What Happened to Simulation-Based Education in Outpatient Setting in The 21st Century: A Scoping Review

Introduction

Simulation-based education (SBE) is an instructional approach that aims to accurately recreate real-life scenarios and engage learners in the practical application of lesson content. By replicating critical elements of clinical situations, SBE facilitates a deeper understanding and better preparation for managing such conditions in actual clinical practice. SBE offers promising prospects for improving medical education and patient care in various settings, such as outpatient clinics. Therefore, this scoping review aims to determine to what extent the most effective components and standards of the simulation have been considered in outpatient education.

Methods

The present scoping review adheres to the guidelines outlined in the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist" and the "Joanna Briggs Institute (JBI) Reviewers' Manual". This review focused on articles that specifically focused on the use of simulation in outpatient education. Google Scholar, PubMed, Scopus, Embase, and ERIC were searched for keywords related to simulation, ambulatory care, outpatient clinics, and medical education from January 1, 2001, to August 12, 2023.

Results

The search indicated 513 articles, which were narrowed down by title and abstract relatedness. Twenty-nine articles entered the study's second phase, and after reviewing their full text, nine articles that explicitly reported simulation use in outpatient education remained. Based on the findings of eligible articles, the ten most frequent components of SBE that should be considered and followed discussed. These features were training facilitators, pre-briefing sessions, the type of simulation techniques, the site of simulation participation, the simulation duration, unit of participation, extent of direct participation, Simulation fidelity, feedback, and debriefing and reflection.

Conclusion

SBE is a contemporary method of practical training for medical students that involves realistic modeling or simulation of clinical situations. It enhances learning effectiveness and provides a safe, educational atmosphere for teaching and learning. Designing simulations adhering to established standards and carefully considering essential components improves efficiency and effectiveness.

Need assessment of medical school curriculum for MOOCs: perspectives of instructors and students of Shiraz University of Medical Sciences

INTRODUCTION

Designing, developing, and implementing a course without assessing and prioritizing instructional needs may result in inefficiency due to the disregard for the actual needs of the target population. The present study aimed to determine and prioritize medical students' instructional needs regarding Massive Open Online Courses (MOOCs) at Shiraz University of Medical Sciences.

METHODS

This survey study was carried out in three stages (2020-2021) using the Delphi technique. Purposive and snowball sampling methods were used to select the instructors. The students were selected through simple random sampling. The first round of the Delphi technique involved a questionnaire consisting of one open-ended question, completed by 49 basic/clinical faculty members and 47 senior medical students. In the second round, a 5-point Likert scale-based questionnaire was used to prioritize the instructional needs. The reliability of the questionnaire was verified by Cronbach's alpha coefficient. In the third round, a focus group was used. A total of six expert faculty members and one senior medical student were invited to the focus group session to prioritize the needs. Data were analyzed using Friedman's non-parametric ranking test in SPSS version 26.

RESULTS

Ten instructional needs priorities were extracted, including common pharmacotherapies (antibiotics and narcotics), prescriptions, physiology, anatomy, physical examination, electrocardiography interpretation, radiography, computed tomography scans, serum electrolyte disorders, and cardiovascular and internal (endocrine and metabolic) diseases. The chi-squared calculated value (715.584) indicated a significant difference in the importance of the questionnaire's questions (P < 0.001). These questions did not have equal value, and the importance, from the respondent's point of view and the observed distribution of ranks, was not the output of a random factor.

CONCLUSIONS

The findings of this study can be used to design MOOCs, revise instructional programs, and adapt the curriculum to meet the needs of general practitioners, which will, in turn, help meet the medical needs of the general population.

The sudden transition to online learning: Teachers' experiences of teaching during the COVID-19 pandemic

INTRODUCTION

The sudden transition from face-to-face teaching to virtual remote education and the need to implement it during COVID-19 initially posed specific challenges to educational institutions. Identifying and understanding teachers' experiences pave the way for discovering and meeting educational needs. This study explored faculty members' teaching experiences during the COVID-19 pandemic.

MATERIALS AND METHODS

The qualitative descriptive design via conventional content analysis was used. It was conducted from January 13, 2020, to May 10, 2022. In-depth interviews (online and in-person) of ten faculty members, three managers, and one staff from Lorestan University of Medical Sciences were conducted. They were purposefully selected with maximum variation. Simultaneously with data collection, analysis was performed using the approach Graneheim and Lundman proposed (2004). Lincoln and Goba's criteria were used to obtain the study's rigor.

RESULTS

Six categories emerged from the data: education in the shadow of the crisis, Challenges related to the teaching-learning process, Blurred boundaries between personal and professional lives, Positive consequences of e-learning, Trying to deal with the crisis, And dealing with the crisis.

CONCLUSIONS

Initially, teachers faced several challenges in the teaching-learning process and even in their personal life. However, with time, the actions of the teachers and the managers caused an increase in the quality of education. However, planning and foresight are needed in developing countries, including Iran, to appropriately face and optimally manage similar crises and move towards blended learning.

Dual-Centre Harmonised Multimodal Positron Emission Tomography/Computed Tomography Image Radiomic Features and Machine Learning Algorithms for Non-small Cell Lung Cancer Histopathological Subtype Phenotype Decoding

AIMS

We aimed to build radiomic models for classifying non-small cell lung cancer (NSCLC) histopathological subtypes through a dual-centre dataset and comprehensively evaluate the effect of ComBat harmonisation on the performance of single- and multimodality radiomic models.

MATERIALS AND METHODS

A public dataset of NSCLC patients from two independent centres was used. Two image fusion methods, namely guided filtering-based fusion and image fusion based on visual saliency map and weighted least square optimisation, were used. Radiomic features were extracted from each scan, including first-order, texture and moment-invariant features. Subsequently, ComBat harmonisation was applied to the extracted features from computed tomography (CT), positron emission tomography (PET) and fused images to correct the centre effect. For feature selection, least absolute shrinkage and selection operator (Lasso) and recursive feature elimination (RFE) were investigated. For machine learning, logistic regression (LR), support vector machine (SVM) and AdaBoost were evaluated for classifying NSCLC subtypes. Training and evaluation of the models were carried out in a robust framework to offset plausible errors and performance was reported using area under the curve, balanced accuracy, sensitivity and specificity before and after harmonisation. N-way ANOVA was used to assess the effect of different factors on the performance of the models.

RESULTS

Support vector machine fed with selected features by recursive feature elimination from a harmonised PET feature set achieved the highest performance (area under the curve = 0.82) in classifying NSCLC histopathological subtypes. Although the performance of the models did not significantly improve for CT images after harmonisation, the performance of PET and guided filtering-based fusion feature signatures significantly improved for almost all models. Although the selection of the image modality and feature selection methods was effective on the performance of the model (ANOVA P-values <0.001), machine learning and harmonisation did not change the performance significantly (ANOVA P-values = 0.839 and 0.292, respectively).

CONCLUSION

This study confirmed the potential of radiomic analysis on PET, CT and hybrid images for histopathological classification of NSCLC subtypes.

Outpatient education, a momentous in clinical education: a qualitative study of medical students', faculty members', and residents' perspectives

BACKGROUND

Even though a lot of scholars have been looking at outpatient education lately because it has become more popular and they want to know about its successes, failures, and problems, we have not been able to find a complete study. Therefore, our study aims to gain a deeper understanding of the various aspects of outpatient education based on the actual experiences of medical students, faculty, and residents.

METHODS

Face-to-face and semi-structured interviews were used to collect data for this qualitative study. Until data saturation was reached, the interviews continued. A total of 21 participants from Shiraz University of Medical Sciences, including medical students, residents, and teachers, were enrolled. The Guba and Lincoln-first written standards for scientific accuracy in qualitative research were used to figure out how reliable the data were.

RESULTS

Fourteen categories were extracted from four main themes. The results show that four categories: "physical space and equipment," "prerequisites related to the curriculum," "teaching skills development," and "near-peer teachers" should be considered for outpatient education preparation. Theme 2, "implementation requirements," included "student dimension," "faculty's commitment to planning," and "program supervision." Theme 3, "challenges of outpatient education," was described by five related categories, including "curriculum implementation challenges," "student challenges," "faculty challenges," "system-related challenges," and "patient-related challenges." Finally, two categories emerged about facilitators of outpatient education: internal and external facilitators.

CONCLUSION

Outpatient clinics represent a crucial aspect of medical practice. To effectively leverage this resource, preliminary planning, considering all the prerequisites, paying attention to the implementation requirements, getting to know the challenges, and trying to solve them, especially with incentives, are essential.

Clinical learning evaluation questionnaire: a reliable and valid tool for the evaluation of clinical education by educators and students

BACKGROUND

The clinical learning evaluation questionnaire can be used in the clinical trial period of medical students to measure the effectiveness of the clinical learning environment. The purpose of this study was to collect validity evidence of an adapted questionnaire to measure the transcultural adaptation of a Persian version of CLEQ.

METHODS

A total of 200 questionnaires were completed by students who were at the end of their clinical rotation. The study instrument was the latest version of the CLEQ consists of 18 Items in four dimensions. The CLEQ was translated into Persian language through a four-step process of forward and backward translation. Data analysis was performed on two softwares, SPSS, version 22 and Lisrel, version 8.8.

RESULTS

The results showed that the 18-question CLEQ could be applied to the Persian translation of the tool. The response process evidence of the Persian questionnaire was established through feedback from 15 students in the sample group. The content validity index (CVI) for the items were between 0.8 and 0.9, and the content validity ratio (CVR) for the entire questionnaire was 0.9. The 4-factor feature of CLEQ was good model fit. The internal consistency analysis indicated that the Cronbach's alpha values for all items of the 18-item questionnaire were equal to 0.87 and for the subscales were 0.68 to 0.79.

CONCLUSION

The Persian translation of the 4-factor CLEQ has sufficient validity evidence to measure the transcultural adaptability of clinical education activities by instructors and students. The validity evidence are content, response process and internal structure. We recommend that the English 6-factor and 6-factor versions of CLEQ be tested on medical students at multiple foreign academic institutions to assess their efficiency.

Face-to-face, online, or blended: which method is more effective in teaching electrocardiogram to medical students

BACKGROUND

Electrocardiogram (ECG) remains an important medical diagnostic and screening tool. This study aimed to compare the effectiveness of online classes instead of traditional face-to-face or blended methods in medical students' ECG learning.

METHODS

Two hundred and fifteen medical students (including 105 (48.8%) males and 110 (51.2%) females) were studied from February 2021 to February 2022. Regardless of their grade, participants were divided into three groups: online, face-to-face, and blended. Then all participants sat for an ECG interpretation exam, and their results were compared.

RESULTS

Twenty-six (12.1%) participants were residents, and 189 (87.9%) were interns. Thirty-five (16.3%), 85 (39.5%), and 95 (44.2%) participants were taught ECG through face-to-face, online, and blended methods, respectively. Regarding participants' preferences on teaching methods, 118 (54.9%) preferred face-to-face learning, and the remaining 97 (45.1%) chose online learning (p < 0.001). The blended method seemed more promising in almost half of the exam questions regarding teaching method effectiveness. The mean total exam score was also significantly higher in participants who were taught blended than in the others (7.20 ± 1.89, p = 0.017). Face-to-face (5.97 ± 2.33) and online teaching methods (6.07 ± 2.07) had similar efficacy according to the mean total score (p = 0.819).

CONCLUSION

While most students preferred face-to-face learning to online learning, a blended method seemed more promising regarding students' skill enhancement to interpret ECG.

Validity and reliability of the Persian version of modified motivated strategies for learning questionnaire: a methodological study among medical students

BACKGROUND

Medical undergraduates need to improve their techniques for learning in the different settings of learning in clinical rotations. Reflective learning, in which a person can learn from their experiences, is among the most well-known learning skills. In this study, we aim to translate the newly developed modified form of the motivated strategies for learning questionnaire (MSLQ) to Persian and evaluate its reliability and validity among medical students.

METHODS

This study was performed on medical students in clinical stages at the Shiraz University of Medical Science in 2022. The modified MSLQ questionnaire was used in this study which is a 32-item tool measuring different aspects of self-reflecting, including self-orientation, feedback-seeking, critical thinking, and self-regulation. This questionnaire was translated into Persian properly. Cronbach's alpha and confirmatory factor analysis were used to ascertain the reliability and validity of the tool.

RESULTS

A total of 325 medical students consisting of 174 men and 151 women with an average age of 23.79 (± 2.21) were enrolled. Path diagrams of confirmatory factor analysis for both standardized regression coefficients and t-values and all the fitness indicators were in favor of the proper validation of the translated version. The overall Cronbach's alpha for the questionnaire was 0.9, and the value for each of four subscales was above 0.7.

CONCLUSIONS

Our study showed that the Persian-translated version of the modified MSLQ is valid and reliable without taking too much time and effort to implement. We recommend that the developed tool be distributed to medical students from other Iran universities.

Developing and validating a national set of standards for undergraduate medical education using the WFME framework: the experience of an accreditation system in Iran

BACKGROUND

Defining standards is the first step toward quality assurance and improvement of educational programs. This study aimed at developing and validating a set of national standards for the Undergraduate Medical Education (UME) program through an accreditation system in Iran using the World Federation for Medical Education (WFME) framework.

METHODS

The first draft of standards was prepared through consultative workshops with the participation of different UME program stakeholders. Subsequently, standards were sent to medical schools and UME directors were asked to complete a web-based survey. The content validity index at the item level (I-CVI) was computed using criteria including clarity, relevance, optimization and evaluability for each standard. Afterward, a full-day consultative workshop was held and a wide range of UME stakeholders across the country (n = 150) discussed the survey results and made corrections to standards.

RESULTS

Analysis of survey results showed that relevance criteria had the best CVI as only 15 (13%) standards demonstrated CVI < 0.78. More than two-thirds (71%) and a half (55%) of standards showed CVI < 0.78 for optimization and evaluability criteria. The final set of UME national standards was structured in 9 areas, 24 sub-areas, 82 basic and 40 quality development standards, and 84 annotations.

CONCLUSIONS

We developed and validated national standards as a framework to ensure the quality of UME training with input from UME stakeholders. We used WFME standards as a benchmark while addressing local requirements. The standards and participatory approach to developing standards may guide relevant institutions.

Surfing the clinical trials of ECG teaching to medical students: A systematic review

Interpreting an electrocardiogram (ECG) is crucial for every physician. The physician's competency in ECG interpretation needs to be improved at any stage of medical education. The aim of the present study was to review the currently published clinical trials of ECG teaching to medical students and provide suggestions for future works. On May 1, 2022, PubMed, Scopus, Web of Science, Google Scholar, and ERIC were searched to retrieve relevant articles on clinical trials of ECG teaching to medical students. The quality of the included studies was assessed utilizing the Buckley et al. criteria. The screening, data extraction, and quality appraisal processes were duplicated independently. In case of disagreements, consultation with a third author was put forth. In total, 861 citations were found in the databases. After screening abstracts and full texts, 23 studies were deemed eligible. The majority of the studies were of good quality. Peer teaching (7 studies), self-directed learning (6 studies), web-based learning (10 studies), and various assessment modalities (3 studies) comprised the key themes of the studies. Various methods of ECG teaching were encountered in the reviewed studies. Future studies in ECG training should focus on novel and creative teaching methods, the extent to which self-directed learning can be effective, the utility of peer teaching, and the implications of computer-assisted ECG interpretation (e.g., artificial intelligence) for medical students. Long-term knowledge retention assessment studies based on different approaches integrated with clinical outcomes could be beneficial in determining the most efficient modalities.

Impact of dyadic practice on the clinical self-efficacy and empathy of nursing students

BACKGROUND

Dyadic practice of learners creates supportive learning. So far, few studies have investigated the impact of this approach on students' empathy and self-efficacy. This study aimed to investigate the effect of dyadic practice on nursing students' clinical self-efficacy and empathy.

METHODS

This study was based on a pretest-posttest randomized group from September to December 2018. All the junior nursing students (n = 44) were divided into intervention (n = 22) and control groups (n = 22) using stratified random sampling. The intervention group was trained for 6 days as student dyads, while the control group was under the supervision of an instructor and worked individually. The students' levels of empathy and self-efficacy were evaluated on the first day (pretest) and the last day (post-test) by The Self-Efficacy in Clinical Performance Scale and Mehrabian and Epstein empathy scale. The data were analyzed using the SPSS software by Fisher's exact test, Mann-Whitney test, independent t-test paired t-test, Wilcoxon signed-rank, and Analysis of covariance.

RESULTS

Dyadic practice increased empathy in the intervention group compared to the control group (P < 0.001). The adjusted mean of total empathy in the intervention group was 21.1 degrees higher than the adjusted mean of total empathy in the control group. However, no significant differences were found between the two groups in clinical self-efficacy (P = 0.762).

CONCLUSIONS

The employment of this approach seems helpful in creating an empathic atmosphere. However, further studies are required to prove the effectiveness of this method on self-efficacy.

Estimating the parameters of a dependent model and applying it to environmental data set

In this paper, a new dependent model is introduced. The model is motivated using the structure of series-parallel systems consisting of two series-parallel systems with a random number of parallel sub-systems that have fixed components connected in series. The dependence properties of the proposed model are studied. Two estimation methods, namely the moment method, and the maximum likelihood method are applied to estimate the parameters of the distributions of the components based on observing the system's lifetime data. A Monte Carlo simulation study is used to evaluate the performance of the estimators. Two real data sets are used to illustrate the proposed method. The results are useful for researchers and practitioners interested in analyzing bivariate data related to extreme events.

Critical appraisal skills training to undergraduate medical students: A Randomized Control Study

INTRODUCTION

Critical appraisal skills are presumed to perform a principal part in evidence-based health education and practice methods. This study aimed to design an educational intervention around critical appraisal in this context, evaluate the efficacy of the teaching methods, and investigate critical appraisal skills training to undergraduate medical students.

METHODS

In this prospective Randomized Control Trial (RCT), 256 sixth-year undergraduate medical students from Shiraz University of Medical Science, Shiraz, Iran, participated. 124 of the students were not taught critical thinking methods as a control group, and 132 participants were taught critical thinking methods by multi-media and attended an online Critical Appraisal Skills (CAS) training workshop as an intervention group. We used the Critical Appraisal Skills Programme (CASP) questionnaire to evaluate students' knowledge, attitude, confidence, and appraisal skills. This questionnaire was translated into Persian for the first time in Iran by Shokooh Varai, et al. They investigated its validity and reliability, the reliability of the questionnaire being obtained by the Richardson Index (0.75), and the validity being confirmed by some faculty members of Tehran Nursing and Midwifery School. To compare both control and intervention groups, we used an independent t-test and a Chi-Square test at a significance level of 5%, and to analyze the demographic information, we applied some descriptive statistics: frequency, frequency percentage, mean and standard deviation. All of the statistical approaches were analyzed, using SPSS 22.

RESULTS

In all dimensions of the critical appraisal skills, medical students who completed the critical appraisal multi-media training and workshop performed better than those who did not (control group), and this difference was statistically significant (p<0.05). Moreover, the Chi-Square test results showed no statistical relationship between the groups regarding the demographic variables (p>0.05). Also, the Cohen's D effect size values in the knowledge and confidence dimensions were greater than 0.5; this meant a large effect. Regarding the attitude and appraises Skill dimensions, the effect size was between 0.2 and 0.5, which meant a medium effect.

CONCLUSIONS

Teaching critical appraisal skills through multi-media and CAS online workshops to medical students effectively improves the students' knowledge and confidence in appraising articles. This teaching also indicated a medium effect on students' attitudes and behavior. Our findings can justify implementing critical appraisal skills teaching modules in the undergraduate medical education curriculum.

Estimation of phosphate extractability in flooded soils: Effect of solid-solution ratio and bicarbonate concentration

The Olsen method is widely used to determine bioavailable phosphate (P) in upland soils. It is also used in flooded soils, although different estimates of extractable-P are obtained under anoxic and oxic conditions. In this study, variations in extractable-P in three soils under different redox conditions were evaluated as a function of solid to solution ratio (SSR) (1:5-1:200) and bicarbonate concentration (0.1-1 M). The parameterized CD-MUSIC model was used to describe the data, with optimization of reactive surface area (RSA) and reversibly adsorbed-P (R-PO₄). The RSA may vary due to the reductive dissolution of iron minerals and/or the formation of new reactive surfaces upon the establishment of reducing conditions. Changes in SSR and bicarbonate concentration significantly affected extractable-P under both oxic and anoxic conditions; more P was extracted under anoxic than under oxic conditions. The difference was 1.5-2 times greater for the highest SSR considered. In the soil samples with higher organic carbon content, the effect of bicarbonate concentration on extractable-P was remarkable. The large differences in extractable-P under oxic and anoxic conditions were probably due to differences in iron (hydr)oxide content. The CD-MUSIC model successfully predicted the effect of SSR on extractable-P under both conditions. R-PO₄ data were fitted for oxic conditions and assumed unchanged for anoxic samples, while RSA data were fitted for both conditions. The RSA values were lower in anoxic than in oxic samples. Overall, our data and model calculations indicate that using wet soil samples obtained in-situ for evaluation of Olsen-P in submerged soils lead to a higher estimation of extractable-P than estimated in oxic soils. If soil testing in the presence of target plants confirms the reliability of in-situ sampling for Olsen-P estimation, the P fertilizer dose applied to submerged soils could be reduced, which is very important from environmental and economic perspectives.

Relationship between research self-efficacy and evidence-based practice in the medical students

BACKGROUND

Due to the rapid advancement of medical knowledge, promotion in research is necessary to have the best clinical practice. Research Self-efficacy (RSE) is the researcher's confidence in their ability to conduct a specific study. The Evidence-Based Practice (EBP) represents how to improve the quality of care and treatment of patients. RSE and EBP are the cornerstones of successful research and then efficacious medical practice. This study aims to evaluate RSE and acceptance of EBP and their correlation among medical students.

MATERIALS AND MEHODS

This is a cross-sectional study designed on 600 clinical students at the medical school of Shiraz, using a census method in 2020. Students were invited to fill out the standardized Phillips and Russell's questionnaires about RSE (4 domains, 33 questions) and Rubin and Parrish's questionnaire of EBP (10 questions). The gathered data were analyzed through the SPSS at α = 0.05 using descriptive statistics, t-test, Chi-square, and multiple linear regressions.

RESULTS

There was a positive correlation between EBP and RSE score (P < 0.05). The results of linear regression test showed that all variables had a significant effect on our response variables and their effect were significant (P < 0.05). The highest mean score in RSE was shown in the subscale of writing skills (52.54). The lowest score was observed in the subscale of quantitative (student's subjective assessment of their ability to work with statistically related data and formulas) as well as computer skills (35.61).

CONCLUSIONS

Students who participated in a research project, workshop, or Master of Public Health program got a higher RSE and EBP. Due to the positive correlation between RSE and EBP, we conclude that trained physicians who can research independently and use research evidence can find the best treatment approach for patients. These finding support the importance of integrating research education in medical curriculum to increase RSE and finally improvement of EBP among medical students.

The Relationship between Experiences Level and Clinical Decision-Making Skill in Midwifery Students: A Cross-Sectional Study

Background: Development and assessment of clinical decision-making skills are essential in midwifery education because of their role in mothers' and infants' safety. Therefore, the present study's primary objective was to evaluate the relationship between experience levels and clinical decision-making skills using the key features (KFs) examination.

Methods: One hundred and two midwifery students in five different education levels participated in this cross-sectional study through convenient sampling. Twenty KFs questions were designed based on the principles of the KFs examination. The participants' information, including grade point average (GPA), theoretical and practical scores of the obstetrics course, were collected. KFs scores were compared according to students' training semester by one-way analysis of variance (ANOVA). Pearson correlation was conducted to explore the correlation between KFs scores and GPA as well as theoretical and practical scores. All statistical analyses were performed at a significance level of 0.05 (p≤0.05). We used five kinds of effect size calculators, which include mean difference (MD), standardized mean difference (cohend), partial Eta-squared, Cohenf, and partial omega-squared.

Results: There was no correlation between KFs scores and the grade point average, theoretical exam scores, and practical exam scores. KFs scores linearly rose as the learners' level increased with a mean± SD score of 7.61±1.09 during the third semester compared to 11.55 ± 1.89 during the eighth semester (p=0.001). The effect size of this result was large (partial omega square=0.35, partial eta square=0.38 & cohen’s f=0.73). The largest SMD was related to the comparison of KFs scores between the eighth and third semester (MD=3.58, SMD=2.554 [CI 95%: 1.719-3.389], p-value═ 0.001), and the lowest was related to the comparison between the third and fourth semesters (MD=0.354, SMD= 0.2 [CI 95%: -0.421-0.821], p=0.987).

Conclusion: Establishing proficiency in clinical decision-making skills is a linear process greatly enhanced by experience, clearly shown by the present study results. Using KFs examination and obtaining extensive evidence to its benefit can allow us to renegotiate proficiency evaluation methods for students in clinical fields. the education curriculum should focus more on identifying clinical KFs skills than merely teaching knowledge about disease processes.

Reliability and validity of the Persian version of the ACE tool: assessing medical trainees' competency in evidence-based medicine

BACKGROUND

Evidence-based medicine (EBM) allows users to integrate evidence into decision-making alongside clinical expertise and patient values. This study aimed to evaluate the reliability and validity of the Persian version of the Assessing Competency in EBM (ACE) tool across knowledge, skills, and attitude.

METHODS

This cross-sectional study was performed on medical residents (first-year residents and junior residents) of Shiraz University of Medical Sciences in 2019. The study instrument was the ACE tool which consists of 15 two-choice questions (yes-no) and each of these questions measures one of four steps in evidence-based medicine (1- asking the answerable question, 2- searching the literature, 3- critical appraisal, and 4- applying the evidence to scenario). This tool was translated into Persian according to international standards. To ensure that the original and translated ACE questionnaire can be matched accurately and conceptuality, content validity index (CVI) and content validity ratio (CVR) were determined. Cronbach's alpha was applied to determine the internal consistency for each scale and Confirmatory factor analysis (CFA) was used to survey the factor structure validity.

RESULTS

One hundred sixty-three questionnaires were studied, selecting 59 first-year medical residents and 104 s-year medical residents. The results showed that using the Persian translation of the ACE tools, the content validity index (CVI) values were equal to or above 0.8 for all items. The content validity ratio (CVR) value was 0.90 for the total scale. The indicators of the confirmatory factor analysis (CFA) for the ACE tool revealed that this model had an acceptable fit. Cronbach's alpha for the overall score was 0.79.

CONCLUSION

The Persian translated version of the ACE tool is a valid and reliable instrument for assessing medical trainees' competency in EBM.

Impact of Peer-Assisted Learning in Chest Tube Insertion Education on Surgical Residents

Objective

To investigate the impact of peer-assisted learning (PAL) in chest tube insertion education on surgical residents.

Methods

This study is a quasi-experimental study conducted on thirty general surgeon residents enrolled in the PAL program. They were divided into two learner groups (A and B) based on the period of residency start. Group A and B had six and one months of general surgery residency experience, respectively. All participants received adequate training for chest tube insertion by a recently graduated general surgeon. Chest tubes insertion skill was assessed using the tool for assessing chest tube insertion competency (TACTIC) test.

Results

Post-TACTIC test score was significantly higher (p=0.001) than Pre-TACTIC test score in both groups. However, a comparison of mean Pre-TACTIC test scores and mean Post-TACTIC test scores between group A and group B showed that PAL effectiveness in group A was significantly higher (p=0.001) than group B.

Conclusion

There was a positive relationship between the PAL program and the improvement of chest tube insertion technical skills in surgical residents. Based on our findings and similar studies, it can be concluded that the PAL program can increase the chest tube insertion skill of surgical residents.

Psychometric properties of the Persian version of System for Evaluation of Teaching Qualities by students: A tool for assessing clinical tutors from students' viewpoint

BACKGROUND

Effective clinical teaching is crucially important for patient care in future. Therefore, proper clinical training is essential to make physicians capable of delivering high-quality health care.

MATERIALS AND METHODS

The present study was a cross-sectional research. After translating the questionnaire into Persian, it was distributed among medical students in the clinical years of medical education in teaching hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences in 2018. The System for Evaluation of Teaching Qualities (SETQ) has 25 questions in a 6-scale Likert scale that evaluates clinical tutors in five dimensions of teaching and learning environment, professional attitude toward students, transferring of goals, evaluation of students, feedback, and promoting self-directed learning. Instrument reliability was assessed by calculating the Cronbach's alpha coefficient, whereas questionnaire content validity was evaluated by relative content validity ratio (CVR) and content validity index (CVI). To evaluate the structural validity, an exploratory factor analysis was conducted.

RESULTS

The SETQ was completed by 127 medical students. Cronbach's alpha coefficient of the total questionnaire was estimated as 0.908. The factor analysis showed that the questionnaire was composed of six factors, explaining 66.14% of the total variance. The CVI and CVR indices of the individual items were also acceptable.

CONCLUSION

The findings of our study showed that the Persian version of SETQ questionnaire had the acceptable reliability and validity to be used in assessing clinical tutors in different hospitals in Iran.

Pathologists' professional lifestyle: Excellence in practice, ethics, education, health promotion, and personal life

For a successful treatment process, the medical team members must be in good physical and mental condition. Pathologists are one of the main modern medicine members that should be consulted in all stages of the treatment procedure. Sixty-six percent of clinical decisions are made based on in vitro diagnosis. Burnout is defined as chronic uncontrolled occupational stress. Burnout has a massive impact on patient safety, quality of treatment, and reduced patient satisfaction. Physician satisfaction with his job affects patient satisfaction and the quality of medical services provided. The most influential factors on quality of life were exercise and physical activity, having leisure time, and not smoking. In different aspects of lifestyle, physicians have scored lower on their physical activity index. One of the most critical pillars of human life is their religiosity. The presence of religious beliefs among physicians is strong. Workload and increased responsibilities are the most effective factors on pathologists' stress. Pathology creates a bridge between basic sciences and clinical sciences. Therefore, promoting pathology education leads to training better physicians. The purpose of compiling this Narrative review is to clarify the issues raised in various aspects of pathologists' lives and provide solutions to improve each of them. There are several solutions to the problems raised in this article: Increasing salaries, improving working conditions, creating a better view of pathologists by avoiding isolation and being more active and visible, and paying attention to medical education. We recommend that researchers review issues in other medical specialties to provide accurate and concise information to physicians and policymakers.

Spatial epidemiology of skin cancer in Iran: separating sun-exposed and non-sun-exposed parts of the body

Background

Skin cancer is among the most common cancer types with an increasing global trend of incidence rate. This study explores the spatial distribution of skin cancer, considering body sites exposed and not exposed to sunshine separately.

Methods

We used 4302 skin cancer cases recorded by Fars Cancer Registry in south-western Iran for over 6 years (2011–2017). The variables included in the study were patients’ residence address, gender, age, report date, and final topographical code. The patients’ addresses were geocoded to the counties of the study area. Skin cancer sites were categorized based on sun exposure in male and female cases. We used the empirical Bayesian smoothing approach to smooth the skin cancer incidence rate at the county level to remove any potential population size bias. Finally, Anselin’s Local Moran’s Index and Getis Ord G* were used to identify the clustered and high-risk skin cancer geographical areas.

Results

The incidence rates had an increasing trend from 14.28 per 100,000 people in 2011 to 17.87 per 100,000 people in 2016, however, it was decreased to 13.05 per 100,000 people in 2017. Out of 4302 patients with skin cancer, 2602 cases (60%) were male. The cancer cumulative incidence rate in males and females who were not exposed to sunshine was 7.80 and 14.18 per 100,000, respectively. The rates increased to 86.22 and 48.20 in males and females who were exposed to the sun. There were some high-risk spatial clusters of skin cancer in the study area. Further investigations are required to identify the underlying cause of the formation of these clusters.

Conclusions

Patients exposed to sunshine, especially among the male group, experienced much higher rates of cancer occurrence as compared to unexposed individuals. With a heterogeneous spatial pattern, hotspots were identified in non-sun-exposed and sun-exposed categories in the study area. Researchers and policymakers can significantly benefit from the spatial analyses of skin cancer incidence. These analyses can provide useful and timely prevention policies as well as tailored monitoring techniques in high-risk regions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00798-2.

The effect of the online flipped classroom on self-directed learning readiness and metacognitive awareness in nursing students during the COVID-19 pandemic

Background

The COVID-19 pandemic has initiated digital developments in higher education while closing in-person university classes. As this crisis continues, the need to revive virtual learning opportunities was seriously felt. The present study was conducted to determine the online flipped classroom’s effect on nursing students’ self-directed learning readiness and metacognitive awareness.

Methods

This quasi-experimental single-group study with pretest-posttest design recruited 34 sophomore students of a nursing school in Lorestan province, Western Iran selected by census according to the inclusion criteria. Online asynchronous learning and online flipped classrooms were used during the semester’s first and second eight weeks, respectively. Students filled out self-directed learning readiness scale and metacognitive awareness inventory online before, in the middle of, and at the end of the semester. Data were analyzed using paired t-test in Stata-14 software.

Results

There was no significant difference between the mean score of metacognitive awareness before and after Online asynchronous learning (P=0.15), but the mean score of self-directed learning readiness increased significantly after OA (P=0.0004). After applying online flipped classrooms, students’ mean (SD) scores of metacognitive awareness and self-directed learning readiness were 272.03 (53.03) and 162.03 (21.77), respectively, which confirmed their significant improvement compared to before the intervention. A comparison of the mean score changes of both methods indicated that their implementation did not lead to significant differences between the mean total score of metacognitive awareness (P=0.15) and the mean total score of self-directed learning readiness (P=0.07).

Discussion

Online flipped classroom approach can be used as an effective method in nursing education by improving self-directed learning and metacognitive awareness, which are essential in online education for nursing students.

The role of educating health-care personnel in prevention, diagnosis, or treatment of COVID-19: A narrative mini review

Front-line clinicians and health-care workers need to be educated to provide care in critical situations such as large-scale catastrophes and pandemics. This narrative review is focused on investigating educational strategies in confrontation with coronavirus disease 2019 (COVID-19) pandemic. We conducted a literature search in December 2020 through LitCovid, PubMed, ERIC, and Cochrane Library in order to retrieve relevant studies regarding the role of education in prevention, diagnosis, and treatment of COVID-19. There were 12 reviewed studies related to this specific subject. The articles selected for this study demonstrated that education and training had a positive impact on the knowledge and attitude of the participants and also the educational interventions, whether they were simulation-based or other formats of training, would be deemed crucial for enhancing participants' level of perceptions and confidence. Therefore, it is highly recommended that public health policymakers consider this important issue.

Distance learning strategies in medical education during COVID-19: A systematic review

The current outbreak of coronavirus disease 2019 (COVID-19) across the world forced universities to suspend learning to limit the spread of the virus. Many medical schools have shifted to online education as an information delivery mechanism where the educator and learner are separated in space and potentially also in time. This systematic review aims to explore and understand the variety of distance learning strategies in medical students in the contexts of COVID-19. A systematic review was conducted in Web of Sciences, PubMed, Educational Resources and Information Center, and Scopus from December 2019 to July 2020. Eight sets of terminology were used, combining "Distance learning" AND "Medical education" AND "Pandemic." Studies were reviewed independently by two reviewers. Data were extracted and quality appraised using QualSyst tools, and synthesized by performing thematic analysis. A total of 473 articles were identified after removing duplicates and 314 records were screened, of which 125 were included in this study. The primary articles were 52 primarily qualitative articles. Five learning strategies consisted of technology-enhanced learning (TEL), simulation-based learning, technology-based clinical education, mobile learning, and blended learning. Tools, methods, and learning resources associated with these five learning strategies were extracted from the articles. Our review highlights that TEL and simulation-based learning were more commonly used than others in distance learning in medical education during the COVID-19 pandemic. These strategies have the potential to improve learners' level of knowledge and performance through making online learning resources such as Massive Open Online Courses, virtual clinical cases, and blended sources accessible.

The effect of integration of basic and clinical aspects of a specific topic in a parasitology course on medical students learning: A randomized controlled trial

BACKGROUND AND AIM

Parasitology course is one of the basic science courses in the educational curriculum for medical students. Since the integration of basic and clinical sciences has helped students better understand the basic science course content, the aim of the present study was to determine the effect of integration of basic and clinical aspects of a specific topic in a parasitology course on medical students learning.

MATERIALS AND METHODS

A randomized controlled trial was conducted on 110 undergraduate fifth-semester medical students from April to July 2018. The students were randomly divided into two groups, based on student identification number: Intervention and control groups. The topic selected for this study from the parasitology course was "cutaneous leishmaniasis." At the beginning of the program, a dermatologist presented the clinical aspects of the topic to the intervention group. Then, a parasitologist delivered a traditional lecture about the basic aspects of the topic to both groups. The students' scores on questions related to cutaneous leishmaniasis in the final exam were used as a measure of learning and teaching outcomes. A questionnaire that consisted of seven items and three open-ended questions was used based on the objectives of the randomized controlled trial. Statistical analysis was performed by SPSS software.

RESULTS

Based on the result of the final examination, there was no significant difference in the learning rate of students between the intervention and control groups (P ≥ 0.05). According to students' comments, the teaching of clinical science alongside basic science increased the importance of the topic and the students' interest in basic science. Most students agreed that this method prepares them for their clinical years.

CONCLUSION

Many medical students believe that the content of many basic science courses are forgotten in the future. Therefore, basic science education alongside clinical science presentations are suggested.

Competencies required for medical students to confront the COVID-19 pandemic: A needs assessment study

BACKGROUND

The outbreak of coronavirus disease 2019 (COVID-19) has turned attention to the essential competencies needed to confront pandemics for a physician. However, medical students, as future physicians, are not adequately trained for such a situation. This study aimed to determine the essential competencies for a medical student to face the COVID-19 pandemic.

MATERIALS AND METHODS

We performed this mixed-method needs assessment study at Shiraz University of Medical Sciences in May-June 2020 in three steps: the first step was a brainstorming session followed by a nominal group technique with the experts' participation. The second step was determining the validity of competencies by calculating the content validity ratio. In the third and last step, three rounds of the modified Delphi technique were held with the participation of 22 medical faculty members and 45 undergraduate medical students to reach a consensus about the competencies utilizing quantitative analysis.

RESULTS

A total of 30 key competencies essential for a medical student were obtained through the current study. They were categorized into four major themes: (1) developing knowledge and abilities for effective diagnosis and treatment of COVID-19, (2) demonstrating safety principles correctly, (3) demonstrating effective behavior, and (4) determining the meta-competencies.

CONCLUSIONS

Although medical students will be the frontline physicians in the future pandemics, they are not prepared to display the diversity of requisite skills to practice effectively and safely. This study provides essential competencies for medical students during the COVID-19 pandemic and underlines the importance of a paradigm shift from traditional time-based to competency-based education.

Assessing empathy in final-year medical students using the Persian version of the Jefferson Scale of Physician Empathy

BACKGROUND

A doctor-patient relationship built on the concept of empathy is so essential to attain the best clinical outcomes in medicine. Since empathy has a positive role in interpersonal relationships and medical outcomes, its assessment is highly crucial. The aim of this study was to assess the empathy in last-year medical students using the Persian version of the Jefferson Scale of Physician Empathy (JSPE) and correlate empathy scores with demographic features.

MATERIALS AND METHODS

In this cross-sectional study, last-year medical students at Shiraz Medical School, Shiraz, Iran, were recruited for this study. In this research, we used the Persian version of JSPE. The validity and reliability of the Persian version of this tool were confirmed in the previous research. For the analysis of data, we employed descriptive statistics and the independent sample t-test.

RESULTS

One hundred and eighty-five final-year medical students were included in this study. The maximum score of the questionnaire was 140, and the total mean score of empathy was 98.15 ± 13.29. The females' total mean score (102.05 ± 11.89) was higher than the males' score (93.57 ± 13.46). The difference between the mean score of gender and empathy was significant (P value <.001), but there was no significant difference between empathy and the two other demographic factors (P > 0.05).

CONCLUSIONS

Although physicians would gain the essential characteristics of empathy during their career, attending professors and other responsible policymakers in medical education should focus more on the factors related to physicians' empathy to train better and more professional physicians.

Study of patients' satisfaction toward photographing their skin lesions for educational purposes

BACKGROUND

Medical images have been widely used for various aims, especially for the educational purposes. Patient confidentiality and consent should be deemed crucial. In this study, we sought to assess patients' satisfaction with taking medical photos of their skin lesions and giving their physicians consent to use them for educational purposes.

MATERIALS AND METHODS

This multi-method study included quantitative and qualitative phases and was performed from April to November 2018 in the Dermatology Department of Shiraz Faghihi Hospital in South Iran. Demographic information was analyzed using the descriptive statistics. To resolve the simultaneous effect of demographic variables on patient satisfaction, we conducted linear regression. All the tests were analyzed at the 0.05 significance level.

RESULTS

In this study, all the patients except one (99.5%) preferred that only a physician who had a direct role in their care can access their digital photos. Of 200 patients, 134 patients (62.33%) preferred the utilization of hospital cameras in photographing their skin lesions (P = 0.002). On the other hand, 131 patients (49.81%) did not gave consent about using a personal phone camera for photographing their skin lesions (P = 0.001). In the qualitative phase, two major themes (trusting attending physician and paying attention to patient confidentiality) and five sub-themes (considering their physicians as professional people who always do the right thing, allowing physicians to use their images for educational purposes, covering patient's face, using hospital cameras, and obtaining informed consent from patients) were derived from qualitative semi-structured interviews.

CONCLUSION

The results showed that there is a need for developing international and national photography guidelines in the era of technology development.

Inappropriate hospital stays and association with lack of homecare services

Background

Efforts to reduce inappropriate hospital stay, including alternatives such as homecare, are important to improve patient care and reduce health care costs.

Aims

This study evaluated inappropriate hospital stay in Shiraz, Islamic Republic of Iran and the extent to which these stays were due to lack of homecare services and others factors needed for homecare.

Methods

This cross-sectional study was conducted between January 2018 and September 2019 at two public hospitals in Shiraz. All adult patients hospitalized in these two hospitals in the study period were included, except patients in mental care wards. Appropriateness of patients' hospital stay was assessed on a daily basis using the Iranian version of the Appropriateness Evaluation Protocol. The chi-squared test was used to assess association between need for homecare and patient characteristics.

Results

Of 6458 hospitalization days assessed (for 1954 patients), 710 (11.0%) days were inappropriate. The greatest proportion of causes of inappropriate stay were physician-related (32.9%). Of the 710 inappropriate hospitalization days, 231 were due to lack of homecare services. Most patients who were inappropriately hospitalized because of lack of homecare services were insured through Salamat insurance (64.0%). A statistically significant relationship was found between the need for homecare services and the type of health insurance (P = 0.01). Of the patients admitted to hospital because of lack of homecare services, 36.8% had endocrine diseases, especially diabetes, and 21.8% needed oxygen services.

Conclusion

Institutionalizing home health care in the Iranian health system could encourage more home health care referral and reduce inappropriate hospitalization, especially for diabetes.

Student support systems for undergraduate medical students during the COVID-19 pandemic: a systematic narrative review of the literature

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has boosted medical students' vulnerability to various problems. Given the stressful nature of medical disciplines, considerable attention must be paid to student support systems during pandemics. This study aimed to review the current literature regarding medical student support systems systematically.

METHODS

We performed a systematic review of six databases and grey literature sources in addition to a hand search in the references of the articles on April 5, 2021. We included all studies about support for undergraduate medical students delivered in response to the COVID-19 pandemic. In conducting this review, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

RESULTS

A total of 3646 articles were retrieved from the databases, and 16 additional papers were extracted from other sources. After removing duplicates, we screened 2434 titles and abstracts according to our criteria. Among them, 32 full-text articles were assessed for eligibility. Ultimately, 10 studies were included for review. We identified two major themes: (a) academic support and (b) mental health support. All of the included studies utilized online methods whether for transitioning from previous support systems or developing novel approaches. Students and faculty members seemed to be receptive to these new systems. Despite indicating outstanding program outcomes, most studies merely described the positive effects of the program rather than providing a precise evaluation.

CONCLUSION

There are several methods of supporting medical students who are experiencing unprecedented changes in their educational trajectory. Due to substantial differences in undergraduate medical education in different regions of the world, cultural and contextual-oriented support is indispensable for developing a safe learning environment. Future research should investigate the question of the extent to which online support can supersede in-person strategies.

Application of community-based nutrition education needs assessment in reviewing the course plan of medical and nursing students

Background: Training needs assessment is the process of recognizing educational needs. This study aimed to apply a community-based nutrition education needs assessment to revise the nutrition course plan in the curriculum of the doctorate of medicine and that of the baccalaureate of nursing.

Methods: The study was designed in 2 phases: (1) nutritional needs assessment; (2) community-based revision of nutrition course plan. In the first phase, 13 nutrition professionals working in the region set out 5 priorities of nutrition-related health problems in the community by a training need assessment based on a survey and scoring system. Then, an expert panel determined the priorities of behavioral and nonbehavioral causes of the nutrition-related health problems by the nominal group technique (NGT). The results of the first phase were used to review the topics of nutrition course plans up to 20%.

Results: The priorities identified in Abadan, Khorramshahr, and Shadegan were obesity and type 2 diabetes mellitus in adults as well as anemia in pregnant women, respectively. Also, wrong eating habits and insufficient nutrition knowledge were among the most important behavioral causes of nutrition-related health problems in the target community. These results were applied to a community-based review of nutrition course plans for medical and nursing students.

Conclusion: The use of nutritional needs assessment approaches by a survey and nominal group technique with a group of professionals provided an opportunity for a community-based review of the nutrition course plan for medical and nursing students as a first phase in the development of a community-based nutrition course plane.

A survey of midwifery graduates' opinions about midwifery education in Iran: a cross-sectional study

BACKGROUND

Attaining high-quality education requires continuous evaluation and revision of the curriculum. The view of the graduate students can provide valuable insight into the necessary evaluations and revisions. Therefore, this study aimed to evaluate the opinions of midwifery graduates about midwifery education in Iran METHODS: This was a descriptive cross-sectional study and the research data were collected through a census sampling procedure from all (82) midwifery graduates of the Nursing and Midwifery School of Shiraz University of Medical Sciences between 2018 and 2020. The data collection instrument was a validated researcher-made questionnaire derived from the Graduation Questionnaire (GQ) developed by the Association of American Medical Colleges (AAMC). The data were then analyzed using SPSS 22.

RESULTS

In this study, about 62% of the graduates were satisfied with the quality of the midwifery education they had received during the four-year program. Moreover, 61% of the graduates maintained that theoretical courses were well-integrated with the clinical experience they needed. The quality of the internships in different wards and departments was also evaluated from the viewpoints of the graduates, and the results indicated that they were relatively satisfied with their internship experiences. However, only 40% of the graduates were satisfied with the quality of their clinical evaluation, since they faced the most significant challenges in the clinical and maternity wards (47%) with the midwifery staff and gynecology residents and found the quality of facilities in the clinical program to be lacking. According to the participants, the quality of teaching was not good for some courses such as biochemistry and microbiology.

CONCLUSION

It seems that the midwifery curriculum needs to be constantly revised, aiming to improve student satisfaction with their midwifery education. Some effective measures in this regard are employing experienced professors, developing cooperation between midwifery instructors and clinical departments, and trying to improve the educational environment. Attention to the improvement of facilities and equipment and agreement between the content of the theoretical education and practical topics are also recommended to improve the quality of midwifery education.

Context, Input, Process, and Product Evaluation Model in medical education: A systematic review

BACKGROUND

Evaluation is one of the most important tools for determining the quality of any educational program, which can lead to reformation, revision, or termination of programs. Quality in higher education requires assessment and judgment of goals and strategies, executive policies, operational processes, products, and outcomes. The Context, Input, Process, and Product (CIPP) model is a comprehensive perspective that attempts to provide information in order to make the best decisions related to CIPP. Due to the importance of this topic, the present study examined the application of the CIPP model in the evaluation of medical education programs through a systematic review.

MATERIALS AND METHODS

In this systematic review, Persian databases including ISC, SID, Mag Iran, CivilicaL, and Noormags and English databases including PubMed, Web of Science, Scopus, ProQuest Dissertations, Embase, CINAHL, ERIC, and Google Scholar were searched using relevant keywords, such as evaluation, program evaluations, outcome and process assessment, educational assessment, and educational measurements. The search was done with no time limits and 41 papers were obtained until May 22, 2020. This systematic review was performed by following the data extraction steps and assessing the quality of the studies and findings. Critical Appraisal Skills Programs and Mixed-Methods Appraisal Tool checklists were used to check the quality of the papers.

RESULTS

This systematic review was conducted on 41 studies, 40 of which were research papers and one was a review paper. From the perspective of the CIPP model of evaluation, most papers showed quite a good level of evaluation of educational programs although some studies reported poor levels of evaluation. Moreover, factors such as modern teaching methods, faculty members, financial credits, educational content, facilities and equipment, managerial and supervisory process, graduates' skills, produced knowledge, and teaching and learning activities were reported as the factors that could influence the evaluation of educational programs.

CONCLUSION

Due to the important role of evaluation in improvement of the quality of educational programs, policymakers in education should pay special attention to the evaluation of educational programs and removal of their barriers and problems. To promote the quality of educational programs, policymakers and officials are recommended to make use of the CIPP model of evaluation as a systemic approach that can be used to evaluate all stages of an educational program from development to implementation.

Challenges and opportunities from the COVID-19 pandemic in medical education: a qualitative study

INTRODUCTION

Since the onset of the COVID-19 pandemic, many higher education and health centers have faced challenges. Educational leaders have tried to manage the new situation, but the human infrastructure was not ready for such an event. This study aims to explain the challenges and opportunities of the COVID-19 pandemic for medical education.

METHOD

This qualitative study used conventional content analysis to collect data from face-to-face and semi-structured interviews. The interviews continued until data saturation was reached. The participants were 12 students and 14 faculty members at Shiraz University of Medical Sciences. To ensure data rigor, we used member checks, peer checks and an external observer.

RESULTS

Three main categories and 15 subcategories were extracted. The findings showed that four subcategories, e.g. perception on feasibility of e-learning, standardizing of e-learning, dedicated teaching, and networking and interdisciplinary collaborations, affected the development of medical e-learning. The main opportunities from the COVID-19 pandemic for medical education were classified into five subcategories: attitudes to e-learning and adaptability, preventing students' separation from the educational environment, documentation and monitoring education, take control of own learning, and increasing perceived usefulness. The main challenges were divided into four subcategories, e.g. noncompliance with virtual classroom etiquette, inadequate interactions, time limitations, and infrastructure defects and problems. Finally, participants believed that methods of evaluation in e-learning were more suitable for diagnosis and formative evaluations. Generally, two subcategories were extracted, e.g. formative and summative.

CONCLUSION

Medical schools have necessarily moved towards e-learning to compensate for the interruption in classroom education, such that traditional classes have been replaced with e-learning. These rapid, extensive changes in teaching and learning approaches have consequences for medical schools.

Teaching clinical reasoning to undergraduate medical students by illness script method: a randomized controlled trial

BACKGROUND

The illness script method employs a theoretical outline (e.g., epidemiology, pathophysiology, signs and symptoms, diagnostic tests, interventions) to clarify how clinicians organized medical knowledge for clinical reasoning in the diagnosis domain. We hypothesized that an educational intervention based on the illness script method would improve medical students' clinical reasoning skills in the diagnosis domain.

METHODS

This study is a randomized controlled trial involving 100 fourth-year medical students in Shiraz Medical School, Iran. Fifty students were randomized to the intervention group, who were taught clinical reasoning skills based on the illness script method for three diseases during one clinical scenario. Another 50 students were randomized to the control group, who were taught the clinical presentation based on signs and symptoms of the same three diseases as the intervention group. The outcomes of interest were learner satisfaction with the intervention and posttest scores on both an internally developed knowledge test and a Script Concordance Test (SCT).

RESULTS

Of the hundred participating fourth-year medical students, 47 (47%) were male, and 53 (53%) were female. On the knowledge test, there was no difference in pretest scores between the intervention and control group, which suggested a similar baseline knowledge in both groups; however, posttest scores in the intervention group were (15.74 ± 2.47 out of 20) statistically significantly higher than the control group (14.38 ± 2.59 out of 20, P = 0.009). On the SCT, the mean score for the intervention group (6.12 ± 1.95 out of 10) was significantly higher than the control group (4.54 ± 1.56 out of 10; P = 0.0001). Learner satisfaction data indicated that the intervention was well-received by students.

CONCLUSION

Teaching with the illness script method was an effective way to improve students' clinical reasoning skills in the diagnosis domain suggested by posttest and SCT scores for specific clinical scenarios. Whether this approach translates to improved generalized clinical reasoning skills in real clinical settings merits further study.

Implementation and evaluation of extracurricular theme for undergraduate basic sciences medical courses at Shiraz Medical School

BACKGROUND

In recent years, to achieve the fundamental goal of educating meta-competent future medical doctors, varieties of educational methods have been proposed in all medical schools. In Shiraz Medical School, we implemented an extracurricular theme focusing mostly on medical education's psychosocial aspect. This study aims to discuss the implementation and evaluation of this extracurricular theme.

MATERIALS AND METHODS

The present study is a descriptive-analytic one; we included all undergraduate medical students in basic sciences courses who started medical education in 2014 and 2015 in Shiraz Medical School. The evaluation tools were questionnaires designed in different formats and handed out to medical students before and after the workshops. Data were analyzed by paired sample t-test in SPSS Software Version 23.

RESULTS

Students' satisfaction was more than 60% in all items of all workshops, except in some items of studying and learning methods and research methods workshops, which were lower than 60%. Students' knowledge about all aspects of communication skills, stress management, critical thinking, studying and learning methods, and research methods workshops improved significantly after participation in these workshops.

CONCLUSIONS

Medical students can become meta-competent future medical doctors. They can reach all of the learning outcomes described in the three-circle model of learning. This goal cannot be achieved by implementing a medical curriculum which only contains medical literature. Some extracurricular issues based on students' and societies' requirements must be added to the main curriculum. The whole curriculum must be evaluated continuously, and required changes must be applied.

Psychometric properties of the Persian version of bedside teaching (BST) Instrument

INTRODUCTION

Bedside teaching plays a crucial role in acquiring essential clinical skills. Therefore, the main aim of this study is assessing the validity and reliability of the Persian version of German bedside teaching (BST) instrument. This instrument was specially developed for evaluation of bedside teaching.

METHOD

The present cross-sectional study was conducted on 150 last year medical students, using convenience sampling. The Persian version of the bedside teaching (BST) was used for data gathering. To calculate the reliability of the questions, Cronbach's alpha was used and to determine the construct validity of the questionnaire, confirmatory factor analysis was used. All analyses were performed in LISREL 10 and SPSS 21 software.

RESULTS

Cronbach's alpha indicated excellent reliability for each subscale (α =0.77-0.85). All of the value of the questions are more than a significant number of 1.96 and concluded to be significant. There was an acceptable fit between the hypothetical model and the data and all comparative fit indices (CFI, NFI, RFI, IFI) showed good model fitness. BST is a valid and reliable instrument for the assessment of clinical teaching at bedside. It has 18 items with 5 point Likert scales.

CONCLUSION

The findings suggest that the Persian version of the BST questionnaire is a valid and reliable tool for the evaluation of teachers and providing feedback in a clinical setting. However, more studies should be conducted in other cities in Iran.

A qualitative content analysis of "problem students": how can we identify and manage them?

Objectives

Problem students is one of the important issues in medical education. This study aimed to identify the problem students and the ways for managing these students from the educational experts view. Purposive sampling was used, and data collection continued until data saturation was achieved. Data analysis was performed by the content analysis method based on the Heidegger approach. We interviewed 12 educational experts who had a history of dealing with "problem students”.

Results

After data analysis, five main themes and 28 categories, and 164 codes were extracted. The reasons for changing a student to a problem students was: student self-regulation skills, multilayer interactions, curriculum failure, identification policy and supportive solutions. The results indicated that despite revision in the curriculum, there were shortcomings in identification and management of problem students. According to participants, existence of a comprehensive system and a capable counseling center can identify the problem student sooner. On the other hand by improving self-regulation skills, active teaching methods and frequent formative evaluation and the use of supportive strategies, problem student can be encouraged to complete their education successfully. This study emphasized faculty development, reviewing the faculty member recruitment, strengthening counseling centers, improving the exams.

The predictive role of personality traits on academic performance of medical students: The mediating role of self-efficacy

Background: Determining the variables influencing students’ academic performance is one of the main preoccupations in medical colleges. Therefore, this study examined the effect of the Big Five personality traits on medical students’ academic performance, considering the mediating role of self-efficacy.

Methods: We applied a cross sectional research design using a PLS-SEM approach. A total of 249 medical students participated in this study. Two valid and reliable questionnaires, including Big Five Inventory (BFI-10) and New General Self Efficacy (GSE) were used. Data were analyzed using both SPSS 18 and PLS2 software.

Results: The validity and reliability of the questionnaires were confirmed by confirmatory factor analysis. The results revealed that openness (β= 0.16, p<0.001), conscientiousness (β=0.22, p<0.001), agreeableness (β=0.19, p<0.001), and self-efficacy (β=0.24, p<0.001) had a significant positive and direct effect on academic performance. Neuroticism (β=-0.21, p<0.001) had a significant negative and direct effect on academic performance. Also, openness (β=0.47, p<0.001) and conscientiousness (β=0.33, p<0.001) had a direct positive effect on self-efficacy. Neuroticism (β=-0.15, p<0.001) had a direct negative effect on self-efficacy. Moreover, the results showed an indirect positive effect of conscientiousness (β=0.08, p<0.001) and openness (β=0.11, p<0.001) on academic performance through self-efficacy. In addition, the results showed that neuroticism (β=-0.03, p<0.001) had an indirect negative effect on academic performance through self-efficacy.

Conclusion: This study discovered the relationships between personality traits, self-efficacy, and academic performance of medical students. The results showed that individual differences in personality traits directly and indirectly play an essential role, through self-efficacy, in contributing to the students’ academic performance.