Teaching clinical reasoning to medical students: A brief report of case-based clinical reasoning approach.

BACKGROUND: Case-based clinical reasoning (CBCR) is the proposed method to improve clinical reasoning. This brief report aimed to evaluate CBCR effectiveness to improve clinical reasoning via an online course. SETTINGS AND DESIGN: This study is a brief report of a before-after quasi-experimental study to evaluate CBCR in medical students of Shahid Beheshti University of Medical Sciences. MATERIALS AND METHODS: Ten online weekly 2-hour sessions of CBCR presentations were instructed to medical students. Each session started with an illness script, and then, the instructor posed the students' five clinical questions in five steps according to the CBCR approach. The clinical reasoning ability of students was evaluated before and 2 weeks after the online courses using four types of standard clinical questions. STATISTICAL ANALYSIS USED: A Wilcoxon signed-rank test was used to assess the difference between pretest and posttest examination scores. RESULTS: This brief report revealed that twenty-one medical students participated in all ten sessions of the CBCR online course and were evaluated in pretest and posttest examinations. A significant improvement in the clinical reasoning total scores in the posttest examination compared with the pretest examination was observed (P = 0.001). In terms of specific types of clinical questions, the mean posttest scores for clinical reasoning problem (CRP) and key feature (KF) examinations were higher than the pretest scores (P = 0.001 and P = 0.005, respectively). CONCLUSIONS: Applying the CBCR approach improved the total clinical reasoning score of medical students during the course. Further studies are needed to evaluate whether this improvement would persist in workplace settings or not.

Knowledge of Thyroid Disorders during Pregnancy among General Practitioners in Iran.

BACKGROUND AND OBJECTIVES: Thyroid disorders during pregnancy are important health problems worldwide. The aim of this study was to assess the knowledge of general practitioners (GPs) about thyroid disorders during pregnancy. METHODS: In this cross sectional study, 120 GPs were randomly selected among participants of a continuous medical education (CME) program, entitled "practical endocrinology". To assess the knowledge and educational requirements of GPs regarding thyroid disorders during pregnancy, a validated and localized multiple-choice questionnaire was used. RESULTS: A total of 100 GPs completed the questionnaire. The mean age of the participants was 37.0 years, and 41.4% were men. The mean knowledge score of GPs was 39.9%. On average, the rate of correct response to questions concerning the definition, pathophysiology, diagnosis, complications, and treatment of thyroid disorders was 39.0%, 39.3%, 48.8%, 34.3%, and 44.6%, respectively. There was a significant difference in knowledge among GPs, who had and had not passed the training course on thyroid disorders. In addition, GPs who had passed continuous medical education programs obtained higher knowledge scores regarding diagnosis and treatment (P < 0.05). CONCLUSIONS: GPs attending pregnant women in Iran lack sufficient information on the pathophysiology, diagnosis, and management of thyroid disorders during pregnancy. Considering the key role of GPs in the public healthcare system, design of high-quality educational programs and development of specific educational packages about thyroid disorders and pregnancy are necessary.

Leadership and management curriculum planning for Iranian general practitioners.

INTRODUCTION: Leadership and management are two expected features and competencies for general practitioners (GPs). The purpose of this study was leadership and management curriculum planning for GPs which was performed based on Kern's curriculum planning cycle. METHODS: This study was conducted in 2011- 2012 in Iran using an explanatory mixed-methods approach. It was conducted through an initial qualitative phase using two focus group discussions and 28 semi-structured interviews with key informants to capture their experiences and viewpoints about the necessity of management courses for undergraduate medical students, goals, objectives, and educational strategies according to Kern's curriculum planning cycle. The data was used to develop a questionnaire to be used in a quantitative written survey. Results of these two phases and that of the review of medical curriculum in other countries and management curriculum of other medical disciplines in Iran were used in management and leadership curriculum planning. In the qualitative phase, purposeful sampling and content analysis with constant comparison based on Strauss and Corbin's method were used; descriptive and analytic tests were used for quantitative data by SPSS version 14. RESULTS: In the qualitatively stage of  this research, 6 main categories including the necessity of management course, features and objectives of management curriculum, proper educational setting, educational methods and strategies, evolutionary method and feedback result were determined. In the quantitatively stage of the research, from the viewpoints of 51.6% of 126 units of research who filled out the questionnaire, ranked high necessary of management courses. The coordination of care and clinical leadership was determined as the most important role for GPs with a mean of 6.2 from sample viewpoint. Also, team working and group dynamics had the first priority related to the principles and basics of management with a mean of 3.59. Other results were shown in the paper. CONCLUSION: Results of this study indicated the need to provide educational programs for GPs; it led to a systematic curriculum theory and clinical management using Kern cycle for general practitioner's discipline. Implementation and evaluation of this program is recommended.

Psychometric properties of the postgraduate hospital educational environment measure in an Iranian hospital setting.

BACKGROUND: Students' perceptions of the educational environment are an important construct in assessing and enhancing the quality of medical training programs. Reliable and valid measurement, however, can be problematic - especially as instruments developed and tested in one culture are translated for use in another. MATERIALS AND METHOD: This study sought to explore the psychometric properties of the Postgraduate Hospital Educational Environment Measure (PHEEM) for use in an Iranian hospital training setting. We translated the instrument into Persian and ensured its content validity by back translation and expert review prior to administering it to 127 residents of Urmia University of Medical Science. RESULTS: Overall internal consistency of the translated measure was good (a=0.94). Principal components analysis revealed five factors accounting for 52.8% of the variance. CONCLUSION: The Persian version of the PHEEM appears to be a reliable and potentially valid instrument for use in Iranian medical schools and may find favor in evaluating the educational environments of residency programs nationwide.