Identifying and prioritizing the stressors of obstetrics and gynecology residents.

BACKGROUND: Studies have shown that the obstetrics and gynecology residents face severe burnout and a large number of stressors, and excessive stress could adversely affect performance and quality of patient care. Thus, the current study attempts to identify and prioritize the stressors of obstetrics and gynecology residents at Isfahan University of Medical Sciences. MATERIALS AND METHODS: A cross-sectional descriptive-analytical study was conducted on 62 residents and faculty members in the department of obstetrics and gynecology at Isfahan University of Medical Sciences in 2022. Respondents were selected by census method. The stressors of obstetrics and gynecology residents were investigated using a researcher-made, 37-item questionnaire. The questionnaire was prepared based on a literature review and respondents' opinions, then its validity and reliability were confirmed. Collected data were analyzed using the SPSS 20, non-parametric Friedman's test, and descriptive statistics methods. RESULT: This study included 46 respondents (74%), 16 faculty members, and 30 residents, who were asked to rate each stressor of the given questionnaire. The residents and their teachers believed that the main stressors were heavy workloads, lack of personal time, long shifts, financial problems, sleep deprivation, and compassion fatigue. Insufficient study time, study workload, and inappropriate assessment systems for residents were among the high-priority stressors, according to the residents. However, the faculty members reported medical errors, unreasonable expectations from residents, and residents' multiple responsibilities as high-priority stressors. According to the Friedman's test, there was a significant difference in rates received from both the faculty members and medical residents (P value <0/001). CONCLUSION: The stressors due to the nature of obstetrics and gynecology, medical care, residency training, and medical resident assessment are the highest priority. The findings of this study could be beneficial to the officials in residency training programs to take the necessary corrective actions.

A model for improving the learning environment in high-stress and emotion-bound clinical settings.

INTRODUCTION: In clinical settings, it is necessary to create a clinical learning environment that provides the ground for the learners to acquire competencies especially in high-stress and emotion-bound clinical settings. METHODS: In the present study, a model for improving the learning environment in high-stress and emotion-bound clinical settings was designed by conducting a multi-method study in the form of three sub-studies. RESULTS: This model was designed with 3 pivotal concepts; organizing learning opportunities around safe care, fair participation in learning opportunities and creating a positive emotional climate and 6 peripheral concepts; designing physical space and appropriate equipment for education and care, preparing learners to attend the clinical setting, preparing learners to participate in learning opportunities, balancing the learner role and the care provided by the learners, the presence of a competent educator and providing education to all learners, and acquiring the ability to manage emotions by learners, faculty and staff. CONCLUSIONS: The implementation of the model obtained from this study provides the basis for solving the challenges of clinical learning environments, especially in high-stress and emotion-bound clinical settings, and improves clinical education and the realization of educational and care outcomes.

Underpinning Learning Theories of Medical Educational Games: A Scoping Review.

Background: Gamification is the process of game thinking and game mechanics to attract learners and solve problems. It is a unique growing phenomenon in education and training programs. Educational games, by application of game design and game elements in learning environments, motivate students to learn and improve the teaching and learning process. Herein, this scoping review presents an overview of the theoretical underpinnings of gamification that is crucial in understanding the theoretical pillar of successful educational games. Methods: This scoping review follows Arksey and O'Malley's stages of scoping review. In this review, the gamification in medical education articles that implicitly or explicitly presented underpinning learning theories of gamification in medical education was retrieved. So, keywords such as gamification, learning theories, higher education, and medical education were searched in Scopus, PubMed, WEB OF SCIENCE, EMBASE, ERIC, and Cochrane Library from 1998 to March 2019. Results: The search indicated 5416 articles which were narrowed down by title and abstract relatedness. 464 articles entered the second phase of the study and after reviewing their full text, finally, 10 articles which were explicitly and implicitly reported the underpinning learning theories remained. Conclusion: Gamification is a strategy using game design techniques for non-game experiences for more effective learning and provides a more attractive environment for teaching and learning. Designing gamification based on learning theories (behavioral, cognitive, and constructivist), makes them more efficient, and the application of learning theories in designing gamification is recommended.

The double-edged sword of emotions in medical education: A scoping review.

Emotions are universal in academic and clinical settings. A student is likely to hope for success, maybe be worried about failure, or may feel comfortable after an exam. These feelings undoubtedly affect his/her motivation, effort, academic performance, and progress. This study aimed to investigate the role of emotion in the learning and performance of medical students and its mechanism. This study was a scoping review conducted in 2022 to examine the role of emotions in medical education. The three databases PubMed, ERIC, and Science Direct and the search engine Google Scholar were searched using the following keywords: "emotion," "medical student," "teaching," "learning," and "medical education." English articles published from 2010 to 2022 were reviewed, and finally, 34 articles that met the inclusion criteria were reviewed. Review of the selected articles showed that there was a significant relationship between the cognitive system and emotions in the brain. The conceptual framework of the relationship between cognition and emotion can be explained in the form of dimensional and discrete views of emotions and based on cognitive load theory. Emotions affect cognition with the four mechanisms of memory, cognitive resources, cognitive strategies, and motivation and can be effective in learning self-regulation, clinical reasoning, and academic achievement of medical students. Emotions in medical education is a double-edged sword. In other words, it is highly recommended to divide emotions into activating and inactivating, instead of dividing them into positive and negative ones. In this context, medical educators can use the positive aspects of nearly all emotions to improve the quality of their teaching.

Nurses as Gifted Artists in Caring: An Analysis of Nursing Care Concept.

Background: Nursing care happens with the artistic presence of the nurse in the care setting. Despite its importance in nursing, yet many ambiguities surround its definition and characteristics. The aim of this study was to analyze the concept of nursing care. Materials and Methods: This concept analysis was conducted using Walker and Avant's approach. An extensive literature search was done in the Medline, CINAHL, Embase and SID databases to find articles published in English between 1988 and 2019. The search keywords were "care", "nursing care", "concept", "concept analysis", and similar words. According to Walker and Avant's approach, after selecting the concept and determining the aim of analysis, 3742 references were reviewed and 68 articles and 2 books were selected to determine and extract the defining attributes, antecedents, consequences, and empirical referents of the nursing care concept. Results: The three main defining attributes of the concept were relationship, compassion, and professional action. The antecedents were nurse-related, client-related and environment-related, and the consequences were for nurses, clients and community. Conclusions: The defining attributes, antecedents, and consequences determined in the present study help better understand the concept of nursing care. This study highlights the importance of the communicative, caring, and advocacy roles of nurses and their compassionate professional action in the promotion of individual and community health.

Generational characteristics of general medicine students in Iran.

BACKGROUND: Purpose: The success of any educational system depends on the fitness of the curriculum components with the characteristics of its audience. The students of the present generation are different from the previous ones due to the changes resulting from the changes that have taken place in society, media, technology, and communication as we entered the 21th century. Hence, this study was conducted to identify the characteristics of MD students in universities of medical sciences in Iran. MATERIALS AND METHODS: This qualitative study was conducted on 32 MD students among 7 universities of medical universities of Iran. The participants were selected through purposive sampling method, and the data were collected via semi-structured interviews after getting informed consent. Then, the data were analyzed using conventional content analysis method. RESULTS: Technology as a Double-Edged Sword, in digital age, Quick access, Reasoning the basis of acceptance. Evaluation ambiguity, Seeking independence,get involved in problems, desirable teaching qualities, my favorite teacher, features of content, Role models traces,my favorite teacher, The rest are unchanged. CONCLUSION: MD students are interested in using various teaching methods and technologies, applying methods that are similar to their future job and learning by doing; they also tend to use visual materials and shortening the time and memorizing content. They prefer professors who love to teach and are good role models for them. What motivates them is to be involved in the classroom, to be active, to be respected, and not to be ignored.

Generation-dependent non-educational characteristics of medical students.

BACKGROUND: Educational centers accommodate people of varying generations. Indeed, each generation has its specific priorities and values that affect its performance and decisions in various aspects, including educational aspects. Understanding the traits of members of a given generation facilitates understanding how their performance can be improved inside and outside the classroom. So, this study was designed to identify the non-educational characteristics of MD students in the universities of medical sciences in Iran. MATERIALS AND METHODS: The present study adopted a qualitative exploratory approach. Data were collected through face-to-face, semi-structured interviews. Participants included general medicine students who had completed at least one semester. Sampling was purposive with maximum variation. Sampling was continued until data saturation, and a total of 32 interviews were conducted. Graneheim and Lundman's content analysis approach was adopted to analyze the data. Lincoln and Guba's reliability criteria were used to achieve the accuracy and reliability of the data. RESULTS: A total of 32 students were interviewed (n = 18 women and n = 14 men; age range: 19-27 years). The participants had completed 2-13 semesters and had between one and six siblings. A total of 10 major categories emerged as the generational traits of students. The main categories included devoted parents, money as the key reference of value, non-sexism, religious perplexity, experiencing oneself with others, my life's address, tunnel vision, evasion from responsibility, winning fame, and I and nothing else. CONCLUSION: For them, gender and religion have lost their former meaning and they believe in more freedom. They are also one-dimensional people, lethargic and night people, who evade responsibility and have a strong desire to be seen, approved, and respected. They also prioritize themselves and their peace of mind. Since these characteristics can have many direct and indirect effects on various aspects of their lives, including the educational aspect, it can be very beneficial for people interacting with them to identify and consider these characteristics.

Improving the Effectiveness of Noncommunicable Disease Prevention Training Based on Health and Education Experts' Opinions.

Background: The first need of any society is to have a healthy life that can be achieved through preventive education. Despite providing training in the prevention of risk factors for noncommunicable diseases in the country's educational programs, we are witnessing an increase in the incidence of these diseases. We aimed to summarize the views of experts in the field of health and education on improving the effectiveness of these trainings. Methods: This study was conducted with a qualitative approach and conventional content analysis method. Participants were 12 experts in the field of health and 19 employees in education who were selected by purposive and available sampling method with maximum diversity. The data collection method was semistructured interview with note-taking. Results: A total of 32 subcategories and 9 main categories were extracted: "Macro health policies," "Strategic health system," "The role of education system in health promotion," "Schools and Lifestyle modification," "Informal learning," "Preventive strategies in promoting health," " Lifestyle, multifactorial phenomena," "The impact of stress on health," and "Factors affecting preventive education." Conclusions: Providing preventive education to students is one of the ways to prevent noncommunicable diseases. If these trainings have the necessary attractiveness and support by the authorities (and especially the health system), then it will not only raise students' awareness, but also change their attitude and improve their performance.

Transcultural adaptation and validation of the Persian version of the Brief Emotional Intelligence Scale.

BACKGROUND: Increasing the level of emotional intelligence (EI) is seen as a strategy for improving both relational quality and efficiency at work. As of today, there was no validated Persian brief instrument for evaluating EI. To fill this gap, this article was aimed to investigate the validity and reliability of the Persian version of the Brief Emotional Intelligence Scale (BEIS-10). MATERIALS AND METHODS: A methodological cross-sectional study was conducted among 201 Persian-speaking individuals. These individuals were selected from different parts of Iran using the convenience sampling method. Translation of the BEIS-10 was conducted by employed forward-backward method. Internal consistency was evaluated by Cronbach's α, and for test-retest reliability, the intraclass correlation coefficient (ICC) was employed. The construct validity was investigated by confirmatory factor analysis (CFA). RESULTS: The Persian version of BEIS-10 indicates a good test-retest reliability (ICC = 0.612, 95% confidence interval: 0.384 and 0.769) as well as internal consistency (Cronbach's alpha = 0.748, ranging from 0.359 to 0.868 for different domains). The construct validity was evaluated by CFA and five factors from ten items were confirmed and all goodness-of-fit-indices were in acceptable levels. CONCLUSION: The article concludes that the Persian version of BEIS-10 in five factors from ten items was a reliable and valid instrument for measuring EI in the general population. As well, the article was suggesting that the Persian version of BEIS-10 may stand as a suitable alternative to time-consuming tools for EI measurement since this scale appears to be time-saving and applicable to Iranian society.

Development and psychometric evaluation of a reflection on clinical practice questionnaire for nursing students.

BACKGROUND: Reflection on clinical practice is the core of education for nursing students. Evaluating reflection on clinical experiences requires a tool which accurately measures reflection skills. The present study aims to develop and test the psychometric properties of a tool for measuring nursing students' reflection on clinical practice. METHODS: Based on a mix-method exploratory approach, the study was carried out in two stages: in the first stage (the qualitative phase), the concept of reflection on clinical practice was established. In the second stage (the quantitative phase), the psychometric properties of the developed scale were evaluated. RESULTS: Based on the results of the exploratory factor analysis and the verification process, the final version of the scale came to consist of 36 items and 6 dimensions. The dimensions were: professional competence, internal sources of motivation, challenging situational clinical setting, dynamic organizational atmosphere, reflection-based self-management, and dynamic professional growth. Overall, 6 factors accounted for 62.79% of the variances. The factor loadings of the items ranged between 0.62 and 0.94, all of which were significant. The total intraclass correlation (ICC) of the scale was found to be 0.94. Also, evaluation of the reliability of the scale as measured through internal homogeneity yielded a total Cronbach's alpha of 0.90. CONCLUSION: The findings show that the developed scale for evaluation of nursing students' reflection on clinical practice possesses satisfactory validity and reliability, and nursing professors can use this instrument to assess students' reflection skills.

Medical interns; the neglected learners of the maternity ward learning environment.

BACKGROUND: Clinical training during internship is an important part of medical education. The maternity ward is a clinical environment in which medical students pass their obstetrics and gynecology internship to obtain competencies in this field. The present study was conducted to explain medical interns' manner of learning in the maternity ward. MATERIAL AND METHODS: The present study was conducted using a qualitative approach with the inductive content analysis method. This study observed the maternity wards of teaching hospitals affiliated to medical sciences universities of Isfahan and Shahrekord. Data were collected through observation and semi-structured individual interviews. RESULTS: Two main categories and seven subcategories emerged from the analysis of the data. Inadequate participation in learning opportunities included the following three subcategories: the incongruousness of the learning opportunities with the educational goals, inadequate readiness for participation in learning opportunities, and the overlap between learning opportunities and diminished autonomous practice. Inadequate formal and structured education included the following four subcategories: inadequate learning support and direction, subordinate roles and aimless presence, the pale educational role played by the attendants and senior residents, and learning through the support of midwifery educators. CONCLUSION: Participation in and access to learning opportunities in the maternity ward are very difficult for interns. Interns, therefore, need to attend the maternity ward by a structured program and in the company of training supervisors or competent educators to obtain the required competencies in pregnancy and childbirth.

The most prominent problems of diabetes education in Iran: A qualitative content analysis.

BACKGROUND: Education in vulnerable communities can be a health affordable strategy to promote patient empowerment. Recognition and understanding the problems of diabetes education are of significance to overcome the barriers and advance the educational and care services to control diabetes and promotion of society health. The aim of this study was to explore participants' perspectives, experiences, and preferences, regarding diabetes education problems. MATERIALS AND METHODS: This descriptive, qualitative study was conducted from March 2016 to September 2017. The participants were 23 people including nine patients with diabetes and their family members and 14 members of diabetes healthcare team (physicians, nurses, and nutritionists). The data were collected through individual semi-structured interviews and analyzed through conventional content analysis approach proposed by Graneheim and Lundman. Some main categories and subcategories emerged. RESULTS: Three main categories showed the most prominent problems of diabetes education, namely, inadequate infrastructure for diabetes education, insufficient defined and de facto position for the role of diabetes nurse educator, and the failure in patient-oriented team approach in diabetes education. CONCLUSION: This article addresses the most important problems of diabetes education. The fundamental strategy to overcome these problems seems to be the planning and management of diabetes education as a high priority in the noncommunicable disease management policies of the Ministry of Health and Medical Education.

The components of diabetes educator's competence in diabetes self-management education in Iran: A qualitative study.

BACKGROUND: Limited research has been conducted in the field of diabetes educator's competency. However, no comprehensive and integrated explanations of educator's competence requirements in treatment centers exist in Iran. The aim of this study is to explain the components of diabetes educator's competence in diabetes self-management education in Iran. MATERIALS AND METHODS: This was a qualitative descriptive-exploratory study. The data were collected through semi-structured and in-depth interviews and using purposeful sampling method in Isfahan University of medical science from April to October 2018. Sampling continued until data saturation. Participants included 20 people who were selected by purposive and snowball sampling method. The interviews were analyzed using content analysis method of Graneheim, Lundman. RESULTS: Data analysis resulted in the emergence of three main categories including (1) Patient and family centered education, (2) process-based education, and (3) continuous progress in profession and also seven subcategories (patient and family activation, empower), facilitating educational process, comprehensive education assessment, development, implementation and evaluation of educational plans, developing educators' educational knowledge and skills, development of creativity and innovation, promote inter-professional cooperation in education. CONCLUSION: The evaluation of facilitation factors for participation and empowerment patient and family along with creativity and interprofessional collaboration for comprehensive evaluation of patients in designing, implementation of educational programs were mentioned as important competencies of diabetes educators, which can have a significant impact on patients' recovery, treatment, and the promotion of society's health.

Restrictors of the effectiveness of diabetes self-management education: A qualitative content analysis.

BACKGROUND: A key step for improving the effectiveness of diabetes self-management education (DSME) is to identify its restrictors. OBJECTIVES: The aim of this study was to explore the restrictors of the effectiveness of DSME. METHODS: This descriptive qualitative study was conducted in March 2016-2017. Participants were 16 DSME providers (viz., physicians, nurses, nutritionists, and psychologists) and nine DSME receivers (viz., patients and their family members) - 25 in total. Semi-structured interviews were held for data collection. Interviews were transcribed word by word and analyzed through conventional content analysis approach proposed by Graneheim and Lundman. RESULTS: The restrictors of the effectiveness of DSME were categorized into three main categories and 11 subcategories, namely patients' limited welcoming of DSME classes (allocating limited time for participation in DSME classes, inadequate knowledge about diabetes mellitus [DM] importance, inappropriate educational environment, and financial problems), unfavorable adherence to treatments: serious challenge (inattention to educations, poor motivation for adherence to medical recommendations, and inattention to the psychological aspects of DM), and the difficulty of adult education (the difficulty of changing health-related attitudes and behaviors, mere information delivery during education, adults' physical and perceptual limitations, and diabetes educators' limited competence in adult education). CONCLUSION: The findings of the present study provide an in-depth understanding about the restrictors of the effectiveness of DSME. DM management authorities and policymakers can use these findings to develop strategies for improving the effectiveness of DSME.

Challenges and Strategies of Needs Assessment Implementing in Diabetes Self-management Education in Iran: A Qualitative Study.

BACKGROUND: Many diabetes educators in Iran do not have the necessary skills and competence for performing a needs assessment, and thus, cannot provide Diabetes Self-Management Education (DSME) to suit individual educational needs and conditions. The purpose of the present study was to explore and analyze needs assessment implementation in DSME and evaluate the barriers and the appropriate strategies from educators' viewpoints. MATERIALS AND METHODS: The present qualitative study was conducted using a conventional content analysis approach with semi-structured and in-depth interviews and using a purposeful sampling method on 20 nurses, physicians, and endocrinologists. The data of this study were collected from April to October 2018. The interviews were analyzed using the content analysis method of Graneheim and Lundman. RESULTS: Qualitative data analysis resulted in the emergence of two main categories of educational challenges of needs assessment and managerial challenges of needs assessment and four subcategories (lack of structured educational planning, lack of needs assessment practical patterns, managers' insufficient support and supervision, and managers' insufficient attention to motivational factors). CONCLUSIONS: Educational strategic planning, managers' obligation and support in designing practical patterns, and supervision tools to evaluate educators' performance in the needs assessment domain can result in the promotion of DSME needs assessment, the efficiency of plans, and the promotion of society's health.

A systematized review of cognitive load theory in health sciences education and a perspective from cognitive neuroscience.

INTRODUCTION: To design instructions in health sciences education, it is highly relevant to heed the working memory and the approaches for managing cognitive load. In this article, we tried to mention the implications of cognitive load theory (CLT) for optimizing teaching-learning in health sciences education and discussing cognitive load from the perspective of cognitive neurosciences as brain-aware medical education. MATERIALS AND METHODS: We searched databases of Pubmed, Proquest, SCOPUS, and ISI Web of Science for relevant literature in September 1, 2018. RESULTS: The 27 articles out of a total of 46 records, along with 23 papers from snowballing and hand searching were included in this study. Main items encompassed; "Various types of cognitive loads," "Aim of cognitive load theory," "Strategies to managing Cognitive Load," "Cognitive Load Theory in novice and experienced learners and "expertise reversal effect," Medical and Health Sciences Curriculums and Cognitive Load Theory," "Challenges of Cognitive Load Theory." CONCLUSIONS: We discussed six important themes for CLT in health sciences education according to the literature. Mental imagery (visualization) as one of the useful techniques to optimize germane load was suggested, as it processes further gain access to neural circuits that are engaged in sensory, motor, executive, and decision-making pathways in the brain.

Strategies to non communicable diseases prevention improvement from the viewpoints of students in Isfahan: A qualitative research.

BACKGROUND AND AIM: Full health is one of the basic human rights and requires a healthy lifestyle. Public continuous education, especially among the students who are a great target group and the future of the country, is the best way to modify lifestyle. Therefore, the present study was conducted with the aim of analyzing the factors affecting the prevention of non communicable diseases from students' viewpoints in Isfahan in the academicyear of 2016-2017. METHODS: This study was carried out through the qualitative approach and conventional content analysis method. Participants included 27 students who were selected by convenient and purposeful sampling method with maximum variation. Method of data collection was semi structured interviews with sound recordings with note-taking, and data analysis method was inductive content analysis. RESULTS: After removing repetitive codes and merging the similar ones, 1237 codes were obtained from interviews that were placed in 7 main categories and 18 subcategories. The main categories included "grand health policy-makings," "the role of the educational system in promoting health," "schools and healthy nutrition models," "schools and sports and physical activity development," "informal learning," "preventive strategies in health promotion,"and "lifestyle modification." CONCLUSION: It seems that controlling and improving the factors affecting lifestyle and making school education more effective are the main factors that influence the efficacy of preventive educational programs of non communicable diseases.

Practical points for brain-friendly medical and health sciences teaching.

BACKGROUND: Special learning outcomes are considered for medical and health sciences education which can be acquired by some interactive learning systems in the human brain. Given the importance of this issue, based on literature, we attempted at mentioning certain practical points for medical and health sciences educators to employ in preclinical and clinical teaching. MATERIALS AND METHODS: We searched databases of PubMed, Proquest, Scopus, ERIC, and ISI Web of Science for relevant literature from January 2010 to January 2019. RESULTS: From a total of 1029 records, 30 articles along with 35 papers from snowballing and hand searching were included in this study. The following 12 main items were encompassed: teaching students the basic neuroscience of learning and set individual learning goals, "just right challenge" heeding the balance between supervision and autonomy, brain-friendly coaching, repetition with spaced learning, visualization as a powerful learning tool, multimodal teaching, cognitive learning and mental model, cognitive-emotional learning, active and social learning, creativity and art, sleep, medical faculty's participation regarding the courses of "neuro-education studies," and "neuro-myths" were suggested for brain-friendly medical and health sciences teaching. CONCLUSIONS: We considered 12 practical points for brain-aware medical and health sciences teaching according to the recent literature on the basis of the association between education, cognitive science, neuroscience, and psychology. Interdisciplinary research and practice regarding this issue can improve teaching-learning quality, students' well-being, and ultimately patient outcomes.

The Balint group and its application in medical education: A systematic review.

INTRODUCTION: The Balint group's seminars were developed by Michael and Enid Balint for the purpose of a better understanding of doctor-patient relationships. This study aimed to introduce the Balint group and its application to the medical science educational program and to provide an up-to-date perspective on Balint group research. MATERIALS AND METHODS: The study was carried out as a systematic literature search published from January 2008 to September 2018 in the databases of PubMed, Scopus, Science Direct, and Proquest, which were searched with keywords such as the Balint group and medical education along with numerous related terms. Duplicates, non-English language articles were discarded from the review. RESULTS: A total of nine papers entered the study. Among included articles, four used a qualitative methodology, four used a quantitative methodology, and one applied a mixed methodology. Four main aims emerged from the content of papers: (1) to evaluate resident and medical student experiences in Balint groups, (2) to improve communication skills and reduce burnout level, (3) to assess the Balint group's effects on empathy, and (4) to explore the contexts and triggers of cases presented in Balint groups. CONCLUSION: Our results help us to the achievement of a better planning and design of an efficient Balint group in medical education. The findings enable the policymakers to make better decisions on the topic. Balint groups may guide medical students (residents) to become more patient centered by improving their communication skills and empathic abilities and reducing the level of burnout.