Background: Lower back pain (LBP) is defined as any recurring lumbar pain between the rib cage and the buttocks present at the time of the study. This study investigated the point prevalence, associated risk factors, and degree of disability of LBP among medical students at Alfaisal University, Riyadh, Saudi Arabia. Methods: A cross-sectional study evaluated 331 medical students using the Oswestry Disability Index (ODI; used to gauge LBP degree of disability) supplemented with demographic and lifestyle questions. The respondents were mostly first-year, female, and between the ages of 17 and 21 years. Results: Analysis uncovered that Female students, extended durations of phone usage, and those who did not exercise were more likely to experience LBP (p < 0.001; p = 0.042; p = 0.001). A higher degree of disability was associated with participants older than 21 years, who used their devices for extended periods, and who slept less (β = 0.170, p = 0.006). While most students experienced LBP (73.4%), the ODI revealed that the majority were not deemed disabled (56.9%). Factors associated with LBP prevalence were not necessarily associated with a higher degree of disability per the ODI. Conclusions: LBP is highly prevalent among medical students, with several associated risk factors. Female medical students remain a significant at-risk group. These findings highlight the need for a broader intervention against LBP, such as ergonomic and lifestyle improvements that consider a multitude of factors.

This study explores the implementation of Team-Based Learning (TBL) at Alfaisal University’s College of Medicine through the lens of Complex Adaptive Systems (CAS) theory. The research question investigates how the application of CAS principles can enhance the implementation and effectiveness of TBL in medical education. The study employed a convergent parallel mixed methods longitudinal design, integrating quantitative performance metrics and qualitative themes. Quantitative analysis revealed modest improvements in individual and team-based learning scores, with a promising trend of students moving from the lower to the higher quartiles over time. Qualitative insights aligned with CAS principles, highlighting the adaptive implementation, emergent outcomes, self-organization, positive feedback loops, and depth of learning facilitated by TBL. The findings demonstrate the value of a CAS-informed approach in navigating the complexities of educational change and fostering a more resilient and adaptive educational model. The study contributes to the understanding of how CAS theory can guide the successful implementation of innovative pedagogies like TBL in medical education.

Background: Career decision-making in medical education predominantly reflects Western individualistic frameworks emphasizing personal autonomy. The intersection of clinical rotation experiences with family collective agency and culturally embedded gender norms in collectivist contexts remains insufficiently examined. Methods: We conducted 32 semi-structured interviews with medical ( n = 18; 9 female, 9 male) and dental students ( n = 14; 8 female, 6 male) aged 20–25 years across four institutions in Peshawar, Pakistan (August–November 2024). We used reflexive thematic analysis, applying Social Cognitive Career Theory (SCCT), Communities of Practice (CoP), and intersectionality as sensitizing concepts to examine how rotation experiences are interpreted through family decision-making and Pashtun sociocultural norms. Results: Five interrelated themes emerged. Clinical stress was frequently interpreted through family honor ( izzat ), extending beyond individual performance concerns. Career decision-making operated through collective family deliberation, with economic obligation commonly shaping men’s specialty trajectories and marriage-related expectations consistently constraining women’s career planning through anticipatory specialty screening. Participation patterns ranged from progressive apprenticeship to persistent gender-based marginalization, including exclusion of female students from male patient examinations and restricted access to night shifts in Peshawar institutions. Female participants described a “doctor daughter” paradox in which medical education was encouraged while post-graduation practice was constrained. The absence of female role models in surgical specialties undermined surgical self-efficacy among female participants considering male-dominated fields. Conclusion: Career development in collectivist contexts operates through family collective agency and culturally structured participation norms that are not well captured by individualistic models. Our findings suggest SCCT may require reconceptualization to incorporate collective efficacy, honor-based outcome expectations, family approval–filtered goal formation, and cultural context as a central organizing condition. Medical education policy should recognize career “choice” as a negotiated family process rather than an exclusively individual decision.

Background/Objective: Hand hygiene is a cornerstone of infection prevention; however, compliance is inconsistent in intensive care units (ICUs), particularly in resource-constrained settings. This study evaluated whether a low-cost, multimodal quality improvement intervention could improve process-level hand hygiene compliance using routine, episode-based audits embedded in the ICU practice. Methods: We conducted a single-cycle Plan-Do-Study-Act quality improvement project in a 12-bed mixed medical–surgical ICU in Pakistan (December 2023–January 2024). Hand hygiene performance was assessed using the unit’s routine weekly episode-based audit protocol, aligned with the WHO Five Moments framework. A targeted multimodal intervention comprising education, point-of-care visual reminders, audit feedback, and leadership engagement was implemented between the pre- and post-intervention phases (four weeks each). Non-applicable moments were scored as “compliant by default” according to the institutional protocol. A sensitivity analysis was performed excluding these moments to calculate pure adherence. Compliance proportions were summarized using exact 95% Clopper–Pearson confidence intervals without inferential testing. Results: A total of 942 audit episodes (471 per phase) generated 4710 moment-level assessments were generated. Composite hand hygiene compliance increased from 63.1% pre-intervention to 82.0% post-intervention [absolute increase: 18.9 percentage points (pp)]. Sensitivity analysis excluding non-applicable moments demonstrated pure adherence improvement from 54.2% to 82.5% (+28.3 pp), confirming a genuine behavioral change rather than a measurement artifact. Compliance improved across all five WHO moments, with the largest gains in awareness-dependent moments targeted by the intervention: before touching the patient (+27.0 pp) and after touching patient surroundings (+40.0 pp). Week-by-week compliance remained stable within both phases, without immediate post-intervention decay. Conclusions: A pragmatic, low-cost multimodal intervention embedded in routine ICU workflows was associated with substantial short-term improvements in hand hygiene compliance over a four-week observation period, particularly for awareness-dependent behaviors. Episode-based audit systems can support directional process monitoring in resource-limited critical care settings without the need for electronic surveillance. However, its long-term sustainability beyond one month and generalizability to other settings remain unknown. Sensitivity analyses are essential when using “compliant by default” scoring to distinguish adherence patterns from measurement artifacts.

Peer-assisted learning enhances conceptual understanding in anatomy education; however, its impact on structured cognitive outcomes remains unclear. We evaluated the effect of the Peer-Assisted Uniform Learning (PAUL) program on musculoskeletal (MSK) anatomy objective structured practical examination (OSPE) performance. We used a cross-sectional, controlled, observational design to analyse the OSPE scores of 304 students. Seventy-nine students who attended at least two PAUL sessions formed the exposure group, while 225 served as the control group. The PAUL participants alternated between tutor and tutee roles during the sessions. The OSPE items were divided into Cluster 1 (identification/recall) and Cluster 2 (application/analysis). A validated survey was used to assess the participants perceived learning outcomes and satisfaction. PAUL participants outperformed non-participants in Cluster 1 (78.4 vs. 73.7, p = 0.01) and Cluster 2 (87.2 vs. 82.8, p = 0.02). The relative gain was greater for application-based items (interaction effect: F = 8.37, p = 0.004), supporting the program's effect on higher-order reasoning. Survey responses (91 % response rate) showed high satisfaction (mean 4.3 ± 0.6) and perceived learning gains (mean 4.1 ± 0.7); 85 % of students reported improved understanding of the subject. The PAUL program, grounded in social constructivist principles and supported by faculty oversight, improved performance in both recall and application of MSK anatomy OSPE items, with the strongest impact on application-based learning.

Medical education faces increasing demand for scalable grading solutions. Large language models have been proposed as automated graders for high-stakes assessments, but evidence for their reliability in multimodal practical examinations remains limited. This retrospective inter-rater reliability study compared three LLMs: ChatGPT-4o, Gemini 2.5 Flash, and Claude 3.5 Haiku with original human reference scores on 19 integrated anatomy, histology, and physiology objective structured practical examination items completed by 309 pre-medical students. Human reference scores were assigned during live summative grading by two content experts who divided items, with each item marked by one expert across all students; no human inter-rater reliability estimate was available. Items required simultaneous image interpretation and short-answer responses. Models were evaluated using zero-shot prompting reflecting deployment-realistic conditions. Agreement was assessed using Spearman's ρ, Cohen's κ, intraclass correlation coefficients, and Bland-Altman analysis. Item-level gap analysis compared student success rates with LLM performance across items. Rank-order correlations were strong across all models (ρ = 0.784-0.921), but categorical agreement diverged substantially. Pass/fail agreement ranged from 52.1% (ChatGPT; κ = 0.067, slight) to 84.1% (Claude; κ = 0.680, substantial). Bland-Altman analysis showed inconsistent systematic bias: Claude over-scored by +2.5 points, Gemini under-scored by -5.0 points, and ChatGPT by -10.0 points. Item-level gap analysis highlighted three recurring divergence patterns: non-standard histological staining, three-dimensional spatial reasoning from two-dimensional images, and semantic inflexibility in short-answer evaluation. The most extreme case was a pelvic three-dimensional model item on which 93.3% of students succeeded by human grading but all three LLMs assigned a mean score of zero. Strong rank-order correlation alone does not support LLM grading for categorical decisions in high-stakes assessment contexts. LLMs may serve as assessment assistants for first-pass ranking and discrepancy flagging, but item-level human review of flagged discordances, error-profile monitoring, and preserved human authority over pass/fail decisions are required before high-stakes deployment.