Dr. Asma Al-Mazrouei – Transformation Story from Hesitation to Leadership in the Neonatal Intensive Care Unit

Introduction
Dr. Asma Al-Mazrouei, a Saudi physician, works as a consultant in Neonatology and Neonatal Neurology. She also serves as the Director of the Neonatal and Premature Fellowship Program at King Fahd Armed Forces Hospital in Jeddah, Saudi Arabia. She obtained her Neonatology fellowship from Western University in Canada, followed by a fellowship in Neonatal Neurology from the University of Toronto, which provided her with a deep specialization in managing delicate and complex cases in this field.

She experienced FIRSTmed-ADLX Framework in January 2025 during a learning journey held at the International Medical Center (IMC), where she found that it addresses  clinical training challenges practically and comprehensively.
The challenge was the presence of a fellow who, after three evaluation rounds, had not achieved the basic indicators required for promotion to “Senior Fellow” status. This performance gap affected her self-confidence and triggered feelings of frustration, which reflected in her participation during shifts and learning activities and reduced her engagement with the team. Nevertheless, this problem revealed hidden opportunities for re-empowerment and individual support. As the program director, Dr. Asma decided to turn this challenge into a comprehensive development opportunity by designing and facilitating an Active Deep Learner eXperience using FIRSTmed-ADLX Framework, including an on ongoing “Probing and Assessment” and  deep reflective “Reviewing Actively” stage.
This experience primarily targeted one participants within the fellowship group, but also included two of her first-year colleagues. All participants worked in an academic government center, aged between 32 and 36. They had access to technological and medical resources, alongside an advanced clinical environment, which enabled the implementation of a high-quality, customized educational intervention.

Learning Design Overview
FIRSTmed-ADLX Framework was selected because it offers an integrated model that focuses on learner behavior, encourages group interaction, promotes reviewing actively, sequence the activities for a smooth flow, and transfers learning to real-life performance. What distinguishes this framework from others is that it doesn’t merely transfer knowledge—it transforms learner mindsets and builds their leadership and professional skills. The KSA (Knowledge-Skills-Attitudes) model was used to assess the learner’s readiness to advance to the next level of clinical responsibility.
Through the integration of constructive assessment tools, regular feedback, and facilitation of individual reflective sessions, an Active Deep Learner eXperience was designed as a personalized support plan focused on building confidence and motivating intrinsic drive. Six structured learning meetings were scheduled, along with three intensive simulation workshops spread over a three-month period. Activities included: case discussions, clinical learning, high-fidelity simulation, and written reflections.

Learning Outcomes:
The learning outcomes were as follows:
• Attitude:

• To internalize values of responsibility, mental flexibility, and growth mindset.
• To recognize the importance of patient safety and continuous learning.
• To value collaboration and openness to feedback.
• To understand the importance of quality improvement and systematic performance tracking.

• Skills:

• To enhance decision-making skills under pressure in critical situations.
• To master procedural skills such as intubation, line insertion, and resuscitation.
• To develop leadership and coordination skills within the NICU.

• Knowledge:

• To deeply understand neonatal physiology and evidence-based interventions.
• To list the CanMEDS roles and how to integrate them into daily practice.

• Parallel Outcomes:

• To increase self-awareness of strengths and areas for improvement.
• To boost internal motivation to meet consultant-level competencies.

Journey Summary:
The journey extended over three months and included in-person educational sessions, simulation workshops, and individual reflective activities. It progressed from observational learning to supervised execution, then to partial case management as an introduction to taking on “senior fellow” responsibility. The design blended synchronous (on-site) learning with asynchronous missions, such as guided readings and reflection journaling after each shift. Below are some RAR-model-designed activities.

Activity One: Simulation of Critical Cases in the NICU
In the Readiness Increase stage, the participant was provided with clinical scenarios in advance and guided to review relevant sources. A supportive environment was created by reassuring her and clearly outlining expectations.
During Activity Facilitation, the participant engaged in a high-fidelity simulation on neonatal resuscitation, taking the lead in managing the case and organizing the team.
In Reviewing Actively stage, the participant shared the steps she took, such as airway management and mission distribution. She discussed how this activity boosted her confidence, improved her communication under pressure, and accelerated her decision-making. She also planned to apply these skills in actual shifts to reduce error likelihood.

Activity Two: Reflective Review of Clinical Cases
In the Readiness Increase stage, the participant was asked to select a real clinical case where she had faced decision-making challenges and to analyze it in advance.
During Activity Facilitation, an individual reflective dialogue session was held with the facilitator. They discussed strengths and gaps, and the participant openly received feedback.
In Reviewing Actively stage, the participant reviewed her decisions and their impact on the case. She extracted lessons applicable to future similar situations and developed an action plan to improve her performance in upcoming complex cases.

Application of the Five FIRST Domains
F – Focusing on the Learner
The facilitator personalized feedback after each session to address the participant’s needs. She used probing questions to assess her clinical reasoning and helped her identify knowledge gaps. The participant was encouraged to adopt self-directed learning and take ownership of her performance improvement, guided by ongoing feedback.

I – Interacting within Positive Group Dynamics
A supportive and encouraging environment was fostered during simulation sessions through positive reinforcement and embracing errors as learning opportunities. The facilitator promoted open discussions between peers and nurses to strengthen team communication. Motivation was reinforced by highlighting progress milestones during evaluations.

R – Reviewing Activities within RAR Model
The facilitator applied the RAR model in all core activities, ensuring the participant moved from mental readiness to practical application, then to deep reflection. This led to connecting theory to practice and fostering reflective and experiential learning.

S – Sequencing within the Learner eXperience
The journey was structured in logical progression—from shadowing to supervised practice, and eventually taking the lead as a “senior fellow” in selected cases. Core concepts like stabilization protocols were reinforced through varied activities (simulation, case reviews, clinical teaching). At the end of each session, key points were summarized to ensure concept retention.

T – Transforming Learning into Real Performance
Learning was directly connected to the real NICU context by allowing the participant to apply new skills during supervised shifts. Regular follow-up sessions were conducted to evaluate progress and reinforce skills. Comprehension was strengthened by exposing her repeatedly to complex cases until performance indicators were met.

Conclusion
Impact on the Participant: Over twelve weeks, the participant showed remarkable growth in several areas: her clinical decisions became more precise, her performance during night shifts improved, and she demonstrated greater independence in managing ventilators and adjusting medications. Her leadership and communication skills within the team advanced, along with her self-awareness and development needs. The participant stated:
“Today I feel more confident in facing emergencies, and I know I have the knowledge and support system to make well-considered decisions.”

Impact on the Facilitator:
The experience reshaped the facilitator’s perspective on the importance of real-time feedback and reflective training. She became more aware of the power of continuous probing and assessment and its cumulative effect. She also began integrating CanMEDS roles into daily evaluations. Dr. Asma plans to expand simulation activities and increase multidisciplinary team participation in learning.

Impact on the Surrounding Community:
The participant’s improved performance directly enhanced care quality in the NICU, strengthening patient safety and intervention effectiveness. This learning model is now a candidate for application with other fellows in the program, reinforcing a culture of personalized mentorship and continuous growth.

Final Word:
This experience shows how a uniquely tailored Active Deep Learner eXperience built on the FIRSTmed-ADLX Framework can transform a learner’s path—from hesitation to confidence, from passive reception to leadership. It proved that empowerment does not come through content alone, but through intention, follow-up, and sincere guidance.