Using evaluation research to improve medical education.

BACKGROUND: Evaluation research is a form of applied research that scrutinises how well a particular programme, practice, procedure or policy is operating. Evaluation researchers use both quantitative and qualitative research data to construct a collective picture of the programme under evaluation. CONTEXT: Medical educators need to provide information about a particular programme using the methods of evaluation research in order to make a decision on the potential adoption, improvements and refinements of the programme. Improving curricula and pedagogical methods using these methods may enhance health care education. INNOVATION: We provide an overview of the methods of evaluation research in the context of medical education. We discuss the application, general methodology, methods of collecting data and analysis for each type of evaluation research. IMPLICATIONS: The methods of evaluation research described in this article enable medical educators to gain a comprehensive understanding of evaluation research in the context of medical education. The use of evaluation research findings helps medical educators to make informed decisions regarding a programme and any future actions related to it.

Educating doctors about breaking bad news: an Iranian perspective.

BACKGROUND: The breaking of bad news is a frequent and well recognized task that is performed by a variety of health professionals including medical doctors. In this article, we explore both how this topic is dealt with in medical education in Iran and also consider how this aspect of the curriculum might be enriched in the future. METHODS: This article is based on research, which was undertaken using a purposively selected sample of medical course planners in Iran. Semistructured interviews were conducted with each of 10 carefully selected participants. Their interview responses were analyzed in such a way as to provide an in-depth exploration and interpretation of both their perceptions and experiences in relation to this sensitive and highly important topic. RESULTS: Four major themes emerged from the analysis of the interview transcripts: medical paternalism, religion, training issues, and professional barriers. CONCLUSIONS: On the basis of this analysis, there appears to be an urgent need for integrating more emphasis on techniques for breaking bad news into the Iranian medical education curriculum. This curriculum could in the future place more emphasis on addressing specific religious issues, which are unique to the local culture. A number of other specific recommendations are formulated and discussed.

The involvement of clinicians in medical education research.

BACKGROUND: Medical education, like other forms of professional preparation, is a complex and demanding process, which can benefit enormously from careful research. Although such research can be conducted by researchers from outside medical education, there is also a clear need for clinicians to participate in such research and conduct studies that can draw upon their experience and insights. However, despite recent endeavours to involve clinical educators in such research, there are very few published articles reporting research conducted by such individuals. OBJECTIVE: To explore the factors that impact upon clinicians' engagement in medical education research. METHOD: Interview data, concerning potential involvement in medical education research, were gathered directly from 20 clinicians. A detailed systematic analysis was conducted on the interview transcripts. RESULTS: Three general themes emerged from the interviews, all of which relate to clinicians' engagement in medical education research. They are: (a) effective leadership, (b) promoting professional growth, and (c) all-encompassing support. CONCLUSION: The study shows that there is a need for clinical leaders with inspirational qualities to drive research in medical education. Also, clinicians need better training in educational research methods and more funding is needed to support this type of research.

Opposite gender doctor-patient interactions in Iran.

BACKGROUND: The importance of physician gender in patient health outcomes has been recognized for some time in the West. For example, there is some evidence to show that female doctors use good interpersonal communication skills with their patients and that patients are satisfied with female doctors. There is little known, however, about the contribution of different configurations of gender identities to a variety of positive health outcomes in non-Western countries. In Iran, in particular, the attention given to "cross-gender dyads" in doctor-patient interactions is severely limited. DESCRIPTION: The findings were based on a well-designed questionnaire, validated and found to be reliable in Australia, which we administered to medical students in Iran. EVALUATION: Overall, there was no significant difference between the mean scores of students in relation to opposite-gender comfort. Results indicate that both male and female students were more comfortable conducting intimate physical examinations on patients of the same gender as themselves. Performing a testicular examination was significantly disagreeable for both genders, but particularly for female students. CONCLUSIONS: Both genders appeared to be comfortable talking to patients of the opposite gender about intimate matters, but same-gender dyads were viewed as preferable to cross-gender dyads in relation to physical examinations. Further qualitative research is needed to understand how these views are constituted and how they operate in practice. We make some recommendations, and we discuss the limitations of study.

Grounded Theory in Medical Education Research.

The grounded theory method provides a systematic way to generate theoretical constructs or concepts that illuminate psychosocial processes common to individual who have a similar experience of the phenomenon under investigation. There has been an increase in the number of published research reports that use the grounded theory method. However, there has been less medical education research, which is based on the grounded theory tradition. The purpose of this paper is to introduce basic tenants of qualitative research paradigm with specific reference to ground theory. The paper aims to encourage readers to think how they might possibly use the grounded theory method in medical education research and to apply such a method to their own areas of interest. The important features of a grounded theory as well as its implications for medical education research are explored. Data collection and analysis are also discussed. It seems to be reasonable to incorporate knowledge of this kind in medical education research.

Medical Education in Iran: An Exploration of Some Curriculum Issues.

BACKGROUND: Although Iran is a large and populous country, the state of medical education is poorly understood and under researched. However, it is apparent that, in recent years, calls for reform in medical education have not tended to lead to major changes. As a result, the curricula used are in danger of being perceived as dated and less effective than they should be. PURPOSE: This exploratory study is designed to investigate the perspectives and experiences of a group of the most influential medical education course planners in Iran. Its aim is to investigate their views about the nature of the undergraduate medical curriculum in Iran and explore with them ways in which such curricula could be modernized and improved. METHODS: In-depth, semi-structured interviews were used to explore the perceptions of an elite group of medical education course planners who all work in prestigious universities in Tehran. Each of these 10 individuals was interviewed twice, over a period of several months, in order that an in-depth view of their perceptions could be unraveled. RESULTS: A deep concern about the lack of an innovative medical education curriculum in Iran emerged as the strongest theme from the interviews. There is widespread agreement that the current curriculum is too oriented towards the students passively learning facts. There is also a perceived lack of integration between the two-year basic science courses and clinical learning. Furthermore, participants feel that poor teaching facilities and overcrowding of students has provided an unsuitable learning environment. Both positive and negative attitudes toward educational strategies in curriculum development were demonstrated. Some of the barriers to curriculum change were also discussed. CONCLUSIONS: There is a real need for major changes in the medical education curriculum in Iran. The results of this study suggest that a move towards a curriculum that engages students as active participants in a process of lifelong learning would be highly beneficial. As clinically qualified doctors they will face many challenges in the years ahead, and a modernized curriculum should help them to acquire the necessary knowledge and develop the clinical skills and problem solving abilities they will need.

A needs assessment for a communication skills curriculum in Iran.

BACKGROUND: Although communication skills have been observed as a crucial element in the delivery of high-quality medical care, the emphasis given to them within medical education in Iran is severely limited, and the state of such teaching is unknown in many other countries. PURPOSE: This exploratory study investigated the views and experiences of medical education course planners in Iran with respect to the current status of communication skills training within Iranian medical schools. METHOD: The findings are based on the in-depth interviews with Iranian medical course planners. RESULTS: The findings demonstrate that there is a deep concern about the lack of communication skills training within the Iranian medical curriculum. Medical students' acquisition and use of communication skills is consistently poor. Furthermore, medical litigation can then result from poor communication skills among medical students. Both positive and negative attitudes toward integrating communication skills into the medical curriculum were revealed. CONCLUSION: There is a real need to integrate communication skills into Iranian medical education with due attention to ethnical and religious issues. Some recommendations are made, and the limitations of the study are discussed.

A quantitative survey of intern's knowledge of communication skills: an Iranian exploration.

BACKGROUND: It is a high priority that health care providers have effective communication skills. It has been well documented that the doctor-patient relationship is central to the delivery of high quality medical care, and it has been shown to affect patient satisfaction, to decrease the use of pain killers, to shorten hospital stays, to improve recovery from surgery and a variety of other biological, psychological and social outcomes. This study sought to quantify the current knowledge of interns in Iran about communication skills. METHODS: A cross-sectional study using a self-report questionnaire was conducted among interns. Data analysis was based on 223 questionnaires. The internal consistency of the items was 0.8979. RESULTS: Overall, knowledge levels were unsatisfactory. Results indicated that interns had a limited knowledge of communication skills, including identification of communication skills. In addition, there was a significant difference between the mean scores of interns on breaking bad news and sex education. The confidence of males about their communication skills was significantly higher than for females. Analysis of the total scores by age and sex showed that there was a statistically significant main effect for sex and the interaction with age was statistically significant. Free response comments of the interns are also discussed. CONCLUSIONS: It is argued that there is a real need for integrating a communication skills course, which is linked to the various different ethnic and religious backgrounds of interns, into Iranian medical curricula. Some recommendations are made and the limitations of the study are discussed.