Investigating graduates’ perception of overall goal attainment of a resilience-focused medical program offered in MENA: a quantitative cross-sectional study

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Although resilience-focused initiatives are widely adopted in health and care professions’ education, these initiatives seem to take the form of discrete interventions, as opposed to a longitudinal and integrated focus throughout respective programs. Objective To investigate the effectiveness of an innovatively resilience-focused medical program offered through an academic health system in Dubai (United Arab Emirates) through measuring its overall goal attainment from the perspective of its graduates. Methods A quantitative cross-sectional research design was used. Graduates of the first three cohorts of Bachelor of Medicine and Bachelor of Surgery of Mohammed Bin Rashid University of Medicine and Health Sciences – Dubai Health were invited to a survey (throughout October 2025). Analysis of scales included computing overall extent of agreement score for each of four scales. Results Out of 122 graduates, 76 responded. Percentage of total average of agreement that ‘Program Enables Attainment of Program Learning Outcomes’ was 87.11% and that ‘Program Enables Attainment of Program Objective’ was 85.14%. Also, percentage of total average of agreement that ‘Program Enables Building of Personal Resilience’ was 73.55% and that ‘Self-regulated Learning Enables Attainment of Goals’ was 80.76%. Conclusion Medical programs are encouraged to strive to reinforce individual learners’ resilience, in an integrated manner. This calls for deploying innovative ways to develop non-technical, transversal skills, complementary to basic and clinical medical sciences competencies. Collectively, those competencies are expected to result in resilient, and culturally competent and globally conscious health and care professionals who can engage in work transcending national borders. Health and care professions’ learners program effectiveness resilience self-regulated learning United Arab Emirates sustainable development Figures Figure 1 Figure 2 Figure 3 Introduction Health and care professionals continue to witness substantial change in healthcare delivery (Deml et al., 2022; J.R., 2005). Traditionally, medical education has articulated competences around core medical expertise. The Flexner report marked a constructive transformation in medical education, enabling medicine to become firmly rooted in biological science. It is believed, though, that the implementation of the report’s recommendations contributed to the erosion of the societal perception of physicians as value-driven, trusted healers (Senok, 2022). Relevantly, many health and care professionals perceive their duties to be related to their technical competences only, and fail to recognize their role as teachers, advocates, and companions (Clark, 2001). There is recognition that healthcare providers competences need to extend beyond medical sciences (Ninan & Patel, 2018; White et al., 2013). This emphasizes the importance of learning about skills, complementary to the basic and clinical medical sciences competencies, such as resilience, that enable the attainment of the desired well-roundedness among those professionals. The challenge is around how best to prepare and maintain humane and holistic future-ready health and care professionals, who (in this complex, ever-changing healthcare environment) are effective and efficient in truly meeting the 21 st century patient and population needs. This is in alignment with the goals of multiple health systems around the world that set ‘compassion’ as the core value (Clark et al., 2022; West & Bailey, 2023). Within this context, compassion is believed to include four key elements: paying attention to the other (i.e., attending- ‘listening with fascination’), understanding what is causing the other’s distress (i.e., understanding), having an empathetic response (i.e., empathizing), and taking intelligent (thoughtful and appropriate) action to help relieve other’s suffering (i.e., helping) (West M., 2017; West, 2021). Care that is compassionate has been demonstrating positive effects on patient satisfaction and health outcomes (West M., 2017). For health and care professionals to develop the resilience to lead compassionately, they need to first, and foremost, effectively take care of themselves, since ‘one cannot pour from an empty cup’ and ‘real change comes from the inside out’ (Frangieh et al., 2023; Sharma & Srikanth, 2023; Vala, 2022). As such, the starting point for authentic compassion is attending to, understanding, empathizing with, and helping oneself (i.e., self-compassion) (M.A., 2021), and it has been established that, contrary to popular belief, the corresponding resilience skillset is not inherent, and developing it requires intentionality and proactiveness (Darwish & Huber, 2003; Lomas et al., 2023; Sosik & Jung, 2002; Triandis, 2001). It has been suggested that developing the skillset needed to take care of oneself and to regularly restore one’s capacity to give, and in turn become truly resilient is facilitated by belonging to abundant, resourceful environments (Ballout, 2024; Raddawi, 2025). In fact, enabling environments, that inspire and empower individuals to take care and nourish themselves, and build their own personal resilience [in order to truly realize their potential in serving others, perhaps as depicted in ‘self-actualization’ of Maslow’s hierarchy of needs (Singha, 2024)], and that offer individuals sufficient reason and space to do so, are of utmost importance (Clarke, 2008; Johnston & Paton, 2003; Lengnick-Hall & Beck, 2016; Rieckert et al., 2021). This is particularly relevant among health and care professions’ learners who are on educational and in turn career trajectories that are exceptionally demanding (Ellestad et al., 2023; Jones, 2015; Joseph et al., 2025). The complex, ever-changing healthcare environment, and the demanding medical curricula which expect high continuing academic investment, alongside the sustained stress that likely arises from caring for patients (Shapiro et al., 1998) often strain health and care professions’ learners (Oro et al., 2021; Sender Romeo R., 2007). Relevantly, burnout or job-related stress, among medical trainees, and health and care professionals, is an increasingly recognized problem worldwide (Boni et al., 2018). This is particularly true closer to graduation, and as resident doctors (Dyrbye et al., 2014). Evidence indicates that burnout has been associated with high stress levels, anxiety, depression, substance abuse, and risk of suicide (Jackson et al., 2016; Koutsimani et al., 2019), all of which naturally lead to suboptimal clinical performance and ultimately poor outcomes of care (Yuguero et al., 2017). This likely deterioration of the psychological wellbeing of medical students continuing as they become resident doctors (Shanafelt T.D., 2002) is a reality that needs to be proactively addressed (Azim et al., 2025; Galaiya et al., 2020; Heath et al., 2020; Major et al., 2021; Neufeld et al., 2020; Pavlacic et al., 2024). Both personal and institutional factors substantially impact medical students’ resilience development (Major et al., 2021). From this perspective, developing, implementing, and evaluating (the effectiveness of) learning and teaching interventions that would enable the nurturance of resilient, globalized health and care professionals is important. The literature around the subject matter indicates a lot of variations in what characterizes resilient, globalized health and care professionals, how they are referred to, what is said to differentiate such professionals from their counterparts, and how such professionals can be nurtured (Arruda, 2024; Bludau, 2021; Otaki, Naidoo, et al., 2022; Svarstad & Risager, 2024; Wingenbach et al., 2023). A common ground across this literature is the established importance of experiential, self-regulated learning, where learning and doing go hand-in-hand, in nurturing such well-rounded health and care professionals (Bransen et al., 2022; Chitra et al., 2022; Cuyvers et al., 2021; Hanrieder, 2019; Panadero, 2017). To mitigate stressors and enhance learners’ resilience, it is important for health and care professions’ educators to cultivate a supportive learning environment, strengthen faculty-learner relationships, and increase academic and financial support as well as enable access to mental health resources (Azim et al., 2025). The literature is increasingly emphasizing, as well, the importance of developing, among health and care professions’ learners, non-technical, transversal skills (complementary to basic and clinical medical sciences competencies) that collectively reinforce individuals’ resilience (DePierro et al., 2021; Dyrbye et al., 2019; Galaiya et al., 2020; Scheepers et al., 2020; West et al., 2016). Accordingly, focused initiatives that inspire and empower health and care professions’ learners to build their own resilience have been developed and implemented (Lebeaut et al., 2023; Major et al., 2021; Shapiro et al., 2000; Slavin & Chibnall, 2016; Witt et al., 2019). Such individual-focused interventions include mindfulness-based approaches (Colgan et al., 2019; Goldhagen et al., 2015; Goodman & Schorling, 2012; Krasner et al., 2009; Ospina-Kammerer, 2000; Podgurski et al., 2019; Rosdahl & Kingsolver, 2014); peer support facilitation (Rossouw & Ruberto, 2025; Wu et al., 2020); stress and anger management (Neufeld et al., 2020), and self-care training (Milstein et al., 2009; Weight et al., 2013; Winefield et al., 1998); communication and leadership skills (Giordano et al., 2022), and emotional intelligence training (Bragard et al., 2010; Clayton et al., 2013; Fujimori et al., 2003; Fujimori et al., 2014; Neufeld et al., 2020); and small group curricula (Fujimori et al., 2003; Margalit et al., 2005; Rø et al., 2008). A good proportion of those interventions seem to have positively impacted the receiving learners. Although such resilience-focused initiatives are widely adopted and evaluated in health and care professions’ education, to the best of the authors’ knowledge, these initiatives all seem to take the form of either a one-off event [e.g., reflection groups and curriculum changes (Bock et al., 2025; Mohmand et al., 2022; Wadi et al., 2024)], or at best- a set of discrete interventions. These isolated islands of efforts (albeit their likely usefulness) are unlikely to attain the desired, sustained outcome which constitute of modification of the learners’ underlying attitudes and resultant habits empowering them to become more proactive about maintaining their own resilience. This sustained outcome is what is expected to enable those learners to thrive both personally and professionally (Amorøe et al., 2025; Neufeld et al., 2020), ultimately feeding into the provision of high-quality patient care (Azim et al., 2025). Hence, the upskilling of professionals, in terms of their resilience, requires a longitudinal focus, weaved (in an integrated manner, via omnichannel learning and teaching interventions) throughout the respective programs. Coupling the development of resilience with the capacity and affinity for self-regulated learning further reinforces the sustainability of the effects of such resilience-focused learning and teaching efforts. From this perspective, in terms of appraising these effects, it obviously does not suffice to evaluate the immediate output of discrete interventions. It is important to follow through with the learners until after graduation, and to measure not solely the individual intended learning outcomes but rather combining such linear investigations with a reliable means of capturing the human constructs, such as resilience, that the respective learning outcomes are meant to collectively lead to. Accordingly, the purpose of this study is to investigate the effectiveness of the innovatively resilience-focused, outcomes-based medical program of Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) – Dubai Health in Dubai, United Arab Emirates (UAE) (Buhumaid et al., 2024; Otaki et al., 2023), through measuring its overall goal attainment from the perspective of its graduates. The research questions include: To what extent do the graduates agree that the program enabled them to become the health and care professionals whom the respective program is meant to nurture [as articulated in the corresponding Program Learning Outcomes (PLOs) and program objective]? To what extent do the graduates agree that the program enabled them to build their personal resilience? To what extent do the graduates agree that self-regulated learning, that had been purposively fostered as part of the respective program, is enabling them to thrive in their careers (in terms of continuing education and/ or employment)? The output of this research project contributes to understanding the learning and development needs of ‘future-ready health and care professionals’, in general, and more specifically, when it comes to select human constructs (e.g., globalization, and self-regulated learning and resilience) that in principle constitute the combined effects of nontechnical, transversal skills, complementing the foundational technical basic and clinical medical sciences competencies (Otaki, Amir-Rad, et al., 2022; Otaki et al., 2025; Otaki, Naidoo, et al., 2020, 2022). More specifically, the findings of this study reinforce what we have learned from the coronavirus disease of 2019 (COVID-19) times (i.e., extreme conditions) in relation to understanding health and care professions students’ learning needs (Du Plessis et al., 2021; Otaki, Amir-Rad, et al., 2022) to become resilient/ to build resilience (skills), to thrive in their respective careers, and/ or to realize their potential in serving others and in contributing to sustainable development. Methods Context of the study The United Arab Emirates (UAE) represents a diverse, multicultural, and multi-ethnic society within the Middle East and North Africa (MENA) region, grounded in Islamic principles and Arab heritage. It operates as a constitutional federation composed of seven emirates. Based on indices evaluating economic, social, and political aspects of globalization, the UAE is regarded as the most globalized nation in the MENA region (Alameddine et al., 2022; Gygli et al., 2019; KOF, 2025). Among the emirates, Dubai is the largest and most densely populated (Alameddine et al., 2020). Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), named in honour of His Highness Sheikh Mohammed Bin Rashid Al Maktoum, Vice President, Prime Minister of the UAE, and Ruler of Dubai, was established in September 2014 in Dubai and subsequently licensed as a higher education institution by the Ministry of Higher Education and Scientific Research later that year. In January 2015, Queen’s University Belfast (QUB, 1845) joined MBRU as the primary advisor for curriculum development. The university was formally instituted by royal decree in June 2016. MBRU currently comprises three colleges: the College of Medicine (CoM), the Hamdan Bin Mohammed College of Dental Medicine (HBMCDM), and the Hind Bint Maktoum College of Nursing and Midwifery (HBMCoNM). Its institutional culture emphasizes evidence-informed decision-making and the systematic application of implementation science cycles, including approaches such as design-based research. Studies conducted within this framework commonly employ mixed methods research designs to foster comprehensive insights, with learners actively involved in both designing and analysing educational interventions (Chen & Reeves, 2020; Kimmons, 2020; Kimmons R., 2020). Data gathered in these studies typically align with various levels of the Kirkpatrick Evaluation Model (Otaki, Khamis, et al., 2020a). This study focuses on the Bachelor of Medicine and Bachelor of Surgery program (MBBS) at MBRU, covering the period from 2016 to 2024. As a locally developed, outcomes-driven undergraduate medical program established from scratch, this MBBS undergoes continuous enhancement through design-based research, similar to the other MBRU programs. Subject matter experts contribute feedback on early versions of teaching and learning interventions (McKenney & Reeves, 2021). Ongoing collaboration among designers, practitioners, and researchers from different disciplines supports iterative improvements to these initial designs (Sandars & Goh, 2020). The evolving prototypes are regularly evaluated by stakeholders through interactive group discussions, enabling the incorporation of lessons learned in practice and the advancement of underlying educational theories embedded in the design. Consequently, design-based research serves as a flexible and valuable approach for simultaneously strengthening educational practice and theory (Dolmans & Tigelaar, 2012). The inaugural MBBS cohort, consisting of 56 students, commenced their studies at the CoM in the academic year 2016–2017. By the conclusion of the academic year 2023–2024, a total of 122 students across three cohorts had graduated from the program, with approximately 20% entering residency training programs in Dubai through MBRU’s Graduate Medical Education unit. Delivered by the College of Medicine, the respective MBBS spans six years and is structured around a competency-based framework designed to reflect Dubai’s highly globalized environment. Both the program as a whole and its individual components incorporate innovative teaching approaches grounded in the integration of Kolb’s experiential learning theory and social constructionism (Al-Jayyousi et al., 2025; Alsuwaidi et al., 2023; Buhumaid et al., 2024; Otaki et al., 2023; Otaki et al., 2025; Otaki, Khamis, et al., 2020a). The MBBS curriculum is organized into three distinct phases (Figure 1). The curriculum follows a spiral structure (Otaki et al., 2023), with integrated courses delivered over six academic years, each consisting of two semesters. Phase 1 corresponds to the first year and introduces students to foundational medical concepts. Phase 2 spans the second and third years, during which instruction is organized by organ systems and integrated with clinical medicine. Phase 3 includes the fourth through sixth years, where students participate in clinical clerkships across both public and private healthcare settings. These placements occur within Dubai Health facilities as well as the private Mediclinic Middle East (MCME) network. Dubai Health encompasses six hospitals, in addition to various ambulatory care and medical fitness centres. MBRU has maintained a public-private partnership with MCME since 2016 (Du Preez L., 2024). MCME operates approximately 1,000 inpatient beds and employs around 1,300 physicians across the UAE, delivering a comprehensive spectrum of services ranging from preventive to advanced quaternary care. Within the UAE, MCME manages seven hospitals: three located in Dubai, and 29 outpatient clinics, 16 of which are in Dubai (Alameddine et al., 2022; MCI, 1983). Furthermore, since 2021, MCME has operated two independent outpatient dialysis centres that provide public healthcare services in collaboration with Dubai Health. The respective MBBS has the following nine PLOs: Practice in a safe and competent manner Observe (i.e., fulfil or comply with) ethical and professional standards Practice evidence-based medicine and engage in scholarship and generation of new knowledge Communicate clearly & effectively Advocate for health promotion of individuals and communities Distinguish various healthcare systems and their management Educate and share knowledge and skills Participate effectively in multidisciplinary teams Demonstrate commitment to life-long, self-directed learning, and performance improvement It is worth pointing out that only one/ the first PLO relates (includes but should not be restricted) to technical, medical sciences competencies. Accordingly, this outcomes-based program, through attaining the abovementioned PLOs, aims to nurture competent and conscientious globalized health and care professionals who are resilient and are continuously learning towards the realization of their true potential in serving others and in contributing to sustainable development, while remaining rooted in their values, through the pursual of a career in medicine of their choice, as part of meaningful interdependencies. MBRU, upon inception, had set out to become an integrated AHS, with clear articulation of its direction in the University’s goal upon inception: ‘To advance health in the UAE and the region, through an innovative and integrated academic health system , that is nationally responsive and globally connected, serving individuals and communities.’ As a resilient organization, MBRU takes evidence-driven precautionary measures to ensure multiple layers of protection for all critical assets, including people, products, and properties (Muir et al., 2025). A lot of changes took place within and outside MBRU since the inception of the MBBS, the most prominent ones were COVID-19 and the organizational response to it, and the inception of Dubai Health (Dubai’s first integrated academic health system, with four pillars: ‘care’, ‘learning’, and ‘discovery’, and ‘giving’). MBRU’s active involvement in steering the local, and also in the national and international response to the pandemic brought forth the learning needs of health and care professions’ learners (Otaki, Naidoo, et al., 2020) across the continuum of lifelong learning of health and care professionals (i.e., skilling, upskilling, and reskilling) that can start as early as the transition from secondary to tertiary education (Alsuwaidi et al., 2023; Bowe & Armstrong, 2017). Accordingly, among MBRU’s proactive measures is its commitment to continuously developing and to building personal resilience, across its community, which is evident through its flagship learning and teaching interventions that are implemented (as previously mentioned, in alignment with the principles of design-based research) to, either directly or indirectly, foster self-regulated learning and building resilience among learners (Figure 2). These omnichannel learning and teaching interventions include a homegrown curricular course that is offered to medical learners to inspire and empower them to build their own resilience skills (Nair et al., 2023; Otaki et al., 2025). There are other interventions offered by MBRU, via the MBBS program, that foster individual and collective resilience indirectly through curricular [e.g., contextualized professionalism training (Buhumaid et al., 2024), and five-course research module (Otaki et al., 2023)] and co-curricular self-regulated learning. There are further curricular activities, as well, that are fostering resilience via a hidden curriculum [e.g., self-regulated learning along with other transversal skills via pharmacology (Kaddoura et al., 2024), and via early clinical experience embedded in foundation of clinical medicine curriculum (Al-Jayyousi et al., 2025)]. An example of a flagship co-curricular program would be the MBRU – Summer Scholars’ Program (Otaki, Naidoo, et al., 2020, 2022; Senok, 2022) that supports the learners in their journey towards becoming global citizens. MBRU has been the implementation vehicle for the ‘learning’ and ‘discovery’ arms of Dubai Health (Health, 2023). In addition to sharing its goals with Dubai Health, MBRU efforts align nationally with the Ministry of Higher Education and Scientific Research- Outcome-based Evaluation Framework (Research, 2025) and internationally with the United Nations- Sustainable Development Goals (SDGs) (Nations, 2015) (Figure 3). Research design A quantitative cross-sectional research design was deployed for the current study. Unlike other types of observational studies, cross-sectional studies do not follow individuals up over time (Wang & Cheng, 2020). They are usually easy to conduct and inexpensive, allowing for sufficient control over the instrument and its measures (Eesley, 2018). They are often used to describe features of a population (e.g., several cohorts of the same program), at a single point in time (Grujicic & Nikolic, 2021). Accordingly, MBRU’s MBBS graduates of Classes of 2022, 2023, and 2024 were invited to respond, throughout October 2025, to a tailormade survey. Such a data collection tool is believed to provide a comprehensive point-in-time (i.e., cross-sectional) self-report of graduates career trajectories, lifelong learning orientations, retrospective perceptions of curricular experiences, and individual characteristics (Cabrera et al., 2003). Such insights enable educators to learn about the overall effects of their degree offerings (Dawe et al., 2023), and in turn to make informed changes targeting the human constructs (e.g., globalization, and self-regulated learning and resilience) that their offerings aim to foster. Ethical approvals for the study were granted by the Mohammed Bin Rashid University of Medicine and Health Sciences Institutional Review Board (MBRU-IRB-2025-240) and in turn Dubai Scientific Research Ethics Committee (DSREC-09/2025_39). Data collection All the MBBS graduates of Classes of 2022, 2023, and 2024 were invited by a neutral gatekeeper, entirely independent from the research team (a staff member within Administrative Affairs, with no affiliation to the research team and no involvement in the research process) to respond to a tailormade survey: self-assessment (Appendix I). The study’s principal investigator had access only to anonymized, aggregated data. The study population of 122 graduates of three MBBS cohorts (96 females and 26 males) is from 26 nationalities (from within MENA and beyond), of whom 40 are locals/ Emirati nationals. In terms of the Kirkpatrick Evaluation Model of four levels (Level 1: Reaction, Level 2: Learning, Level 3: Behaviour, and Level 4: Results) (Otaki, Khamis, et al., 2020a), the proposed investigation tapped into Level 2: Learning and Level 3: Behaviour. The survey (Appendix I) was developed following an exploration of what is available in the literature (and practice- through desk review and benchmarking) in terms of means of evaluating (medical) program effectiveness. To start with, published evaluations/ surveys of programs’ goal attainment were retrieved and reviewed (Armstrong & Barsion, 2006; Beroz et al., 2020; Cumming et al., 2007; Curran et al., 2006; Curran & Fleet, 2005; Kikukawa et al., 2014; Kusmiati, 2025; McNEIL et al., 2006; Nuebel et al., 2020; Torkzadeh & Keshavarzi, 2018). Also, relevant AMEE guidelines (Challis, 1999; Dolmans & Tigelaar, 2012; Frye & Hemmer, 2012; Harden, 1999; Pangaro & Ten Cate, 2013; Shumway & Harden, 2003; Smith, 1999) were taken into account in the process of survey formation, especially in relation to means of evaluating the predetermined constructs and the overall structuring of the survey. The resulting tailor-made survey is composed of five questions (Table 1). The first question inquires for the graduating class, that the study participants, belongs to (2022, 2023, or 2024). The second and third questions constitute five-point Likert-type scales of levels of agreement that the program enables attainment of Program Learning Outcomes (nine components) and its overall program objective (seven components), respectively. The fourth and fifth questions are also five-point Likert-type scales. The former inquiries about level of agreement that the program enables building of personal resilience [as conceptualized by Press Ganey ® (Ganey, 2017), with eight components], and the latter inquires for level of agreement that, more precisely, self-regulated learning that had been fostered as part of the MBBS enables the learners in attainment of all the goals portrayed in the preceding three questions (nine components). Table 1 Outline of tailor-made survey. Q1: Graduating class Q2: ‘Program Enables Attainment of Program Learning Outcomes’ scale Q3: ‘Program Enables Attainment of Program Objective’ scale Q4: ‘Program Enables Building of Personal Resilience ’ scale Q5: ‘Self-regulated Learning Enables Attainment of Goals ’ scale Single selection question Five-point Likert-type scales (levels of agreement) Three options (2022, 2023, and 2024) Nine components (2.1 through 2.9) Seven components (3.1 through 3.7) Eight components (Four corresponding to ‘Decompression’, followed by four corresponding to ‘Activation’) (4.1 through 4.8) Nine components (5.1 through 5.9) The respective tailor-made survey underwent face and content validation prior to assembly, where five current year 6 students were asked on comment on the content and structure of the respective survey, and five graduates of graduating class 2025 were asked to provide their feedback on the survey (i.e., pseudo-participation) and in turn to share their thoughts around the perceived purpose of the survey. According to the received feedback, the sentence structure of a couple of components of the respective scales was modified, and also a brief explanation of select (potentially confusing) terms in the context of study was added. The survey was assembled via Explorance Blue: a comprehensive, automated feedback analytics platform designed primarily for higher education evaluation software (Explorance, 2019), by a neutral gatekeeper. The survey was assembled throughout October 2025, with three reminders (one week apart). The goal was to attain at least 60% response rate. Data analysis The quantitative data were analysed using SPSS for Windows version 27. The descriptive analysis for the first question revolved around calculating proportions (of study participants belonging to each of the three included graduating classes). As for the descriptive analyses of the four five-point Likert-type scales, they constituted of computing the overall extent of agreement score for each scale. The mean and standard deviation for each of those scores (no.= four) and each component of theirs [no.= nine, seven, eight (four: ‘Decompression’, and four: ‘Activation’), and nine, respectively] were calculated. Cutoffs were based on an assumed normal distribution, which is according to established interpretation recommendations (with 16 divisions to reflect the five-point Likert-type scale) (Sullivan & Artino Jr, 2013; Warmbrod, 2014)- 0-6.25%: Strongly Disagree, 18.75-31.25%: Disagree, 43.75-56.25%: Neutral, 68.75-81.25%: Agree, and 93.75-100%: Strongly Agree. The reliability test of Cronbach’s Alpha and validity test of Principal Component Analysis (PCA), latter accompanied by bivariate analysis, were performed to check and ensure the internal consistency and external variance of the four scales, respectively. A test of normality was conducted for those four overall extent of agreement scores and each component of theirs to select the appropriate inferential analysis tests. The data across all the scales appeared to be not normally distributed, and hence, Kruskal-Wallis one-way analysis of variance test was used to assess the potentiality of associations between the variables. Lastly, the Bivariate Spearman Correlations was utilised to investigate the relation between the scores (and their respective components). Results Out of those 122 graduates, as per Table 2, 76 responded (i.e., overall response rate= 62.30%). Table 2 Response rates across graduating classes. Graduating class Number of responses Total number of graduates Response Percentage 2022 17 49 34.70 2023 22 31 70.97 2024 37 42 88.10 Total 76 122 62.30 Corresponding to the current study’s first research question, the percentage of the total average of the agreement that the Program Enables Attainment of Program Learning Outcomes score was 87.11%, as per Table 3. In addition, the percentage of the total average of the agreement that the Program Enables Attainment of Program Objective score was 85.14%, as per Table 4. In relation to the second research question, the percentage of the total average of the agreement that the Program Enables Building of Personal Resilience score was 73.55%, as per Table 5. As for the third research question, the percentage of the total average of the agreement that the Self-regulated Learning Enables Attainment of Goals score was 80.76%, as per Table 6. The four corresponding scales proved to be reliable and valid in the context of the study (Appendix II). Table 3 Output of descriptive quantitative analysis of the level of agreement that the Program Enables Attainment of Program Learning Outcomes scale. Program Enables Attainment of Program Learning Outcomes scale Mean (SD) Percentage of the mean Category Component 2.1: Practice in a safe and competent manner 4.47 (0.64) 89.40 A-SA Component 2.2: Observe ethical and professional standards 4.55 (0.58) 91.00 A-SA Component 2.3: Practice evidence-based medicine, and engage in scholarship and generation of new knowledge 4.34 (0.70) 86.80 A-SA Component 2.4: Communicate clearly and effectively 4.54 (0.61) 90.80 A-SA Component 2.5: Advocate for health promotion of individuals and communities 4.17 (0.92) 83.40 A-SA Component 2.6: Distinguish various healthcare systems and their management 4.05 (0.95) 81.00 A Component 2.7: Educate and share knowledge and skills 4.41 (0.66) 88.20 A-SA Component 2.8: Participate effectively in multidisciplinary teams 4.28 (0.78) 85.60 A-SA Component 2.9: Demonstrate commitment to life-long, self-regulated learning, and performance improvement 4.38 (0.71) 87.60 A-SA Overall score 39.20 (5.09) 87.11 A-SA A= Agree (68.75-81.25%) and SA= Strongly Agree (93.75-100%) Table 4 Output of descriptive quantitative analysis of the level of agreement that the Program Enables Attainment of Program Objective scale. Program Enables Attainment of Program Objective scale Mean (SD) Percentage of the mean Category Component 3.1: Developing your self-efficacy 4.26 (0.79) 85.20 A-SA Component 3.2: Fostering your conscientiousness 4.37 (0.78) 87.40 A-SA Component 3.3: Becoming a global citizen, while remaining rooted in your personal values 4.26 (0.81) 85.20 A-SA Component 3.4: Building your resilience skills 4.39 (0.66) 87.80 A-SA Component 3.5: Realizing your true potential in serving others and in contributing to sustainable development 4.25 (0.84) 85 A-SA Component 3.6: Pursuing a career in medicine of your choice 4.13 (0.97) 82.60 A-SA Component 3.7: Engaging in meaningful interdependencies 4.13 (0.96) 82.60 A-SA Overall score 29.80 (4.93) 85.14 A-SA A= Agree (68.75-81.25%) and SA= Strongly Agree (93.75-100%) Table 5 Output of descriptive quantitative analysis of the level of agreement that the Program Enables Building of Personal Resilience scale. Program Enables Building of Personal Resilience scale Mean (SD) Percentage of the mean Category Decompression Component 4.1: Enjoy your personal time without focusing on work matters 3.25 (1.12) 65.00 N-A Component 4.2: Rarely lose sleep over work issues 3.00 (1.10) 60.00 N-A Component 4.3: Free your mind from work when you are away from it 3.12 (1.12) 62.40 N-A Component 4.4: Disconnect from work during your free time (e.g., emails, WhatsApp, and phone calls) 3.03 (1.13) 60.60 N-A Overall Decompression score 12.39 (3.85) 61.95 N-A Activation Component 4.5: Care for all patients/ clients equally even when it is difficult 4.29 (0.76) 85.80 A-SA Component 4.6: See every patient/ client as an individual person with specific needs 4.36 (0.69) 87.20 A-SA Component 4.7: Realize that the work you do makes a real difference 4.14 (0.88) 82.80 A-SA Component 4.8: Realize your work is meaningful 4.24 (0.81) 84.80 A-SA Overall Activation score 17.03 (2.80) 85.15 A-SA Overall score 29.42 (5.56) 73.55 A N=Neutral (43.75-56.25%), A= Agree (68.75-81.25%), and SA= Strongly Agree (93.75-100%) Table 6 Output of descriptive quantitative analysis of the level of agreement that the Self-regulated Learning Enables Attainment of Goals scale. Self-regulated Learning Enables Attainment of Goals scale Mean (SD) Percentage of the mean Category Component 5.1: Become ambitious in relation to your career aspirations 4.26 (0.94) 85.20 A-SA Component 5.2: Become proactive in relation to your career 4.16 (0.97) 83.20 A-SA Component 5.3: Exercise agency/ choice in relation to your career 4.01 (1.03) 80.20 A Component 5.4: Secure your ‘primary continuing education and/ or employment choice’ 3.67 (1.26) 73.40 A Component 5.5: Excel in what you have been doing since graduation 3.96 (1.04) 79.20 A Component 5.6: Maximize what you have been doing since graduation 3.99 (0.97) 79.80 A Component 5.7: Align what you have been doing since graduation with your career aspirations 3.96 (0.97) 79.20 A Component 5.8: Better prepare yourself for what you have been doing since graduation 4.04 (0.93) 80.80 A Component 5.9: Become more resilient 4.29 (0.80) 85.80 A-SA Overall score 36.34 (7.51) 80.76 A A= Agree (68.75-81.25%) and SA= Strongly Agree (93.75-100%) In terms of inferential analysis tests, two of the four overall scores only: Program Enables Attainment of Program Learning Outcomes and Program Enables Attainment of Program Objective, seemed to be significantly associated with which graduating class the study participants belong to (highest is 2022 followed by 2024 and then 2023) (P0.05), the overall score of one of its subsections, namely: Activation, seemed to be significantly associated with which graduating class the study participants belong to (following the same pattern: highest is 2022 followed by 2024 and then 2023) (P<0.05). In relation to the components of the four scales, the following: 2.2, 2.3, 2.5, 2.7, and 2.9 of Program Enables Attainment of Program Learning Outcomes; 3.1, 3.2, and 3.3 of Program Enables Attainment of Program Objective; and 4.8 of Program Enables Building of Personal Resilience seemed to be significantly associated with which graduating class the study participants belong to (following the same pattern: highest is 2022 followed by 2024 and then 2023) (P<0.05). Also, there seemed to be a statistically significant association across the components of the four scales and their overall scores (including the scores of the two subsections of the Program Enables Building of Personal Resilience scale: Decompression and Activation) (P<0.05). Discussion The current study, through investigating (from the perspective of ‘fresh’ graduates of the respective program) the extent to which preset medical program goals (i.e., PLOs and overall program objective) were met and corresponding human constructs were developed, gives an impression of the effectiveness of a young, innovatively resilience-focused, outcomes-based medical program. This study shows that this medical program, that proactively fosters transversal resilience skills among its enrolees, in an integrated manner via omnichannel learning and teaching interventions throughout the entailed self-regulated learning journey, enabled the development of the enrolees’ resilience (with ‘Building your resilience’ as the top-rated component of the ‘Program Enables Attainment of Program Objective’ scale). This study also revealed that the participating graduates consider the self-regulated learning, that had been fostered as part of respective program, to have enabled (as a moderator and/ or mediator) the attainment of the program goals (with ‘Become more resilient’ as the top-rated component of the corresponding scale). The study experimented with the deployment of a variation of Press Ganey® (Ganey, 2017 ) resilience scale, where the graduates were asked about their level of agreement that the program enabled building and exercising their own personal resilience [as defined by Press Ganey® (Ganey, 2017 )]. According to the respective scale, resilience involves locating and in turn deploying the necessary resources to rest (i.e., decompression), and not solely to take initiative (i.e., activation). It sheds light on the interplay that needs to take place to allow for effective self-regulation and in turn exhibition of resilience. As previously mentioned, this study showed that the medical program, under investigation, enabled the development of the learners’ resilience; it seems to be fostering their ‘activation’ more than their ‘decompression’, though. Accordingly, it is worth considering teaching the learners and enabling them to rest and unwind (Ghafar, 2023 ; Pienaar et al., 2022 ), when the need arises. It is often assumed that resting happens naturally; this is not always the case, especially among those who are under high pressure to perform (such as: health and care professions’ learners, markedly the high-functioning ones). The proposed study feeds into the ongoing global pursuit around fostering self-regulated, lifelong learning as an enabler for building resilience (Berkhout et al., 2018 ; Kucuksuleymanoglu, 2025 ); for realizing career aspirations and/ or one’s true potential in serving others (Li et al., 2010 ; Ricotta et al., 2022 ); for building and activating one’s agency (Gupta et al., 2024a , b ); and/ or for thriving in one’s career (Mlambo et al., 2021 ; Ten Cate et al., 2024 ). This study shows that self-regulated learning is likely playing a moderator and/ or a mediating role in the relationship between experiencing the program, and the attainment of the program learning outcomes and overall objective. Relevantly, it is established in the literature that increasing the learners’ capacity and willingness to learn, and encouraging them to maintain a learning/ growth mindset raises their resilience (Khan & Bibi, 2025 ; Lee & Kwon, 2023 ; Singaravelu & Chandrakumari, 2025 ). In the context of the current study, the deployed variation of Press Ganey® (Ganey, 2017 ) resilience scale (i.e., ‘Program Enables Building of Personal Resilience’ scale), similar to the ‘Program Enables Attainment of Program Objective’ scale, constituted an example of a ‘synthetic framework’, according to characterization of Association for Medical Education in Europe (AMEE). Such evaluation frameworks are believed to view and appraise competence holistically, focusing on performance in real-world activities (Shumway & Harden, 2003 ; Smith, 1999 ). AMEE characterizes an evaluation framework as a group of ideas or categories to reflect the educational goals against which a trainee's level of competence or progress is gauged (Harden, 1999; Pangaro & Ten Cate, 2013 ). From this perspective, different frameworks provide different ways of looking at the practice of medicine and have different purposes (Frye & Hemmer, 2012 ; McNEIL et al., 2006 ). In the corresponding AMEE guidelines, a clear distinction is made between analytic and synthetic frameworks (Challis, 1999 ; Tackett et al., 2016 ). As opposed to the synthetic frameworks, analytic ones (such as: ‘Program Enables Attainment of Program Learning Outcomes’ scale) deconstruct competence into individual pieces, to evaluate each separately. The current study also showed that the respective medical program is enabling the attainment of its nine preset learning outcomes. In terms of improvement, the greatest opportunity seems to lie around the sixth learning outcome: ‘Distinguish various healthcare systems and their management’. The MBBS under investigation in the current study already offers an innovative, experiential longitudinal theme throughout Phase 3, as illustrated in Fig. 1 , of health systems and quality/ performance improvement (Al-Jayyousi et al., 2025 ). It is worth further reinforcing this longitudinal offering with content, related to public health, in general, and health management and policy, more specifically, that will enable learners to differentiate between the various healthcare systems across the world (understanding the pros and cons of each, and how those systems are reinforcing the behaviours, whether favourable/ desirable or not, of their health and care professionals) (Ferreira-Guerrero et al., 2023 ). This type of content can be delivered in a way to strengthen the learners’ capacity to engage in proper strategic planning (starting with developing a thorough understanding of situations), in system thinking (i.e., input, process, output, outcome, and impact) (Bowe & Armstrong, 2017 ; Toosi et al., 2021 ), and in systemic and systematic monitoring and evaluation (via a balanced scorecards or otherwise) (Nuebel et al., 2020 ). This is aligned with the encouraged shift in medical education, where the perception of well-being and illness is transitioning toward acknowledging them as outcomes arising from the complex interplay of individual, social, and environmental/ ecosystemic factors (Gülpınar & Tanrıöver, 2025 ). The current study showed that the MBBS under investigation is attaining its overall objective, from the perspective of its graduates. It also showed, through measuring the third component of the ‘Program Enables Attainment of Program Objective’ scale: ‘Becoming a global citizen, while remaining rooted in your values’, that the respective program contributed to the graduates capacity to recognizing themselves as members of a worldwide community, without compromising their individuation [the lifelong process of becoming a unique, whole, and distinct self (Nice & Joseph, 2023 )]. COVID-19 pandemic has demonstrated the importance for health and care professionals to engage in work transcending national borders and to deeply understand perspectives of health and care in other countries (Du Plessis et al., 2021 ; Giordano et al., 2022 ; Jenkins et al., 2021 ; Otaki, Amir-Rad, et al., 2022 ; Rad et al., 2021 ). Globalization of health and care professions’ education can play a key role to that end (Bedoll et al., 2021 ; Jenkins et al., 2021 ; Otaki, Naidoo, et al., 2022 ; Senok, 2022). Corresponding educational programs can strive to prepare culturally competent and globally conscious professionals. A previously conducted scoping review of the current practices and formats in globalization in medical education showed that the literature around the subject matter is favouring perspectives and understandings that were typically representative of the Global North in general and Northern America more specifically (Wu et al., 2022 ). That review emphasized the importance of health and care education to become more inclusive, and for all health and care professions’ learners to gain access to international perspectives and experiences. It also showed a disconnect between what medical curricula hope to accomplish and the reality of the learning and teaching practice on the ground. Moreover, the current study showed, through measuring the seventh component of the ‘Program Enables Attainment of Program Objective’ scale: ‘Engaging in meaningful interdependencies’, that the respective program contributed to the graduates capacity to have the choice to collaborate with other independent people and for this collaboration to be healthy (i.e., ‘we' instead of 'I' without compromising 'me'), forming synergies, where 'the whole becomes greater than the sum of its parts'. This is relevant to the previously introduced Stephen Covey’s ‘maturity continuum’ (Covey, 2012 , 2020 ) that suggests that for there to be healthy interdependence, one needs to evolve from dependent to independent, only then can someone autonomously choose to be truly interdependent (Oko, 2024 ; Pahl, 2011 ). Moving from dependence to setting common goals with others without passing through ‘independence’, as a stage of maturity, is considered but a shift of dependency from one party (e.g., parents) to another (e.g., work colleague), likely causing unhealthy emotional enmeshment and hampering development, personally and interpersonally, and beyond (Smith et al., 2024 ). The challenge of preparing and maintaining humane and holistic future-ready health and care professionals is particularly relevant to professionals who are receiving their training in Dubai, UAE: the most globalized country in the MENA (Alameddine et al., 2022 ; Gygli et al., 2019 ; KOF, 2025 ). The homegrown program, investigated in the current study, was developed with the intention of reflecting the extent of globalization of its context: Dubai, UAE. The unique context of the study, in terms of primarily globalization (Azaza & Zinoubi, 2022 ) but also other differentiators, starting with the composition of the study participants (i.e., MBBS graduates), program (i.e., MBBS), college (i.e., CoM), and institution (i.e., MBRU – Dubai Health), all the way to the geographical location (i.e., Dubai, UAE, Gulf, and MENA), allows for the generation of insights around the nurturance of global citizens/ globalized health and care professionals that arguably do not stand the chance of getting generated elsewhere (Ashour & Kleimann, 2024 ). It is worth highlighting some of the intangible attributes that further differentiate the context of the proposed study. Dubai, UAE values of ‘respect for others’ and ‘tolerance’ are enabling the harmonious co-existence across its varied populations (Rai & Beresford-Dey, 2025 ). UAE, in general, and Dubai more specifically offer a unique presentation of the value of ‘fairness’, where there seems to be a justifiable prioritization of locals/ Emirati nationals, in terms of empowerment and enablement. Consequentially, the context becomes authentically rich, where the locals/ Emirati nationals tend to relate to each other and to expatriates, and operate from a place of abundance (often striving to contribute to the greater good, keeping in mind and protecting everyone’s rights), reflecting how true strength comes from the inside out. It is established that policymakers in education should pay special attention to the evaluation of educational programs (Toosi et al., 2021 ). Over the years, given the interest of the institution, in which the program under investigation in the current study is offered, in research around innovative health and care professions’ education (Otaki et al., 2025 ; Otaki, Khamis, et al., 2020a ; Otaki, Naidoo, et al., 2020 , 2022 ; Senok, 2022) compounded with its commitment to continuous quality enhancement via implementation science (e.g., design-based research) (Al-Jayyousi et al., 2025 ; Du Preez et al., 2025 ; Kaddoura et al., 2024 ), several, diverse investigations have taken place in relation to segments of this program (e.g., an educational intervention or a course). These scientifically-sound investigations revealed positive indications (e.g., learners’ satisfaction and developed competencies) and also shed light on opportunities for improvement (e.g., evidence-driven means to maximize learning value of an innovative educational intervention). There remained a gap, however, around evaluating the respective program systemically (Ballejos et al., 2023 ; Ferreira-Guerrero et al., 2023 ; Toosi et al., 2021 ), which is established to be a key component of the corresponding quality assurance and continuous quality enhancement functions (Bedoll et al., 2021 ; Colbert & Bierer, 2022 ; Otaki, Khamis, et al., 2020b ; Toosi et al., 2021 ). The current study constitutes an attempt to systematically evaluate, leveraging the Kirkpatrick Evaluation Model (Level 2: Learning and Level 3: Behaviour), the respective program from a macro-perspective (meeting preset goals and fostering select predetermined human constructs). Moreover, although the generalizability of the proposed study is limited, its practical value lies in the transferability of its findings and lessons learned to other similar programs. The means of evaluating the program effectiveness, and the firsthand experiences with learning and teaching (including but not limited to the curriculum and mode of delivery), are all also worth leveraging for the benefit of other similar higher education institutions. The study introduced three quantitative data collection tools (five-point Likert-type scale): ‘Program Enables Attainment of Program Learning Outcomes’, ‘Program Enables Attainment of Program Objective’, and ‘Self-regulated Learning Enables Attainment of Goals’ scales, all of which proved to be reliable and valid in the context of the study. These tools can be used by other similar institutions to capture their graduates/ graduates’ perspective of the effects of the respective educational offerings that they had graduated from. The current initiative, as a whole, also encourages, in alignment with the literature around the subject matter (Allen et al., 2022 ; Constantinou & Wijnen-Meijer, 2022 ; Toosi et al., 2021 ), other medicine and health sciences higher education institutions to embark on similar institutional research activities that aim to measure the extent of attainment of program goals through the eyes of their graduates. The current work also offers a methodological contribution around design-based research (Chen & Reeves, 2020 ; McKenney & Reeves, 2021 ), encouraging its utilization in academia, in general, and higher education more specifically. It is quite applicable within this context given the parallelism that can be established between the continuous, iterative nature of design-based research (Kimmons R., 2020 ; Sandars & Goh, 2020 ) and the evidently cyclical nature of academia (Reinking, 2021 ; Ustun & Tracey, 2021 ). It is worth highlighting the differing levels in which implementation science (e.g., design-based research) is enacted within MBRU – Dubai Health (which positions itself as a learning, value-based academic health system): segments of courses (e.g., study around early clinical exposure), courses (e.g., study around pharmacology course), basic and clinical medical sciences phases, program, college, university/ higher education institution, and (learning) academic health system (i.e., learning organization) (Du Preez et al., 2025 ). The current study has a few limitations. To start with, the generalizability of the findings is limited since the study took place in a single university of medicine and health sciences, including only the first three cohorts of graduates of an undergraduate program. The transferability of findings to similar programs is quite strong, though, given the provision of a detailed description of the context of the respective study. In addition, the study relied on self-reported data, which may be subject to response bias, in general, and more specifically, social desirability effects. Also, in terms of response rate of the current study, it is considered acceptable for research based on a cross-sectional design (Sataloff & Vontela, 2021 ). Yet, if the response rate per stratum/ cohort is considered, that of graduating classes 2023 and of 2024 (70.97% and 88.10%, respectively) would be considered acceptable/ high enough, as for that of 2022 (as previously mentioned), a response percentage of 34.70 is considered low (and hence, not much emphasis was put on discussing any significant variation across the cohorts; this, from a research perspective, constitutes a missed opportunity). It will be useful for future studies, covering more than one cohort of participants, to assure meeting response threshold per stratum/ cohort. Moreover, the deployed tool [including four scales, one of which is a variation of Press Ganey® (Ganey, 2017 ) resilience scale] was tailor-made for the purpose of the study. To ensure bypassing the potential weaknesses of this informed choice around the study’s data collection, the internal consistency and external variance of the four scales were performed to assure their reliability and validity, respectively, in the context of the study (Appendix II). In addition, although the current outcome-evaluation study provided important information around desired effects of the MBBS program under investigation, it did not necessarily capture the sophisticated nature of the entailed educational interventions and processes that lead to the outcomes, longer term outcomes, and unintended outcomes. It would be worthwhile for upcoming studies to move beyond outcome-evaluations (such as those suggested by the Kirkpatrick Evaluation Model, answering: ‘did it work?’) to program-evaluations that aim to understand how and why outcomes have occurred (Allen et al., 2022 ), such as: realist evaluation (Nair & Otaki, 2021 ); and Context, Input, Process and Product (CIPP) evaluation (Toosi et al., 2021 ). Such a holistic framework (Bowe & Armstrong, 2017 ; Toosi et al., 2021 ) could evaluate all stages of the respective educational program from development to implementation, and integrate the inferences of the current investigation with that derived from different perspectives (e.g., faculty and employers’ perspectives) and sources (e.g., continuing medical education and on-the-job performance, and outcomes of care) (Nawaz et al., 2022 ). These investigations can take the form of longitudinal studies that examine the effects (over time) of the program as the learners’ progress in their respective careers, providing further insights into the impact of the program. As such, these investigations can also test the hypothesis suggested in the current study that self-regulated learning could be acting as a moderating variable in the relationship between experiencing the program, and the attainment of the program learning outcomes and overall objective. Moreover, the current study investigates constructs (e.g., globalization, self-efficacy, conscientiousness, interdependence, and resilience) that can be considered abstract or ‘too broad’. Accordingly, it is worthwhile to conduct systematic literature reviews to derive a single definition for each of these constructs from all previous published attempts of conceptualizing them in the context of health and care professions’ education since the onset of COVID-19. Conclusion This study reinforces what became apparent during the extreme conditions of COVID-19 times. Its findings encourage medical programs to strive to continuously reinforce individual learners’ self-regulation and resilience, in an integrated manner, through multiple learning and teaching channels. This calls for deploying innovative ways to develop non-technical, transversal skills, that complement the foundational basic and clinical medical sciences competencies. Collectively, those competencies are expected to result in resilient, and culturally competent and globally conscious health and care professionals. These well-rounded health and care professionals are more likely to engage in work transcending national borders, recognizing themselves as members of a worldwide community, without compromising their individuation. This study also highlights the importance of evaluating the respective programs systematically and systemically as a portal towards effective continuous quality enhancement of the entailed outcomes-based learning and teaching. The introduced data collection tools can be leveraged by other similar programs to evaluate the extent to which they meet their preset goals. Declarations Ethics approval and consent to participate Ethical approval for the study was granted by the Mohammed Bin Rashid University of Medicine and Health Sciences Institutional Review Board (MBRU-IRB-2025-240) and in turn Dubai Scientific Research Ethics Committee (DSREC-09/2025_39). All methods were performed in accordance with guidelines and regulations on research with human subjects. Participants provided informed consent for participation. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' contributions FO-led the research study conceptualization; led the development of the data collection tool; analyzed the collected data; and composed the final version of the manuscript. KC-contributed to the doctoral student supervision; contributed to the research study conceptualization; and contributed to the final version of the manuscript. TC- contributed to the doctoral student supervision; contributed to the research study conceptualization; and contributed to the final version of the manuscript. LDP-contributed to the research study conceptualization; and maintained the macro perspective of the research study. LA- facilitated the collection of data. NB- contributed to development of the data collection tool. DEM- contributed to development of the data collection tool. TL- maintained the macro perspective of the research study. AP- led the doctoral student supervision; contributed to the research study conceptualization; and contributed to the final version of the manuscript. All authors approved the final manuscript. Acknowledgements The authors would also like to acknowledge the MBRU Research and Graduate Studies academic unit for supporting this research work. Authors' information FO- leverages her transdisciplinary expertise to promote evidence-based decision-making in health and care professions’ education, and in health systems. FO is currently handling the Institutional Research portfolio as part of the Quality Assurance and Institutional Effectiveness framework at the Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) – Dubai Health, Dubai, United Arab Emirates (UAE). Concurrently, FO is pursuing Doctor of Philosophy (PhD) in the intersect between health professions’ education and value-based healthcare in the Care and Public Health Research Institute (CAPHRI) in Maastricht University, Maastricht, Netherlands. KC- is a Professor of Public Health Leadership and Workforce Development, Head of Department of International Health, and Chair of Collaboration Commission of Care and Public Health Research Institute (CAPHRI) in Maastricht University, Maastricht, Netherlands. TC- is an Associate Professor and Program Coordinator of Master Governance and Leadership in European Public Health in Department of International Health in Maastricht University, Maastricht, Netherlands. LDP- is Associate Provost of Clinical Partnership and Academic Integration at the Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) – Dubai Health, Dubai, United Arab Emirates (UAE). LA- is an Associate Professor of Molecular Hematology at College of Medicine (CoM) and Dean of Student Affairs at the Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) – Dubai Health, Dubai, United Arab Emirates (UAE). NB- is Chief Administrative Officer and Head of Strategy of Press Ganey Associates, Inc., South Bend, Indiana, United States of America (USA). DEM- is Executive Director of Institute for Innovation of Press Ganey Associates, Inc., South Bend, Indiana, United States of America (USA). TL- is a Professor of Public Health and Epidemiology at College of Medicine (CoM) at the Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) – Dubai Health, Dubai, United Arab Emirates (UAE). 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(2013). International plastic surgery missions: a framework for resident education using the CanMEDS competencies. Ann Plast Surg , 71 (4), 324-327. https://doi.org/10.1097/SAP.0b013e318257380b Winefield, H., Farmer, E., & Denson, L. (1998). Work stress management for women general practitioners: an evaluation. Psychology, Health & Medicine , 3 (2), 163-170. Wingenbach, G., Graham, T., & Gomez, N. (2023). Becoming a global citizen: Belief vs. action. Advancements in Agricultural Development , 4 (1), 32-47. Witt, K., Boland, A., Lamblin, M., McGorry, P. D., Veness, B., Cipriani, A., Hawton, K., Harvey, S., Christensen, H., & Robinson, J. (2019). Effectiveness of universal programmes for the prevention of suicidal ideation, behaviour and mental ill health in medical students: a systematic review and meta-analysis. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9335366","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":627456497,"identity":"589424b5-e507-4ce9-9a07-1d3e25109a7b","order_by":0,"name":"Farah Otaki","email":"data:image/png;base64,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","orcid":"","institution":"Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) - Dubai Health","correspondingAuthor":true,"prefix":"","firstName":"Farah","middleName":"","lastName":"Otaki","suffix":""},{"id":627456498,"identity":"053efb01-a654-421a-a217-e2831f5d19dd","order_by":1,"name":"Katarzyna Czabanowska","email":"","orcid":"","institution":"Maastricht University","correspondingAuthor":false,"prefix":"","firstName":"Katarzyna","middleName":"","lastName":"Czabanowska","suffix":""},{"id":627456500,"identity":"74a7b765-fee9-4965-b9aa-e0fb5b4701b1","order_by":2,"name":"Timo Clemens","email":"","orcid":"","institution":"Maastricht University","correspondingAuthor":false,"prefix":"","firstName":"Timo","middleName":"","lastName":"Clemens","suffix":""},{"id":627456502,"identity":"af7c7ea4-71ca-4690-a90b-8655ce789100","order_by":3,"name":"Leon Du Preez","email":"","orcid":"","institution":"Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) - Dubai Health","correspondingAuthor":false,"prefix":"","firstName":"Leon","middleName":"","lastName":"Du Preez","suffix":""},{"id":627456504,"identity":"590da6bd-713f-451c-8a6c-5a2b3de5309e","order_by":4,"name":"Laila Alsuwaidi","email":"","orcid":"","institution":"Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) - Dubai Health","correspondingAuthor":false,"prefix":"","firstName":"Laila","middleName":"","lastName":"Alsuwaidi","suffix":""},{"id":627456506,"identity":"ef70a7e0-053c-4835-80fa-61325f9d3960","order_by":5,"name":"Nell Buhlman","email":"","orcid":"","institution":"Press Ganey","correspondingAuthor":false,"prefix":"","firstName":"Nell","middleName":"","lastName":"Buhlman","suffix":""},{"id":627456507,"identity":"5eb846cf-e768-46fd-81ce-3c1b7ec7422d","order_by":6,"name":"Deirdre E. Mylod","email":"","orcid":"","institution":"Press Ganey","correspondingAuthor":false,"prefix":"","firstName":"Deirdre","middleName":"E.","lastName":"Mylod","suffix":""},{"id":627456509,"identity":"fb6c9264-a9ee-4cc5-a30a-ba7ef4c108c8","order_by":7,"name":"Tom Loney","email":"","orcid":"","institution":"Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) - Dubai Health","correspondingAuthor":false,"prefix":"","firstName":"Tom","middleName":"","lastName":"Loney","suffix":""},{"id":627456510,"identity":"1c6b49ba-bd0c-491f-9fa6-fb07d5e879b0","order_by":8,"name":"Agnes Paulus","email":"","orcid":"","institution":"Maastricht University","correspondingAuthor":false,"prefix":"","firstName":"Agnes","middleName":"","lastName":"Paulus","suffix":""}],"badges":[],"createdAt":"2026-04-06 15:25:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9335366/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9335366/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107833665,"identity":"7871ea56-99d6-4551-a3b2-e09aaa0249ef","added_by":"auto","created_at":"2026-04-26 15:40:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":253194,"visible":true,"origin":"","legend":"\u003cp\u003eBird’s-eye view of MBBS at MBRU, as first illustrated in a mixed methods investigation that took place in the same context of the this study (Al-Jayyousi et al., 2025).\u003cbr\u003e\nQI: Quality Improvement.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9335366/v1/840b6ea1563bfc25e33c8c9a.png"},{"id":107833663,"identity":"3a605873-2842-46a2-9b26-fa8842b9c2d4","added_by":"auto","created_at":"2026-04-26 15:40:14","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":87135,"visible":true,"origin":"","legend":"\u003cp\u003eOutline of learning and teaching interventions at MBRU, that are continuously developing through design-based research, aimed at building resilience skills through fostering self-regulated learning, as first illustrated in a previously conducted research work that took place in the same context of this study (Du Preez et al., 2025).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9335366/v1/d358e0e918bbe8a14e8cfb4b.png"},{"id":107833693,"identity":"765633eb-db95-4a82-bcf9-3b37d16beb3d","added_by":"auto","created_at":"2026-04-26 15:40:24","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":204559,"visible":true,"origin":"","legend":"\u003cp\u003eAlignment of goals (micro-, meso-, and macro-levels), as first illustrated in a mixed methods investigation that took place in the same context of the proposed study (Al-Jayyousi et al., 2025). This figure shows how the pillars of Dubai Health (Care, Learning, and Discovery, and Giving) are feeding into the pillars of the ministerial Outcome-based Evaluation Framework (OEF) which in tun contribute to select Sustainable Development Goals (SDGs). Patient first, as the core value of Dubai Health [purposely located in the heart of the illustration, slightly towards the left (in Green, which is considered a balanced anchor for the other colours of the visible spectrum)]. This patient centricity is among the differentiators of MBRU from the rest of the Higher Education Institutions governed by the OEF of the UAE Ministry of Higher Education and Scientific Research.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9335366/v1/d1053c350cfe15c99b3bd728.png"},{"id":107833730,"identity":"77a14d8a-fd35-4d3c-8f8d-dba32eb1924a","added_by":"auto","created_at":"2026-04-26 15:40:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1156869,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9335366/v1/3698f063-caed-4886-8044-d5a66b947642.pdf"},{"id":107833679,"identity":"a16d5828-503f-4f15-92d1-e6e41e56c078","added_by":"auto","created_at":"2026-04-26 15:40:22","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":22136,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-9335366/v1/d63f4a14cb2cd02e28454820.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Investigating graduates’ perception of overall goal attainment of a resilience-focused medical program offered in MENA: a quantitative cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHealth and care professionals continue to witness substantial change in healthcare delivery (Deml et al., 2022; J.R., 2005). Traditionally, medical education has articulated competences around core medical expertise. The Flexner report marked a constructive transformation in medical education, enabling medicine to become firmly rooted in biological science. It is believed, though, that the implementation of the report\u0026rsquo;s recommendations contributed to the erosion of the societal perception of physicians as value-driven, trusted healers (Senok, 2022). Relevantly, many health and care professionals perceive their duties to be related to their technical competences only, and fail to recognize their role as teachers, advocates, and companions (Clark, 2001). There is recognition that healthcare providers competences need to extend beyond medical sciences (Ninan \u0026amp; Patel, 2018; White et al., 2013). This emphasizes the importance of learning about\u0026nbsp;skills,\u0026nbsp;complementary to the basic and clinical medical sciences competencies, such as resilience, that enable the attainment of the desired well-roundedness among those professionals.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe challenge is around how best to prepare and maintain humane and holistic future-ready health and care professionals, who (in this complex, ever-changing healthcare environment) are effective and efficient in truly meeting the 21\u003csup\u003est\u003c/sup\u003e century patient and population needs. This is in alignment with the goals of multiple health systems around the world that set \u0026lsquo;compassion\u0026rsquo; as the core value (Clark et al., 2022; West \u0026amp; Bailey, 2023). Within this context, compassion is believed to include four key elements: paying attention to the other (i.e., attending- \u0026lsquo;listening with fascination\u0026rsquo;), understanding what is causing the other\u0026rsquo;s distress (i.e., understanding), having an empathetic response (i.e., empathizing), and taking intelligent (thoughtful and appropriate) action to help relieve other\u0026rsquo;s suffering (i.e., helping) (West M., 2017; West, 2021).\u003c/p\u003e\n\u003cp\u003eCare that is compassionate has been demonstrating positive effects on patient satisfaction and health outcomes (West M., 2017). For health and care professionals to develop the resilience to lead compassionately, they need to first, and foremost, effectively take care of themselves, since \u0026lsquo;one cannot pour from an empty cup\u0026rsquo; and \u0026lsquo;real change comes from the inside out\u0026rsquo; (Frangieh et al., 2023; Sharma \u0026amp; Srikanth, 2023; Vala, 2022). As such, the starting point for authentic compassion is attending to, understanding, empathizing with, and helping oneself (i.e., self-compassion) (M.A., 2021), and it has been established that, contrary to popular belief, the corresponding resilience skillset is not inherent, and developing it requires intentionality and proactiveness (Darwish \u0026amp; Huber, 2003; Lomas et al., 2023; Sosik \u0026amp; Jung, 2002; Triandis, 2001). It has been suggested that developing the skillset needed to take care of oneself and to regularly restore one\u0026rsquo;s capacity to give, and in turn become truly resilient is facilitated by belonging to abundant, resourceful environments (Ballout, 2024; Raddawi, 2025). In fact, enabling environments, that inspire and empower individuals to take care and nourish themselves, and build their own personal resilience [in order to truly realize their potential in serving others, perhaps as depicted in \u0026lsquo;self-actualization\u0026rsquo; of Maslow\u0026rsquo;s hierarchy of needs (Singha, 2024)], and that offer individuals sufficient reason and space to do so, are of utmost importance (Clarke, 2008; Johnston \u0026amp; Paton, 2003; Lengnick-Hall \u0026amp; Beck, 2016; Rieckert et al., 2021). This is particularly relevant among health and care professions\u0026rsquo; learners who are on educational and in turn career trajectories that are exceptionally demanding (Ellestad et al., 2023; Jones, 2015; Joseph et al., 2025).\u003c/p\u003e\n\u003cp\u003eThe complex, ever-changing healthcare environment, and the demanding medical curricula which expect high continuing academic investment, alongside the sustained stress that likely arises from caring for patients (Shapiro et al., 1998) often strain health and care professions\u0026rsquo; learners (Oro et al., 2021; Sender Romeo R., 2007). Relevantly, burnout or job-related stress, among medical trainees, and health and care professionals, is an increasingly recognized problem worldwide (Boni et al., 2018). This is particularly true closer to graduation, and as resident doctors (Dyrbye et al., 2014). Evidence indicates that burnout has been associated with high stress levels, anxiety, depression, substance abuse, and risk of suicide (Jackson et al., 2016; Koutsimani et al., 2019), all of which naturally lead to suboptimal clinical performance and ultimately poor outcomes of care (Yuguero et al., 2017). This likely deterioration of the psychological wellbeing of medical students continuing as they become resident doctors (Shanafelt T.D., 2002) is a reality that needs to be proactively addressed (Azim et al., 2025; Galaiya et al., 2020; Heath et al., 2020; Major et al., 2021; Neufeld et al., 2020; Pavlacic et al., 2024). Both personal and institutional factors substantially impact medical students\u0026rsquo; resilience development (Major et al., 2021).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFrom this perspective, developing, implementing, and evaluating (the effectiveness of) learning and teaching interventions that would enable the nurturance of resilient, globalized health and care professionals is important. The literature around the subject matter indicates a lot of variations in what characterizes resilient, globalized health and care professionals, how they are referred to, what is said to differentiate such professionals from their counterparts, and how such professionals can be nurtured (Arruda, 2024; Bludau, 2021; Otaki, Naidoo, et al., 2022; Svarstad \u0026amp; Risager, 2024; Wingenbach et al., 2023). A common ground across this literature is the established importance of experiential, self-regulated learning, where learning and doing go hand-in-hand, in nurturing such well-rounded health and care professionals (Bransen et al., 2022; Chitra et al., 2022; Cuyvers et al., 2021; Hanrieder, 2019; Panadero, 2017).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo mitigate stressors and enhance learners\u0026rsquo; resilience, it is important for health and care professions\u0026rsquo; educators to cultivate a supportive learning environment, strengthen faculty-learner relationships, and increase academic and financial support as well as enable access to mental health resources (Azim et al., 2025). The literature is increasingly emphasizing, as well, the importance of developing, among health and care professions\u0026rsquo; learners, non-technical, transversal skills (complementary to basic and clinical medical sciences competencies) that collectively reinforce individuals\u0026rsquo; resilience (DePierro et al., 2021; Dyrbye et al., 2019; Galaiya et al., 2020; Scheepers et al., 2020; West et al., 2016). Accordingly, focused initiatives that inspire and empower health and care professions\u0026rsquo; learners to build their own resilience have been developed and implemented (Lebeaut et al., 2023; Major et al., 2021; Shapiro et al., 2000; Slavin \u0026amp; Chibnall, 2016; Witt et al., 2019). Such individual-focused interventions include mindfulness-based approaches (Colgan et al., 2019; Goldhagen et al., 2015; Goodman \u0026amp; Schorling, 2012; Krasner et al., 2009; Ospina-Kammerer, 2000; Podgurski et al., 2019; Rosdahl \u0026amp; Kingsolver, 2014); peer support facilitation (Rossouw \u0026amp; Ruberto, 2025; Wu et al., 2020); stress and anger management (Neufeld et al., 2020), and self-care training (Milstein et al., 2009; Weight et al., 2013; Winefield et al., 1998); communication and leadership skills (Giordano et al., 2022), and emotional intelligence training (Bragard et al., 2010; Clayton et al., 2013; Fujimori et al., 2003; Fujimori et al., 2014; Neufeld et al., 2020); and small group curricula (Fujimori et al., 2003; Margalit et al., 2005; R\u0026oslash; et al., 2008). A good proportion of those interventions seem to have positively impacted the receiving learners.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlthough such resilience-focused initiatives are widely adopted and evaluated in health and care professions\u0026rsquo; education, to the best of the authors\u0026rsquo; knowledge, these initiatives all seem to take the form of either a one-off event [e.g., reflection groups and curriculum changes (Bock et al., 2025; Mohmand et al., 2022; Wadi et al., 2024)], or at best- a set of discrete interventions. These isolated islands of efforts (albeit their likely usefulness) are unlikely to attain the desired, sustained outcome which constitute of modification of the learners\u0026rsquo; underlying attitudes and resultant habits empowering them to become more proactive about maintaining their own resilience. This sustained outcome is what is expected to enable those learners to thrive both personally and professionally (Amor\u0026oslash;e et al., 2025; Neufeld et al., 2020), ultimately feeding into the provision of high-quality patient care (Azim et al., 2025). Hence, the upskilling of professionals, in terms of their resilience, requires a longitudinal focus, weaved (in an integrated manner, via omnichannel learning and teaching interventions) throughout the respective programs. Coupling the development of resilience with the capacity and affinity for self-regulated learning further reinforces the sustainability of the effects of such resilience-focused learning and teaching efforts. From this perspective, in terms of appraising these effects, it obviously does not suffice to evaluate the immediate output of discrete interventions. It is important to follow through with the learners until after graduation, and to measure not solely the individual intended learning outcomes but rather combining such linear investigations with a reliable means of capturing the human constructs, such as resilience, that the respective learning outcomes are meant to collectively lead to.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccordingly, the purpose of this study is to investigate the effectiveness of the innovatively resilience-focused, outcomes-based medical program of Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) \u0026ndash; Dubai Health in Dubai, United Arab Emirates (UAE) (Buhumaid et al., 2024; Otaki et al., 2023), through measuring its overall goal attainment from the perspective of its graduates.\u003c/p\u003e\n\u003cp\u003eThe research questions include:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eTo what extent do the graduates agree that the program enabled them to become the health and care professionals whom the respective program is meant to nurture [as articulated in the corresponding Program Learning Outcomes (PLOs) and program objective]?\u003c/li\u003e\n \u003cli\u003eTo what extent do the graduates agree that the program enabled them to build their personal resilience?\u003c/li\u003e\n \u003cli\u003eTo what extent do the graduates agree that self-regulated learning, that had been purposively fostered as part of the respective program, is enabling them to thrive in their careers (in terms of continuing education and/ or employment)?\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe output of this research project contributes to understanding the learning and development needs of \u0026lsquo;future-ready health and care professionals\u0026rsquo;, in general, and more specifically, when it comes to select human constructs (e.g., globalization, and self-regulated learning and resilience) that in principle constitute the combined effects of nontechnical, transversal skills, complementing the foundational technical basic and clinical medical sciences competencies (Otaki, Amir-Rad, et al., 2022; Otaki et al., 2025; Otaki, Naidoo, et al., 2020, 2022). More specifically, the findings of this study reinforce what we have learned from the coronavirus disease of 2019 (COVID-19) times (i.e., extreme conditions) in relation to understanding health and care professions students\u0026rsquo; learning needs (Du Plessis et al., 2021; Otaki, Amir-Rad, et al., 2022) to become resilient/ to build resilience (skills), to thrive in their respective careers, and/ or to realize their potential in serving others and in contributing to sustainable development.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003ch3\u003eContext of the study\u003c/h3\u003e\n\u003cp\u003eThe United Arab Emirates (UAE) represents a diverse, multicultural, and multi-ethnic society within the Middle East and North Africa (MENA) region, grounded in Islamic principles and Arab heritage. It operates as a constitutional federation composed of seven emirates. Based on indices evaluating economic, social, and political aspects of globalization, the UAE is regarded as the most globalized nation in the MENA region (Alameddine et al., 2022; Gygli et al., 2019; KOF, 2025). Among the emirates, Dubai is the largest and most densely populated (Alameddine et al., 2020).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMohammed Bin Rashid University of Medicine and Health Sciences (MBRU), named in honour of His Highness Sheikh Mohammed Bin Rashid Al Maktoum, Vice President, Prime Minister of the UAE, and Ruler of Dubai, was established in September 2014 in Dubai and subsequently licensed as a higher education institution by the Ministry of Higher Education and Scientific Research later that year. In January 2015, Queen\u0026rsquo;s University Belfast (QUB, 1845) joined MBRU as the primary advisor for curriculum development. The university was formally instituted by royal decree in June 2016.\u003c/p\u003e\n\u003cp\u003eMBRU currently comprises three colleges: the College of Medicine (CoM), the Hamdan Bin Mohammed College of Dental Medicine (HBMCDM), and the Hind Bint Maktoum College of Nursing and Midwifery (HBMCoNM). Its institutional culture emphasizes evidence-informed decision-making and the systematic application of implementation science cycles, including approaches such as design-based research. Studies conducted within this framework commonly employ mixed methods research designs to foster comprehensive insights, with learners actively involved in both designing and analysing educational interventions (Chen \u0026amp; Reeves, 2020; Kimmons, 2020; Kimmons R., 2020). Data gathered in these studies typically align with various levels of the Kirkpatrick Evaluation Model (Otaki, Khamis, et al., 2020a).\u003c/p\u003e\n\u003cp\u003eThis study focuses on the Bachelor of Medicine and Bachelor of Surgery program (MBBS) at MBRU, covering the period from 2016 to 2024. As a locally developed, outcomes-driven undergraduate medical program established from scratch, this MBBS undergoes continuous enhancement through design-based research, similar to the other MBRU programs. Subject matter experts contribute feedback on early versions of teaching and learning interventions (McKenney \u0026amp; Reeves, 2021). Ongoing collaboration among designers, practitioners, and researchers from different disciplines supports iterative improvements to these initial designs (Sandars \u0026amp; Goh, 2020). The evolving prototypes are regularly evaluated by stakeholders through interactive group discussions, enabling the incorporation of lessons learned in practice and the advancement of underlying educational theories embedded in the design. Consequently, design-based research serves as a flexible and valuable approach for simultaneously strengthening educational practice and theory (Dolmans \u0026amp; Tigelaar, 2012).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe inaugural MBBS cohort, consisting of 56 students, commenced their studies at the CoM in the academic year 2016\u0026ndash;2017. By the conclusion of the academic year 2023\u0026ndash;2024, a total of 122 students across three cohorts had graduated from the program, with approximately 20% entering residency training programs in Dubai through MBRU\u0026rsquo;s Graduate Medical Education unit. Delivered by the College of Medicine, the respective MBBS spans six years and is structured around a competency-based framework designed to reflect Dubai\u0026rsquo;s highly globalized environment. Both the program as a whole and its individual components incorporate innovative teaching approaches grounded in the integration of Kolb\u0026rsquo;s experiential learning theory and social constructionism (Al-Jayyousi et al., 2025; Alsuwaidi et al., 2023; Buhumaid et al., 2024; Otaki et al., 2023; Otaki et al., 2025; Otaki, Khamis, et al., 2020a). The MBBS curriculum is organized into three distinct phases (Figure 1).\u003c/p\u003e\n\u003cp\u003eThe curriculum follows a spiral structure (Otaki et al., 2023), with integrated courses delivered over six academic years, each consisting of two semesters. Phase 1 corresponds to the first year and introduces students to foundational medical concepts. Phase 2 spans the second and third years, during which instruction is organized by organ systems and integrated with clinical medicine. Phase 3 includes the fourth through sixth years, where students participate in clinical clerkships across both public and private healthcare settings. These placements occur within Dubai Health facilities as well as the private Mediclinic Middle East (MCME) network. Dubai Health encompasses six hospitals, in addition to various ambulatory care and medical fitness centres. MBRU has maintained a public-private partnership with MCME since 2016 (Du Preez L., 2024). MCME operates approximately 1,000 inpatient beds and employs around 1,300 physicians across the UAE, delivering a comprehensive spectrum of services ranging from preventive to advanced quaternary care. Within the UAE, MCME manages seven hospitals: three located in Dubai, and 29 outpatient clinics, 16 of which are in Dubai (Alameddine et al., 2022; MCI, 1983). Furthermore, since 2021, MCME has operated two independent outpatient dialysis centres that provide public healthcare services in collaboration with Dubai Health.\u003c/p\u003e\n\u003cp\u003eThe respective MBBS has the following nine PLOs:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cem\u003ePractice in a safe and competent manner\u003c/em\u003e\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eObserve (i.e., fulfil or comply with) ethical and professional standards\u003c/em\u003e\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cem\u003ePractice evidence-based medicine and engage in scholarship and generation of new knowledge\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eCommunicate clearly \u0026amp; effectively\u003c/em\u003e\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eAdvocate for health promotion of individuals and communities\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eDistinguish various healthcare systems and their management\u003c/em\u003e\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eEducate and share knowledge and skills\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eParticipate effectively in multidisciplinary teams\u003c/em\u003e\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eDemonstrate commitment to life-long, self-directed learning, and performance improvement\u003c/em\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eIt is worth pointing out that only one/ the first PLO relates (includes but should not be restricted) to technical, medical sciences competencies. Accordingly, this outcomes-based program, through attaining the abovementioned PLOs, aims to \u003cem\u003enurture competent and conscientious globalized health and care professionals who are resilient and are continuously learning towards the realization of their true potential in serving others and in contributing to sustainable development, while remaining rooted in their values, through the pursual of a career in medicine of their choice, as part of meaningful interdependencies.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eMBRU, upon inception, had set out to become an integrated AHS, with clear articulation of its direction in the University\u0026rsquo;s goal upon inception:\u003c/p\u003e\n\u003cp\u003e\u0026lsquo;To advance health in the UAE and the region, through an innovative and \u003cem\u003eintegrated academic health system\u003c/em\u003e, that is nationally responsive and globally connected, serving individuals and communities.\u0026rsquo;\u003c/p\u003e\n\u003cp\u003eAs a resilient organization, MBRU takes evidence-driven precautionary measures to ensure multiple layers of protection for all critical assets, including people, products, and properties (Muir et al., 2025). A lot of changes took place within and outside MBRU since the inception of the MBBS, the most prominent ones were COVID-19 and the organizational response to it, and the inception of Dubai Health (Dubai\u0026rsquo;s first integrated academic health system, with four pillars: \u0026lsquo;care\u0026rsquo;, \u0026lsquo;learning\u0026rsquo;, and \u0026lsquo;discovery\u0026rsquo;, and \u0026lsquo;giving\u0026rsquo;).\u003c/p\u003e\n\u003cp\u003eMBRU\u0026rsquo;s active involvement in steering the local, and also in the national and international response to the pandemic brought forth the learning needs of health and care professions\u0026rsquo; learners (Otaki, Naidoo, et al., 2020) across the continuum of lifelong learning of health and care professionals (i.e., skilling, upskilling, and reskilling) that can start as early as the transition from secondary to tertiary education (Alsuwaidi et al., 2023; Bowe \u0026amp; Armstrong, 2017). Accordingly, among MBRU\u0026rsquo;s proactive measures is its commitment to continuously developing and to building personal resilience, across its community, which is evident through its flagship learning and teaching interventions that are implemented (as previously mentioned, in alignment with the principles of design-based research) to, either directly or indirectly, foster self-regulated learning and building resilience among learners (Figure 2). These omnichannel learning and teaching interventions include a homegrown curricular course that is offered to medical learners to inspire and empower them to build their own resilience skills (Nair et al., 2023; Otaki et al., 2025). There are other interventions offered by MBRU, via the MBBS program, that foster individual and collective resilience indirectly through curricular [e.g., contextualized professionalism training (Buhumaid et al., 2024), and five-course research module (Otaki et al., 2023)] and co-curricular self-regulated learning. There are further curricular activities, as well, that are fostering resilience via a hidden curriculum [e.g., self-regulated learning along with other transversal skills via pharmacology (Kaddoura et al., 2024), and via early clinical experience embedded in foundation of clinical medicine curriculum (Al-Jayyousi et al., 2025)]. An example of a flagship co-curricular program would be the MBRU \u0026ndash; Summer Scholars\u0026rsquo; Program (Otaki, Naidoo, et al., 2020, 2022; Senok, 2022) that supports the learners in their journey towards becoming global citizens.\u003c/p\u003e\n\u003cp\u003eMBRU has been the implementation vehicle for the \u0026lsquo;learning\u0026rsquo; and \u0026lsquo;discovery\u0026rsquo; arms of Dubai Health (Health, 2023). In addition to sharing its goals with Dubai Health, MBRU efforts align nationally with the Ministry of Higher Education and Scientific Research- Outcome-based Evaluation Framework (Research, 2025) and internationally with the United Nations- Sustainable Development Goals (SDGs) (Nations, 2015) (Figure 3).\u003c/p\u003e\n\u003ch3\u003eResearch design\u003c/h3\u003e\n\u003cp\u003eA quantitative cross-sectional research design was deployed for the current study. Unlike other types of observational studies, cross-sectional studies do not follow individuals up over time (Wang \u0026amp; Cheng, 2020). They are usually easy to conduct and inexpensive, allowing for sufficient control over the instrument and its measures (Eesley, 2018). They are often used to describe features of a population (e.g., several cohorts of the same program), at a single point in time (Grujicic \u0026amp; Nikolic, 2021). Accordingly, MBRU\u0026rsquo;s MBBS graduates of Classes of 2022, 2023, and 2024 were invited to respond, throughout October 2025, to a tailormade survey. Such a data collection tool is believed to provide a comprehensive point-in-time (i.e., cross-sectional) self-report of graduates career trajectories, lifelong learning orientations, retrospective perceptions of curricular experiences, and individual characteristics (Cabrera et al., 2003). Such insights enable educators to learn about the overall effects of their degree offerings (Dawe et al., 2023), and in turn to make informed changes targeting the human constructs (e.g., globalization, and self-regulated learning and resilience) that their offerings aim to foster.\u0026nbsp;Ethical approvals for the study were granted by the Mohammed Bin Rashid University of Medicine and Health Sciences Institutional Review Board (MBRU-IRB-2025-240) and in turn Dubai Scientific Research Ethics Committee (DSREC-09/2025_39).\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eAll the MBBS graduates of Classes of 2022, 2023, and 2024 were invited by a neutral gatekeeper, entirely independent from the research team (a staff member within Administrative Affairs, with no affiliation to the research team and no involvement in the research process) to respond to a tailormade survey: self-assessment (Appendix I). The study\u0026rsquo;s principal investigator had access only to anonymized, aggregated data. The study population of 122 graduates of three MBBS cohorts (96 females and 26 males) is from 26 nationalities (from within MENA and beyond), of whom 40 are locals/ Emirati nationals.\u003c/p\u003e\n\u003cp\u003eIn terms of the Kirkpatrick Evaluation Model of four levels (Level 1: Reaction, Level 2: Learning, Level 3: Behaviour, and Level 4: Results) (Otaki, Khamis, et al., 2020a), the proposed investigation tapped into Level 2: Learning and \u0026nbsp;Level 3: Behaviour.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe survey (Appendix I) was developed following an exploration of what is available in the literature (and practice- through desk review and benchmarking) in terms of means of evaluating (medical) program effectiveness. \u0026nbsp;To start with, published evaluations/ surveys of programs\u0026rsquo; goal attainment were retrieved and reviewed (Armstrong \u0026amp; Barsion, 2006; Beroz et al., 2020; Cumming et al., 2007; Curran et al., 2006; Curran \u0026amp; Fleet, 2005; Kikukawa et al., 2014; Kusmiati, 2025; McNEIL et al., 2006; Nuebel et al., 2020; Torkzadeh \u0026amp; Keshavarzi, 2018). Also, relevant AMEE guidelines (Challis, 1999; Dolmans \u0026amp; Tigelaar, 2012; Frye \u0026amp; Hemmer, 2012; Harden, 1999; Pangaro \u0026amp; Ten Cate, 2013; Shumway \u0026amp; Harden, 2003; Smith, 1999) were taken into account in the process of survey formation, especially in relation to means of evaluating the predetermined constructs and the overall structuring of the survey. The resulting tailor-made survey is composed of five questions (Table 1). The first question inquires for the graduating class, that the study participants, belongs to (2022, 2023, or 2024). The second and third questions constitute five-point Likert-type scales of levels of agreement that the program enables attainment of Program Learning Outcomes (nine components) and its overall program objective (seven components), respectively. The fourth and fifth questions are also five-point Likert-type scales. The former inquiries about level of agreement that the program enables building of personal resilience [as conceptualized by Press Ganey\u003csup\u003e\u0026reg;\u003c/sup\u003e (Ganey, 2017), with eight components], and the latter inquires for level of agreement that, more precisely, self-regulated learning that had been fostered as part of the MBBS enables the learners in attainment of all the goals portrayed in the preceding three questions (nine components).\u003c/p\u003e\n\u003cp\u003eTable 1 Outline of tailor-made survey.\u003c/p\u003e\n\u003ctable\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eQ1: Graduating class\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eQ2: \u0026lsquo;Program Enables Attainment of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eProgram Learning Outcomes\u0026rsquo; scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eQ3: \u0026lsquo;Program Enables Attainment of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eProgram Objective\u0026rsquo; scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eQ4: \u0026lsquo;Program Enables Building of Personal Resilience\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo; scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eQ5: \u0026lsquo;Self-regulated Learning Enables Attainment of Goals\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo; scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSingle selection question\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\"\u003e\n \u003cp\u003eFive-point Likert-type scales (levels of agreement)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eThree options\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;(2022, 2023, and 2024)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNine components\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;(2.1 through 2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSeven components\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;(3.1 through 3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEight components (Four corresponding to \u0026lsquo;Decompression\u0026rsquo;, followed by four corresponding to \u0026lsquo;Activation\u0026rsquo;)\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;(4.1 through 4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNine components\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;(5.1 through 5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe respective tailor-made survey underwent face and content validation prior to assembly, where five current year 6 students were asked on comment on the content and structure of the respective survey, and five graduates of graduating class 2025 were asked to provide their feedback on the survey (i.e., pseudo-participation) and in turn to share their thoughts around the perceived purpose of the survey. According to the received feedback, the sentence structure of a couple of components of the respective scales was modified, and also a brief explanation of select (potentially confusing) terms in the context of study was added. The survey was assembled via Explorance Blue: a comprehensive, automated feedback analytics platform designed primarily for higher education evaluation software (Explorance, 2019), by a neutral gatekeeper. The survey was assembled throughout October 2025, with three reminders (one week apart). The goal was to attain at least 60% response rate.\u003c/p\u003e\n\u003ch3\u003eData analysis\u003c/h3\u003e\n\u003cp\u003eThe quantitative data were analysed using SPSS for Windows version 27. The descriptive analysis for the first question revolved around calculating proportions (of study participants belonging to each of the three included graduating classes). As for the descriptive analyses of the four five-point Likert-type scales, they constituted of computing the overall extent of agreement score for each scale. The mean and standard deviation for each of those scores (no.= four) and each component of theirs [no.= nine, seven, eight (four: \u0026lsquo;Decompression\u0026rsquo;, and four: \u0026lsquo;Activation\u0026rsquo;), and nine, respectively] were calculated. Cutoffs were based on an assumed normal distribution, which is according to established interpretation recommendations (with 16 divisions to reflect the five-point Likert-type scale) (Sullivan \u0026amp; Artino Jr, 2013; Warmbrod, 2014)- 0-6.25%: Strongly Disagree, 18.75-31.25%: Disagree, 43.75-56.25%: Neutral, 68.75-81.25%: Agree, and 93.75-100%: Strongly Agree. The reliability test of Cronbach\u0026rsquo;s Alpha and validity test of Principal Component Analysis (PCA), latter accompanied by bivariate analysis, were performed to check and ensure the internal consistency and external variance of the four scales, respectively.\u003c/p\u003e\n\u003cp\u003eA test of normality was conducted for those four overall extent of agreement scores and each component of theirs to select the appropriate inferential analysis tests. The data across all the scales appeared to be not normally distributed, and hence, Kruskal-Wallis one-way analysis of variance test was used to assess the potentiality of associations between the variables. Lastly, the Bivariate Spearman Correlations was utilised to investigate the relation between the scores (and their respective components).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOut of those 122 graduates, as per Table 2, 76 responded (i.e., overall response rate= 62.30%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2 Response rates across graduating classes.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGraduating class\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of responses\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal number of graduates\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResponse Percentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e34.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e70.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e88.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e62.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCorresponding to the current study\u0026rsquo;s first research question, the percentage of the total average of the agreement that the Program Enables Attainment of Program Learning Outcomes score was 87.11%, as per Table 3. In addition, the percentage of the total average of the agreement that the Program Enables Attainment of Program Objective score was 85.14%, as per Table 4.\u003c/p\u003e\n\u003cp\u003eIn relation to the second research question, the percentage of the total average of the agreement that the Program Enables Building of Personal Resilience score was 73.55%, as per Table 5.\u003c/p\u003e\n\u003cp\u003eAs for the third research question, the percentage of the total average of the agreement that the Self-regulated Learning Enables Attainment of Goals score was 80.76%, as per Table 6.\u003c/p\u003e\n\u003cp\u003eThe four corresponding scales proved to be reliable and valid in the context of the study (Appendix II).\u003c/p\u003e\n\u003cp\u003eTable 3 Output of descriptive quantitative analysis of the level of agreement that the Program Enables Attainment of Program Learning Outcomes scale.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProgram Enables Attainment of Program Learning Outcomes scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage of the mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 2.1: Practice in a safe and competent manner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.47 (0.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e89.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 2.2: Observe ethical and professional standards\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.55 (0.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e91.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 2.3: Practice evidence-based medicine, and engage in scholarship and generation of new knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.34 (0.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e86.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 2.4: Communicate clearly and effectively\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.54 (0.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e90.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 2.5: Advocate for health promotion of individuals and communities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.17 (0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e83.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 2.6: Distinguish various healthcare systems and their management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.05 (0.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e81.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 2.7: Educate and share knowledge and skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.41 (0.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e88.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 2.8: Participate effectively in multidisciplinary teams\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.28 (0.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e85.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 2.9: Demonstrate commitment to life-long, self-regulated learning, and performance improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.38 (0.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e87.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e39.20 (5.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e87.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eA= Agree (68.75-81.25%) and SA= Strongly Agree (93.75-100%)\u003c/p\u003e\n\u003cp\u003eTable 4 Output of descriptive quantitative analysis of the level of agreement that the Program Enables Attainment of Program Objective scale.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProgram Enables Attainment of Program Objective scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage of the mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 3.1: Developing your self-efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.26 (0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e85.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 3.2: Fostering your conscientiousness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.37 (0.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e87.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 3.3: Becoming a global citizen, while remaining rooted in your personal values\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.26 (0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e85.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 3.4: Building your resilience skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.39 (0.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e87.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 3.5: Realizing your true potential in serving others and in contributing to sustainable development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.25 (0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 3.6: Pursuing a career in medicine of your choice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.13 (0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e82.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 3.7: Engaging in meaningful interdependencies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.13 (0.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e82.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e29.80 (4.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e85.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eA= Agree (68.75-81.25%) and SA= Strongly Agree (93.75-100%)\u003c/p\u003e\n\u003cp\u003eTable 5 Output of descriptive quantitative analysis of the level of agreement that the Program Enables Building of Personal Resilience scale.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eProgram Enables Building of Personal Resilience scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage of the mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eDecompression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eComponent 4.1: Enjoy your personal time without focusing on work matters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.25 (1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e65.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eN-A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eComponent 4.2: Rarely lose sleep over work issues\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.00 (1.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eN-A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eComponent 4.3: Free your mind from work when you are away from it\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.12 (1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e62.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eN-A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eComponent 4.4: Disconnect from work during your free time (e.g., emails, WhatsApp, and phone calls)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.03 (1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eN-A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOverall Decompression score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.39 (3.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eN-A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eActivation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eComponent 4.5: Care for all patients/ clients equally even when it is difficult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.29 (0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e85.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eComponent 4.6: See every patient/ client as an individual person with specific needs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.36 (0.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e87.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eComponent 4.7: Realize that the work you do makes a real difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.14 (0.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e82.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eComponent 4.8: Realize your work is meaningful\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.24 (0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e84.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOverall Activation score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17.03 (2.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e85.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.42 (5.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e73.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eN=Neutral (43.75-56.25%), A= Agree (68.75-81.25%), and SA= Strongly Agree (93.75-100%)\u003c/p\u003e\n\u003cp\u003eTable 6 Output of descriptive quantitative analysis of the level of agreement that the Self-regulated Learning Enables Attainment of Goals scale.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-regulated Learning Enables Attainment of Goals scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage of the mean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 5.1: Become ambitious in relation to your career aspirations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.26 (0.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e85.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 5.2: Become proactive in relation to your career\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.16 (0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e83.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 5.3: Exercise agency/ choice in relation to your career\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.01 (1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e80.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 5.4: Secure your \u0026lsquo;primary continuing education and/ or employment choice\u0026rsquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e3.67 (1.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e73.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 5.5: Excel in what you have been doing since graduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e3.96 (1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e79.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 5.6: Maximize what you have been doing since graduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e3.99 (0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e79.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 5.7: Align what you have been doing since graduation with your career aspirations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e3.96 (0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e79.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 5.8: Better prepare yourself for what you have been doing since graduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.04 (0.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e80.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eComponent 5.9: Become more resilient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4.29 (0.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e85.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA-SA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e36.34 (7.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e80.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eA= Agree (68.75-81.25%) and SA= Strongly Agree (93.75-100%)\u003c/p\u003e\n\u003cp\u003eIn terms of inferential analysis tests, two of the four overall scores only: Program Enables Attainment of Program Learning Outcomes and Program Enables Attainment of Program Objective, seemed to be significantly associated with which graduating class the study participants belong to (highest is 2022 followed by 2024 and then 2023) (P\u0026lt;0.05). Although Program Enables Building of Personal Resilience score seemed not to be significantly associated with which graduating class the study participants belong to (P\u0026gt;0.05), the overall score of one of its subsections, namely: Activation, seemed to be significantly associated with which graduating class the study participants belong to (following the same pattern: highest is 2022 followed by 2024 and then 2023) (P\u0026lt;0.05). In relation to the components of the four scales, the following: 2.2, 2.3, 2.5, 2.7, and 2.9 of Program Enables Attainment of Program Learning Outcomes; 3.1, 3.2, and 3.3 of Program Enables Attainment of Program Objective; and 4.8 of Program Enables Building of Personal Resilience seemed to be significantly associated with which graduating class the study participants belong to (following the same pattern: highest is 2022 followed by 2024 and then 2023) (P\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eAlso, there seemed to be a statistically significant association across the components of the four scales and their overall scores (including the scores of the two subsections of the Program Enables Building of Personal Resilience scale: Decompression and Activation) (P\u0026lt;0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study, through investigating (from the perspective of \u0026lsquo;fresh\u0026rsquo; graduates of the respective program) the extent to which preset medical program goals (i.e., PLOs and overall program objective) were met and corresponding human constructs were developed, gives an impression of the effectiveness of a young, innovatively resilience-focused, outcomes-based medical program. This study shows that this medical program, that proactively fosters transversal resilience skills among its enrolees, in an integrated manner via omnichannel learning and teaching interventions throughout the entailed self-regulated learning journey, enabled the development of the enrolees\u0026rsquo; resilience (with \u0026lsquo;Building your resilience\u0026rsquo; as the top-rated component of the \u0026lsquo;Program Enables Attainment of Program Objective\u0026rsquo; scale). This study also revealed that the participating graduates consider the self-regulated learning, that had been fostered as part of respective program, to have enabled (as a moderator and/ or mediator) the attainment of the program goals (with \u0026lsquo;Become more resilient\u0026rsquo; as the top-rated component of the corresponding scale).\u003c/p\u003e \u003cp\u003eThe study experimented with the deployment of a variation of Press Ganey\u0026reg; (Ganey, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) resilience scale, where the graduates were asked about their level of agreement that the program enabled building and exercising their own personal resilience [as defined by Press Ganey\u0026reg; (Ganey, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2017\u003c/span\u003e)]. According to the respective scale, resilience involves locating and in turn deploying the necessary resources to rest (i.e., decompression), and not solely to take initiative (i.e., activation). It sheds light on the interplay that needs to take place to allow for effective self-regulation and in turn exhibition of resilience. As previously mentioned, this study showed that the medical program, under investigation, enabled the development of the learners\u0026rsquo; resilience; it seems to be fostering their \u0026lsquo;activation\u0026rsquo; more than their \u0026lsquo;decompression\u0026rsquo;, though. Accordingly, it is worth considering teaching the learners and enabling them to rest and unwind (Ghafar, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Pienaar et al., \u003cspan citationid=\"CR127\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), when the need arises. It is often assumed that resting happens naturally; this is not always the case, especially among those who are under high pressure to perform (such as: health and care professions\u0026rsquo; learners, markedly the high-functioning ones). The proposed study feeds into the ongoing global pursuit around fostering self-regulated, lifelong learning as an enabler for building resilience (Berkhout et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Kucuksuleymanoglu, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e2025\u003c/span\u003e); for realizing career aspirations and/ or one\u0026rsquo;s true potential in serving others (Li et al., \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Ricotta et al., \u003cspan citationid=\"CR135\" class=\"CitationRef\"\u003e2022\u003c/span\u003e); for building and activating one\u0026rsquo;s agency (Gupta et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2024a\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003eb\u003c/span\u003e); and/ or for thriving in one\u0026rsquo;s career (Mlambo et al., \u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Ten Cate et al., \u003cspan citationid=\"CR159\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This study shows that self-regulated learning is likely playing a moderator and/ or a mediating role in the relationship between experiencing the program, and the attainment of the program learning outcomes and overall objective. Relevantly, it is established in the literature that increasing the learners\u0026rsquo; capacity and willingness to learn, and encouraging them to maintain a learning/ growth mindset raises their resilience (Khan \u0026amp; Bibi, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Lee \u0026amp; Kwon, \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Singaravelu \u0026amp; Chandrakumari, \u003cspan citationid=\"CR150\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the context of the current study, the deployed variation of Press Ganey\u0026reg; (Ganey, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) resilience scale (i.e., \u0026lsquo;Program Enables Building of Personal Resilience\u0026rsquo; scale), similar to the \u0026lsquo;Program Enables Attainment of Program Objective\u0026rsquo; scale, constituted an example of a \u0026lsquo;synthetic framework\u0026rsquo;, according to characterization of Association for Medical Education in Europe (AMEE). Such evaluation frameworks are believed to view and appraise competence holistically, focusing on performance in real-world activities (Shumway \u0026amp; Harden, \u003cspan citationid=\"CR149\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Smith, \u003cspan citationid=\"CR154\" class=\"CitationRef\"\u003e1999\u003c/span\u003e). AMEE characterizes an evaluation framework as a group of ideas or categories to reflect the educational goals against which a trainee's level of competence or progress is gauged (Harden, 1999; Pangaro \u0026amp; Ten Cate, \u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). From this perspective, different frameworks provide different ways of looking at the practice of medicine and have different purposes (Frye \u0026amp; Hemmer, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; McNEIL et al., \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). In the corresponding AMEE guidelines, a clear distinction is made between analytic and synthetic frameworks (Challis, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e1999\u003c/span\u003e; Tackett et al., \u003cspan citationid=\"CR158\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). As opposed to the synthetic frameworks, analytic ones (such as: \u0026lsquo;Program Enables Attainment of Program Learning Outcomes\u0026rsquo; scale) deconstruct competence into individual pieces, to evaluate each separately.\u003c/p\u003e \u003cp\u003eThe current study also showed that the respective medical program is enabling the attainment of its nine preset learning outcomes. In terms of improvement, the greatest opportunity seems to lie around the sixth learning outcome: \u0026lsquo;Distinguish various healthcare systems and their management\u0026rsquo;. The MBBS under investigation in the current study already offers an innovative, experiential longitudinal theme throughout Phase 3, as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, of health systems and quality/ performance improvement (Al-Jayyousi et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). It is worth further reinforcing this longitudinal offering with content, related to public health, in general, and health management and policy, more specifically, that will enable learners to differentiate between the various healthcare systems across the world (understanding the pros and cons of each, and how those systems are reinforcing the behaviours, whether favourable/ desirable or not, of their health and care professionals) (Ferreira-Guerrero et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This type of content can be delivered in a way to strengthen the learners\u0026rsquo; capacity to engage in proper strategic planning (starting with developing a thorough understanding of situations), in system thinking (i.e., input, process, output, outcome, and impact) (Bowe \u0026amp; Armstrong, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Toosi et al., \u003cspan citationid=\"CR160\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), and in systemic and systematic monitoring and evaluation (via a balanced scorecards or otherwise) (Nuebel et al., \u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This is aligned with the encouraged shift in medical education, where the perception of well-being and illness is transitioning toward acknowledging them as outcomes arising from the complex interplay of individual, social, and environmental/ ecosystemic factors (G\u0026uuml;lpınar \u0026amp; Tanrı\u0026ouml;ver, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe current study showed that the MBBS under investigation is attaining its overall objective, from the perspective of its graduates. It also showed, through measuring the third component of the \u0026lsquo;Program Enables Attainment of Program Objective\u0026rsquo; scale: \u0026lsquo;Becoming a global citizen, while remaining rooted in your values\u0026rsquo;, that the respective program contributed to the graduates capacity to recognizing themselves as members of a worldwide community, without compromising their individuation [the lifelong process of becoming a unique, whole, and distinct self (Nice \u0026amp; Joseph, \u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)]. COVID-19 pandemic has demonstrated the importance for health and care professionals to engage in work transcending national borders and to deeply understand perspectives of health and care in other countries (Du Plessis et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Giordano et al., \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Jenkins et al., \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Otaki, Amir-Rad, et al., \u003cspan citationid=\"CR117\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Rad et al., \u003cspan citationid=\"CR130\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Globalization of health and care professions\u0026rsquo; education can play a key role to that end (Bedoll et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Jenkins et al., \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Otaki, Naidoo, et al., \u003cspan citationid=\"CR122\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Senok, 2022). Corresponding educational programs can strive to prepare culturally competent and globally conscious professionals. A previously conducted scoping review of the current practices and formats in globalization in medical education showed that the literature around the subject matter is favouring perspectives and understandings that were typically representative of the Global North in general and Northern America more specifically (Wu et al., \u003cspan citationid=\"CR177\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). That review emphasized the importance of health and care education to become more inclusive, and for all health and care professions\u0026rsquo; learners to gain access to international perspectives and experiences. It also showed a disconnect between what medical curricula hope to accomplish and the reality of the learning and teaching practice on the ground.\u003c/p\u003e \u003cp\u003eMoreover, the current study showed, through measuring the seventh component of the \u0026lsquo;Program Enables Attainment of Program Objective\u0026rsquo; scale: \u0026lsquo;Engaging in meaningful interdependencies\u0026rsquo;, that the respective program contributed to the graduates capacity to have the choice to collaborate with other independent people and for this collaboration to be healthy (i.e., \u0026lsquo;we' instead of 'I' without compromising 'me'), forming synergies, where 'the whole becomes greater than the sum of its parts'. This is relevant to the previously introduced Stephen Covey\u0026rsquo;s \u0026lsquo;maturity continuum\u0026rsquo; (Covey, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2012\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) that suggests that for there to be healthy interdependence, one needs to evolve from dependent to independent, only then can someone autonomously choose to be truly interdependent (Oko, \u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Pahl, \u003cspan citationid=\"CR123\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Moving from dependence to setting common goals with others without passing through \u0026lsquo;independence\u0026rsquo;, as a stage of maturity, is considered but a shift of dependency from one party (e.g., parents) to another (e.g., work colleague), likely causing unhealthy emotional enmeshment and hampering development, personally and interpersonally, and beyond (Smith et al., \u003cspan citationid=\"CR153\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe challenge of preparing and maintaining humane and holistic future-ready health and care professionals is particularly relevant to professionals who are receiving their training in Dubai, UAE: the most globalized country in the MENA (Alameddine et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Gygli et al., \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; KOF, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). The homegrown program, investigated in the current study, was developed with the intention of reflecting the extent of globalization of its context: Dubai, UAE. The unique context of the study, in terms of primarily globalization (Azaza \u0026amp; Zinoubi, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) but also other differentiators, starting with the composition of the study participants (i.e., MBBS graduates), program (i.e., MBBS), college (i.e., CoM), and institution (i.e., MBRU \u0026ndash; Dubai Health), all the way to the geographical location (i.e., Dubai, UAE, Gulf, and MENA), allows for the generation of insights around the nurturance of global citizens/ globalized health and care professionals that arguably do not stand the chance of getting generated elsewhere (Ashour \u0026amp; Kleimann, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). It is worth highlighting some of the intangible attributes that further differentiate the context of the proposed study. Dubai, UAE values of \u0026lsquo;respect for others\u0026rsquo; and \u0026lsquo;tolerance\u0026rsquo; are enabling the harmonious co-existence across its varied populations (Rai \u0026amp; Beresford-Dey, \u003cspan citationid=\"CR132\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). UAE, in general, and Dubai more specifically offer a unique presentation of the value of \u0026lsquo;fairness\u0026rsquo;, where there seems to be a justifiable prioritization of locals/ Emirati nationals, in terms of empowerment and enablement. Consequentially, the context becomes authentically rich, where the locals/ Emirati nationals tend to relate to each other and to expatriates, and operate from a place of abundance (often striving to contribute to the greater good, keeping in mind and protecting everyone\u0026rsquo;s rights), reflecting how true strength comes from the inside out.\u003c/p\u003e \u003cp\u003eIt is established that policymakers in education should pay special attention to the evaluation of educational programs (Toosi et al., \u003cspan citationid=\"CR160\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Over the years, given the interest of the institution, in which the program under investigation in the current study is offered, in research around innovative health and care professions\u0026rsquo; education (Otaki et al., \u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Otaki, Khamis, et al., \u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e2020a\u003c/span\u003e; Otaki, Naidoo, et al., \u003cspan citationid=\"CR121\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, \u003cspan citationid=\"CR122\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Senok, 2022) compounded with its commitment to continuous quality enhancement via implementation science (e.g., design-based research) (Al-Jayyousi et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Du Preez et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Kaddoura et al., \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), several, diverse investigations have taken place in relation to segments of this program (e.g., an educational intervention or a course). These scientifically-sound investigations revealed positive indications (e.g., learners\u0026rsquo; satisfaction and developed competencies) and also shed light on opportunities for improvement (e.g., evidence-driven means to maximize learning value of an innovative educational intervention). There remained a gap, however, around evaluating the respective program systemically (Ballejos et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Ferreira-Guerrero et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Toosi et al., \u003cspan citationid=\"CR160\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), which is established to be a key component of the corresponding quality assurance and continuous quality enhancement functions (Bedoll et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Colbert \u0026amp; Bierer, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Otaki, Khamis, et al., \u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e2020b\u003c/span\u003e; Toosi et al., \u003cspan citationid=\"CR160\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The current study constitutes an attempt to systematically evaluate, leveraging the Kirkpatrick Evaluation Model (Level 2: Learning and Level 3: Behaviour), the respective program from a macro-perspective (meeting preset goals and fostering select predetermined human constructs). Moreover, although the generalizability of the proposed study is limited, its practical value lies in the transferability of its findings and lessons learned to other similar programs. The means of evaluating the program effectiveness, and the firsthand experiences with learning and teaching (including but not limited to the curriculum and mode of delivery), are all also worth leveraging for the benefit of other similar higher education institutions.\u003c/p\u003e \u003cp\u003eThe study introduced three quantitative data collection tools (five-point Likert-type scale): \u0026lsquo;Program Enables Attainment of Program Learning Outcomes\u0026rsquo;, \u0026lsquo;Program Enables Attainment of Program Objective\u0026rsquo;, and \u0026lsquo;Self-regulated Learning Enables Attainment of Goals\u0026rsquo; scales, all of which proved to be reliable and valid in the context of the study. These tools can be used by other similar institutions to capture their graduates/ graduates\u0026rsquo; perspective of the effects of the respective educational offerings that they had graduated from. The current initiative, as a whole, also encourages, in alignment with the literature around the subject matter (Allen et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Constantinou \u0026amp; Wijnen-Meijer, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Toosi et al., \u003cspan citationid=\"CR160\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), other medicine and health sciences higher education institutions to embark on similar institutional research activities that aim to measure the extent of attainment of program goals through the eyes of their graduates.\u003c/p\u003e \u003cp\u003eThe current work also offers a methodological contribution around design-based research (Chen \u0026amp; Reeves, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; McKenney \u0026amp; Reeves, \u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), encouraging its utilization in academia, in general, and higher education more specifically. It is quite applicable within this context given the parallelism that can be established between the continuous, iterative nature of design-based research (Kimmons R., \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Sandars \u0026amp; Goh, \u003cspan citationid=\"CR140\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and the evidently cyclical nature of academia (Reinking, \u003cspan citationid=\"CR133\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Ustun \u0026amp; Tracey, \u003cspan citationid=\"CR163\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). It is worth highlighting the differing levels in which implementation science (e.g., design-based research) is enacted within MBRU \u0026ndash; Dubai Health (which positions itself as a learning, value-based academic health system): segments of courses (e.g., study around early clinical exposure), courses (e.g., study around pharmacology course), basic and clinical medical sciences phases, program, college, university/ higher education institution, and (learning) academic health system (i.e., learning organization) (Du Preez et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe current study has a few limitations. To start with, the generalizability of the findings is limited since the study took place in a single university of medicine and health sciences, including only the first three cohorts of graduates of an undergraduate program. The transferability of findings to similar programs is quite strong, though, given the provision of a detailed description of the context of the respective study. In addition, the study relied on self-reported data, which may be subject to response bias, in general, and more specifically, social desirability effects. Also, in terms of response rate of the current study, it is considered acceptable for research based on a cross-sectional design (Sataloff \u0026amp; Vontela, \u003cspan citationid=\"CR141\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Yet, if the response rate per stratum/ cohort is considered, that of graduating classes 2023 and of 2024 (70.97% and 88.10%, respectively) would be considered acceptable/ high enough, as for that of 2022 (as previously mentioned), a response percentage of 34.70 is considered low (and hence, not much emphasis was put on discussing any significant variation across the cohorts; this, from a research perspective, constitutes a missed opportunity). It will be useful for future studies, covering more than one cohort of participants, to assure meeting response threshold per stratum/ cohort. Moreover, the deployed tool [including four scales, one of which is a variation of Press Ganey\u0026reg; (Ganey, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) resilience scale] was tailor-made for the purpose of the study. To ensure bypassing the potential weaknesses of this informed choice around the study\u0026rsquo;s data collection, the internal consistency and external variance of the four scales were performed to assure their reliability and validity, respectively, in the context of the study (Appendix II). In addition, although the current outcome-evaluation study provided important information around desired effects of the MBBS program under investigation, it did not necessarily capture the sophisticated nature of the entailed educational interventions and processes that lead to the outcomes, longer term outcomes, and unintended outcomes. It would be worthwhile for upcoming studies to move beyond outcome-evaluations (such as those suggested by the Kirkpatrick Evaluation Model, answering: \u0026lsquo;did it work?\u0026rsquo;) to program-evaluations that aim to understand how and why outcomes have occurred (Allen et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), such as: realist evaluation (Nair \u0026amp; Otaki, \u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e2021\u003c/span\u003e); and Context, Input, Process and Product (CIPP) evaluation (Toosi et al., \u003cspan citationid=\"CR160\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Such a holistic framework (Bowe \u0026amp; Armstrong, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Toosi et al., \u003cspan citationid=\"CR160\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) could evaluate all stages of the respective educational program from development to implementation, and integrate the inferences of the current investigation with that derived from different perspectives (e.g., faculty and employers\u0026rsquo; perspectives) and sources (e.g., continuing medical education and on-the-job performance, and outcomes of care) (Nawaz et al., \u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). These investigations can take the form of longitudinal studies that examine the effects (over time) of the program as the learners\u0026rsquo; progress in their respective careers, providing further insights into the impact of the program. As such, these investigations can also test the hypothesis suggested in the current study that self-regulated learning could be acting as a moderating variable in the relationship between experiencing the program, and the attainment of the program learning outcomes and overall objective. Moreover, the current study investigates constructs (e.g., globalization, self-efficacy, conscientiousness, interdependence, and resilience) that can be considered abstract or \u0026lsquo;too broad\u0026rsquo;. Accordingly, it is worthwhile to conduct systematic literature reviews to derive a single definition for each of these constructs from all previous published attempts of conceptualizing them in the context of health and care professions\u0026rsquo; education since the onset of COVID-19.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study reinforces what became apparent during the extreme conditions of COVID-19 times. Its findings encourage medical programs to strive to continuously reinforce individual learners\u0026rsquo; self-regulation and resilience, in an integrated manner, through multiple learning and teaching channels. This calls for deploying innovative ways to develop non-technical, transversal skills, that complement the foundational basic and clinical medical sciences competencies. Collectively, those competencies are expected to result in resilient, and culturally competent and globally conscious health and care professionals. These well-rounded health and care professionals are more likely to engage in work transcending national borders, recognizing themselves as members of a worldwide community, without compromising their individuation. This study also highlights the importance of evaluating the respective programs systematically and systemically as a portal towards effective continuous quality enhancement of the entailed outcomes-based learning and teaching. The introduced data collection tools can be leveraged by other similar programs to evaluate the extent to which they meet their preset goals.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eEthical approval for the study was granted by the Mohammed Bin Rashid University of Medicine and Health Sciences Institutional Review Board (MBRU-IRB-2025-240) and in turn Dubai Scientific Research Ethics Committee (DSREC-09/2025_39).\u0026nbsp;All methods were performed in accordance with guidelines and regulations on research with human subjects. Participants provided informed consent for participation.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eFO-led the research study conceptualization; led the development of the data collection tool; analyzed the collected data; and composed the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003eKC-contributed to the doctoral student supervision; contributed to the research study conceptualization; and contributed to the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003eTC- contributed to the doctoral student supervision; contributed to the research study conceptualization; and contributed to the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003eLDP-contributed to the research study conceptualization; and maintained the macro perspective of the research study.\u003c/p\u003e\n\u003cp\u003eLA- facilitated the collection of data.\u003c/p\u003e\n\u003cp\u003eNB- contributed to development of the data collection tool.\u003c/p\u003e\n\u003cp\u003eDEM- contributed to development of the data collection tool.\u003c/p\u003e\n\u003cp\u003eTL- maintained the macro perspective of the research study.\u003c/p\u003e\n\u003cp\u003eAP- led the doctoral student supervision; contributed to the research study conceptualization; and contributed to the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors would also like to acknowledge the MBRU Research and Graduate Studies academic unit for supporting this research work.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; information\u003c/p\u003e\n\u003cp\u003eFO- leverages her transdisciplinary expertise to promote evidence-based decision-making in health and care professions\u0026rsquo; education, and in health systems. FO is currently handling the Institutional Research portfolio as part of the Quality Assurance and Institutional Effectiveness framework at the Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) \u0026ndash; Dubai Health, Dubai, United Arab Emirates (UAE). Concurrently, FO is pursuing Doctor of Philosophy (PhD) in the intersect between health professions\u0026rsquo; education and value-based healthcare in the Care and Public Health Research Institute (CAPHRI) in Maastricht University, Maastricht, Netherlands.\u003c/p\u003e\n\u003cp\u003eKC- is a Professor of Public Health Leadership and Workforce Development, Head of Department of International Health, and Chair of Collaboration Commission of Care and Public Health Research Institute (CAPHRI) in Maastricht University, Maastricht, Netherlands.\u003c/p\u003e\n\u003cp\u003eTC- is an Associate Professor and Program Coordinator of Master Governance and Leadership in European Public Health in Department of International Health in Maastricht University, Maastricht, Netherlands.\u003c/p\u003e\n\u003cp\u003eLDP- is Associate Provost of Clinical Partnership and Academic Integration at the Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) \u0026ndash; Dubai Health, Dubai, United Arab Emirates (UAE).\u003c/p\u003e\n\u003cp\u003eLA- is an Associate Professor of Molecular Hematology at College of Medicine (CoM) and Dean of Student Affairs at the Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) \u0026ndash; Dubai Health, Dubai, United Arab Emirates (UAE).\u003c/p\u003e\n\u003cp\u003eNB- is Chief Administrative Officer and Head of Strategy of Press Ganey Associates, Inc., South Bend, Indiana, United States of America (USA).\u003c/p\u003e\n\u003cp\u003eDEM- is Executive Director of Institute for Innovation of Press Ganey Associates, Inc., South Bend, Indiana, United States of America (USA).\u003c/p\u003e\n\u003cp\u003eTL- is a Professor of Public Health and Epidemiology at College of Medicine (CoM) at the Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) \u0026ndash; Dubai Health, Dubai, United Arab Emirates (UAE).\u003c/p\u003e\n\u003cp\u003eAP- is a Professor of Economics of Education and Healthcare, and Chair of Creating Value-based Healthcare (VHC) research line in the Care and Public Health Research Institute (CAPHRI) in Maastricht University, Maastricht, Netherlands.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAl-Jayyousi, R., Abu Mahfouz, N., Otaki, F., Paulus, A., Czabanowska, K., Zaman, Q., AlAshkar, M., Stanley, A., \u0026amp; Kilian, P. 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Descriptive study of association between quality of care and empathy and burnout in primary care. \u003cem\u003eBMC Med Ethics\u003c/em\u003e,\u003cem\u003e 18\u003c/em\u003e(1), 54. https://doi.org/10.1186/s12910-017-0214-9 \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Health and care professions’ learners, program effectiveness, resilience, self-regulated learning, United Arab Emirates, sustainable development","lastPublishedDoi":"10.21203/rs.3.rs-9335366/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9335366/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt is vital to develop transversal skills that collectively reinforce individual learners’ resilience. Although resilience-focused initiatives are widely adopted in health and care professions’ education, these initiatives seem to take the form of discrete interventions, as opposed to a longitudinal and integrated focus throughout respective programs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo investigate the effectiveness of an innovatively resilience-focused medical program offered through an academic health system in Dubai (United Arab Emirates) through measuring its overall goal attainment from the perspective of its graduates.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA quantitative cross-sectional research design was used. Graduates of the first three cohorts of Bachelor of Medicine and Bachelor of Surgery of Mohammed Bin Rashid University of Medicine and Health Sciences – Dubai Health were invited to a survey (throughout October 2025). Analysis of scales included computing overall extent of agreement score for each of four scales.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of 122 graduates, 76 responded. Percentage of total average of agreement that ‘Program Enables Attainment of Program Learning Outcomes’ was 87.11% and that ‘Program Enables Attainment of Program Objective’ was 85.14%. Also, percentage of total average of agreement that ‘Program Enables Building of Personal Resilience’ was 73.55% and that ‘Self-regulated Learning Enables Attainment of Goals’ was 80.76%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMedical programs are encouraged to strive to reinforce individual learners’ resilience, in an integrated manner. This calls for deploying innovative ways to develop non-technical, transversal skills, complementary to basic and clinical medical sciences competencies. Collectively, those competencies are expected to result in resilient, and culturally competent and globally conscious health and care professionals who can engage in work transcending national borders.\u003c/p\u003e","manuscriptTitle":"Investigating graduates’ perception of overall goal attainment of a resilience-focused medical program offered in MENA: a quantitative cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-26 15:39:16","doi":"10.21203/rs.3.rs-9335366/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-18T12:12:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-17T21:38:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"203321841927839376087036750664150770169","date":"2026-04-22T05:18:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"61243563669137473304168150915764142683","date":"2026-04-17T14:44:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-16T12:55:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-16T11:13:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-13T13:05:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-10T07:23:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-04-10T07:05:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b1f09cfa-c322-451d-9264-5be7e3ae9fd1","owner":[],"postedDate":"April 26th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-18T12:12:01+00:00","index":96,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-17T21:38:59+00:00","index":95,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-26T15:39:20+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-26 15:39:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9335366","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9335366","identity":"rs-9335366","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}