Background, The attitude of Leaving the emergency department (ED) without being seen or without completing treatment is attributed to prolonged waiting time. The impact of such behaviour and fate of such patients remain undetermined. Aim This study aimed to investigate the prevalence of Left Without Being Seen (LWBS) and Left Without Completing Treatment (LWCT), analyse the contributing factors for such behaviour and the mortality rate within one week of leaving the ED. Methods A retrospective observational study was performed in a tertiary hospital in Riyadh, Saudi Arabia, for three months. All adult patients of more than  14  years of age who visited the ED and LWBS or LWCT were included. Patients were seen by physicians and triaged-out, and those who were directed towards the outpatient clinic were excluded. Patients were asked about the reason for leaving, and their intention to return to the same ED again via call. Results The total number of LWBS and LWCT was 286 patients, with a response rate of 75%. The mean age was 45.8 years. About 46.6% sought medical help within seven days of leaving ED. However, the mortality rate was nil. Many patients (69.3%) reported their intention to revisit the same ED in the near future. A positive correlation was found between increasing age and admission within the same seven days’ period. Conclusion Prolonged waiting time is a public health concern that needs management strategies, the number of patients whom LWBS and LWCT require continuous monitoring and exploration.

Background: In-training evaluations have an invaluable role in assessing the clinical competency of the trainee. In this study, we explore which trainees' characteristics have the strongest impact on their evaluation and whether these characteristics fit in the Royal College of Physicians and Surgeons of Canada's CanMEDS Physician Competency Framework. Based on the seven roles that physicians need to have, the framework describes the capabilities that physicians need to produce better patient outcomes. Methods: Emergency medicine attending physicians involved in supervising residents at the four main emergency medicine residency training sites in Riyadh, Saudi Arabia participated in focus group sessions to identify resident characteristics most frequently noted and their impact on the overall evaluation. The interview process followed a standard format. All interviews were audiotaped, and field notes were taken. Two independent coders coded the interviews using CanMEDS competencies as a framework. The frequency of each mention of a particular characteristic was recorded. Following the interviews, participants were also asked to complete a questionnaire about the CanMEDS competencies they routinely or rarely assess. Results are presented in a descriptive fashion. Results: A total of six focus groups sessions were held with 19 participants. The focus group sessions yielded a total of 145 features, or characteristics. Characteristics relating to medical expertise competencies had the strongest impact, followed by professionalism-related competencies, while characteristics relating to health advocacy and managerial skills had the weakest impact on the evaluation. Conclusion: Our results are consistent with previous literature in showing that evaluators tend to base their evaluations on certain competencies and fail to evaluate competencies across the entire CanMEDS spectrum.