals. The Objective Structured Clinical Examination (OSCE) is a performance assessment tool that is widely adopted for this purpose. Despite its widespread use in Saudi medical schools, the implementation and impact of the OSCE in Saudi Arabia (SA) have not been widely investigated. The aim of this research is to provide an in-depth understanding of OSCE usage in Saudi medical schools, the opportunities and challenges offered by its adoption, and to develop recommendations to improve implementation. Using a qualitative constructivist philosophy, this research employs a case study design in two different Saudi medical schools, integrating document review with interviews and focus groups with medical school leaders and their Faculty. Reflexive thematic analysis and codebook methods were applied to interviews/focus groups and documents, respectively. The analysis generated a series of key themes that impacted the OSCE implementation in Saudi medical schools. These themes constitute a conceptual framework that requires careful consideration in order for them to function harmoniously to produce a high-quality OSCE. This research also highlights that each stage of OSCE implementation in the investigated medical schools involves a series of dilemmas and compromises. Analysis suggests that funding sources (public or private schools), accreditation status, faculty experience, and resource availability all influence the quality of OSCE implementation. The research findings are consistent with the international OSCE literature; however, this work brings new insights into the use of the OSCE in SA, a non-western culture, and sheds light on the integrative nature of the factors that contribute to successful implementation. It concludes with a series of recommendations that individual medical schools and organisational networks can employ to improve the OSCE in SA, and beyond.39 0Item Restricted Assessment of Interprofessional Education for Undergraduate health-care students: a systematic review and intervention study(Hailah Almoghirah, 2023) Almoghirah, Hailah Abdulrahman A; Illing, Jan; Nazar, HamdeIntroduction: Interprofessional education (IPE) provides health care students and practitioners with the training necessary to be ready to collaborate, and to work effectively in interprofessional teams. It is widely believed that interprofessional working improves the healthcare system and reduces medical errors, thus improving patient safety. Furthermore, it has been suggested that interprofessional training for undergraduates is a useful strategy to improve staff wellbeing and patient care in the future. Aim: The overall aim of this thesis was to design, and test an IPE educational intervention and improve IPE assessment for undergraduate students. Method: A systematic review was conducted to critically appraise IPE assessment tools used for undergraduate IPE. From this review, an IPE Assessment Decision Aid was then developed to help educators select the appropriate IPE assessment tool. The next phase involved the development of a robust, authentic intervention and an evidence based assessment approach based on the systematic review findings. Final year medical students and final and third year pharmacy students were recruited via email to participate in this intervention. Medical and pharmacy students were assigned in pairs to work together online to undertake a hospital discharge process. The IPE intervention was repeated three times using three different patient scenarios. A multi-modality approach to assessment of students was taken to gain a better understanding of student learning and improvement. Quantitative and qualitative data were collected from different sources. Data collected included: a validated scale completed by an interprofessional assessment team, discharge letters completed by students, written feedback provided by the assessment team, student reflections on their performance, and focus groups conducted with the students and the assessment team. Results: Eighteen students (nine from each professional programme) completed the study and a total of 27 IPE sessions were conducted. The assessment team completed 54 Interprofessional Professionalism Assessments (IPA) of the students’ performance, evaluated 27 discharge letters and 31 student reflections, which were received from the eighteen students who participated. Additionally, nine focus groups were conducted with students, and one focus group was conducted with the assessment team. The third IPE iteration showed a statistically significant improvement in students’ interprofessional behaviour. The discharge letter, used as a proxy for patient outcome, also improved over the IPE iterations. Students found the educational sessions useful and relevant. Conclusion: The selection of an appropriate assessment tool is a decision to be taken alongside the conception and design of the IPE intervention. No single IPE tool is suited to all IPE interventions. This PhD project provides educators with a decision aid about which tools might be most appropriate for the purpose of their planned IPE intervention. The developed and implemented intervention and assessment approach illustrated the benefits of repeating the same IPE intervention for students to develop skills and assess improvement. In the assessment, having the opportunity to provide qualitative feedback is important to provide a more global assessment of student performance. This IPE study was distinguished from other IPE studies in its ability to capture the impact of interdependence, as students worked with different partners across each iteration.77 0