KBIM in 2023: Year in Review

Written on Jan 25th, 2024 by Dr. Ahmad Alhashemi
When reflecting on the year 2023, any small advances we made in our program are rendered trivial when compared to the atrocities inflicted on the Palestinian people by their occupiers. To ignore that would be a grave injustice. We stand with the Palestinian people and offer them our unconditional support.

The work described here would not have been possible without the great work and contribution of our residents and tutors. I want to especially thank members of our Residency Program Committee, who have worked tirelessly as a team to come up with ways to make the program better every day and make sure that all of those ideas are translated into reality at every site and in every aspect of the program.

In the Academic Year 2023/2024, we have:

What we achieved in 2023

Faculty Development Day. Tutors across all sites of the program gathered for our very first Faculty Development Day! We had great lectures and workshops by some of our very own tutors with expertise in Medical Education as well as local experts from other organizations. It was a great opportunity to learn together, connect, and exchange ideas.

Ongoing assessment. More feedback. Better help. Since we implemented the Royal College of Physicians Competence by Design (CBD) curriculum and the launch of our electronic platform, our residents have been receiving significantly more written feedback!

Just in 2023, our tutors have completed,

And our Competence Committee and subcommittee members have,

Handling this amount of data required an expansion of our Competence Committee from a single committee responsible for 26 residents at the beginning of 2023, we now have 5 subcommittees in addition to the main Competence Committee, together responsible for 106 residents in the CBD cohort.

This is a transition that was planned for and carefully executed over months by the Assistant Program Director and Head of the Competence Committee, Dr. Ammar Alkhateeb, together with the heads of all subcommittees Drs. Yousef Behbehani, Hebah Al Wayel, Naela Al-Mazeedi, Ahmed Mahdy Abdelalim, and Abdulhamied Alfaddagh.

Residents who are excelling and progressing quickly are now allowed to take on more responsibilities without being held back by the classic time-based training model. Residents who are struggling are being identified much earlier in the program and provided with the help and support they need.

Longitudinal Internal Medicine Clinic. As promised in last year's end-of-year review, the Longitudinal Internal Medicine Clinic launched in 2023. Each resident will have their weekly clinic, held at a fixed site with a fixed tutor supervisor, for a year (from mid-R4 to mid-R5). They will carry their patients across clinics for follow-ups and learn how to run their clinics in a way that is safe, effective, and efficient.

This project was led by Dr. Ebtihal Aljamaan, who was passionate about adding a longitudinal outpatient component to the program from the first meeting she attended in the Residency Program Committee as a Site Coordinator from Jaber Hospital.

Complete overhaul of the academic day curriculum for 2023/2024. The new academic curriculum was built from scratch taking into account feedback from residents, tutors, and recent graduates of the program. The curriculum was focused on Royal College competencies and our program's exam blueprints.

The design of the new curriculum was led by Drs. Hawra Al-Matrouk, Nawal Alotaibi, and Maryam Al-Sarraji, with help and feedback from many residents and tutors as well as Assistant Program Director Dr. Abeer Al-Mutawa who brought her years of experience running our Academic Day.

The refreshed academic day curriculum incorporates the research, QI, patient safety, and leadership activities that had been added the year before. It consists of a dedicated track for each R-level in the program. The activities are now hosted in Jaber Hospital, with better access to services (aka, cafés) and a more central location.

Introducing base sites for residents. Starting in the 2023/2024 academic year, each resident had a base site assigned to them. The base site acts as the administrative site for the residents and is the place where residents do at least four months of their training (will become six months in 2024/2025). The base site for each resident changes every academic year and cannot be the same site two years in a row.

Computerized resident scheduling. There are many ways to schedule 180 residents into 80 rotations over 12 months (172,800 ways to be exact). While the perfect schedule doesn't exist and we can't always give everyone their top choice, using computers we can create the best possible (aka "optimal") schedule given all the constraints we have.

This means that every resident now gets to give us an exact score for every rotation in the program and the computer will take every single score into account while creating the schedule.

Point-of-Care Ultrasound (POCUS) course. Thanks to the great leadership and efforts of Dr. Abdullah Al-Awadhi, our POCUS training launched and consists of a day-long, hands-on, ultrasound workshop followed by longitudinal training at different sites of the program coupled with a logbook.

Leadership Workshop. Designed and implemented by one of the greatest leaders in our program, Dr. Hawra Al-Matrouk, together with Drs. Soumoud Hussein, Maryam Al-Sarraji and Fatima Al-Sarraf. This full-day workshop consolidated our R5's knowledge and experience in leadership as they got ready to complete the program and assume their roles as leaders in different hospitals across the country.

Ice Cream Rounds and advocacy for our residents. Last year we introduced Dr. Nawal Alotaibi as our new Wellness and Resident Safety Lead and she's done a fantastic job in that role. She has held multiple "Ice Cream Rounds", an open space for residents to discuss their training and any challenges they're facing, during their academic day protected time. Dr. Nawal has been a big advocate for residents during our Residency Program Committee Meetings.

First cohorts of research and QI projects completed. In his role as Research Lead, Dr. Mohammad Shehab managed to re-introduce our research curriculum for R3 residents as a longitudinal component of the program culminating in the completion of 8 research projects by the end of the academic year.

Our QI and Patient Safety curriculum introduced in R4 last year, designed, authored, and delivered by Dr. Mohammad Behbehani, who's an expert in the field, similarly led to the completion of 6 QI group projects.

With the establishment of those programs, every resident in KBIM will now be involved in completing both a research as well as a QI project as part of their program.

Sabah Hospital joined the program as the newest major site with one MTU and two subspecialty rotations. Dr. Ahmed Altabeekh, Site Coordinator, and Dr. Abdulla Al-Faras, Head of the Department at that time, were instrumental in preparing the site and creating this opportunity with their team.

Drafted 4 new policies covering on-call duties, research electives, attendance, and pregnancy and maternity leaves and accommodations, in their final stages, pending RPC approval as well as an updated leave policy.

The Exam Committee is now authoring the R1 exam and the admissions exam in addition to creating two versions of the R2 (Part 1) exam every year. Our Committee, led by Dr. Ahmad Al-Ansari, rose to this challenge and did an excellent job creating high-quality exams.

Introduced the role of Rotation Coordinators. Rotation coordinators will be responsible for:

Academic coaches, practice MCQs, and OSCE-like scenarios for R5s. To motivate and guide our R5s in their studies for their final KBIM exam, we introduced a bundle of changes at the beginning of the 2023/2024 academic year. The changes include:

Those changes are all in addition to our Mock OSCE exam we've been doing for all our R5s for years. In addition, the annual Internal Medicine Review continues to be an incredible resource for residents and all internists. While it is organized parallel to the program, our program's leadership, clinical tutors, and residents all contribute significantly to the organization and delivery of this fantastic course.

Incoming R1s are now given an opportunity to enter the ACP-ITE. The American College of Physicians In-Training Exam (ACP-ITE) is an annual comprehensive exam that covers all subspecialties of Internal Medicine and provides residents with detailed reports regarding their performance in different areas of Internal Medicine. We've been conducting the ACP-ITE for residents in R1 to R4 and optionally for R5 for years. Starting in 2023 however, we offered the exam optionally to our incoming R1s. The exam took place just before the incoming R1s started their residency program and they received the results shortly after they started. This gives those who chose to participate in the exam a great starting point for where to study and how to study.

Finally, some changes in our leadership team over the past year.

Dr. Sundus Al-Duaij stepped down as Assistant Program Director in June 2023, after serving in that role for 6 years. I was very fortunate to be able to rely on her wisdom and experience as I was starting as a new Program Director.

Dr. Ammar Alkhateeb accepted the position of Assistant Program Director in July 2023. As a long-time member of the Residency Program Committee in his role as a Site Coordinator, he's had a long history of contributing to virtually every aspect of the program. I can't think of a better person for this role.

We have also welcomed several new talented members to the Residency Program in 2023. Drs. Soumoud Hussein, Mariam Kareemi, Maha Anbar, Ahmed Altabeekh, Hassan Elzain, Ahmad Alsaffar join the Committee as Site Coordinators. Dr. Abdullah Al-Awadhi joined as POCUS Lead.

Drs. Farah Alyaseen (R5) and Hussa AlOuda (R2) remain on the Committee as resident representatives from previous years and are now joined by Drs. Ali AlMelahi (R4), Fahd Almutairi (R3), and Mohammed AlMaayoufi (R1).

What about Royal College Accreditation?

By the end of 2022 (one year ago), we felt that we'd completed all accreditation requirements and we'd already started working on implementing some of the non-required (optional) recommendations. This was based on extensive work we did to address all issues that were raised during a Diagnostic Review by the Royal College followed by closely working with two Royal College-appointed advisors, who are previous Program Directors who'd successfully gone through the process of accreditation for their Canadian Programs.

Our paper application was "ready", from our point of view, and was sent through the accreditation pipeline. We were waiting for some final feedback from KIMS before the application was sent to the Royal College accreditation committee.

Unfortunately, due to delays in signing contracts at the Ministerial level, the agreement between KIMS and the Royal College was put on hold, including all accreditation applications. Therefore, we haven't been able to make progress through the formalities of accreditation.

But we do have some encouraging news. First, a new agreement was signed between KIMS and the Royal College, and pending some further paperwork, we expect that the accreditation process will be officially back on track very soon!

Second, we assure you that we have not been sitting idle while the agreement was on hold. We have used this time to double down on improving every aspect of the program, responding to feedback, and making sure what we already built continues to be maintained and sustainable. We are making sure that once we get the opportunity to apply for accreditation again, our chances of receiving it will be better than ever.

What to Expect in 2024

In addition to continuing all the projects we started over the past two years, there are several new changes, projects, and initiatives to expect in 2024, which will be covered in this section.

More important than the individual changes is why we are making them and understanding the general direction, which I will go over in the next section 'The Road Ahead'.

The first KBIM Day will take place on Feb 17th, 2024. It's a day to which all of our residents and tutors will be invited. Residents will have poster presentations of their QI and Research projects. There will be a keynote speech, updates about the program, awards for some tutors and residents, and most importantly, an opportunity to be together, think together, and plan together for the future of Internal Medicine training in Kuwait.

Note that this event is separate from Faculty Development Day, which will take place in April this year.

Communication skills course for R5s. This new course will take place in the summer of 2024 and is being delivered by Dr. Yasser Abdelmoiz and organized by Dr. Abeer Almutawa.

Standards for sites and rotations. As we increase the number of residents, tutors, sites, and rotations, the need to standardize becomes more pressing.

Last year, we asked all rotations to prepare and submit a "Rotation Description Form", designed to make sure that rotations cover each component of the curriculum mapped to them. Documents like this help us all as tutors, residents, rotations, sites, and program leadership be on the same page in terms of what is happening at every rotation.

Rotations and tutors will start getting feedback reports. The reports will contain summaries of resident evaluations of rotations and tutors over at least 12 months.

We initially planned to release those reports sometime last year but decided to extend the time frame to make sure residents get more anonymity with a longer period and a larger number of resident evaluations collected together.

So far, our residents have submitted a total of

We look forward to seeing you take this feedback to heart and use it to improve your teaching and rotations.

Evaluations of academic activities. This overdue component of our evaluation will soon be added to our platform. It will allow residents to evaluate academic lectures given during academic days and weekly site-based lectures. The feedback will be compiled and sent to speakers to help them improve their performance.

Fully Academic Units (FAUs) Pilot. This is a designation that will be given to units willing to commit to a set of additional standards in exchange for special privileges in the program. Fully Academic Units (FAUs) are the future of the program. You can read more about them in the next section.

The Road Ahead — Fully Academic Units (FAUs)

If we do our job well, our program would be the most efficient way to transform medical school graduates into Internal Medicine consultants.

This is what want to focus on next: increasing the educational value of all of our rotations by increasing their efficiency. The way to achieve this would be through:

Those three attributes go hand-in-hand and our experience tells us that the best indicator of having those attributes is when a unit is reliant on residents.

Units in which residents are seen as add-ons, not needed to run the service, but nice to have around, struggle to achieve those goals.

In those units, residents may get shielded from the reality of working in the service. They might be asked to shadow a fixed Registrar who's running the show and the resident may be given simpler tasks or a small part of the task. If the resident doesn't show up to work, no one will notice.

Whenever I raise this issue with tutors, many of them tell me that they would love to rely more on residents. However, their concern is that they might not always have a resident or enough residents to restructure their entire service to be reliant on residents. They find it too risky and worry they will end up being stranded if the program decides not to send them a resident on a particular month, for example.

To solve this dilemma, we are introducing FAUs as a pilot program. FAUs can either be General Internal Medicine units or Subspecialty Units. Compared to non-FAUs, FAUs will have several benefits and privileges, but they will also have strict conditions and responsibilities.

FAU Benefits & Privileges

FAU Conditions & Responsibilities

FAUs are the Future of KBIM

As described above, FAUs will have priority in resident assignments. As the number of FAUs increases, the number of residents available to work in non-FAUs will become limited. Rotations not interested in becoming FAUs may be left behind.

We will be actively pushing all rotations in this direction. At some point, we'd like the program to be composed almost exclusively of FAUs.

Creating Subunits

FAUs will start as a pilot program for the next Academic Year. Application forms will be made available soon and the deadline to apply to become an FAU will be near the end of February 2024.

Some tutors may be interested in working in a FAU but they may be in units where there's a mixture of academic and non-academic senior physicians as well as several fixed assistants and/or registrars. This would disqualify the whole unit from becoming an FAU, but there's the option to create subunits and make the subunit an FAU.

One way to address this is to assign fixed staff or non-teaching senior physicians to other units and consolidate all tutors interested in teaching into fewer teaching units.

For subspecialty rotations, you can also consider creating teaching and non-teaching subunits. However, when creating subunits, residents must continue to experience the full range of pathologies, patient populations, and clinical experiences.

For example, you shouldn’t divide the subunits by patient gender, as residents must see both male and female patients. You shouldn’t divide subunits by certain conditions, such as creating a separate rheumatoid arthritis service and designating that as the “non-teaching subunit” as this will impact the case mix that residents will see in the “teaching subunit”.

You can, however, create a non-teaching subunit or a “service” in which there’s high volume but low-educational yield service such as a refill clinic or an outpatient triage clinic as long as it doesn’t compete with the resident's responsibility to fully assess new referrals for the first time and formulate a plan.

We hope that you share our enthusiasm for a future in which every unit in the program is structured first and foremost around education and our hospitals are run by our highly motivated and enthusiastic residents!

How you can help

We’re constantly looking for skilled and enthusiastic clinical tutors, educators, as well as collaborators to join our leadership team. If you’d like to help, please approach your site coordinators or the leads responsible for the areas you’re interested in.

You can find the list of our leadership team, including all site coordinators, as well as all of our faculty across all sites, on the Faculty page of our website here: https://kbim.app/im/faculty/.

Finally, I want to again thank every resident, clinical tutor, and member of our incredible leadership for their hard work over the last year. With you, our program is heading to great success.

I would also like to acknowledge and thank:

I can't wait to see what we will accomplish together in 2024!

Sincerely,

Dr. Ahmad Alhashemi
MBBCh, ABIM, FRCPC, MScCH (HPTE), MSCS
Program Director - KBIM