Comparing the Familiarity of the Basic and Clinical Faculty Members of Iran University of Medical Sciences with the Principles of Digital Professionalism.

Background: Due to the changing conditions of education, research, and treatment in the world, especially the recent pandemic, and more use of virtual space, there is a need for evaluation of digital professionalism in faculty members as the most influential people who have a direct and deep impact on the next generation. Methods: In this analytical cross-sectional study that was conducted in 2023 on 149 faculty members of Iran University of Medical Sciences, they were invited to participate in the study through various methods (SMS, E-mail, and media messages). The link to the Persian standardized questionnaire was made available for participants. If a person received less than 70% of the score in each area, he/she would receive solutions to improve his/her situation in that area at the end of answering the questions. The self-administered questionnaire has 5 fields and 33 questions. Maximum scores were 10 points. Spearman and Pearson correlation coefficients and statistical tests consisting of chi-square, t-test, Mann-Whitney U, one-way ANOVA, and Kruskal-Wallis H were used in the analysis. Results: The mean overall score of people in principles of digital professionalism was 0.8. Women and basic sciences faculties had a significantly better status than men and clinical faculties in the principles of digital professionalism as a whole (P = 0.001 and P = 0.049, respectively). The domain of "knowledge management and information literacy" had significantly lower scores in professors in comparison with other degree (instructors, assistant professors, and associate professors (P = 0.039). Conclusion: The mean score of the principles of digital professionalism is acceptable at 80%. Coherent, timely, and up-to-date training to ensure the effective, safe and appropriate use of digital technology, especially for men, professors and clinical faculty members who had a lower score than others, should be done.

Developing The Spiritual Health Curriculum Approach Based on Tyler's Model in Iran.

Background: Spiritual health education is known as an important element in its implementation in the health system, which has different approaches to its implementation. Spiritual health has a positive effect on health, longevity, and recovery from physical ailments. Without spirituality education, education cannot function properly in biological, psychological, spiritual, and social dimensions or reach its maximum capacity. The present study aimed to develop the spiritual health curriculum approach based on Tyler's model in Iran between 2020 and 2021. Methods: In this qualitative study, by using a directed content analysis method and using validated curriculum models (Tyler's model), we developed a new spiritual health curriculum approach for Iranian society. This study was done between April 2021 and February 2022. Results: Because the spiritual health curriculum in Iran should be based on the philosophical and social principles of Iran, a new approach to spiritual health education based on Tyler's model was developed. Conclusion: Tyler's Iranian-Islamic model, which is suitable for our Iranian-Islamic culture and is valid for developing spirituality, was introduced.

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

Background: Development and assessment of clinical decision-making skills are essential in midwifery education because of their role in mothers' and infants' safety. Therefore, the present study's primary objective was to evaluate the relationship between experience levels and clinical decision-making skills using the key features (KFs) examination. Methods: One hundred and two midwifery students in five different education levels participated in this cross-sectional study through convenient sampling. Twenty KFs questions were designed based on the principles of the KFs examination. The participants' information, including grade point average (GPA), theoretical and practical scores of the obstetrics course, were collected. KFs scores were compared according to students' training semester by one-way analysis of variance (ANOVA). Pearson correlation was conducted to explore the correlation between KFs scores and GPA as well as theoretical and practical scores. All statistical analyses were performed at a significance level of 0.05 (p≤0.05). We used five kinds of effect size calculators, which include mean difference (MD), standardized mean difference (cohend), partial Eta-squared, Cohenf, and partial omega-squared. Results: There was no correlation between KFs scores and the grade point average, theoretical exam scores, and practical exam scores. KFs scores linearly rose as the learners' level increased with a mean± SD score of 7.61±1.09 during the third semester compared to 11.55 ± 1.89 during the eighth semester (p=0.001). The effect size of this result was large (partial omega square=0.35, partial eta square=0.38 & cohen's f=0.73). The largest SMD was related to the comparison of KFs scores between the eighth and third semester (MD=3.58, SMD=2.554 [CI 95%: 1.719-3.389], p-value═ 0.001), and the lowest was related to the comparison between the third and fourth semesters (MD=0.354, SMD= 0.2 [CI 95%: -0.421-0.821], p=0.987). Conclusion: Establishing proficiency in clinical decision-making skills is a linear process greatly enhanced by experience, clearly shown by the present study results. Using KFs examination and obtaining extensive evidence to its benefit can allow us to renegotiate proficiency evaluation methods for students in clinical fields. the education curriculum should focus more on identifying clinical KFs skills than merely teaching knowledge about disease processes.

Strategies to Promote the Quality of Occupational Therapy Fieldwork Education: A Qualitative Study.

Background: Clinical education is a bridge between theory and practice. The purpose of this study was to develop strategies to promote the quality of occupational therapy fieldwork education. Methods: The qualitative content analysis was used to identify the promoting strategies of fieldwork quality in occupational therapy from students' and fieldwork educators' perspectives during the 2019-2020 academic sessions. Participants were 12 fieldwork educators (mean age=39.33 yr, Male=5, female 7) and 14 students (mean age=23.28 yr, Male=7, female 7) in the code extraction phase and 16 fieldwork educators (12 of them were in code extraction phase too) in actions of strategies scoring phase. Results: Following the content analysis of the data, the prompting strategies categorized into 4 major categories and 10 subcategories: factors related to Fieldwork educators (Improving clinical teaching skills, Enhancing fieldwork management skills, Motivating fieldwork educators, and Fostering coordination between fieldwork educators), related to Educational Planning (Modifying clinical fieldwork planning, Revising curriculums), related to Students (Empowering students, Motivating students) and related to Fieldwork settings ( Improving the social environment, Improving physical environment ). Based on the qualitative content analysis and 3 expert panels. Finally, the 23 promoting actions were identified. Conclusion: Improving the quality of fieldwork education in occupational therapy needs a systematic collaboration between educators, students, and educational planners. Doing the promoting actions on fieldwork education process in occupational therapy may improve the quality of fieldwork education process.

Which models can be used as a clinical education model in occupational therapy? Introduction of the models: A scoping review study.

Background: Clinical education is a vital part of occupational therapy education process. High clinical education quality in fieldwork settings leads to higher clinical competency and occupational proficiency. One of the most effective clinical education methods in equalizing the conditions of clinical education to students is the correct use of educational models related to each field of medical sciences. In the field of clinical education, various models have been designed with a specific subject. However, limited research has been done on the introduction of the usability of these models in occupational therapy settings. This study was conducted to determine which models have the potential to be used as clinical education models in occupational therapy. Methods: A scoping review was conducted and studies published in English between 2000 and 2018 that examined clinical education models were selected. Results: A total of 8 articles were entered in the review, and a central theme of implementing clinical education models in occupational therapy was determined by thematic analysis. This central theme consisted of 3 categories: (1) evaluative models, (2) acting models, and (3) evaluative/acting models. Conclusion: Occupational therapists, especially who work as educators should be aware of the different types of clinical education models and try to use these models in clinical education process and minimize the variation of teaching methods in fieldwork settings to promote the clinical education quality. However, more research should be done to improve evidence-based occupational therapy practice in clinical education.

Core competencies for academic leaders in Iran University of Medical Sciences.

INTRODUCTION: Integrated educational, health, and medical services necessitate the development of high-competent academic leaders in medical universities of Iran. Most organizations attempt to limit the total number of competencies to a rational number and consider the most important competencies. Therefore, the purpose of this study was to determine core competencies which can be improved through development programs for the academic leaders in Iran University of Medical Sciences. METHODS: This study was conducted in two phases. The first phase was the critical review based on Carnwell and Daly's approach. The search time was from 2000 to 2017. The searches were conducted in PubMed, Emerald, ERIC, ProQuest, Web of Science, Scopus, SID, and nor gram. The second phase was modified Delphi in three rounds. The purposive sampling was used to employ appropriate participants. RESULT: According to the critical review results, competencies were categorized in two groups, including 62 personal competencies and 19 functional competencies. Also, according to modified Delphi results, 19 competencies, including 12 personal competencies and 7 functional competencies were selected as trainable core competencies. CONCLUSION: In order to design a development program for academic leaders in the integrated educational system in Iran University of Medical Sciences, both personal and functional competencies need to be considered together.

Challenges in promoting clinical empathy skills in medical students: A content analysis study.

Background: Empathy is a key clinical skill in the medical profession, and many studies have reported a decline in it among medical students during their years of education; especially, in the clinical stage, and this affective decline persists in the physician-hood. This study aimed to explore the participants' perceptions about challenges for promoting clinical empathy in training stages. Methods: A qualitative design using content analysis was applied. Semi-structured interviews were applied to obtain data. Individual interviews were conducted with 14 interns and six clinical professors. The data were analyzed through conventional content analysis and the credibility, trustworthiness, and conformability of the data were confirmed. Results: Data analysis led to the extraction of two main categories, including overt and covert challenges, and also four categories and nine sub-categories. Conclusion: Resolving clinical empathy challenges in medical students requires financial and human resources, and training on the principles of effective doctor-patient interactions. Furthermore, professionalism should be strengthened in professors, and both official and hidden curricula should be revised accordingly.

Spirituality in medical education: a concept analysis.

Spirituality in medical education is an abstract multifaceted concept, related to the healthcare system. As a significant dimension of health, the importance and promotion of this concept has received considerable attention all over the world. However, it is still an abstract concept and its use in different contexts leads to different perceptions, thereby causing challenges. In this regard, the study aimed to clarify the existing ambiguities of the concept of spirituality in medical education. Walker and Avant (Strategies for theory construction in nursing, Prentice Hall, Boston, 2011) concept analysis eight-step approach was used. After an extensive review of online national and international databases from 2000 to 2015, 180 articles and 3 books in English and Persian were retrieved for the purposes of the study. Analysis revealed that the defining attributes of spirituality in medical education are: teaching with all heart and soul, Life inspiring, ontological multidimensional connectedness, religious-secular spectrum, and socio-cultural intricacies. Moreover, innate wisdom, skillful treatment, transcendent education, and environmental requirements were antecedents to this concept, with the health of body and soul, intrapersonal development and elevation, and responsive treatment and education being its consequences. The defining attributes provided in this study can assist physicians, instructors, and professors to develop and implement evidence-based, health based and comprehensive education plans according to the guidelines of professional ethics and qualification of using spirituality in practice. The clarification of the noted concept facilitates further development of medical knowledge, research, and research instruments.

Self- directed learning barriers in a virtual environment: a qualitative study.

INTRODUCTION: There is a growing trend in online education courses in higher education institutes. Previous studies have shown that high levels of self-direction are essential for successful online learning. The present study aims to investigate challenges of and barriers to self-directed virtual-learning among postgraduate students of medical sciences. METHOD: 23 postgraduate virtual students of medical sciences in Iran, collected through maximum variation purposive sampling and semi-structured interviews, served as the sample of this study. The collected data were analyzed using the inductive content analysis method. RESULTS: Three themes and six sub-themes were identified as barriers to self-directed learning in virtual education, including cognitive barriers (information overload and lack of focus on learning or mind wondering), communication barriers (inadequate coping skills and inadequate writing skills) and educational environment barriers (heavy workload and role ambiguity). CONCLUSION: By the importance of self-direction in online education, the present study results can be used by virtual education planners in the review and design of courses, so as to adequately equip students, obviate barriers to self-directed virtual education, and ultimately train highly self-directed learners in online medical education.

Contextualization and validation of the interprofessional collaborator assessment rubric (ICAR) through simulation: Pilot investigation.

BACKGROUND: Simulation can be used for educating, evaluating and assessing psychometric properties of an instrument. The aim of this study was to contextualize and assess the validity and reliability of the Interprofessional Collaborative Assessment tool (ICAR) in an Iranian context using simulation. METHODS: In this descriptive study, contextualization of the ICAR was assessed through several steps. Firstly, validity assessment was approved through expert panels and Delphi rounds. Secondly, reliability assessment was done by arranging a simulation video and assessing reproducibility, test-retest (ICC), internal consistency (Cronbach's Alpha) and inter-rater reliability (Kappa).The participants included 26 experts, 27 students and 6 staff of the Standardized Simulation Office of Teheran University of Medical Sciences. RESULTS: Contextualization and validity of the ICAR were approved in an Iranian context. The reliability of the tool was computed to be 0.71 according to Cronbach´s Alpha. The test-retest was calculated to be 0.76. CONCLUSION: The Iranian ICAR can be a useful tool for evaluating interprofessional collaborative competencies. The development of the instrument through a simulation scenario has been a positive prospect for researchers.

Clinical reasoning assessment through medical expertise theories: past, present and future directions.

Exploration into the concept of "medical expert" dates back to more than 50 years ago, yet yielding three leading theories in the area of clinical reasoning, namely, knowledge structure, hypotheticdeductive, and dual process. Each theory defines "medical expert" in a dissimilar way. Therefore, the methods of assessment through which the experts are identified have been changed during the time. In this paper, we tried to categorize and introduce some widely used tests for identification of experts within the framework of existing main theories. Implementation of the proposed categorization for providing future assessment tools is discussed.

Comparison of quality of clinical supervision as perceived by attending physicians and residents in university teaching hospitals in Tehran.

BACKGROUND: Clinical supervision is an important factor in the development of competency in residency program. Attending physicians play a key role in supervision of residents. However little is known about how attending physicians and residents perceive the quality of clinical supervision. The aim of this study was to explore the differences between perceived qualities of supervision in these two groups in different wards in teaching hospitals in Tehran, Iran. METHODS: A valid questionnaire were completed by 219 attending physicians and residents from surgery, psychiatry, gynecology, pediatrics, internal medicine, orthopedics and radiology wards in two teaching hospital affiliated to Iran University of Medical Sciences. This questionnaire contained 15 items in regards to supervisory roles, rated on a five point Likert scale (1=never, 2=seldom, 3=sometimes, 4=often, 5=always). RESULTS: Out of 219 participants, 90 (41%) were attending physicians and 129 (59%) were residents. The overall mean±SD scores of perceived clinical supervision achieved by attending physicians and residents were respectively, 4.20±0.5 and 3.00±0.7 which was statistically significant (p<0.05). Attending physicians and residents acquired minimum scores (mean=4.06 and 2.7, respectively) regarding expectation from their supervisor to know and do during training period of residency. CONCLUSION: It seems that the clinical supervisory does not have an efficient performance in teaching hospitals which needs to be more assessed and improved. Therefore it is suggested that policymakers in medical education system pay more attention to this important issue and enhance some faculty development programs for clinical educators in Iran.

Assessing validity and reliability of Dundee ready educational environment measure (DREEM) in Iran.

BACKGROUND: If an institute is looking for improvement of its learning environment, a reliable and valid assessment tool is needed for measurement of the educational environment .The Dundee Ready Educational Environment Measure (DREEM) has been used in various studies to evaluate the educational environment. However, psychometric evaluations of the instrument seem necessary, for all known versions of the instrument. The aim of this study was to investigate the reliability and validity of Persian version of the DREEM in the major clinical wards in teaching hospitals affiliated to Iran University of Medical Sciences. METHODS: This descriptive - analytical study, involved medical students (clinical stagers and interns) in 4 major clinical wards. In this study, DREEM questionnaire was reviewed in content, face validity and construct validity through confirmatory factor analysis. The reliability was calculated according to test - retest and the internal consistency was measured using Cronbach's alpha coefficient. RESULTS: A total number of 267 questionnaires were completed by medical stagers (60%) and interns (40%) including 181 females and 82 males. The mean age of stagers and interns were 23.60 ± 1.27 and 25.45 ± 1.22 years, respectively. The total mean of the questionnaire was calculated as 96.15 (93.5375, 98.7547) out of 176, with 95% confidence interval. The face validity of the questionnaire was confirmed. The mean of content validity ratio (CVR) was calculated as 0.35, and 6 questions were omitted in this step. The content validity index (CVI) was 0.39. The reliability coefficient mean was 0.71. In confirmatory factor analysis five factors were confirmed that changed the orientation of some questions. The Cronbach's alpha coefficient of the whole questionnaire was obtained as 0.914. CONCLUSION: The modified and validates DREEM questionnaire in Persian language with 44 items and appropriate psychometric attributes is capable of being used in assessment of clinical education environments in Iran.

Challenging script concordance test reference standard by evidence: do judgments by emergency medicine consultants agree with likelihood ratios?

BACKGROUND: We aimed to compare the clinical judgments of a reference panel of emergency medicine academic physicians against evidence-based likelihood ratios (LRs) regarding the diagnostic value of selected clinical and paraclinical findings in the context of a script concordance test (SCT). FINDINGS: A SCT with six scenarios and five questions per scenario was developed. Subsequently, 15 emergency medicine attending physicians (reference panel) took the test and their judgments regarding the diagnostic value of those findings for given diseases were recorded. The LRs of the same findings for the same diseases were extracted from a series of published systematic reviews. Then, the reference panel judgments were compared to evidence-based LRs. To investigate the test-retest reliability, five participants took the test one month later, and the correlation of their first and second judgments were quantified using Spearman rank-order coefficient. In 22 out of 30 (73.3%) findings, the expert judgments were significantly different from the LRs. The differences included overestimation (30%), underestimation (30%), and judging the diagnostic value in an opposite direction (13.3%). Moreover, the score of a hypothetical test-taker was calculated to be 21.73 out of 30 if his/her answers were based on evidence-based LRs. The test showed an acceptable test-retest reliability coefficient (Spearman coefficient: 0.83). CONCLUSIONS: Although SCT is an interesting test to evaluate clinical decision-making in emergency medicine, our results raise concerns regarding whether the judgments of an expert panel are sufficiently valid as the reference standard for this test.