Clearing the confusion about post-accreditation monitoring, meta-evaluation and meta-accreditation

We have recently published the experience of the accreditation body of undergraduate medical education in Iran on developing and validating standards based on the WFME framework (Gandomkar et al., BMC Med Educ 23:379, 2023). Agabagheri et al. extended our work and proposed a blueprint for post-accreditation monitoring based on their experience in developing an official guide in their Matters Arising (Aghabagheri et al., BMC Med Educ). The authors have used post-accreditation monitoring as a process of monitoring and controlling accreditation activities, procedures often referred to as meta-evaluation or meta-accreditation (depending on the objectives of evaluation) in the literature. On the contrary, post-accreditation monitoring alludes to the process of continuous quality improvement of educational programs after accreditation. We would like to make clarifications between post-accreditation monitoring, meta-evaluation and meta-accreditation which have been used interchangeably in their paper. Considering the emerging interests in scholarship and non-scholarship activities and reports in undergraduate medical education accreditation, this clarification provides a better understanding of the roles of these crucial concepts in the accreditation process.

A systematic review of faculty development programs based on the Harden teacher's role framework model

BACKGROUND

Despite the changing roles of faculty in the health professions over the past two decades, none of the reviews has been paid enough attention to the impact of the faculty development programs on these roles. The objective of this review is to synthesize the existing evidence that addresses the questions: "What are the types and outcomes of faculty development programs based on the Harden teachers' role framework and which of the areas described by Harden and Crosby are the authors referring to?"

METHODS

This review was conducted according to the guidance for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. In 2020, a literature search was conducted in MEDLINE/PubMed, Scopus, ERIC, ScienceDirect, Google Scholar, Magiran and SID databases. The review included 119 studies (between 1990 and 2020) that met the review criteria. Data were extracted using a modified coding sheet. We used the modified Kirkpatrick model to assess the educational outcomes of faculty development programs.

RESULTS

The majority of faculty development programs were workshops (33.61%) with various durations. Most programs focused on the domain of information provider and coach (76.47%), followed by the facilitator of learning and mentor (53.78%) and assessor and diagnostician (37.81%). Only five faculty development programs focused on the domain of role model. The majority (83.19%) of outcomes reported were at level 2B, level 1 (73.95%) and level 2A (71.42%). Gains in knowledge and skills related to teaching methods and student assessment were frequently noted. Behavior changes included enhanced teaching performance, development of new educational curricula and programs, improved feedback and evaluation processes, new leadership positions, increased academic output and career development. The impact on the organizational practice continued to be underexplored.

CONCLUSION

Based on the review findings, broadening the scope of faculty development programs beyond the traditional roles of the faculty members by utilizing a competency-based framework for developing a comprehensive faculty development program is recommended. Attention to individualized form of faculty development programs and incorporating more informal approaches into the design and delivery of faculty development programs is also needed.

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.

The impact of a three-phase education-support-follow-up program on the mothers' perceptions of the needs of their multiple infants: A protocol study for a clinical trial

BACKGROUND

Infertility, a problematic issue to the newly married couples, should be treated as no couple should be deprived of having children. The treatment, however, poses new challenges to the multiples and subsequent preterm births, health system, and families. Therefore, the aim of this study is to investigate the effect of an education-support-follow-up program on the mothers' perceptions of their multiples' needs.

MATERIALS AND METHODS

This research is a three-phase interventional study. The first phase develops an educational program through review of the literature and using the opinions of experts. In the second phase, the developed program will be implemented in the neonatal intensive care unit (NICU) for the mothers of multiples. In the third phase, based on the developed plan, the required support will be applied and followed up. The data collection tool is a researcher-made questionnaire which is completed by the mothers (N = 30) before and after the intervention. Convenience sampling method will be used, and the mothers will be allocated randomly. Data gathering started from September 2020 and would continue until the sample collection is completed. Data will be analyzed through the descriptive and analytical statistics with Statistical Package for the Social Sciences (SPSS) version 21.

RESULTS

The present study can address the needs of the multiple infants based on the implementation of an education-support-follow-up program for mothers and their families.

CONCLUSION

The mothers of multiple infants are required to specify unique physical and developmental needs of their infants, while their perceptions of these needs may be different based on the education-support-follow-up program. The researchers designed the program to help them define highly specialized needs of multiples and also examined their perceptions of these needs.

Design, implementation, and evaluation of self-care program in the prevention of breast cancer among women in Isfahan: a community-based participatory action research protocol

Introduction

Breast cancer is one of the most prevalent cancers among women in Isfahan, Iran; however, its prevention is not desirable in this city. This disease poses several health, social and economic challenges for women. To promote women's self-care in breast cancer prevention, this study aims to design, implement and evaluate a self-care program among women in Isfahan through using a community-based participatory action research method.

Methods

The present study is based on a community-based participatory action research approach. In this study, the participatory action research includes four general phases of organizing, action planning, action, and rethinking. These phases are summarized as follows: In the organizing phase, the needs of the participants and the action research settings are examined. This means that the current situation is identified and the views of the process owners are assessed. In the action planning phase, using the results of the first phase, some strategies are designed to promote self-care behaviors in the prevention of breast cancer among women in Isfahan. In the implementation phase, the selected strategies are implemented with the help of the process owners. Finally, in the rethinking phase, the results of the implementation of the strategies are monitored and evaluated. This cycle continues until the intended results are achieved.

Discussion

Changing the role of individuals from a passive status to an aware and active status in the care process requires motivation, responsibility, and active participation of individuals in the disease control process. Moreover, many cultural and social factors affect the active participation of Iranian women. Therefore, individuals can be involved in promoting their health using a community-based participatory action research approach.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40695-022-00077-8.

Isfahan COVID cohort study: Rationale, methodology, and initial results

BACKGROUND

The Isfahan COVID Cohort (ICC) study was designed to investigate the short- and long-term consequences of patients with COVID-19 in Iran. This report presents the rationale, methodology, and initial results of ICC.

MATERIALS AND METHODS

ICC is a 5-year multicentric prospective cohort study that is ongoing on two groups including 5000 patients hospitalized with moderate or severe and 800 nonhospitalized patients with mild or asymptomatic COVID-19 in Isfahan. The ICC endpoints are morbidity, mortality, incident cases, or worsening of underlying noncommunicable diseases (NCDs) and their risk factors. In the current analysis, we examined the persistent symptoms and incident NCDs or risk factors in 819 previously hospitalized patients who completed 1-year follow-up.

RESULTS

The two most common symptoms were joint pain/myalgia (19.7%) and dry cough/dyspnea (18.7%). Around 60% of patients had at least one symptom which was more common among women than men and in middle aged than younger or older patients. Female (odds ratio [OR] =1.88, 95% confidence interval [CI]: 1.39-2.55) and highly-educated patients (OR = 2.18, 95% CI: 1.56-3.04) had higher risk of having any symptom in 1-year follow-up. New cases of hypertension followed by diabetes then coronary heart disease (CHD) were the most common incident NCDs.

CONCLUSION

During 1-year follow-up after hospital discharge, about 60% of patients experienced persistent symptoms. Incident hypertension, diabetes, and CHD were the most common events seen. Close monitoring and extensive health services with integrative approaches are needed to improve the health status of these patients.

Noncommunicable disease, clinical course and COVID-19 prognosis: results based on I-CORE Registry

Background

There are no data on the association between clinical course and comorbidity in Iranian patients with COVID-19.

Aims

To determine noncommunicable disease (NCD), clinical characteristics and prognosis of patients hospitalized with COVID-19 in Isfahan, Islamic Republic of Iran.

Methods

This multicentric retrospective observational study was performed on all patients hospitalized with COVID-19 in Isfahan from 17 February to 6 April 2020. We recruited 5055 patients. Data on clinical course and comorbid NCDs such as hypertension, coronary heart disease (CHD), diabetes mellitus (DM), cancer, chronic kidney disease (CKD) and chronic respiratory disease (CRD) were collected. Statistical analyses were done by Mann-Whitney U, χ² and logistic regression tests using Stata version 14.

Results

DM and hypertension were the most prevalent comorbidities in patients with positive and negative reverse transcription polymerase chain reaction (RT-PCR). Odds ratio (95% confidence interval) of mortality-associated factors was significant for DM [1.35 (1.07-1.70)], CHD [1.58 (1.26-1.96)], CRD [2.18 (1.58-3.0)], and cancer [3.55 (2.42-5.21)]. These results remained significant for cancer after adjustment for age, sex and clinical factors. Among patients with positive RT-PCR, death was significantly associated with CRD and cancer, while this association disappeared after adjustment for all potential confounders. There was a significant association between NCDs and higher occurrence of low oxygen saturation, mechanical ventilation requirement and intensive care unit admission after adjustment for age and sex.

Conclusion

The presence of NCDs alone did not increase mortality in patients with COVID-19, after adjustment for all potential confounders including clinical factors.

A narrative review of psychomotor abilities in medical sciences: Definition, categorization, tests, and training

Extensive research in the past decades has evidenced differences in the psychomotor ability of individuals resulting from varying levels of experience, age, gender, response precision, compatibility, performance, and ability. Many studies have called for the need to identify psychomotor ability and appropriate tests that can assess it. This review article surveys the definition, categorization, and tests of psychomotor ability as well as training based on psychomotor ability in medical sciences. We searched the literature with no time limit, using the ProQuest, PubMed, and Eric databases, as well as the Google Scholar search engine. The keywords for the search involved psychomotor, psychomotor performance, assessment, psychomotor ability, motor learning, education, training, psychomotor ability testing, and psychomotor skills. Other relevant papers found through hand searching and snowballing were also included in the review. The EndNote X8 was employed as a reference manager tool. Only abstracts of the papers whose full texts were accessible were reviewed after repetitious papers were excluded. The documents were categorized into five groups: definition of psychomotor skills and ability, psychomotor ability components, psychomotor ability tests, identification of psychomotor ability (task analysis), and training. This review article revealed that there is not a single definition for psychomotor ability and its components. However, it can be said that motor abilities are the foundation for the rapid acquisition of skills and according to the neuroplasticity process are learned through training and practice. Given psychomotor abilities vary among individuals, training courses should also provide different levels of psychomotor training for learners. The literature introduces psychomotor tests as a selection tool, a predictor of future professional behavior, and a means to evaluate progress in performance, academic guidance (ability-oriented medical specialty), and curriculum implementation tailored to the needs of learners of varying graduate disciplines. The tests should be profession-specific because each profession entails its peculiar characteristics and abilities. On the other hand, the major problem in studying and analyzing underlying psychomotor skills and abilities is that the components are being investigated by researchers from varying, and usually unrelated, scientific fields. Therefore, it is necessary to have a holistic view through close interaction between the researchers of different sciences to better understand this area.

Psychomotor abilities in diagnostic upper gastrointestinal endoscopy derived from procedural task analysis techniques and expert review

BACKGROUND

Any prediction of a person's ability to succeed in a motor skill depends on the detection and accurate measurement of the basic abilities for the performance of that skill. Task analysis is needed to determine the psychomotor skills and abilities required to perform an action. This study aimed to determine the components of psychomotor abilities for diagnostic upper gastrointestinal (GI) endoscopy through procedural task analysis (PTA) and expert review.

MATERIAL AND METHODS

A multisource, multimethod task analysis was conducted in six metropolitan teaching hospitals affiliated with the adult gastroenterology and hepatology training centers in the Islamic Republic of Iran in 2019. Observation, video-recording, and think-aloud protocols were used while diagnostic upper GI endoscopy was performed. To confirm the accuracy of the PTA, the incorporated the views of the adult gastroenterology and hepatology subspecialty experts through the checklist of PTA assessment criteria. Finally, to determine the psychomotor abilities for each stage of the procedure, the study incorporated a panel of experts from occupational therapy, physical education, physical medicine, and adult gastroenterology and hepatology subspecialty.

RESULTS

Of the 15 psychomotor abilities examined, 11 were determined for upper GI endoscopy procedure, of which six cases (including visuospatial and perceptual abilities, hand-eye coordination, multilimb coordination, finger dexterity, arm-hand steadiness, and manual dexterity) were the most frequent.

CONCLUSIONS

PTA techniques and subsequent expert review were used to identify the components of psychomotor abilities for diagnostic upper GI endoscopy. It is suggested that PTA is performed for other procedures, and after psychomotor abilities are specified, proportional tests are developed.

An analysis of the challenges in recruiting clinical teachers in Iranian medical universities: A qualitative analysis

BACKGROUND

Employing appropriate and deserving staff is goal of human resource management (HRM). A group of staff at medical science universities are clinical teachers. Considering the position and importance of these peoples, this study addresses the challenges of recruiting clinical teachers.

MATERIALS AND METHODS

This is a qualitative study of the conventional content analysis done in Isfahan medical university in 2018. The participants were selected through intensity sampling of purposive sampling method, and data were obtained through semi-structured interviews conducted to survey 23 experts and clinical faculty members concerning the challenges involved in employing clinical teachers. Data were analyzed using conventional content analysis method and OneNote 2013.

RESULTS

Two main categories and ten subcategories were classified as follows: HRM inadequacy in educational departments with six subscales such as indefiniteness of the workforce status for HR managers, reluctance of educational departments to increase human resources, nonproportionality of the teacher-student ratio, recruitment of faculty based on the needs in the treatment sector, weakness of the infrastructure to use nonfaculty teachers, and reduced public interest in employment as a faculty and weakness of the selection process with four subscales based on data analysis such as undesirable manner of selection, recruitment based on the score given by the national board of medical examiners, purpose-based calls to recruit predefined individuals, and personal and emotional issues, rather than managerial standards, governing cooperation with teachers.

CONCLUSION

Recruitment process is part of HRM tasks. Employment system in a medical sciences university must be considered to improve the clinical faculty recruitment. HRM inadequacy in educational departments and weakness of the selection process are challenges that affect the employment system. According to these findings, it is necessary to review the regulations and tasks of HRM in medical sciences universities.

Management of Comprehensive Care of multiple-birth infants from fetal to infancy period: challenges, training, strategies

Background

Prematurity escalates the crisis of the infants a susceptible group of the society. Multiple delivery further intensifies the susceptibility of both family and health system. A comprehensive care is, thus, necessary to ensure the optimal growth and development of such multiple-births. Accompanied by trainings, challenges, and strategies, the present study was conducted based on a two-year report of comprehensive care management experience on two sets of multiple infants.

Methods

A qualitative case study approach was used to survey these two sets of premature infants (quadruplet and quintuplet) and their families. The data were collected through medical files, interviews, questionnaire, field presence, phone call and WhatsApp application, and continued follow-ups. Content analysis was performed based on survey and interventions during a period of two years in Isfahan, Iran (2018–2020).

Results

Case presentation and comprehensive care management are the main areas resulted from this study. The results of the study were categorized in eight challenging areas (categories) and strategies including sterility and infertility period, transition from the intrauterine to neonatal intensive care unit (NICU), discharge process, physical and developmental status, home visit and home care, development of care plan, socio-economic support, and coronavirus nightmare.

Conclusion

Based on challenges and strategies during these two years, the situation of the multiple-birth infants and their families’ needs should be identified as the first prerequisites in an inter-professional approach and in collaboration with the health providers. Isfahan University of Medical Sciences, Welfare Organization, and the charities were the parties involved with this process in our study. It was also found that developing a separate specific package of comprehensive care management plan for multiple-births is a necessity.

Exploring medical ethics' implementation challenges: A qualitative study

BACKGROUND

Adherence to medical ethics principles by medical professionals is required to improve health-care system's quality. Recognizing medical ethics' challenges and attempting to resolve them are important in the implementation of medical ethics in practice. This study aimed to explore such challenges at Iran's medical sciences universities in 2018.

MATERIALS AND METHODS

This descriptive, qualitative study utilized a conventional content analysis approach for data analysis. This study was conducted using purposeful sampling from participants with experience in teaching or practicing of medical ethics field, and by considering maximum variety of disciplines (e.g., gynecology, internal medicine, surgery, and medical ethics). The data were gathered using semi-structured interviews. The interview guide was designed based on previous research findings by two members of the research team and contained the main interview questions and participants had the opportunity to express their perspectives in detail. Participants were chosen from clinical and ethical faculty members as well as managers. The data collection process continued until the data saturation stage, beyond which no new information or concept achieved by continuing interviews.

RESULTS

After interviewing 14 faculty members and managers, findings were classified into 4 themes, 9 categories, and 42 sub-categories; four main categories of medical ethics challenges are affected by cognitive, educational, practical, and structural factors, respectively.

CONCLUSION

This study suggested that medical ethics' cognitive and educational challenges can alleviate using educational programs intended for improving qualitative and quantitative aspects of medical ethics teaching for medical professionals ranging from students to faculty members. Medical ethics' structural and practical challenges are within policymaking and scheduling activities dealt with through future researches by health-care system's managers and planners.

Research utilization process model: A cyclical, spiral, and developmental process to provide conclusive research knowledge in health professions education

Background: Research utilization plays an important role in evidence-based practice. Health professions education is a research-based discipline. Conclusive research knowledge is ranked as high level of evidence in evidence-based practice. This study was conducted to develop a model to reach conclusive research knowledge in health professions education.

Methods: This study was conducted in 2 phases. In the first phase, a qualitative content analysis of the literature was performed, which provided research utilization concepts to design a model. In the second phase, a group of 5 consultants of health professions education designed a preliminary model and revised it to develop an appropriate model for research utilization in health professions education.

Results: The indicators mentioned in 24 documents were extracted and later categorized into 25 items. Then, 8 concepts emerged, including problem identification, research design and implementation, research reports, research publication, presentation, research access, adoption, and research use. These concepts were arranged to design a model for research utilization in health professions education.

Conclusion: This study illustrated a cyclical, spiral, and developmental model to reach conclusive research knowledge. This model emphasizes both primary and secondary research projects to reach conclusive research knowledge. Also, it distinguishes between aligned transfer and cooperative presentation in research knowledge dissemination. This model reveals the importance of the process use in health profession education. Also, it distinguishes between use and misuse of research findings.

Clinical instructors' recruitment callenges: Interpretive Structural Modeling approach

CONTEXT

Universities of medical sciences are responsible for educating and training human resources (HRs) that provide services to all members of the community. Clinical educators play a significant role in the promotion of health and education in medical sciences universities.

AIMS

The aim of this study was to prioritize and develop a model to illustrate the relationship between faculty recruitment challenges in medical sciences universities.

SETTINGS AND DESIGN

Interpretive structural modeling (ISM) is a system design method initially introduced by Warfield (1974). This method helps create order in the complex interconnections between components of a system by interpreting the opinions of a group of experts. It both determines the priority of elements influencing one another and uncovers the association between the elements of a multipart set in a hierarchical structure.

SUBJECTS AND METHODS

In this method, the identified challenges were built into a paired comparison questionnaire to be completed by policymakers and experts. By the same token, the obtained results were analyzed with the ISM technique.

STATISTICAL ANALYSIS

The four steps include identified variables related to the issue, structural self-interaction matrix, initial reachability matrix, and final reachability matrix was used for analysis. According to these steps, the ISM model was portrayed.

RESULTS

The ISM model was developed in ten levels that divided into three parts including key challenges, strategic challenges, and dependent challenges.

CONCLUSION

Health promotion and quality of education in medical sciences universities is dependent on quality of faculty recruitment system. According to the results, it is imperative that HR managers and policymakers improve existing rules and develop policies to solve the challenges in this area.

Isfahan COvid-19 REgistry (I-CORE): Design and methodology

Health authorities usually exploit after-action reports to collect data on their experience in responding to public health emergencies. To develop an effective approach to manage and learning from health emergencies, we have launched Isfahan COvid-19 REgistry for data collection during routine clinical care as a first “critical incident registry” in Iran. Registries can be employed to explain the natural history of the disease, learn about a particular disease in terms of patient outcomes, the cost-effectiveness of clinical management, monitoring the quality of health-care service, and developing research hypotheses.

How to develop an undergraduate medical professionalism curriculum: Experts' perception and suggestion

INTRODUCTION

Medical professionalism as a main ability of physicians is very important just like its teaching and learning. This study investigated medical professionalism experts' perspectives and experiences about professionalism as a step towards developing a medical professionalism curriculum.

METHODS

A qualitative approach was adopted for this study. The data were obtained from 10 semi-structured interviews with medical professionalism experts with a variety of experiences in Iran between June and September, 2016. All sessions were audio-recorded, transcribed and analyzed using inductive content analysis.

RESULTS

The participants expressed their experiences on professionalism and its features. The data analysis revealed two main categories: 1) teaching and learning strategies including three categories of learning outcome, teaching and learning and evaluation of medical professionalism, 2) role of context with three sub-categories of rules and regulations to develop professionalism, strengthening the hidden curriculum and executive resources.

CONCLUSIONS

To address the development of professionalism in medical students, the main factors, i.e., teaching and learning strategies and context with their categories and subcategories should be considered and revised. To sum up, designing a formal medical professionalism curriculum would be necessary and the notion of professionalism must be integrated with all its phases. Employing effective learning and assessment methods by means of qualified teachers and staff in a supportive learning environment provides students with valuable experiences and facilitates the process of teaching.

The challenge of planning learning opportunities for clinical medicine: a triangulation study in Iran

BACKGROUND

An essential characteristics of clinical education is the need to learn a large number of practical and communication skills along with theoretical knowledge. It is challenging to design learning opportunities (LOs) for clinical setting. We aimed to determine optimal learning opportunities from the viewpoint of Medical curriculum planners, to determine the gap between the current condition and the optimal condition in medical schools, and to present feasible tactic for clinical learning opportunities.

METHODS

This study comprised of three sub-studies and was conducted using triangulation. The first sub-study was performed using the Modified Delphi method with a view to identifying optimal learning opportunities. Data was collected by online focus group discussion and a questionnaire. The second sub-study was conducted with the aim of comparing the current condition and the optimal condition. Data was collected from nine medical schools across Iran using a checklist, available documents, observation, and interview. The third sub-study was conducted using an expert panel comprising of seven curriculum planners of the M.D.

PROGRAM

The goal of this phase was to provide feasible tactic to improve clinical education in medical schools.

RESULTS

In the first sub-study, the participants determined all items, including student-centered learning, non-threatening learning environment, and record and management system of clinical learning opportunities as implementable learning opportunities with over 70% consensus. However, in the second sub-study, student-centered teaching methods were practiced in 33% of medical schools and the non-threatening learning environment in 67% of the schools, while the record and management system of learning opportunities was not launched in any of the schools. From the viewpoint of the expert panel members, learning opportunities adapted to clinical contents, specification of content-based learning opportunities, and continuous supervision on learners to achieve the expected learning outcomes were among clinical learning opportunities with over 70% consensus.

CONCLUSIONS

Student-centered clinical learning practices, together with virtual learning methods, can lead to clinical enhancement. Opportunities such as interactive and participatory practices should gain further consideration. Also assigning responsibility to learners and monitoring them are strategies for enhancement.

The analysis of the trend of educational system in orthotics and prosthetics in Iran and the world: A step toward the foresight

Background:

Along with the growth of science and technology, the orthotics and prosthetics (O and P) have been changing since the past as a dynamic profession and the role of a specialist in O and P has also undergone a change due to needs of society and the growth of technologies. To illustrate the future direction of an educational system, it is necessary to have a trend analysis of what weaknesses and strengths have existed in the past and the present.

Materials and Methods:

In this analysis, two methods of scoping review and interview were conducted. For the purpose of scoping review, database searches of PubMed, ERIC, SID, and Web of Science in combination with a search on websites of key organizations, including universities, World Health Organization, and International Society of O and P were conducted.

Results:

Various trends have been formed from different aspects in the health education system due to multifaceted nature of the O and P. The areas include health and education services, technology, curriculum, educational programs, and accreditation.

Conclusion:

The debate on monitoring and evaluation of O and P educational systems has been also developed along with the progress made in the training of O and P. The training of individuals by setting minimum standards leads to a professional competency in line and is considered as other issues arisen in the field of education; however, in recent years, improvements in this field have not been significant.

Curriculum management/monitoring in undergraduate medical education: a systematized review

BACKGROUND

Monitoring and management of undergraduate medical education (UME) curricula are crucial contributors to successful medical education. This systematized review explores the different approaches that medical schools have to UME curriculum management or monitoring in order to provide a basis for curriculum managers.

METHODS

PubMed, Science Direct, Scopus, and ERIC were searched with no time limitation using the keywords curriculum, medicine, management, monitoring, and alignment. Advanced search options and Boolean operators 'AND' and 'OR' were also used to find more relevant records.

RESULTS

From a total of 673 records, 14 articles along with 7 papers from hand searching and snowballing were included in the review. Documents were categorized into 3 groups of UME curriculum management: developing computerized tools, surveying curriculum stakeholders and reviewing curriculum documents, and introducing managerial structures.

CONCLUSIONS

Different approaches are reported for UME curriculum management/monitoring at different levels. Managerial structures and computerized tools are most frequently used at the college level because of the large number of faculty members who are responsible for the UME curriculum delivery and the large amount of complex curriculum information. Surveys and reviews of curriculum documents are used mostly to manage a part of a UME curriculum or to monitor teaching of a certain subject during all or some of the educational years.

Who are the right teachers for medical clinical students? Investigating stakeholders' opinions using modified Delphi approach

PURPOSE

The purpose of this study was to realize that learning in a clinical setting, the interactions of the students with teachers, learning materials, and learning environments are essential. In clinical education, different groups may play the role of the teacher for medical students. This study was designed to determine the optimal characteristics for medical clinical teachers, their selection criteria, and their responsibilities.

METHODS

The modified Delphi technique was used in this study. Participants comprised vice-chancellors of education, deans of medical schools, and deputies of education in medical schools across Iran. This study was conducted in three rounds. In the first round, the participants were selected using purposive sampling, and the data were collected through focus group discussions and analyzed through content analysis. The data collection tool in the second and third rounds involved a questionnaire derived from the first round, and the consensus criterion to accept or reject the questionnaire items was frequency distribution.

RESULTS

The final number of statements in the first round was 157. The second-round questionnaire was designed in the four sections of teaching team, selection criteria, task description of the teaching team (including faculties, specialist staffs, residents, general practitioners, and health and treatment staff), and incentives separately for the specialist staff, residents, general practitioners, and health and treatment staff. The third-round questionnaire included feedback and items that were not agreed upon in the second round.

CONCLUSION

The results of this study indicated the necessity of forming a teaching team, paying attention to the selection criteria, and planning requirements for assigning responsibilities to the teaching team in accordance with the objectives, programs, and requirements of medical schools, along with using strategies to attract participation and create motivation in the teaching team.

The trend of changes in the evaluation scores of faculty members from administrators' and students' perspectives at the medical school over 10 years

AIM

To assess the trend of changes in the evaluation scores of faculty members and discrepancy between administrators' and students' perspectives in a medical school from 2006 to 2015.

MATERIALS AND METHODS

This repeated cross-sectional study was conducted on the 10-year evaluation scores of all faculty members of a medical school (n=579) in an urban area of Iran. Data on evaluation scores given by students and administrators and the total of these scores were evaluated. Data were analyzed using descriptive and inferential statistics including linear mixed effect models for repeated measures via the SPSS software.

RESULTS

There were statistically significant differences between the students' and administrators' perspectives over time (p<0.001). The mean of the total evaluation scores also showed a statistically significant change over time (p<0.001). Furthermore, the mean of changes over time in the total evaluation score between different departments was statistically significant (p<0.001).

CONCLUSION

The trend of changes in the student's evaluations was clear and positive, but the trend of administrators' evaluation was unclear. Since the evaluation of faculty members is affected by many other factors, there is a need for more future studies.

Creating and validating e-cases as educational tools in general practitioners’ continuing medical education context

Objective

This study aimed at creating electronic cases (e-cases) and analyzing their validity as a diagnostic assessment tool within the context of continuing medical education (CME) to measure general practitioners’ (GPs) knowledge of common infectious disease.

Methods

We designed assessment e-cases in an electronic CME platform. The e-cases were designed to measure GPs’ knowledge about diagnosis and treatment of common infectious disease in outpatient settings. The data collected were analyzed for five forms of evidence: content, response process, internal structure, relations with other variables and consequences.

Results

A total of 46 GPs participated in the study. Among them, 87% perceived the e-cases as resembling the patients whom they visit in their everyday practice. Although attendance in this activity made 85% of the participants more cautious about prescription of antibiotics, we could not detect any statistically significant association between the assessment scores and the physicians’ previous antibiotic prescription. The diagnostic assessment with e-cases was supported by most of the elements of validity evidence, including content, response process, internal structure and consequences.

Conclusions

Overall, evidence suggests that using e-cases might be a valid diagnostic assessment CME activity to measure GPs’ knowledge of common infectious disease, but more research is necessary.

Factors influencing the results of faculty evaluation in Isfahan University of Medical Sciences

OBJECTIVE

This study aimed to explore factors influencing the results of faculty member evaluation from the viewpoints of faculty members affiliated with Isfahan University of Medical Sciences, Isfahan, Iran.

MATERIALS AND METHODS

This qualitative study was done using a conventional content analysis method. Participants were faculty members of Isfahan University of Medical Sciences who, considering maximum variation in sampling, were chosen with a purposive sampling method. Semi-structured interviews were held with 11 faculty members until data saturation was reached. The interviews were transcribed verbatim and analyzed with conventional content analysis method for theme development. Further, the MAXQDA software was used for data management.

RESULTS

The data analysis led to the development of two main themes, namely, "characteristics of the educational system" and "characteristics of the faculty member evaluation system." The first main theme consists of three categories, i.e. "characteristics of influential people in evaluation," "features of the courses," and "background characteristics." The other theme has the following as its categories: "evaluation methods," "evaluation tools," "evaluation process," and "application of evaluation results." Each category will have its subcategories.

CONCLUSIONS

Many factors affect the evaluation of faculty members that should be taken into account by educational policymakers for improving the quality of the educational process. In addition to the factors that directly influence the educational system, methodological problems in the evaluation system need special attention.

Optimal clinical setting, tutors, and learning opportunities in medical education: A content analysis

INTRODUCTION

As an integral and the most important part of medical education, clinical education provides the opportunity to prepare medical students as professionals. This study explores the standpoints of informants concerning the optimal conditions for clinical education and its components, including learning opportunities, clinical settings, and clinical tutors, with the aim to improve clinical teaching and standards.

METHODS

The study design is built on qualitative content analysis with the directed approach. The participants were selected using purposive sampling with maximum variation, and the data were collected through online focus group discussion (FGD) and semi-structured individual interviews conducted either face-to-face or on the telephone.

RESULTS

Twenty vice-chancelleries of education and medical education planners from across the country participated in this study. Concepts resulted in four main categories: educational settings, tutors, creating learning opportunities, and learning situations. The concepts were sorted into 15 subcategories, also 21 subclass 1 and 14 subclass 2. The most extensive subcategories comprised variety of educational settings, teaching team conditions, and learning strategies.

CONCLUSION

Optimal conditions for clinical education are associated with the use of educational settings close to the real workplace of general practitioners such as general inpatient settings, outpatient settings, and emergency department. Moreover, optimal conditions require the provision of learning opportunities by organized team of tutors and team member empowerment along with policy-making and planning on the national scale by the Ministry of Health in consideration of local conditions.

Applicability of the theory of planned behavior in explaining the general practitioners eLearning use in continuing medical education

BACKGROUND

General practitioners (GP) update their knowledge and skills by participating in continuing medical education (CME) programs either in a traditional or an e-Learning format. GPs' beliefs about electronic format of CME have been studied but without an explicit theoretical framework which makes the findings difficult to interpret. In other health disciplines, researchers used theory of planned behavior (TPB) to predict user's behavior.

METHODS

In this study, an instrument was developed to investigate GPs' intention to use e-Learning in CME based on TPB. The goodness of fit of TPB was measured using confirmatory factor analysis and the relationship between latent variables was assessed using structural equation modeling.

RESULTS

A total of 148 GPs participated in the study. Most of the items in the questionnaire related well to the TPB theoretical constructs, and the model had good fitness. The perceived behavioral control and attitudinal constructs were included, and the subjective norms construct was excluded from the structural model. The developed questionnaire could explain 66 % of the GPs' intention variance.

CONCLUSIONS

The TPB could be used as a model to construct instruments that investigate GPs' intention to participate in e-Learning programs in CME. The findings from the study will encourage CME managers and researchers to explore the developed instrument as a mean to explain and improve the GPs' intentions to use eLearning in CME.

Assessment of medical students' learning and study strategies in self-regulated learning

INTRODUCTION

Research on medical students shows that adopting self-regulation of effort, time, and study strategies can positively influence academic achievement. The purpose of the current study was to assess learning and study strategies in medical students.

METHODS

This cross-sectional study was carried out in 2014-2015 at Isfahan University of Medical Sciences. The sample size was determined 360 students based on the results of a pilot study on 30 members of the study population. Medical students in the first to fourth year of their studies were selected through simple sampling randomly. A valid and reliable Persian translation of Learning and Study Strategies Inventory (LASSI) questionnaire was completed by the students. It measures three latent factors of self-regulated learning: Skill, Will, and Self-Regulation. It consists of 80 questions in ten different scales (each scale including eight questions and a variable score of 8-40). Data were analyzed using t-test, correlation analysis, and ANOVA.

RESULTS

Considering the ten LASSI scales, the highest mean score belonged to test strategies (28.67±4.44), and the lowest mean to self-testing (21.91±4.91). The results showed significant statistical differences between male and female students in selecting the main idea, attitude, and self-testing. ANOVA and post hoc Tukey tests showed a significant difference between the mean scores of different areas of LASSI among students with different grade point average (GPA) in the university. In all areas except the study aids, the mean scores of students with GPA higher than 17.5 were significantly higher than those of students with GPA lower than 14.5.

CONCLUSION

The results showed that students need help and consultation in most areas of learning and study strategies. Using 10 areas of LASSI can determine the strengths and weaknesses of students in various areas. Knowing their own limitations, students will be able to improve their study habits. Hence, it is suggested to evaluate the students when enrolling at universities and design educational programs based on the students' characteristics.

A Theory-Based Study of Factors Explaining General Practitioners' Intention to Use and Participation in Electronic Continuing Medical Education

INTRODUCTION

Electronic modes of continuing medical education (eCME) can provide an appropriate and scalable way of updating the knowledge and skills of general practitioners (GPs). To optimize the adoption of eCME and develop efficient and cost-effective eCME programs, factors explaining GPs' intention to use eCME must first be elucidated.

METHODS

Using the Theory of Planned Behavior as a framework, we developed a questionnaire and administered it to GPs in seven CME seminars in Isfahan, Iran, in 2014. Three domains of GPs' intention to use eCME were measured: attitudes, perceived behavioral control, and subjective norms. We used linear and logistic regression to identify the main predictors of intention and behavior.

RESULTS

GPs who had high score in perceived behavioral control and a more positive attitude toward e-learning had a higher intention to adopt it for CME. In contrast, subjective norms (eg, social pressures to use eCME) were not a predictor. Attitude toward usefulness of eCME was the main predictor of being an actual eCME user.

DISCUSSION

Perceived behavioral control and attitude constitute the main predictors of the intention to use eCME. Establishing discussions forums and strengthening organizational support for eCME through an increased awareness among clinical superiors and CME managers would be expected to increase GPs' intention to use eCME.

The effect of clinical supervision model on high alert medication safety in intensive care units nurses

BACKGROUND

Medication errors and adverse drug events of high alert medication are one of the major problems in therapeutic system. The purpose of the present study was to investigate ύthe effect of clinical supervision model on high alert medication safety in intensive care units nurses.

MATERIALS AND METHODS

This was a quasi-experimental study conducted on 32 nurses of intensive care units. The researcher observed the administration of high alert drugs including heparin, warfarin, norepinephrine, dobutamine, and dopamine by nurses and recorded the scores of the work in preventing medication errors, the work in preventing adverse drug events, and medication safety. Then, the researcher performed clinical supervision model and during performance of the model, the researcher reassessed the score of the work in preventing medication errors, The work in preventing adverse drug events and medication safety. Tool of data collection was action plan of high alert medication safety checklists (heparin, warfarin, norepinephrine, dobutamine, and dopamine checklists).

RESULTS

The result of the statistical trials showed that before and after applying the clinical supervision model, there was a statistically significant difference between the average scores of medication safety of heparin (15.7 vs 18.73), warfarin (11.08 vs 15.67), norepinephrine (14.60 vs 19.72), dobutamine (13.80 vs 19.30), and dopamine (14.25 vs 19.47).

CONCLUSIONS

Based on the results of this study, it seems that administration of clinical supervision model in intensive care units can lead to improving the status of safety of high alert medication.

Curriculum leadership in the postgraduate: Gap between current and optimal status

BACKGROUND

Identifying the strengths and weakness points is one of the effective methods to analyze current status, and prioritizing actions based on the gap between current and optimal status is necessary for short-term and long-term planning in departments and colleges. The aim of this study was to determine the gap between current and optimal status of curriculum leadership in the postgraduate courses in two Iranian universities.

MATERIALS AND METHODS

In this cross-sectional study, a sample of 212 faculty members from the two Iranian universities (one medical and one nonmedical) was randomly selected through stratified random sampling method. Data were collected by using a researcher-made questionnaire, with 55 items categorized in four areas of main dimensions in curriculum leadership. The validity of the questionnaire was determined by curriculum studies scholars, and the reliability was confirmed as the Cronbach's alpha calculated 0.969. Data were analyzed using descriptive and inferential statistics according to the variables.

RESULTS

There was a gap in all dimensions and roles. The maximum gap (-1.70) with the highest frequency (98%) were related to "improving the educational atmosphere" dimension. As for items, the maximum gap (-2.41) was related to "society needs and expectations and the labor market" in "curriculum development and revision" dimension.

CONCLUSION

The negative gap between all dimensions of curriculum leadership implies faculty members' dissatisfaction. Curriculum leadership at universities, colleges and departments of the study in all aspects need to be improved. Hence, it is necessary for managers to make use of the viewpoints of the faculty members to decrease the gap.

Factors affecting self-regulated learning in medical students: a qualitative study

INTRODUCTION

Clinical courses are required of all medical students and means that they must develop the key skill of self-regulation during learning. The ability to self-regulate learning strategies is affected by different factors. This study determined the views of medical students on the factors affecting self-regulated learning (SRL).

METHOD

This study uses a qualitative approach and the content analysis method. Nineteen medical students in their fourth, fifth, and sixth years of study at Isfahan University of Medical Science participated in semi-structured, in-depth interviews. The students were selected using purposive sampling based on their overall grade point average (GPA).

RESULTS

Five main themes were found to affect SRL. These themes included family with the two subthemes of family supervisory and supportive roles; peers with the two subthemes of facilitating and inhibiting roles; instructors with the two subthemes of personal and educational instructor's characteristics; educational environment with the two subthemes of facilitator and inhibitor roles; and student with the two subthemes of facilitating and inhibiting personal factors.

CONCLUSION

The outcomes of student understanding of the factors affecting self-regulation indicate that facilitating factors should be used on an individual basis to reduce the effect of inhibiting factors to improve self-regulation in students.

Assessment of educational criteria in academic promotion: Perspectives of faculty members of medical sciences universities in Iran

INTRODUCTION

One of the important criteria in the promotion of faculty members is in the scope of their educational roles and duties. The purpose of this study was the assessment of reasonability and attainability of educational criteria for scientific rank promotion from the perspective of the faculty members of Medical Sciences Universities in Iran.

MATERIALS AND METHODS

This descriptive study was conducted in 2011 in 13 Universities of Medical Sciences in Iran. Through stratified sampling method, 350 faculty members were recruited. A questionnaire developed by the researchers was used to investigate the reasonability and attainability of educational criteria with scores from 1 to 5. The self-administered questionnaire was distributed and collected at each university. The mean and standard deviation of reasonability and attainability scores were calculated and reported by using the SPSS software version 16.

RESULTS

Faculty members considered many criteria of educational activities reasonable and available (with a mean score of more than 3). The highest reasonability and attainability have been obtained by the quantity and quality of teaching with the mean scores (3.93 ± 1.15 and 3.82 ± 1.17) and (3.9 ± 1.22 and 4.13 ± 1.06) out of five, respectively. The mean and standard deviation of total scores of reasonability of educational activities were 50.91 ± 14.22 and its attainability was 60.3 ± 13.72 from the total score of 90.

DISCUSSION AND CONCLUSION

The faculty members of the Universities of Medical Sciences in Iran considered the educational criteria of promotion moderately reasonable and achievable. It is recommended to revise these criteria and adapt them according to the mission and special conditions of medical universities. Furthermore, providing feedback of evaluations, running educational researches, and implementing faculty development programs are suggested.

Investigating the faculty evaluation system in Iranian Medical Universities

INTRODUCTION

To achieve a valid evaluation of faculty members, it is necessary to develop an inclusive and dynamic system of evaluation addressing all the activities and responsibilities of faculty members. Among these responsibilities, educational activities comprise an important part which needs to be investigated. This study aimed to investigate the current system of evaluating the faculty members' educational duties.

METHODS

In this descriptive cross-sectional study, a checklist for investigating the current evaluation system and was developed confirmed by a focus group. The data for checklist were collected through a researcher-made questionnaire and interview with eight experts of faculty evaluation that worked in different Iranian Medical Universities. For completion of information, the available documents and records were studied. Finally, the current evaluation system of different universities was depicted.

RESULTS

The developed checklist had six themes and 123 subthemes. The extracted themes included: Tools, evaluators, processes, appropriateness of faculty field of work with evaluation, feedback status, and university status regarding decisions made based on faculty evaluation results. As for comprehensiveness, all evaluation items except for evaluation and assessment skills and religiosity from personality traits subtheme were fully investigated. The evaluation tools were not enough for different types of education such as clinical education. In six universities, the feedbacks provided were only for making inter/intra department comparison, and no scientific suggestions were included. The results of evaluations were used only for the faculties' promotions.

DISCUSSION

Suitability between evaluation and performance components is a necessity in every evaluation system. The study showed this does not exist in Iranian Universities. For instance, there was no appropriate tool for the evaluation of clinical education. Also, the results of the faculty evaluation were not used for the improvement of their educational performance.

Training and validation of standardized patients for evaluation of general practitioners' performance in management of obesity and overweight

BACKGROUND

Standardized patient (SP) can serve as a valuable tool to measure the physician performance in actual clinical settings, but it has not been validated for obesity/overweight disorders. This study has been conducted to describe the process of creating reliable and valid SPs for evaluation of general-practitioners' management of obesity/overweight in Iran.

MATERIALS AND METHODS

A total of 6 obese/overweight volunteers (potential SPs) took part in training. Three scenarios, along with corresponding checklists including 102 items representing different aspects of diagnosis and treatment of obesity/overweight, were developed by an expert group. The SPs were trained using role playing method. During this part, one of the SPs failed. The SPs' portrayal of their respective scenario was online watched in another room and the checklist filled independently by the physician, research assistant and other SPs. The reliability of the checklist to be used by the SPs was assessed by Cronbach's alpha. The overall inter-rater agreement was calculated by the intraclass correlation coefficient statistic for total scores.

RESULTS

The 5 eligible SPs were all women between 20 years and 39 years of age. Inter-rater agreement between the SPs' total scores was 0.899, value (95% confidence intervals) were 11.8 (0.68-0.98) and P value was <0.001. The Cronbach's alpha for reliability of completed checklists was 0.91.

CONCLUSION

SP could be a powerful instrument for evaluating medical performance of general practitioners in the field of obesity/overweight management. Further research is needed to find the more aspects of training and validation of unannounced SPs in this field.

Pharmacists' opinions and self-reporting performance regarding the professional tasks and responsibilities in Isfahan, Iran

BACKGROUND

The pharmacists' roles and responsibilities toward the pharmaceutical care practice have developed considerably during the recent years.

OBJECTIVES

The aim of this program is to explore the opinions and performances of community pharmacists with regard to their professional tasks and responsibilities in Isfahan city.

MATERIALS AND METHODS

A descriptive cross-sectional questionnaire survey of community pharmacists was conducted on a sample of 150 pharmacists using the Delphi process. Data were collected on the opinions and performances of the pharmacists' task, professional responsibility and expertise, organizational and managing skills, and sociodemographic information.

RESULTS

The response rate was 93.3%. High expressions of agreement were found with most of the task and professional responsibilities and managerial skills and the mean rates of the self-reporting performance of most key tasks were 'always'. The important differences were found in two opinions about the pharmacists' responsibilities, (a) declining to dispense the prescribed drug that was not appropriate for the patient's illness and (b) keeping the patient's medical records for future needs. The pharmacists' opinions on various forms of professional expertise were diverse, especially on recognizing that the required medications were not prescribed for the patient, being informed on the pharmacotherapy subsequence and predicting the therapeutic outcomes, interpreting the laboratory tests results, and assisting persons in need of emergency first aid.

CONCLUSION

Pharmacists largely agreed with most of the professional tasks and responsibilities, however, new educational programs should be developed to promote the pharmacists' knowledge and skills concerning pharmacotherapy. Also an extended role for pharmacists needs to be addressed in the pharmacy regulations and laws.

Are postgraduate students in distance medical education program ready for e-learning? A survey in Iran

INTRODUCTION

Appropriate instructional design plays a crucial role in e-learning success, and analyzing learners is the cornerstone for instructional design process. Students' readiness for e-learning was assessed in the present study as an example of learner analysis for a distance course in medical education master program.

MATERIALS AND METHODS

A census sample of 23 students applied for distance master program on medical education, completed the "Students' E-Learning Readiness Scale" developed by Watkins, via email. The reliability and validity of the scale has been confirmed before. Average scores in total and 6 subscales were calculated. The score range was 1-5 and scores above 3 indicated good readiness. Data was interpreted using descriptive and non-parametric tests (Mann-Whitney U and Kruskal-Wallis).

RESULTS

Response rate was 100%. The students' readiness scores in total and all subscales ("technology access", "online skills and relationships", "motivation", "online audio/video", "readiness for online discussions", and "importance of e-learning to your success") were above 3. Comparing different subscales, students' mean scores in "motivation" and "internet discussion" subscales were less than others, although the difference was not significant. There were no significant gender differences in the readiness scores. Students who were academic staff had significantly higher scores than others in total and in "motivation" and "online skills and relationship" subscales.

CONCLUSION

Good learners' readiness, observed in the present study, may imply that the instructional designer can rely on e-learning strategies and build the course upon them. However, according to the slightly lower scores in "motivation" and "online discussion" subscales, it is recommended to stress more on strategies that improve these two components. To generalize the results, it is needed to test students' readiness in more different degree programs.

Design and implementation of a web directory for medical education (WDME): a tool to facilitate research in medical education

BACKGROUND

Access to the medical resources on the web is one of current challenges for researchers and medical science educators. The purpose of current project was to design and implement a comprehensive and specific subject/web directory of medical education.

METHODS

First, the categories to be incorporated in the directory were defined through reviewing related directories and obtaining medical education experts' opinions in a focus group. Then, number of sources such as (Meta) search engines, subject directories, databases and library catalogs searched/browsed for selecting and collecting high quality resources. Finally, the website was designed and the resources were entered into the directory.

RESULTS

The main categories incorporating WDME resources are: Journals, Organizations, Best Evidence in Medical Education, and Textbooks. Each category is divided into sub-categories and related resources of each category are described shortly within it. The resources in this directory could be accessed both by browsing and keyword searching. WDME is accessible on http://medirectory.org.

CONCLUSIONS

The innovative Web Directory for Medical Education (WDME) presented in this paper, is more comprehensive than other existing directories, and expandable through user suggestions. It may help medical educators to find their desirable resources more quickly and easily; hence have more informed decisions in education.

A comprehensive test of clinical reasoning for medical students: An olympiad experience in Iran

BACKGROUND

Although some tests for clinical reasoning assessment are now available, the theories of medical expertise have not played a major role in this filed. In this paper, illness script theory was chose as a theoretical framework and contemporary clinical reasoning tests were put together based on this theoretical model.

MATERIALS AND METHODS

This paper is a qualitative study performed with an action research approach. This style of research is performed in a context where authorities focus on promoting their organizations' performance and is carried out in the form of teamwork called participatory research.

RESULTS

Results are presented in four parts as basic concepts, clinical reasoning assessment, test framework, and scoring.

CONCLUSION

we concluded that no single test could thoroughly assess clinical reasoning competency, and therefore a battery of clinical reasoning tests is needed. This battery should cover all three parts of clinical reasoning process: script activation, selection and verification. In addition, not only both analytical and non-analytical reasoning, but also both diagnostic and management reasoning should evenly take into consideration in this battery. This paper explains the process of designing and implementing the battery of clinical reasoning in the Olympiad for medical sciences students through an action research.

Research priorities in medical education: A national study

BACKGROUND

One preliminary step to strengthen medical education research would be determining the research priorities. The aim of this study was to determine the research priorities of medical education in Iran in 2007-2008.

METHODS

This descriptive study was carried out in two phases. Phase one was performed in 3 stages and used Delphi technique among academic staffs of Isfahan University of Medical Sciences. The three stages included a brainstorming workshop for 140 faculty members and educational experts resulting in a list of research priorities, then, in the second and third stages 99 and 76 questionnaires were distributed among faculty members. In the second phase, the final questionnaires were mailed to educational research center managers of universities type I, II and III, and were distributed among 311 academic members and educational experts to rate the items on a numerical scale ranging from 1 to 10.

RESULTS

The most important research priorities included faculty members' development methods, faculty members' motives, satisfaction and welfare, criteria and procedures of faculty members' promotion, teaching methods and learning techniques, job descriptions and professional skills of graduates, quality management in education, second language, clinical education, science production in medicine, faculty evaluation and information technology.

CONCLUSIONS

This study shows the medial education research priorities in national level and in different types of medical universities in Iran. It is recommended that faculty members and research administrators consider the needs and requirements of education and plan the researches in education according to these priorities.

Stressors in clinical nursing education in Iran: A systematic review

BACKGROUND

Clinical education is a critical and complex component of nursing education that is influenced by many variables. One of them is stress, which may disturb students' learning, too. Stressors may differ according to the learning situation and environment, and recognizing them, seems to be essential for corrective interventions. The present work was performed to identify stressors in clinical nursing education in Iran, according to the published research reports.

MATERIALS AND METHODS

In this systematic review, all published research reports available in Iranian and International web-based data bases and search engines were searched. Also, the archives of peer reviewed Iranian nursing and medical education journals (published between 1989 and 2009) were hand searched. Out of 1104 retrieved records (by a more general terms of clinical education AND Nursing), after stepwise screening, 15 original research articles were selected for content analysis. Coded data were classified and their frequency was represented in Tables.

RESULTS

THE FOLLOWING THEMES WERE OBTAINED TO CLASSIFY MAIN AREAS OF IMPORTANCE FOR FACTORS RELATED TO STRESS IN CLINICAL NURSING EDUCATION: a) clinical competence and ability to play one's roles, b) care load, or stress due to care, c) main area of education, d) interpersonal relationships and interactions, e) clinical environment (facilities and equipments, space, learning opportunities, etc,…). Subthemes were also identified in each theme.

CONCLUSION

Published studies in Iran provide appropriate background evidences for planning and evaluating interventional programs to reduce stress among nursing students and instructors. Each identified theme in this study could be considered as a subject for planned interventions. Among them, it seems that interpersonal relationships and interactions is of the highest priority.

Shared learning in medical science education in the Islamic Republic of Iran: an investigation

Almost all information about interprofessional education (IPE) comes from a few western countries; little from the rest of the world. This paper helps to rectify that omission. It reports the first phase of a study of "shared learning" between health professions in "medical sciences education" in the Islamic Republic of Iran based on a documentary search and national survey of all government affiliated medical sciences universities (MSUs) with examples which meet some of the criteria for IPE. The second phase, to be reported later, will present findings from an analysis of interviews with administrators at governmental level and teachers and organizers at institutional level regarding their perceptions, experience and expectations of such learning. The study is set in the context of reforms in the organization and delivery of higher education and health care services in Iran.

Developing a holistic accreditation system for medical universities of the Islamic Republic of Iran

This report describes the steps in the development of an accreditation system for medical universities in the Islamic Republic of Iran. The national accreditation project, supported by the government, was performed from 2001 to 2005. The project was carried out in 3 main phases, each phase including a number of tasks. After a review of the international literature on accreditation and through national consensus, a set of national institutional accreditation standards was developed, including 95 standards and 504 indicators in 10 areas. By complying with accepted national standards, Iranian medical universities will play an important role in promoting health system performance.

Contextual adaptation of the Personnel Evaluation Standards for assessing faculty evaluation systems in developing countries: the case of Iran

BACKGROUND

Faculty evaluations can identify needs to be addressed in effective development programs. Generic evaluation models exist, but these require adaptation to a particular context of interest. We report on one approach to such adaptation in the context of medical education in Iran, which is integrated into the delivery and management of healthcare services nationwide.

METHODS

Using a triangulation design, interviews with senior faculty leaders were conducted to identify relevant areas for faculty evaluation. We then adapted the published checklist of the Personnel Evaluation Standards to fit the Iranian medical universities' context by considering faculty members' diverse roles. Then the adapted instrument was administered to faculty at twelve medical schools in Iran.

RESULTS

The interviews revealed poor linkages between existing forms of development and evaluation, imbalance between the faculty work components and evaluated areas, inappropriate feedback and use of information in decision making. The principles of Personnel Evaluation Standards addressed almost all of these concerns and were used to assess the existing faculty evaluation system and also adapted to evaluate the core faculty roles. The survey response rate was 74%. Responses showed that the four principles in all faculty members' roles were met occasionally to frequently. Evaluation of teaching and research had the highest mean scores, while clinical and healthcare services, institutional administration, and self-development had the lowest mean scores. There were statistically significant differences between small medium and large medical schools (p < 0.000).

CONCLUSION

The adapted Personnel Evaluation Standards appears to be valid and applicable for monitoring and continuous improvement of a faculty evaluation system in the context of medical universities in Iran. The approach developed here provides a more balanced assessment of multiple faculty roles, including educational, clinical and healthcare services. In order to address identified deficiencies, the evaluation system should recognize, document, and uniformly reward those activities that are vital to the academic mission. Inclusion of personal developmental concerns in the evaluation discussion is essential for evaluation systems.

Level of oxidative stress markers among physicians in a medical residency program

The authors investigated the effect of engaging in a medical residency program, as a stressful situation, on blood and urine levels of oxidative stress markers. Newly admitted medical residents participated in the study, along with a control group of (nonmedical) students. The authors assessed superoxide dismutase, glutathione peroxidase, catalase, malondialdehyde, micronuclei test, sister chromatid exchange, and 8-hydroxy-2'-deoxyguanosine level. All the biomarkers declined after entrance to the residency program, and the parameters were strongly higher in residents than in the control group. There was no significant relationship between demographic factors and levels of stress biomarkers. The greater extent of oxidative stress may be due to higher tension before entrance to a supposedly critical new position, and the declined levels of biomarkers seen after several months in the program could be attributed to an appropriate adjustment of the residents to the new situation.

Organizational role stress among medical school faculty members in Iran: dealing with role conflict

BACKGROUND

Little research has been conducted to investigate role stress experienced by faculty members in medical schools in developing countries. This becomes even more important when the process of reform in medical education has already taken place, such as the case of Iran. The objectives of this study were to investigate and assess the level and source of role-related stress as well as dimensions of conflict among the faculty members of Iranian medical schools. Variables like the length of academic work, academic rank, employment position, and the departments of affiliation were also taken into consideration in order to determine potentially related factors.

METHODS

A survey was conducted at three different ranks of public medical schools. The validated Organizational Role Stress Scale was used to investigate the level of role stress and dimensions of role conflict among medical faculty members. The response rate was 66.5%.

RESULTS

The findings show that role stress was experienced in high level among almost all faculty members. All three studied medical schools with different ranks are threatened with relatively the same levels of role stress. Specific differences were found among faculty members from different disciplines, and academic ranks. Also having permanent position and the length of services had significant correlation with the level of role stress. The major role- related stress and forms of conflict among faculty members were role overload, role expectation conflict, inter-role distance, resource inadequacy, role stagnation, and role isolation.

CONCLUSION

The most role-related stressors and forms of conflict among faculty members include too many tasks and everyday work load; conflicting demands from colleagues and superiors; incompatible demands from their different personal and organizational roles; inadequate resources for appropriate performance; insufficient competency to meet the demands of their role; inadequate autonomy to make decision on different tasks; and a feeling of underutilization. The findings of this study can assist administrators and policy makers to provide an attractive working climate in order to decrease side effects and consequences of role stress and to increase productivity of faculty members. Furthermore, understanding this situation can help to develop coping strategies in order to reduce role-related stress.