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   Table of Contents - Current issue
Coverpage
April-June 2022
Volume 5 | Issue 2
Page Nos. 85-197

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SYSTEMATIC REVIEWS  

Pneumothorax as a complication of COVID-19: A systematic review of individual patients' characteristics Highly accessed article p. 85
Abdulrahman Mutlag Almalki, Murouj Adnan Almaghrabi, Ahmad Hamed Alharbi, Ahaad Mohammad Basahal, Bashaer Ayidh Alharbi, Mohammad Alfelali, Mohammed Shabrawishi
DOI:10.4103/jnsm.jnsm_87_21  
Since the coronavirus disease-2019 (COVID-19) outbreak in December 2019, evidence suggests an association between COVID-19 and the onset of pneumothorax (PTX). Thus, the present study aimed to investigate the onset of PTX, the possible risk factors, clinical characteristics, management, prognosis, and mechanism of PTX formation in patients with COVID-19 infection. A systematic review was done using several databases for articles published from December 2019 to January 2021. One-hundred and thirty-nine patients in a total of 87 articles fulfilled our criteria. A broad age range was affected (mean and standard deviation of 57 ± 15.39) with male predominance (77.7%). Most patients (66.2%) developed PTX during the hospital stays. In those who developed PTX, the most recognized characteristics included male gender (77.7%), severe COVID-19 infection (41%), mechanical ventilation (43.2%), age >65 years (30.9%), other diseases (79.1%), and smoking (8.6%). A good prognosis was reported in more than half of the patients (83; 59.7%). Death was significantly associated with critical conditions of COVID-19, bilateral PTX, respiratory distress, and mechanical ventilation (P = 0.006, 0.001, 0.013, and 0.001, respectively). PTX is a potential complication of COVID-19 infections, commonly noticed in the right lung. Mechanical ventilation, COVID-19 severity, bilateral PTX, and acute respiratory distress were associated with worse outcomes in COVID-19 patients with PTX.
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Central nervous system sequelae in patients with coronavirus disease 19: A systematic review and meta-analysis of cohort studies Highly accessed article p. 98
Mohamed O Alhamad, Saud A Alkhlofi, Taha S AbuIdrees, Aysha M Ahmed, Salman K Taheri, Reem A Alrowaiei, Mariam Lafi Ali, Ghada Al-Kafaji, Haitham A Jahrami, Ahmed S BaHammam
DOI:10.4103/jnsm.jnsm_39_21  
Study Objectives: This systematic review and meta-analysis was conducted to identify the neurological sequelae and consequences in patients infected with coronavirus disease 19 (COVID-19), as well as to explore the impact of COVID-19 infection on the central nervous system, and the contributing risk factors to the neurological sequelae associated with the disease. Methodology: The World Health Organization COVID-19 database, which included data from 31 multiple databases, was used in February 2021. Exclusion of noncohort studies was conducted as well as the exclusion of studies with pediatric age groups (<18 years of age). There was an English language restriction. The random-effect models meta-analysis model was used with the DerSimonian and Laird methodology. Results: Nineteen papers, involving a total of 45,181 participants, were judged relevant and contributed to the systematic review and meta-analysis of neurological sequelae in patients with COVID-19. The overall event rate of any given neurological sequelae among all studies was 7.6% (95% confidence interval [CI], 3.0%–17.6%). Meta-regression showed an increase of overall neurological sequelae in relation to age, as well as an increased occurrence in females. Stroke had an event rate of 1.8% (95% CI, 0.9%–3.3%). Headache had an event rate of 6.7% (95% CI, 1.9%–20.7%). Delirium had an event rate of 25.2% (95% CI, 13.9%–41.4%). Intracerebral hemorrhage (ICH) had an event rate of 1.0% (95% CI, 0.4%–2.8%). Conclusions: The prevalence of stroke and ICH was higher than that of the global prevalence. Delirium showed a similar prevalence to the global prevalence. Headache was found to have a lower prevalence compared to the global prevalence.
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REVIEW ARTICLE Top

Bibliometric analysis of coronavirus disease 2019 medical research production from Saudi Arabia Highly accessed article p. 109
Amr A Jamal, Samar BinKheder, Raniah N Aldekhyyel, Jwaher Almulhem, Shabana Tharkar, Afaf Ali Batis, Layal Hneiny
DOI:10.4103/jnsm.jnsm_91_21  
In response to the coronavirus disease 2019 (COVID-19) pandemic and as an attempt to fill the knowledge gap related to this topic, extensive research in this area has been published. The Kingdom of Saudi Arabia, as one of the countries affected by the pandemic, has contributed to the growing body of scientific literature related to COVID-19. To measure research contribution produced by Saudi Arabian affiliated researchers, we conducted a bibliometric analysis of COVID-19 research across two databases: the Web of Science and Scopus. Analysis was conducted on February 2, 2021 and included all relevant COVID-19-related publications (n = 1510). The majority of publications were research articles with the average number of citations per publication of 4.8, an authorship collaboration dimension of 5.49 authors per publication, collaboration index of 6.0, and 5.6 mean total citations per year. Further analysis showed that 89.5% of publications were multi-authored reflecting the importance of substantial efforts made toward research collaboration.
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PERSPECTIVE Top

Occupational Safety and Health Personnel are Not All the Same: How to Know the Differences and Make Best Use of the Right People p. 120
Basim Ahmad Baragaba, Tee L Guidotti
DOI:10.4103/jnsm.jnsm_76_21  
Occupational safety and health (OSH) is a multidisciplinary field concerned with the safety, health, and welfare of the workers, their families and communities. It requires teamwork among different OSH professionals like physicians and nurses, engineers and industrial hygienes. This article provide overview for OSH professionals and roadmap for appropriate classification and licensing to ensure assigning the task to the right person to achieve the intended goals.
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ORIGINAL ARTICLES Top

Obstetric danger signs experience and medical care sought among Saudi women: A community-based survey p. 124
Amani Abu-Shaheen, Isamme AlFayyad, Humariya Heena, Abdullah Nofal, Muhammad Riaz
DOI:10.4103/jnsm.jnsm_115_21  
Objective: The objective of the study is to investigate the occurrence of obstetric danger signs and medical care sought during pregnancy, delivery, and postpartum periods among Saudi women. Study Design: A cross-sectional survey was conducted on women from the Riyadh community who had delivered during the past 2 years. Sociodemographic characteristics, the occurrence of danger signs during the antenatal, delivery, and postpartum periods were recorded. Results: A total of 1397 were included in the analysis. Around 35% of the women had a history of at least one of these three danger signs during pregnancy. Five hundred forty (38.7%) participants had a history of at least one of the obstetric danger signs during a delivery. Five hundred and four (36.1%) participants had a history of at least one of the obstetric danger signs during the postpartum period. The experience of at least one obstetric danger was statistically significant and associated with the northern region of Riyadh (odds ratio [OR] = 2.03, 95% confidence interval [CI]: 1.39–2.97); a higher level of education (OR: 1.42, CI: 1.01–1.98); unemployment (OR: 0.67, CI: 0.48–0.93); and having hypertension (OR: 2.11, CI: 1.42–3.13). Conclusions: Although the coverage of ante and postnatal care is good in KSA, awareness programs regarding danger signs at grass root levels in antenatal and postnatal care are needed.
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Comparison between final-year medical students' career choices before and after the conduction of a mentorship activity p. 130
Deemah Ateeq AlAteeq, Nouf Abdullah Alzahrani, Reem Awad Alharbi, Nada Nihad Hassounah, Samah Fathy Ibrahim
DOI:10.4103/jnsm.jnsm_83_21  
Background: The elective specialty's selection significantly impacts the graduates' acceptance rate in a preferable postgraduate specialty training program. This selection has a multifactorial nature of the decision-making process that worries the undergraduate students and alters their academic lives. Objective: This study aimed to assess final-year undergraduate medical students' specialty choices before and after the conduction of a mentorship activity. Methods: The mentorship activity was organized in the academic year 2019–2020 to help the 71 final-year medical students choose their preferred future specialty. Two self-reported pre- and postactivity surveys, including demographics, the chosen specialty, location, factors that influenced their top-ranked choices, needs/feedback about the activity, were used. Results: Sixty-six female students, with a mean age of 23.5 ± 0.8 years, participated in mentoring activity, with a response rate of 92.95%. Most of the participants (73%) decided to be trained in one local residency training program. Surgery (31.8%) and family medicine (28.8%) were the most popular specialties. Personal interest (88%) was endorsed as the most influential factor influencing their choices. The internship mentoring activity significantly increased participants' ability to choose the elective training specialty (P < 0.012) but did not substantially affect the future training selected places (P < 0.6).Conclusion: Professional medical training has various challenges at serial phases, and university mentoring activities should be tailored to meet students' desires and the need of the professional society.
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Prevalence, risk factors, and outcome of diabetic patients infected with COVID-19 in Saudi Arabia p. 137
Hadil Abdulkader AlOtair, Eman Sheshah, Mohammed M AlJuaid, Mashael K AlShaikh, Farrah K AlNajjar, Lolwah M AlAshgar, Faisal A Alzeer
DOI:10.4103/jnsm.jnsm_36_21  
Background: Recent global studies including those coming from Saudi Arabia highlighted the apparent increase in the prevalence and severity of COVID-19 in diabetic patients. Hence, this study was conducted to report the prevalence, clinical outcomes, and risk factors among a cohort of diabetic patients with COVID-19 infection in Saudi Arabia. Research Design and Methods: A retrospective observational case–control study of COVID-19 patients admitted at two major hospitals in Saudi Arabia between April 2020 and July 2020. Electronic charts were retrospectively reviewed, comparing diabetic and nondiabetic patients' demographic, clinical variables, and outcome measures. Results: A total of 564 patients with polymerase chain reaction-confirmed COVID-19 infection were enrolled in the study. Their mean age was 52.3 ± 14.4 years and 254 patients (45%) had diabetes mellitus (DM). Diabetic patients were significantly older compared to patients without DM (P < 0.001) and more likely to have hypertension (P < 0.001), heart failure (P = 0.011), chronic kidney disease (P = 0.002), ischemic heart disease (P = 0.005), and higher D-Dimer level (P = 0.011). Patients with DM had significantly higher risk of acute kidney injury (26.4% vs. 14.8%, P = 0.001) and higher rate of inhospital mortality (25.2% vs. 15.8%, P = 0.006) compared to nondiabetics. The most important independent risk factors in diabetic patients were HbA1c and the average capillary glucose check during admission (P < 0.001). Conclusion: Diabetes is highly prevalent among COVID-19 patients admitted to hospitals in Saudi Arabia. The inhospital mortality rate is increased among diabetic patients of older age group with high HbA1c levels, poor glycemic control during hospitalization, and had multiple comorbid conditions compared to nondiabetics. Early identification of at-risk patients with DM and optimal blood glucose control are extremely important for better clinical outcomes.
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Preparing a teaching hospital and university campus for the COVID-19 pandemic: A Saudi University hospital experience p. 144
Wajdan Al-Assaf, Mohammed Al-Raye, Mercy Joseph, Ahmed Al-Anazi, Sabarina Jumat, Hisham Al-Zughibi, Aseem Allam, Abdulkareem Al-Suwaida
DOI:10.4103/jnsm.jnsm_159_20  
Objectives: To outline the preparation conducted by King Abdullah Bin Abdulaziz University hospital, And princess Nourah Bint Abdulrahman university to deal with COVID-19 pandemic. This experience may assist other healthcare facilities (especially academic hospitals) in pandemic-related disaster planning and management. Methods: A descriptive study outlining the process of disaster preparedness and functional implication of this preparedness for a university campus and its related academic hospital to cope with the merging COVID-19 pandemic for the period from February 2020-October 2020. Results: The implemented measures in both the university and hospital helped in decreasing the rate of COVID-19 cross-infections between healthcare workers, admitted patients and university personnel. Resources were evenly distributed, and clear line of management, reporting and communication was established between the hospital and university. Conclusion : Integration between all stake holders in academic hospital and university leadership is the corner stone in pandemic and disaster management.
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Development and validation of a framework for type 2 diabetes patient self-management education program: A qualitative study p. 150
Lamya AlAbdulkarim, May AlHassan, Sulaiman Abdullah AlShammari, Ahmed Albarrak
DOI:10.4103/jnsm.jnsm_171_20  
Background and Objective: Patient self-management education has been a major factor in the intervention and management of chronic diseases as it engages and empowers patients to control and/or prevent complications of chronic diseases. The objective of this study was to develop and validate a framework standard for diabetic patient's self-management education. Methods: A quantified qualitative research method was applied to design and validate a patient self-management framework. Previously published 26 international diabetes management standards and guidelines were reviewed, analyzed, tabulated, and coded into three categories; systems, constructs, and themes. The resulting matrix with coding criteria was validated by a 3-session focus group for consensus, verification, and re-verification of the model. Co-researchers reviewed and reclassified the focus group re-verification data with >90% reliability. Results: The framework consisted of main three domains: the health system with four constructs and 96 items; the delivery system with five constructs and 139 items; and the system of decision, support, supervision, monitoring, and evaluation with 6 constructs and 32 items. Results are reported for the 3 focus group sessions and the co-researchers' review. It resulted in a modification of <30% of the original framework (N of items = 277 − 203 = 74 [26.7%]). Conclusion: A focus group methodology was effectively used to design and validate an appropriate patient self-management education framework. A valid framework of standards and guidelines for type 2 diabetes mellitus self-management was developed and validated to reflect the diabetic patients' needs. An outcome measurement tool would be developed based on the framework to assess the effectiveness of patient self-management outcomes in Saudi Arabian society.
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Selenium protects against tenofovir/lamivudine/efavirenz-induced nephrotoxicity in rats p. 157
Elias Adikwu, Chidi Emmanuel Ezerioha, Innocent Biradee
DOI:10.4103/jnsm.jnsm_153_20  
Context: Tenofovir/lamivudine/efavirenz (TLE) used for the treatment of human immunodeficiency virus may cause acute or chronic nephrotoxicity. Aim: This study assessed the ability of selenium (Se) to prevent TLE-induced nephrotoxicity in albino rats. Materials and Methods: Forty healthy male albino rats (200–250) randomized into four groups (n = 10) were used. Group 1 (Control) was orally treated with normal saline (0.2 mL) daily for 90 days. Group 2 was orally treated with Se (0.1 mg/kg) daily for 90 days. Group 3 was orally treated with TLE (8.6/8.6/17.1 mg/kg) daily for 90 days. Group 4 was orally co-treated with Se (0.1 mg/kg) and TLE (8.6/8.6/17.1 mg/kg) daily for 90 days. After treatment, the rats were anesthetized and blood samples were collected and evaluated for serum renal function markers. Kidneys were examined for histology and oxidative stress indices. Results: Kidney oxidative damage in TLE-treated rats were marked by significant (P < 0.001) decreases in glutathione (GSH), GSH peroxidase, superoxide dismutase, and catalase levels with significant (P < 0.001) increases in kidney malondialdehyde levels when compared to control. Altered serum renal biochemical markers in TLE-treated rats were characterized by significant (P < 0.001) increases in creatinine, uric acid, and urea levels with significant (P < 0.001) decreases in total protein, albumin, bicarbonate, sodium, chloride, and potassium levels when compared to control. Tubular necrosis, lipid accumulation, and mesangial proliferation were observed in the kidneys of TLE-treated rats. TLE-induced nephrotoxicity was significantly (P < 0.01) reversed in Se supplemented rats when compared to TLE. Conclusion: Se may be clinically used for TLE-associated nephrotoxicity.
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Electronic and regular cigarette use among king saud university students and their association with psychological distress p. 163
Rufaidah Dabbagh, Ruba Barnawi, Atheer Alrsheed, Ruba Alsalem, Shahd Alanzan, Aroob Alhuthail, Norah Alhogail
DOI:10.4103/jnsm.jnsm_111_21  
Background: The growing trend of electronic cigarette (e-cigarette) use among the youth is concerning. This behavior has not been well studied among Saudi young adults, let alone among females. Aims and Objectives: We measured the prevalence of e-cigarette and regular cigarette use among female university students, their association with psychological distress and student characteristics, and the reasons for smoking. Materials and Methods: We conducted a cross-sectional study among 616 female students at King Saud University, from January to March 2019. Self-administered questionnaires were used asking about regular and e-cigarette use behavior, and psychological distress measured by 6-item Kessler Psychological Distress Scale (K6). Results: The response rate was 91.5%, and 7.8% of students smoked regular cigarette, while only 2.6% smoked e-cigarettes. About 86.9% of students had K6 scores suggestive of high levels of stress. Students whose friends smoked had around 16 times the odds for e-cigarette use (odds ratio [OR]: 15.75; 95% confidence interval [CI] = 7.45, 33.31), and 11 times the odds for regular cigarette use (OR: 11.40; 95% CI = 5.31, 24.47) compared to those without friends who smoked. The reasons for smoking e-cigarettes were peer pressure (35.6%), believing they are safer than regular cigarettes (32.2%), for quitting regular cigarettes (25.4%), and out of curiosity (6.8%). Conclusion: Although e-cigarette use prevalence does not seem quite high in this study, the prevalence of regular cigarette smoking was surprisingly higher. Peer pressure and having friends who smoke are important predictors of cigarette use that should be targeted in tobacco prevention planning.
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Approach for an undergraduate surgery course teaching and assessment during the COVID-19 pandemic in Saudi Arabia p. 170
Sultan Alsheikh, Noura Alhassan, Yasser Alfraih, Hamad Alqahtani, Mona M Soliman
DOI:10.4103/jnsm.jnsm_23_21  
Background: The COVID-19 pandemic has caused a sudden shift to online education worldwide. Online education is a challenging experience in medical education. This study describes the approach toward teaching and assessment upon the sudden shift to online education in the undergraduate surgery course due to lockdown and the perception of students. It also describes the preparation for the succeeding new academic year. Methods: In May 2020, after the complete lockdown, online small group interactive tutorial sessions were conducted for the 3rd-year surgery course that included case-based discussion and demonstration of certain clinical skills. The final assessment of the course was delayed to August 2020. Forty-five faculties participated in the exam. Each had 7–6 students to examine a total of 315 students. Seven different sets for the examination were used. Seven closed-ended questionnaires were distributed to the students' online using Google surveys after the final exam students. The questionnaire assessed the students' satisfaction of the urgent arrangement in the course and exams due to the COVID-19 pandemic situations. Likert scale was used to receive students' feedback on 5-point scale. Results: All sessions recorded a participation of 71–92 students. A total of 12 lectures covering four topics and three online surgical clinical topics were conducted using zoom. A total of 288 students of 315 attended the final written exam and 287 attended the objective structured clinical examination (OSCE). A total of 144 students of 293 (49%) responded to the 7 questionnaires that were distributed. Regarding the students' agreement on their benefit from the online tutorials. Fifty-nine percent of the respondents agreed that the tutorials improved their clinical sense and developed interest in surgical skills, while 41% of the students disagreed. The majority of the students agreed on the relevance of the topics discussed in the online tutorials. The majority of students agreed that the online tutorials helped to improve their understanding and knowledge of the topic. In response to whether the online tutorials helped to improve understanding and knowledge of the surgical topics, the majority of the students agreed. Conclusion: Online medical education for undergraduate surgery courses for 3rd-year medical students is a novel and effective method for managing the urgent situation. Students were overall satisfied with the approach and reported that it helped them to achieve the designed learning objectives.
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Infection and case fatality rate of COVID-19 in 100 countries: A comparative study based on economic status p. 175
Rafiuddin Mohammed, Javed Khan, Salah Alshagrawi
DOI:10.4103/jnsm.jnsm_114_21  
Objectives: The purpose of the study was to determine COVID-19 infection rate (IR) and case fatality rate (CFR) among the economic status of the countries. Methods: First 100 countries, according to the highest number of COVID-19 cases recorded as of August 14, 2021, were included in the present study and were classified as high-income (38), upper-middle-income (37), and low-middle-income (25) countries. The data were extracted from the Worldometer website tracking of COVID-19 cases globally. All parameters in this study are expressed as frequencies and percentages. IR and CFR were tabulated using specific formulations. Results: In high-income countries, Czechia (15.62%) and Bahrain (15.32%) reported the highest IR, whereas Hungary (3.71%) and Slovakia (3.19%) reported the highest CFR. In upper-middle-income countries, Georgia (11.99%) and Argentina (11.13%) with the highest IR, followed by Peru (9.25%) and Mexico (8.06%) resulted in the highest CFR. In lower-middle-income countries, Moldova (6.55%) and Palestine (6.12%) reported the highest IR. Egypt (5.82%) and Afghanistan (4.62%) observed the highest CFR of COVID-19. When comparing the economic status, found IR highest among high income countries (7.60%), whereas upper middle income countries showed the highest CFR (2.73%). Interestingly, found the lowest CFR in Qatar (0.26%) and UAE (0.29%) among all countries. Conclusions: Based on the comparison, different countries have responded better than other countries irrespective of the financial and economic status of these countries. The results showed high-income countries are the worst affected by the COVID-19 pandemic. The result of this preliminary study can be used as a benchmark for authorities in the administration of the policies according to the economic status.
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Cartilage ear piercing probable infections among females between 18 and 28 years old in Riyadh p. 182
Khalifa Binkhamis, Hanan A Habib, Mashel K Alkahtani, Dana A Alrasheed, Maha M Barakeh, Lina Mohammed Alohali, Sumayah I Aloqayfi
DOI:10.4103/jnsm.jnsm_108_21  
Background: The prevalence of ear piercings is 8%−32%. Complications can be due to the factors such as the amount of tissue blood supply, the location of the piercing, the extent of hygiene techniques, and much more. Materials and Methods: A total of 586 females (age, 18–28 years) in Riyadh, Saudi Arabia, with at least one ear piercing were included in this analytical cross-sectional study by convenience sampling from September 2019 to April 2020. A link to an Arabic web-based questionnaire was distributed through social media (WhatsApp, Twitter, and Snapchat). It included questions related to both earlobe and ear cartilage piercings. Bivariate statistical tests were carried out. Results: The prevalence of a probable ear piercing-related infection for ear cartilage piercings was found to be significantly higher than for earlobe piercings (41.4% vs. 29.6%) (P = 0.0004) (confidence interval [CI] = 0.443–0.795). A significant association between piercing type (3.3% of earlobe piercings and 8.1% of ear cartilage piercings) and scar formation was observed (P = 0.0002) (CI = 0.209–0.722). The prevalence of ear piercing complications among participants who used piercing needles was lower for both earlobe piercings and ear cartilage piercings (3.65%, 8.75%) (P = 0.0015) than among those who used piercing guns (37.9%, 43.4%) (P = 0.114). Conclusion: Probable external ear infections were more common among those with cartilage ear piercings than those with earlobe piercings. Future studies should include participants of a broader age category and in different locations in Saudi Arabia.
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Medical education at the time of COVID-19: A national multi-institutional experiences in undergraduate education in Saudi Arabia p. 188
Nouf Alrumaihi, Mona Hmoud AlSheikh, Rania G Zaini, Abdulaziz Alamri, Ayyub Patel, Ali Alassiri, Hussein M Ageely, Hamza Abdulghani, Ahmad Alamro, Ahmad Alrumayyan, Khalid Fouda Neel, Mona M Soliman
DOI:10.4103/jnsm.jnsm_50_21  
Background: The coronavirus disease-2019 (COVID-19) pandemic has disrupted medical education worldwide. This study investigates how Saudi medical colleges face the pandemic and proceed with teaching and assessment plans. The study also highlights the best practices employed by Saudi medical colleges during the time of COVID-19 crisis and proposes a contingency plan in the event of future outbreaks necessitating similar containment measures. Methods: This cross-sectional study was conducted among medical colleges in Saudi Arabia between June and August 2020. A convenience sampling method was applied. An online questionnaire was designed. The questionnaire consisted of six main parts: basic demographic data, curriculum, teaching and learning, learning management systems (LMS), assessment, and lessons learned. The questions targeting the educational process focused on what was happening before and what was done during the pandemic. Data were collected using Google Forms. The data was analyzed using SPSS. Results: A variety of teaching modalities were used before the pandemic, including class lectures (95.46%), problem-based learning (70%), case-based learning (47.25%), team-based learning (43.67%), videos/online interaction (24.58%), and flipped classroom (18.13%). During the pandemic, 97.87% of the participants used video lectures. During the pandemic, PBL and tutorial usage were reduced to 40.09% and 48.44% compared to 71.59% and 64.91% before the pandemic, respectively. Most faculty members (65.39%) reported no problems (nor did they encounter any obstacles) during online classes. Fully 96.18% of participants used Blackboard LMS during the pandemic. During the COVID-19 pandemic, 50.83% of participants reported utilizing continuous assessment, and 50.35% reported that the summative (final) assessment they performed was an online assessment. Most participants reported (85.68%) use online multiple-choice questions, followed by students' projects (34.84%), online SAQs (25.53%), and online objective structured clinical examinations (21.47%) if the pandemic were to continue. Conclusions: This study's value lies in the large sample of faculty and nationwide distribution of responses. Study results enable an understanding of early heuristic responses to online education, which may be used as a guide for mitigation efforts and to identify success stories, obstacles, key issues, and solutions.
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