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

INTRODUCTION: Bedside teaching plays a crucial role in acquiring essential clinical skills. Therefore, the main aim of this study is assessing the validity and reliability of the Persian version of German bedside teaching (BST) instrument. This instrument was specially developed for evaluation of bedside teaching. METHOD: The present cross-sectional study was conducted on 150 last year medical students, using convenience sampling. The Persian version of the bedside teaching (BST) was used for data gathering. To calculate the reliability of the questions, Cronbach's alpha was used and to determine the construct validity of the questionnaire, confirmatory factor analysis was used. All analyses were performed in LISREL 10 and SPSS 21 software. RESULTS: Cronbach's alpha indicated excellent reliability for each subscale (α =0.77-0.85). All of the value of the questions are more than a significant number of 1.96 and concluded to be significant. There was an acceptable fit between the hypothetical model and the data and all comparative fit indices (CFI, NFI, RFI, IFI) showed good model fitness. BST is a valid and reliable instrument for the assessment of clinical teaching at bedside. It has 18 items with 5 point Likert scales. CONCLUSION: The findings suggest that the Persian version of the BST questionnaire is a valid and reliable tool for the evaluation of teachers and providing feedback in a clinical setting. However, more studies should be conducted in other cities in Iran.

Barriers of Critical Thinking in Medical Students' Curriculum from the Viewpoint of Medical Education Experts: A Qualitative Study.

INTRODUCTION:  The widespread developments of the twenty-first century have been accompanied by the presentation of intellectual patterns and theories and new achievements. These new achievements emphasize the skill of thinking at high levels, especially in the educational system of universities. This skill is essential for medical students; therefore, the present study aimed to investigate the qualitative barriers of critical thinking in medical students' curriculum. METHODS:  This is a qualitative study in which the content analysis method has been used. Participants of this study included 11 medical education experts and medical students (6 females and 5 males) who were selected through a semi-structured interview and purposeful sampling. The data analysis method was conventional content analysis. In the next part, by more investigation of the data, various obtained concepts will be presented in the form of themes, categories, and subcategories. RESULTS: We obtained two themes (socio-cultural conditions and traditional and unchanging system of education), eight categories and 14 subcategories. Also, these categories were resistance to critical society, intellectual tension, personality characteristics, lack of understanding of society's need for criticism, the rule of traditional teaching pattern, lack of critical thinking skills, ineffective evaluation, and difficulty of critical thinking training. CONCLUSION:  Given the results and the main emphasis of curriculum planners on incorporating high-level critical thinking and revision skills into the curriculum, the country's academic education system requires a change in the thinking style, research, deepening critical thinking, and a change in teachers' attitudes toward curriculum designing (goals, content, teaching and evaluation methods); also, it is suggested that the authorities should pay attention to the need to develop and utilize critical thinking skills in the learners' education.

Combination of different clinical reasoning tests in a national exam.

INTRODUCTION: Clinical reasoning as a critical and high level of clinical competency should be acquired during medical education, and medical educators should attempt to assess this ability in medical students. Nowadays, there are several ways to evaluate medical students' clinical reasoning ability in different countries worldwide. There are some well-known clinical reasoning tests such as Key Feature (KF), Clinical Reasoning Problem (CRP), Script Concordance Test (SCT), and Comprehensive Integrative Puzzle (CIP). Each of these tests has its advantages and disadvantages. In this study, we evaluated the reliability of combination of clinical reasoning tests SCT, KF, CIP, and CRP in one national exam and the correlation between the subtest scores of these tests together with the total score of the exam. METHODS: In this cross sectional study, a total number of 339 high ranked medical students from 60 medical schools in Iran participated in a national exam named "Medical Olympiad". The ninth Medical Olympiad was held in Shahid Beheshti University of Medical Sciences, Tehran, Iran, under the direct supervision of the Ministry of Health and Medical Education in summer 2017. The expert group designed a combination of four types of clinical reasoning tests to assess both analytical and non-analytical clinical reasoning. Mean scores of SCT, CRP, KF, and CIP were measured using descriptive statistics. Reliability was calculated for each test and the combination of tests using Cronbach's alpha. Spearman's correlation coefficient was used to evaluate the correlation between the score of each subtest and the total score. SPSS version 21 was used for data analysis and the level of significance was considered <0.05. RESULTS: The reliability of the combination of tests was 0.815. The reliability of KF was 0.81 and 0.76, 0.80, and 0.92 for SCT, CRP, and CIP, respectively. The mean total score was 169.921±41.54 from 240. All correlations between each clinical reasoning test and total score were significant (P<0.001). The highest correlation (0.887) was seen between CIP score and total score. CONCLUSION: The study showed that combining different clinical reasoning tests can be a reliable way of measuring this ability.

Barriers to the implementation of research priorities in medical education from the point of view of medical education experts at Shiraz University of Medical Sciences: A qualitative study.

OBJECTIVE: To determine the barriers to the implementation of research priorities in medical education from the viewpoint of educational experts. METHODS: The qualitative study was conducted at Shiraz University of Medical Sciences, Shiraz, Iran, from April to October 2016, and comprised medical education professors and experts working at the university's Education Development Centre. These professors had Master degree or PhD in medical education. Content analysis method was used after data was collected using semi-structured interviews followed by focus group discussions. RESULTS: There were 22 academicians in the study. Four themes, each with some sub-themes, were extracted out of the 86 codes derived from the interviews. The themes were: general priorities in educational research, lack of a comprehensive educational research database in medical sciences, discrimination among departments concerning budget, and the lack of the research spirit and teamwork were more prominent. Based on these themes, barriers identified fell in the two categories: manpower and financial resources. CONCLUSIONS: The barriers can partly be eliminated through modifying the mentality and attitude toward research and teamwork in the university, proper planning in the budget of the educational field and managing the university research system.

The perception of hidden curriculum among undergraduate medical students: a qualitative study.

OBJECTIVES: The effect of hidden curriculum on student learning has not been sufficiently recognized in most of the revised curriculums. This study is a qualitative study that measures the students' perception of hidden curriculum through semi-structured interviews. All of the interviews were recorded and then converted into scripts. These scripts were divided to sentences and phrases and named as units. Units aggregated with similar groups and named as codes, then the similar codes were aggregated into themes. RESULTS: Four main themes emerged, role modeling, personal attitude and beliefs, hierarchy, social and ethical culture. The results of the present study showed that it is necessary to discuss the hidden curriculum. We are unaware of the hidden curriculum, but even when were are aware of it, we are unwilling to act. Information about issues related to the hidden and informal curriculum, as well as knowing the viewpoints of students is necessary. It seems necessary to provide data to students about the hidden curriculum and encouraging patient centered curriculums early in training, such as integrated curriculum.

Early clinical exposure program in learning renal physiology.

INTRODUCTION: Teaching renal physiology for undergraduate medical students in an understandable way using methods which improve their deep learning has always been a problem. In this study, Early Clinical Exposure (ECE) was used in teaching renal physiology for the second year medical students in Shiraz Medical School. This article aims to introduce and develop this program and also measure the attitude of medical students toward ECE in learning renal physiology. METHODS: This is a mixed method study conducted on 120 second year undergraduate students. After performing the course, both qualitative and quantitative methods were used for measuring the viewpoints of the students. In the qualitative part, 10 high rank medical students were selected. These students participated in brain storming sessions to express their opinion about the program based on the strengths and weaknesses. For trustworthiness of the qualitative part, member check and peer check were done. In the quantitative part, a researcher-made questionnaire was used based on the objectives of the program in a 4 point Likert scale. The validity of questionnaire was determined by medical education experts and reliability was determined after a pilot study. RESULTS: Based on the results of the quantitative part of the study, 98 percent of the students stated that the ECE program was generally a useful program. In the qualitative part, the students' comments were obtained. The benefits of the program were summarized in 4 main themes. These themes are "understanding of renal physiology", "Integration of basic and clinical knowledge", "Improvement of attitude toward importance of physiology", and "encouragement to study". In response to the questions about negetive aspects of this program in qualitative part, the two main themes were insufficient time and large grup size. CONCLUSION: Students reported that ECE was useful, but they stated that they needed to have more encounter with patients and more hospital teaching. The results also reveal that this ECE program is an excellent approach to strengthen learning in a difficult subject like renal physiology. This approach is adjustable to other basic science topics and subjects as well.

Program evaluation of an Integrated Basic Science Medical Curriculum in Shiraz Medical School, Using CIPP Evaluation Model.

INTRODUCTION: In recent years curriculum reform and integration was done in many medical schools. The integrated curriculum is a popular concept all over the world. In Shiraz medical school, the reform was initiated by stablishing the horizontal basic science integration model and Early Clinical Exposure (ECE) for undergraduate medical education. The purpose of this study was to provide the required data for the program evaluation of this curriculum for undergraduate medical students, using CIPP program evaluation model. METHODS: This study is an analytic descriptive and triangulation mixed method study which was carried out in Shiraz Medical School in 2012, based on the views of professors of basic sciences courses and first and second year medical students. The study evaluated the quality of the relationship between basic sciences and clinical courses and the method of presenting such courses based on the Context, Input, Process and Product (CIPP) model. The tools for collecting data, both quantitatively and qualitatively, were some questionnaires, content analysis of portfolios, semi- structured interview and brain storming sessions. For quantitative data analysis, SPSS software, version 14, was used. RESULTS: In the context evaluation by modified DREEM questionnaire, 77.75%of the students believed that this educational system encourages them to actively participate in classes. Course schedule and atmosphere of class were reported suitable by 87.81% and 83.86% of students. In input domain that was measured by a researcher made questionnaire, the facilities for education were acceptable except for shortage of cadavers. In process evaluation, the quality of integrated modules presentation and Early Clinical Exposure (ECE) was good from the students' viewpoint. In product evaluation, students' brain storming, students' portfolio and semi-structured interview with faculties were done, showing some positive aspects of integration and some areas that need improvement. CONCLUSION: The main advantage of assessing an educational program based on CIPP evaluation model is that the context, input, process and product of the program are viewed and evaluated systematically. This will help the educational authorities to make proper decisions based on the weaknesses and strengths of the program on its continuation, cessation and revision. Based on the results of this study, the integrated basic sciences course for undergraduate medical students in Shiraz Medical School is at a desirable level. However, attempts to improve or reform some sections and continual evaluation of the program and its accreditation seem to be necessary.

Evaluation of the strengths and weaknesses of community-based education from the viewpoint of students.

INTRODUCTION: Responsive medicine is an appropriate training method which trains the graduates who can act effectively in initial and secondary aspects of health issues in the society. METHODS: This was a cross-sectional descriptive-analytic study which was done using quantitative method. The target population of this study was all the students of the Nutrition and Health School of Shiraz University of Medical Sciences. The sample was randomly selected in this study and 75 students were selected based on the methodologist's comments and similar studies and random-number table from a list obtained from the school's department of education. This questionnaire was a researcher-made one which consisted of 23 questions in 2 sections with 21 closed-ended questions and 2 open-ended questions; 70 questionnaires were completed correctly. The closed-ended questions had 4 aspects (completely agree to completely disagree) answered in 5-point Likert scale type. Its face validity was confirmed by 4 faculty members. The construct validity of the questionnaire was analyzed by factor analysis test and its reliability was assessed by a pilot on 20 students with a Cronbach's alpha of 0.85. The data were analyzed using descriptive statistical tests (mean, standard deviation, …) and the Pearson coefficient (p<0.001). RESULTS: The results of this study showed that the maximum mean score was 3.58±0.65 which was related to the context of these courses and the minimum mean was 2.66±1.14 which was related to the logbook implementation. The 2 open-ended questions indicated that the most important strengths were the use of logbooks as a guide and determining the minimum training; of the weaknesses was the mismatch between the theoretical education and the practical activities. Also, developing the minimum training that an expert should know and using the common topics related to theoretical education were the most important points mentioned by the respondents. CONCLUSIONS: The educational planning of the authorities for keeping the balance of the theoretical training with the practical activities and giving opportunities to the trainee or intern to face diseases and the common problems of the community seems to be necessary.

The influence of parenting style on academic achievement and career path.

INTRODUCTION: Several factors affect the academic performance of college students and parenting style is one significant factor. The current study has been done with the purpose of investigating the relationship between parenting styles, academic achievement and career path of students at Shiraz University of Medical Sciences. METHODS: This is a correlation study carried out at Shiraz University of Medical Sciences. Among 1600 students, 310 students were selected randomly as the sample. Baumrind's Parenting Style and Moqimi's Career Path questionnaires were used and the obtained scores were correlated with the students' transcripts. To study the relation between variables Pearson correlation coefficient was used. RESULTS: There was a significant relationship between authoritarian parenting style and educational success (p=0.03). Also findings showed a significant relationship between firm parenting style and Career Path of the students, authoritarian parenting style and Career Path of the students, educational success and Career Path of the students (p=0.001). CONCLUSION: Parents have an important role in identifying children's talent and guiding them. Mutual understanding and close relationship between parents and children are recommended. Therefore, it is recommended that the methods of correct interaction of parents and children be more valued and parents familiarize their children with roles of businesses in society and the need for employment in legitimate businesses and this important affair should be more emphasized through mass media and family training classes.

Knowledge of triage in the senior medical students in Shiraz University of Medical Sciences.

INTRODUCTION: Triage is a response to the problem of overcrowding in Emergency Departments (EDs) and accuracy of decisions made by the triage unit affects the ultimate outcome of EDs. This study was conducted to evaluate the knowledge of triage among last year medical students in Shiraz University of Medical Sciences. METHODS: This is a cross-sectional analytical study whose subjects were all the senior students of medicine (62) in the last year of medicine from January to June 2013 who attended emergency medicine course in the screen room of 2 University Hospitals. This questionnaire was designed in 3 sections including personal data, 15 questions on knowledge of triage and 10 case scenarios for triage decision making and completed by the students. Statistical analysis was performed in SPSS statistical software (version 14) using independent sample t-test, one way ANOVA, and Pearson correlation coefficient (p≤0.001). RESULTS: The total mean score of the participants was 10.6±1.5, ranging from 7 to 13. 58(93.5%) students had poor triage knowledge. In the scenario's section, the percentage of correct triage by students was 49.2% and those of over and under triage were 28.1% and 22.7%, respectively. There was a significant relationship between the triage accuracy and level of triage (ESI 4) (p≤0.001). CONCLUSION: The level of knowledge of triage in the last year medical students was poor, although most of them had passed a course in the screen room. It is recommended that medical students' educational courses should include sections on the knowledge of triage in emergency rooms.

Research priorities in medical education at Shiraz University of Medical Sciences:categories and subcategories in the Iranian context.

INTRODUCTION: Research in education is a globally significant issue without a long history. Due to the importance of the issue in Health System Development programs, this study intended to determine research priorities in medical education, considering their details and functions. By determining barriers existing in research in education progress, it is tried to make research priorities more functional by recommending acceptable strategies. METHODS: This is a qualitative-descriptive study in two descriptive phases. The goal of these phases was to determine research priorities subcategories in medical education by Nominal Group Technique (NGT) and two rounds of Delphi method. Through the first phase, subcategories of research priorities were determined, using Nominal Group Technique under medical education experts' supervision. Through two rounds of Delphi, a questionnaire was constructed based on the subcategories. Eventually, research priorities were determined based on their highest score (scores more than 7 out of 10). RESULTS: In the first phase (NGT), 35 priorities in 5 major fields of medical education were presented. In the second phase, priorities were scored, using Delphi method. Medical Ethics and professionalism gained the highest scores (7.63±1.26) and educational evaluation the lowest (7.28±1.52). In this stage, 7 items were omitted but 2 of them were added again after experts' revision in the third round of Delphi. CONCLUSION: According to the results of the present study and based on previous studies, it really seems that the fields of "Learning and Teaching Approaches" and "Medical Ethics and Professionalism" were more important. Because of financial and resource limitations in our country and the importance of research priorities, it is recommended to frequently study "research priorities determination program" at universities.

Assessment of the interns' ability based on Dundee model in Shiraz University of Medical Sciences.

INTRODUCTION: The importance of medical profession and the role of the physician in society is no secret to anyone. Skills and competencies in clinical practice are necessary for the medical profession. In fact, in patient care, doctors require practical skills in addition to scientific knowledge. This study examines the potentials of medical school students in three areas of doing the right thing, doing the right thing in an intermediate range, and doing the right thing by the right person. METHODS: This study was done in a descriptive-analytical and sectional model. The population of this study was all interns of Shiraz University of Medical Sciences who were passing internship at Internal Medicine, Surgery, Pediatrics, Obstetrics and Emergency wards. About 100 persons were selected by simple randomization. In order to collect data, a questionnaire with 12 questions was designed in two parts. The questionnaire was approved by 7 Faculty members of Clinical Medicine and Medical Education, and its reliability was approved by test-retest method on 20 medical students in the form of a pilot study and through Cronbach's alpha (82%). Collected data were analyzed by SPSS software version 14 using descriptive statistical methods. RESULTS: Results showed that within the inner circle, interns evaluated their skills in surgery, internal medicine, and gynecology wards, intermediate and at other wards as weak. Also within the center circle, interns evaluated adequate educational evidence-based training in the field of medicine, and sufficiency of educational training in the field of clinical decision making and clinical care as suitable. CONCLUSION: According to the results, it seems that medical interns' skills in performing most medical skills are moderate. So teaching students by new educational methods and workshop techniques, using experienced teachers will be effective. The use of clinical skills training centers and objective assessment methods for the students' skills, especially before entering the clinical departments, is very important.

Medical ethics as practiced by students, nurses and faculty members in Shiraz University of Medical Sciences.

INTRODUCTION: Assuming any social role has obligations and fulfilling the related responsibilities has ethical aspects that must be addressed carefully. Each role requires extensive training, which usually takes place in university institutions. Ethics is applied in at least three academic areas, including: a) in education of students' personal growth, b) in patient care, and c) in university communion in population-based health care. Given the importance of this issue in the moral domain, this study examines the correlation among the students, nurses and teacher's opinions regarding principles of medical ethics at Shiraz University of Medical Sciences. METHODS: This is a descriptive-analytic and cross-sectional study conducted in 2010. The participants of this research consisted of all medical students, nurses in public hospitals, and faculty members in Shiraz University of Medical Sciences. For validity evaluation, the expert panel method and for reliability evaluation, test-retest method was used. RESULTS: Based on the medical ethics' scores in these three groups, there was a significant relationship between the mean scores of student-nurses and employed nurses, but there was no significant relationship between those of student-faculties. Also the mean score of the students was the highest in medical ethics. CONCLUSION: In this study, we presented a list of virtues and moral characteristics of medical staff and found out the method of practicing medical ethics in everyday life of students to improve the moral reasoning of teachers, nurses and students. Moreover, medical ethics, with the presentation of specific criteria for ethical behavior in various domains of human life, especially in dealing with patients, can help practice ethical values in the medical community.

Evaluation of the consultation program in Shiraz University of Medical Sciences.

INTRODUCTION: Consultation and guidance is a process of learning which is done through the relationship between two individuals. In this mutual relationship, the ounsellor, through his scientific and occupational skills and qualification, tries to help the students using the methods corresponding to their needs. The main objective of this study was to provide a framework for the management of the advisors' plans in the university based on the analysis of different schools. METHODS: This research is a cross-sectional and descriptive-analytic study. Data were collected both qualitatively (centralized groups at the presence of advisors in universities) and quantitatively (self-assessment of teachers and students' evaluation). Sampling was done randomly from all students of Shiraz University of Medical Sciences. All the teachers who were advisor took part in this study. RESULTS: This study was conducted in eight schools of Shiraz University of Medical Sciences simultaneously and 974 students and 125 teachers took part in it. At the time of data collection, 25.5 percent of the students declared that the advisors have provided allocated time to them and 45.4 percent believed that the advisors helped the students to understand the importance of the courses. CONCLUSION: The emergence of weaknesses and strengths of the academic advising program and the guidance through teacher's self assessment, not only may be the sign of realization of programmed objectives, but also may be the starting point for qualitative improvement of the situation. Moreover, in order to improve the advisory services and guidance, it is necessary to regard consultation as a scientific subject which needs training.

Evaluation of the efficacy of peer-learning method in nutrition students of Shiraz University of Medical Sciences.

INTRODUCTION: One of notable initiatives in improving the academic education is to use the abilities of students to learn together in a new and effective system of peer learning. In this regard, Education  Development Center in Shiraz University of Medical Sciences proceed to implementation and study of the curriculum and teaching methods course in the form of peer learning for college students of nutrition science and survey the efficacy of this implementation. METHODS: This study was conducted two parts: qualitative and quantitative survey. A quasi-experimental, pre test/post-test research was used in quantitative part. In this study, whole groups of undergraduate nutrition students in courses of study and learning techniques with the help of teachers held a course and took a part in a competition in 15 major subjects of study and learning methods. The study lasted for two-week sessions and whole of nutrition students were included. We used pair t test for comparison pre test and post test in this study. RESULTS: In the quantitative part of the study, the results showed a significant difference between pre-test (0.0346±0.108) and post-test scores (0.809±0.187) of the students. This means that the level of knowledge of students, who participated in this course, has significant difference before and after the peer learning course (pair t-test=1.010, p=0.002). The results of the quality survey of the training course also indicated satisfaction of participants and necessity of teacher's presence and control at courses. CONCLUSIONS: The results of this study confirm the results of the previous studies emphasizing numerous positive effects of the peer learning methods in the academic community. The results also suggest that peer learning is effective to enhancement of the students' confidence and learning. Peer learning also helps to develop their future responsibilities.

Relationship between organizational structure and creativity in teaching hospitals.

INTRODUCTION: Organization structure and manpower constitute two basic components of anorganization and both are necessary for stablishing an organization. The aim of this survey was to investigate the type of the organization structure (mechanic and organic) from viewpoint of senior and junior managers in Shiraz teaching hospitals and creativity in each of these two structures. METHODS: In this cross-sectional and descriptive-analytic study, organization structure and organizational creation questionnaires were filled out by hospital managers. According to the statistical consultation and due to limited target population, the entire study population was considered as sample. Thus, the sample size in this study was 84 (12 hospitals and every hospital, n = 7). For data analysis, SPSS 14 was used and Spearman correlation coefficient and t-test were used. RESULTS: RESULTS showed that there is a negative association between centralization and complexity with organizational creation and its dimensions. Also there was a negative association between formalization and 4 organizational creation dimensions: reception change, accepting ambiguity, abet new view and less control outside (p=0.001). CONCLUSION: The results of this study showed that the creation in hospitals with organic structure is more than that in hospitals with mechanic structure.