Background: In medical education, the learning environment (LE) significantly impacts students' professionalism and academic performance. Positive LE perceptions are linked to better academic outcomes. Our study, which was conducted 15 years after curriculum reform at King Saud University's College of Medicine, aimed to explore students' perspectives on their LE and identify areas for improvement. By understanding their experiences, we strive to enhance LE and promote academic success. Methods: This mixed-method study employed an explanatory sequential approach in which a cross-sectional analytical survey phase was collected first using the Johns Hopkins Learning Environment Scale (JHLES), followed by qualitative focus groups. Findings from quantitative and qualitative methods were integrated using joint display. Results: A total of 653 medical students completed the JHLES. The total average score was 81 out of 140 (16.8), and the average subscale scores ranged from 2.27 (0.95) for inclusion and safety to 3.37 (0.91) for community of peers. The qualitative approach encompasses both inductive and deductive analyses, identifying overarching themes comprising proudness, high expectations and competition, and views about the curriculum. The integration of results emphasizes the need for continued efforts to create a supportive and inclusive LE that positively influences students' experiences and academic success. Conclusion: This research offers valuable insights for educational institutions seeking to enhance medical education quality and support systems. Recommendations include faculty development, the cultivation of supportive environments, curriculum revision, improved mentorship programs, and initiatives to promote inclusivity and gender equity. Future research should explore longitudinal and comparative studies, innovative mixed methods approaches, and interventions to further optimize medical education experiences. Overall, this study contributes to the ongoing dialog on medical education, offering a nuanced understanding of the complex factors influencing students' perceptions and suggesting actionable strategies for improvement.

Background: Mental illness affects an estimated 25% of the global population, with treatment gaps persisting worldwide. The COVID-19 pandemic has exacerbated these challenges, leading to a significant increase in mental health issues globally. In Saudi Arabia, the lifetime prevalence of mental disorders is estimated at 34.2%, yet 86.1% of those with a 12-month mental disorder report no service use. To address these challenges, digital health solutions, particularly electronic referral (e-referral) systems, have emerged as powerful tools to improve care coordination and access. Saudi Arabia has pioneered the nationwide Saudi Medical Appointments and Referrals Centre (SMARC), a centralized e-referral system using artificial intelligence and predictive analytics. Objectives: This study aims to analyze Saudi Arabia’s novel nationwide e-referral system for mental health services, using SMARC platform data to examine referral patterns, and service accessibility. This study also aims to demonstrate how digital health technology can inform and improve mental health care delivery and policy making. Methods: This retrospective, cross-sectional study used secondary data from SMARC on 10,033 psychiatric e-referrals in Saudi Arabia during 2020‐2021. Referrals were assessed by patient sociodemographic variables, geographic data, and e-referral characteristics including date, type, bed type, and reason for e-referral. Descriptive statistical analyses identified referral patterns, while regression modeling determined predictors of external referrals to other regions. Results: Analysis of 10,033 psychiatric e-referrals revealed that 58.99% (n=5918) were for patients aged 18‐44 years, 63.93% (n=6414) were for men, and 87.10% (n=8739) were for Saudi nationals. The Western Business Unit generated 45.17% (n=4532) of all e-referral requests. Emergency cases were the most common type of referral overall, followed by routine inpatient and routine outpatient department referrals. However, in the Northern Business Unit, routine inpatient referrals were most frequent. Two-thirds of requests were for ward beds, while critical beds were rarely requested. “Unavailable subspecialty” was the primary reason for referrals across all regions. The utilization of the mental health e-referral system varied across regions, with the Northern Border and Albaha regions showing the highest rates, while Madinah, Eastern, and Riyadh regions demonstrated lower use. Temporal analysis showed almost similar monthly patterns in 2020 and 2021. There was an overall increase in referrals in 2021 compared with 2020. Conclusions: This pioneering study of mental health e-referrals in Saudi Arabia demonstrates how digital health transformation, particularly through an e-referral system, has significantly enhanced access to mental health services nationwide in Saudi Arabia. The success of this digital initiative demonstrates how digital health solutions can transform health care access, particularly in mental health services, offering a valuable model for other health care systems.

Background: E-referral systems, streamlining patient access to specialists, have gained global recognition yet lacked a comparative study between internal and external referrals in Saudi Arabia (KSA). Methods: This retrospective study utilized secondary data from the Saudi Medical Appointments and Referrals Centre system. The data covers 2020 and 2021, including socio-demographic data, referral characteristics, and specialties. Logistic regression analysis was used to assess factors associated with external referrals. Results: Out of 645,425 e-referrals from more than 300 hospitals, 19.87% were external. The northern region led with 48.65%. Males were 55%, and those aged 25– 64 were 56.68% of referrals. Outpatient clinic referrals comprised 47%, while 61% of referrals were due to a lack of specialty services. Several significant determinants are associated with higher rates of external referral with (p-value < 0.001) and a 95% Confidence interval. Younger individuals under 25 exhibit higher referral rates than those aged 25– 64. Geographically, compared to the central region, in descending order, there were increasing trends of external referral in the northern, western, and southern regions, respectively (OR = 19.26, OR = 4.48, OR 3.63). External referrals for outpatient departments (OPD) and dialysis services were higher than for routine admissions (OR = 1.38, OR = 1.26). The rate of external referrals due to the lack of available equipment was more predominant than other causes. Furthermore, in descending order, external referrals for organ transplantation and oncology are more frequent than for medical specialties, respectively (OR = 9.39, OR = 4.50). Conclusion: The study reveals trends in e-referrals within the KSA, noting regional differences, demographic factors, and types of specialties regarding external referrals, benefiting the New Model of Care for the 2030 Vision. Findings suggest expanding virtual consultations to reduce external referrals. Strengthening primary care and preventive medicine could also decrease future referrals. Future studies should assess resource distribution, including infrastructure and workforce, to further inform healthcare strategy.

Background/Objectives: Intensive care unit (ICU) e-referrals are an important indicator for exploring potential deficiencies in critical care resources. This study aimed to examine the epidemiology and patterns of ICU e-referrals across all regions of Saudi Arabia during the COVID-19 pandemic using routinely collected data from April 2020 to December 2021. Methods: This descriptive epidemiological study analyzed data from the Saudi Medical Appointments and Referrals Centre (SMARC). This study reveals novel regional ICU e-referral patterns for critical cases using national unique digital health data, adding insights beyond the existing literature. Variables included age, sex, referral timing, reason, specialty, and region of origin. Descriptive statistics and mapping of administrative areas were performed based on e-referral request rates per 10,000 population. Results: During the study period, 36,619 patients had ICU e-referral requests. The mean age was 54.28 years, with males constituting 64.81% of requests. Out-of-scope e-referrals comprised 71.44% of requests. Referrals related to medical specialties, such as cardiology and pulmonology, were the most common (62.48%). Referral patterns showed peaks in July–August 2020 and May 2021. The Northern Border and Albaha areas had the highest request rates per population, potentially reflecting a higher proportion of severe cases requiring ICU-level care compared to other regions. Conclusions: The temporal pattern and geographic distribution of ICU e-referrals mirrored previously reported critical COVID-19 cases in Saudi Arabia. Preventive measures and vaccination programs contributed to a significant decline in ICU e-referral requests, suggesting a positive impact on controlling severe COVID-19 cases. Population-adjusted analysis revealed regional disparities, highlighting the importance of considering population size in healthcare resource management and policy.

Background/Objectives: Hepatitis B virus (HBV) remains a significant diagnostic and public health challenge worldwide. Despite widespread vaccination, underdiagnosis persists among adults in Saudi Arabia. This study estimated HBV prevalence and identified sociodemographic, clinical, and behavioral predictors relevant to improving targeted diagnostic screening. Methods: A cross-sectional study of 1196 Saudi adults aged ≥18 years was conducted between September 2024 and February 2025 using a structured questionnaire. Data on demographics, clinical history, and behavioral exposures were analyzed using chi-square tests and multivariate logistic regression to identify independent determinants of HBV infection. Results: The study included 1196 adults (60.0% female, mean age 31 ± 12 years). HBV prevalence was 2.0% (95% CI: 1.3–3.0%). Independent predictors included divorced/widowed marital status (OR = 3.99, p = 0.023), diabetes mellitus (OR = 3.59, p = 0.039), family history of HBV (OR = 2.55, p < 0.001), and massage exposure (OR = 3.99, p = 0.025). No significant associations were found with gender, education, or transfusion history. Conclusions: HBV infection persists among high-risk Saudi adults despite immunization success. Integrating HBV testing into diabetes care, premarital and household screening, and regulation of personal care services may enhance early diagnosis and advance national elimination goals.

Background and Objective: Mental disorders significantly impact quality of life and life expectancy, representing a leading cause of global disease burden. Healthcare systems worldwide face challenges in meeting mental health service demands, particularly due to specialist shortages and geographical barriers. Saudi Arabia has implemented an innovative nationwide electronic referral system (SMARC) as part of its digital health transformation strategy to enhance mental healthcare accessibility. This study examined SMARC’s effectiveness in facilitating mental health service access by analyzing patient transfer acceptance rates between healthcare facilities and identifying factors influencing these rates. Methods: This retrospective cross-sectional study analyzed 9722 mental health electronic referrals within SMARC from January 2020 to December 2021. Descriptive statistics characterized referral patterns, while bivariate and multivariable logistic regression analyses identified factors associated with referral acceptance, calculating adjusted odds ratios (aORs) and 95% confidence intervals. Results: The system achieved an overall acceptance rate of 82.5%, with different patterns across age groups and regions. Lower acceptance rates were observed for ages 15– 25 years (aOR = 0.84; 95% CI = 0.70– 0.99) and 46– 65 years (aOR = 0.83; 95% CI = 0.70– 0.99) compared to ages 26– 35 years. Life-saving referrals showed the highest acceptance (aOR = 2.60; 95% CI = 1.51– 4.48), while psychiatrist availability significantly influenced acceptance rates (aOR = 1.36; 95% CI = 1.17– 1.58). External referrals were half as likely to be accepted as internal ones (aOR = 0.51; 95% CI = 0.42– 0.64). Conclusion: SMARC demonstrates effectiveness in optimizing mental healthcare access through strategic matching of patient needs with available resources. The system’s selective acceptance patterns reflect its capability to prioritize care based on clinical urgency and resource availability. These findings provide valuable insights for policymakers to keep enhancing digital health infrastructure and mental healthcare delivery. The SMARC model offers a promising framework for implementing similar digital referral systems globally to improve mental healthcare coordination and accessibility.