ABSTRACT
Background: Today, the development of critical thinking is considered an expected outcome of graduate studies. This study was designed to determine the critical thinking skills of students of Shahid Beheshti and Tehran University of Medical Sciences
Materials and methods: In a descriptive study, evaluated critical thinking skills of 60 medical students of Shahid Beheshti University of Medical Sciences and 60 medical students of Tehran University of Medical Sciences, after completing internship. Data was gathered using California standard test of critical thinking skills [form B] which was run officially. The data was analyzed by SPSS software using T-test, ANOVA and Pearson correlation coefficient
Results: The mean and standard deviation of critical thinking scores for medical students of Shahid Beheshti and Tehran University were 13.03 +/- 5.08 and 12.63 +/- 3.27, respectively [p>0.05]. There was no significant relationship between the ranks in University entrance exam and total score of critical thinking. Among domains of critical thinking, there was just significant relationship between the domains of deductive reasoning and diploma grade, with a relatively low correlation in medical students
Conclusion: The mean scores of critical thinking skill in this research was similar to scores of some survey in our country, but were lower than other countries. This means that the educational program cannot promote critical thinking skills in University and revising the curriculum seems necessary
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Introduction: Diagnosis lies at the heart of general practice. Every day general practitioners [GPs] visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings
Methods: A systematic search to find models of clinical reasoning were performed. To have more precision, we excluded the studies that focused on neurobiological aspects of reasoning, reasoning in disciplines other than medicine decision making or decision analysis on treatment or management plan. All the articles and documents were first scanned to see whether they include important relevant contents or any models. The selected studies which described a model of clinical reasoning in general practitioners or with a focus on general practice were then reviewed and appraisal or critics of other authors on these models were included. The reviewed documents on the model were synthesized
Results: Six models of clinical reasoning were identified including hypothetic-deductive model, pattern recognition, a dual process diagnostic reasoning model, pathway for clinical reasoning, an integrative model of clinical reasoning, and model of diagnostic reasoning strategies in primary care. Only one model had specifically focused on general practitioners reasoning
Conclusion: A Model of clinical reasoning that included specific features of general practice to better help the general practitioners with the difficulties of clinical reasoning in this setting is needed
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Introduction: Over the past few decades, two revolutionary approaches have emerged as a new form of medical education: Electronic Medical Education and Web-based Medical Education. A number of well-known medical institutions, such as Harvard and Johns Hopkins used a wide range of cyberspace capabilities to increase their competitiveness. Researchers have expressed that cyberspace will change health system's main objective of training physicians and medical education. We conducted this study to identify the health system critical considerations on core issues, involving the development of medical education on cyberspace
Methods: In order to conduct this study, we observed the steps of a critical literature review, combined with the 'Four-phase method' adopted by Carnwell and Daly. We focused on particular literature on health and cyber system functions; it was associated with systemic approach
Results: We developed a six-level taxonomy, Cyber level, Governance level, Ministerial level, Organizational level, Program level and Performance level, as a key solution that can be applied for the success of medical education on cyberspace. The results were summarized and appraised in more details
Conclusion: Medical education on cyberspace is a complex interdisciplinary system. It is important that all aspects of the health systems be involved as integral to the development of cyber based medical education; without this convergence, we will be confused by the decisions made by others within the system. Health system should also communicate with those external sectors that are critical to achieving better learning on cyberspace. Integrated planning, governance and management of medical education in cyberspace are pivotal elements for the promotion
Subject(s)
Internet , Medical Informatics , Educational TechnologyABSTRACT
This study aimed to compare evidence-based medicine (EBM) vs. conventional approaches to journal club sessions in teaching critical appraisal skills in reading papers by emergency medicine residents. This double cut off discontinuation regression quasi-experimental study was conducted among emergency medicine residents. EBM vs. the conventional approach were applied to teach critical appraisal skills for half of the residents as an experimental group and another half as a control group respectively. Both groups participated in one hour monthly journal club sessions for six months. Before and after the study, all participants were examined by two tests: the Fresno Test (FT) [to evaluate their knowledge about EBM] and the Critical Appraisal Skills Test (CAST) [to evaluate their competency with critical appraisal skills]. The allocation of the participants into the experimental or control groups was according to their CAST scores before the study. 50 emergency medicine residents participated. After the study, the scores of both groups in the FT and CAST significantly improved (p<0.01), and the promotion of scores of the FT and CAST in the experimental group were more than that of the conventional group (p<0.0001). The current study indicated that an evidence-based medicine approach in journal club sessions was comparatively more advantageous compared to the conventional approach in teaching critical appraisal skills for reading papers among the residents of emergency medicine.
Subject(s)
Emergency Medicine , Evidence-Based Medicine , Internship and Residency , Non-Randomized Controlled Trials as TopicABSTRACT
Introduction: The integration of behavioral and social sciences [BSS] into the curriculum of medical students in order to equip them with the necessary knowledge, skills and attitudes is an essential issue, emphasized in many researches. Our aim is to investigate the barriers to integrate BSS into the general medicine curriculum as well as the recommended strategies to overcome such barriers through a systematic review of literature
Methods: PubMed, ERIC, Scopus, CINAHL, Google Scholar, and OPENGREY were searched for studies on the barriers to integration of BSS into the general medicine curriculum as well as the strategies employed to overcome them until August 28, 2015
Results: Sixteen relevant studies were included and the related domains were categorized as barriers and some strategies were recommended to overcome them. In addition, the quality of the included studies was assessed
Conclusion: Despite the prominent role of BSS in the effectiveness of health care, these sciences have not been included in the curriculum of medical students effectively. The identified barriers and the strategies used to overcome them should be considered for all integration programs. Future studies should focus on the process of BSS integration in the medical curricula and should evaluate the efficacy of this integration in more detail
ABSTRACT
This study aimed to compare evidence-based medicine (EBM) vs. conventional approaches to journal club sessions in teaching critical appraisal skills in reading papers by emergency medicine residents. This double cut off discontinuation regression quasi-experimental study was conducted among emergency medicine residents. EBM vs. the conventional approach were applied to teach critical appraisal skills for half of the residents as an experimental group and another half as a control group respectively. Both groups participated in one hour monthly journal club sessions for six months. Before and after the study, all participants were examined by two tests: the Fresno Test (FT) [to evaluate their knowledge about EBM] and the Critical Appraisal Skills Test (CAST) [to evaluate their competency with critical appraisal skills]. The allocation of the participants into the experimental or control groups was according to their CAST scores before the study. 50 emergency medicine residents participated. After the study, the scores of both groups in the FT and CAST significantly improved (p<0.01), and the promotion of scores of the FT and CAST in the experimental group were more than that of the conventional group (p<0.0001). The current study indicated that an evidence-based medicine approach in journal club sessions was comparatively more advantageous compared to the conventional approach in teaching critical appraisal skills for reading papers among the residents of emergency medicine.
Subject(s)
Emergency Medicine , Evidence-Based Medicine , Internship and Residency , Non-Randomized Controlled Trials as TopicABSTRACT
Introduction: Leadership and management are two expected features and competencies for general practitioners [GPs]. The purpose of this study was leadership and management curriculum planning for GPs which was performed based on Kern's curriculum planning cycle
Methods: This study was conducted in 2011-2012 in Iran using an explanatory mixed-methods approach. It was conducted through an initial qualitative phase using two focus group discussions and 28 semi-structured interviews with key informants to capture their experiences and viewpoints about the necessity of management courses for undergraduate medical students, goals, objectives, and educational strategies according to Kern's curriculum planning cycle. The data was used to develop a questionnaire to be used in a quantitative written survey. Results of these two phases and that of the review of medical curriculum in other countries and management curriculum of other medical disciplines in Iran were used in management and leadership curriculum planning. In the qualitative phase, purposeful sampling and content analysis with constant comparison based on Strauss and Corbin's method were used; descriptive and analytic tests were used for quantitative data by SPSS version 14
Results: In the qualitatively stage of this research, 6 main categories including the necessity of management course, features and objectives of management curriculum, proper educational setting, educational methods and strategies, evolutionary method and feedback result were determined. In the quantitatively stage of the research, from the viewpoints of 51.6% of 126 units of research who filled out the questionnaire, ranked high necessary of management courses. The coordination of care and clinical leadership was determined as the most important role for GPs with a mean of 6.2 from sample viewpoint. Also, team working and group dynamics had the first priority related to the principles and basics of management with a mean of 3.59. Other results were shown in the paper
Conclusion: Results of this study indicated the need to provide educational programs for GPs; it led to a systematic curriculum theory and clinical management using Kern cycle for general practitioner's discipline. Implementation and evaluation of this program is recommended
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Regarding the role and importance of paradigm of evidence based practice and its remarkable impact on the effectiveness and efficiency of clinical services and healthcare, development of an integrated system seems necessary in order to manage dispersed data and ensure using evidence in clinical decision making, thus the aim of this study was designing a model for implementing national system of evidence based health care in Iran. This paper is a study of comparative type which has been written in three stages: investigation of structure and process of evidence based practice in selected countries, investigation and analysis of current status in Iran in this regard and recommendation of strategies which make model implementation feasible in the country. Such methods as review of literature, focus group discussion and Delphi technique were used for investigation. According to studies, insuring an evidence based practice culture in the country requires a system called National Evidence Based Health Care System which consists of three subsystems including national system of clinical knowledge management, national evidence-based practice system and integrated national network of clinical effectiveness. The ultimate goal of health care system in every country is maintaining and improving community health. Achievement of this goal depends on effectiveness of delivered services and consistency of the services with national and local priorities. In order to achieve clinical effectiveness, the best practice should be realized in the country, implementation of which requires a set of macro and micro strategies enabling facilitation, promotion or guaranteeing clinical knowledge application in the country
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Background and Objective: Medical students should learn some skills for better clinical reasoning, decision making and using evidence based medicine. One of the most important attributes of a successful clinician is the ability of critical thinking in patient care situations. The purpose of this study was to evaluate critical thinking skills [analysis, evaluation, inference, and deductive and inductive reasoning] in medical students of Isfahan University of Medical Sciences, Isfahan, Iran
Methods: This non-experimental study was conducted on 92 men in first, third and fifth years of medical education in 2008-2009. Data were collected using California Critical Thinking Skills Test [form B] and analyzed by SPSS software. Statistical tests used for data analysis were ANOVA, Duncan Posthoc and Pearson tests
Results: The mean scores of 5 sub-skills were low in all three groups. Significant differences were found among three groups in regard to evaluation [P = 0.48], inductive reasoning [P < 0.001] and deductive reasoning [P = 0.01]
Conclusion: It seems that students' critical thinking skill is not so desirable in Iran and educational planning should be considered for its development
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This study assessed the relative risk factors for osteoporosis in women referring to the Bone Densitometry Center during 2007, with the aim of designing a formula to estimate the severity of osteoporosis.Subjects andData of outpatients [n=1,047] who visited the Bone Densitometry Center of Chamran Hospital were gathered by administering a questionnaire to subjects before a duAl energy X-ray absorptiometry [DXA] densitometry test of the hip and vertebrae. Of the 1,047 subjects, 764 [73%] were menopausal. The average [ +/- SD] age and weight were 54.5 +/- 10.3 and 69.5 +/- 10.8, respectively. The average [ +/- SD] T score of hip and lumbar spine were-1.88 +/- 1.08 and-1.04 +/- 1.05, respectively. After assessment, the precipitating factors of osteoporosis of the hip were age, menopause, duration of menopause, history of fracture, history and dosage of calcium supplementation, parity and duration of breastfeeding. Protective factors were weight, history of oral contraceptive pill consumption, and exercise, being significant [p<0.05]. Precipitating factors in osteoporosis of vertebrae were age, menopause and duration of menopause, diabetes, history of fracture, history and dosage of calcium supplementation, parity and duration of breastfeeding, with weight as a protective factor [p=<0.05]. Using stepwise regression analysis, a minimal mathematical model for prediction of bone density of the hip and lumbar spine was formulated. Using the mathematical model, along with clinical findings and history, persons at risk of osteoporosis may be identified and early prevention and treatment made possible. Unnecessary expenses of diagnostic procedures for people without the risks of osteoporosis can also be prevented
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Clinical skill centers were designed in 1960, offers innovative, more effective clinical health care and treatment curriculum. Clinical skill center [CSC] can provide a special facility for clinical and communication skills practice in a setting outside hospital wards in order to train students with enough confidence of confronting real patients. Learning clinical skills in these centers are not patient-dependent and by practicing on manikins and simulated models errors in real patients can be prevented. Moreover, possible feedback of this method can be used for evaluation and can improve quality and quantity of the education. This review intends to determine the purpose, undertaking, and structure of CSC. The study emphasizes the importance of integrating the clinical skill centers into the teaching curriculum of medical universities. Apprarently, organizing clinical skill centers can play an important role for improving the quality and quantity of the educational system and consequently post-graduate performance. The authors recommend this program can be a solution for having both the knowledge and skill of diagnosis treatment seasonal and rare diseases