A comprehensive "real need" assessment, a step toward improving the quality of faculty development programs: A survey-based study in Hormozgan University of Medical Sciences.

Background and Aims: Developing a framework to identify the "real" needs of faculty members, the gap between the current and desired conditions, would lead to an effective faculty development program (FDP) and improve higher education quality and health system promotion. For the first time in Iran, instead of needs assessment based on faculty members preferences or assessing needs only in a few areas, this study aimed to assess the difference between "self-rated level of skill" as the current condition and "perceived importance" as the expected condition, regarding all faculty roles and levels at Hormozgan University of Medical Sciences (HUMS). Methods: This study used a research-made questionnaire that included 73 items within nine domains. The content validity of the questionnaire was confirmed, and Cronbach's alpha coefficient ranged from 0.86 to 0.96 for domains. The census method was applied. Participants rated their current skill level and perceived importance for professional development of each item on a 10-anchor scale. Statistical software, SPSS 19, analyzed the data using descriptive statistics and analytic tests. Results: Significant differences existed among participants' ratings of skills and the importance of further training in various areas. Priority professional development domains were e-learning, curriculum development, personal development, program evaluation, leadership and management, student assessment, learning theories and teaching strategies, research and scholarship, and ethics and communication. Conclusion: Additional formal training is required, especially in e-learning and curriculum development, for most faculty members at HUMS to enhance their academic performance. This study is the first needs assessment in Iran based on gaps between current and desired conditions. Conducting a "real needs" assessment before initiating an FDP is necessary for its feasibility.

What Happened to Simulation-Based Education in Outpatient Setting in The 21st Century: A Scoping Review.

Introduction: Simulation-based education (SBE) is an instructional approach that aims to accurately recreate real-life scenarios and engage learners in the practical application of lesson content. By replicating critical elements of clinical situations, SBE facilitates a deeper understanding and better preparation for managing such conditions in actual clinical practice. SBE offers promising prospects for improving medical education and patient care in various settings, such as outpatient clinics. Therefore, this scoping review aims to determine to what extent the most effective components and standards of the simulation have been considered in outpatient education. Methods: The present scoping review adheres to the guidelines outlined in the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist" and the "Joanna Briggs Institute (JBI) Reviewers' Manual". This review focused on articles that specifically focused on the use of simulation in outpatient education. Google Scholar, PubMed, Scopus, Embase, and ERIC were searched for keywords related to simulation, ambulatory care, outpatient clinics, and medical education from January 1, 2001, to August 12, 2023. Results: The search indicated 513 articles, which were narrowed down by title and abstract relatedness. Twenty-nine articles entered the study's second phase, and after reviewing their full text, nine articles that explicitly reported simulation use in outpatient education remained. Based on the findings of eligible articles, the ten most frequent components of SBE that should be considered and followed discussed. These features were training facilitators, pre-briefing sessions, the type of simulation techniques, the site of simulation participation, the simulation duration, unit of participation, extent of direct participation, Simulation fidelity, feedback, and debriefing and reflection. Conclusion: SBE is a contemporary method of practical training for medical students that involves realistic modeling or simulation of clinical situations. It enhances learning effectiveness and provides a safe, educational atmosphere for teaching and learning. Designing simulations adhering to established standards and carefully considering essential components improves efficiency and effectiveness.

Outpatient education, a momentous in clinical education: a qualitative study of medical students', faculty members', and residents' perspectives.

BACKGROUND: Even though a lot of scholars have been looking at outpatient education lately because it has become more popular and they want to know about its successes, failures, and problems, we have not been able to find a complete study. Therefore, our study aims to gain a deeper understanding of the various aspects of outpatient education based on the actual experiences of medical students, faculty, and residents. METHODS: Face-to-face and semi-structured interviews were used to collect data for this qualitative study. Until data saturation was reached, the interviews continued. A total of 21 participants from Shiraz University of Medical Sciences, including medical students, residents, and teachers, were enrolled. The Guba and Lincoln-first written standards for scientific accuracy in qualitative research were used to figure out how reliable the data were. RESULTS: Fourteen categories were extracted from four main themes. The results show that four categories: "physical space and equipment," "prerequisites related to the curriculum," "teaching skills development," and "near-peer teachers" should be considered for outpatient education preparation. Theme 2, "implementation requirements," included "student dimension," "faculty's commitment to planning," and "program supervision." Theme 3, "challenges of outpatient education," was described by five related categories, including "curriculum implementation challenges," "student challenges," "faculty challenges," "system-related challenges," and "patient-related challenges." Finally, two categories emerged about facilitators of outpatient education: internal and external facilitators. CONCLUSION: Outpatient clinics represent a crucial aspect of medical practice. To effectively leverage this resource, preliminary planning, considering all the prerequisites, paying attention to the implementation requirements, getting to know the challenges, and trying to solve them, especially with incentives, are essential.

Clinical reasoning in emergency medical technicians and its compliance with the illness script theory: A pilot study.

BACKGROUND: Emergency medical technicians (EMTs) play a pivotal role in the management and treatment chain of emergency patients and their health outcomes. Knowing the clinical reasoning pattern in prehospital procedures is of particular importance that can help to develop a correct clinical decision-making process in this group. Therefore, this study aimed to clarify the clinical reasoning in EMTs and evaluate its compliance with the "illness script" theory. MATERIALS AND METHODS: This descriptive-analytical study was conducted in 2021 at Hormozgan University of Medical Sciences (HUMS) by involving EMTs in two groups of experts and novices. To collect and analyze participants' mental script-based information, the "think aloud" method was used. In the content analysis of extracted protocols, two main steps were considered: 1) preparing a suitable map to compare the protocol with the base pattern and 2) quantifying the relationship between the protocol and the base pattern. Statistical Package for the Social Sciences (SPSS)-21 software, the Shapiro-Wilk test, and the independent t-test were used for analyzing quantitative data. RESULTS: After exploring the concordance of the clinical reasoning of EMTs with the base pattern, results showed that the components of Enabling condition and Management were consistent with the illness script strategy. Pathophysiology and Diagnosis components did not conform to the base pattern. Regarding Signs and Symptoms, these were significantly different from the classic pattern of illness script. A new component called Contextual insight was suggested for this pattern. Generally, on comparing the clinical script content of experts and novices, only two components of Pathophysiology and Diagnosis did not show any significant difference (P > 0.05) between these two groups. CONCLUSION: Results of evaluating the clinical reasoning of the under-study groups showed that in some components of the pattern, they practiced as in other medical groups, but in relation to some components, this was not the case. It is due to the different nature of the prehospital conditions. Also, there is a need to add new components to the base model, which should be considered in distinguishing between expert and novice EMTs.

Do Opioid Addicts Require Higher Doses of Heparin During Percutaneous Coronary Intervention?

BACKGROUND: Patients who undergo percutaneous coronary intervention (PCI) receive anticoagulants, most commonly heparin to prevent thrombotic events during the procedure. Opioid addicts may require higher doses of heparin for PCI. We aimed to compare the effect of heparin on activated clotting time (ACT) between opioid addicts and non-addicts prior to and during PCI. METHODS: This comparative study included 107 patients scheduled for elective PCI, of whom 50 were opioid addicts and 57 non-addicts. Patients' baseline characteristics including age, gender, weight, comorbidities, drug history, and smoking were recorded. Prothrombin time (PT), ýpartial thromboplastin time (PTT), international normalized ratio (INR), and platelet count were measured in venous blood samples collected from all participants. All patients underwent PCI through femoral access. They received 100 IU/kg heparin right at the beginning of the procedure. ACT was measured at 2 and 30 minutes. FINDINGS: Age, gender, weight, and the amount of heparin used were comparable between groups. As for general characteristics, the number of patients with hyperlipidemia was significantly higher in non-addicts (P = 0.031), and cigarette smoking was higher in opioid addicts (P < 0.001). No significant difference was found between the groups regarding PT, PTT, INR, and platelet count (P > 0.050). ACT at 2 and 30 min were significantly lower in opioid addicts (P < 0.001). Taking other variables into account, ACT at 2 min was directly correlated with drug history of aspirin in opioid addicts (P = 0.031) and inversely correlated with cigarette smoking in non-addicts (P = 0.023). CONCLUSION: Opioid addicts may require higher doses of heparin in PCI for the prevention of thrombotic complications compared to non-addicts.

Physicians' knowledge, attitudes, and practice for hypertension management: A cross-sectional study in Hormozgan province, Iran.

BACKGROUND: Hypertension is a common risk factor for developing cardiovascular, brain, and kidney disorders; and today, it affects about one billion people worldwide. Insufficient clinical knowledge of the practitioners and family physicians and not following the guidelines has led to the improper control of hypertension. This study intended to investigate the knowledge, attitude, and practice of general practitioners (GPs) about hypertension in Hormozgan province, Iran. METHODS: This cross-sectional study used consecutive sampling method. A three-part researcher-made questionnaire was used to collect data on demographic, attitude, knowledge, and practice information from 220 GPs working in Hormozgan province. RESULTS: The mean and standard deviation (SD) of scores on knowledge, practice, and attitude of GPs about hypertension management were (5.00 ± 0.50), (10.00 ± 0.02) and (9.00 ± 0.15), respectively; which present a proper state. Attending training courses and increased work experience have statistically significant effects on the knowledge and attitude of GPs (P < 0.050). The only exception was the area of practice, where there was no significant relationship between the practitioners' work experience and their practice (P = 0.266). CONCLUSION: The results of this study can be utilized by decision-makers and general medicine curriculum designers to plan effective training courses for medical graduates to be used in clinical settings for health promotions.

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.

Effects of morning report case presentation on length of stay and hospitalisation costs.

CONTEXT: The primary goal of discussing patient cases during the morning report is to teach appropriate clinical decision making. In addition, the selection of the best diagnostic strategy and application of evidence-based patient care are important. Reducing hospital costs is fundamental to controlling inflation in health care costs, especially in university hospitals that are subject to budget constraints in developing countries. The goal of this study was to explore the effect of morning report case presentation on length of stay (LoS) and hospitalisation costs in a university teaching hospital. METHODS: A total of 54 patients whose cases had been presented at morning report sessions in the department of internal medicine during a 3-month period (presented group) were selected and their medical records reviewed for data on final diagnosis, hospital LoS and detailed hospital costs. A control group of 104 patients, whose cases had not been presented, were selected on the basis that their final diagnoses matched with those of the presented group. In addition, the groups were matched for age, sex, occupation, comorbidities and insurance coverage. Final diagnoses were based on International Classification of Disease 10 (ICD-10) diagnostic code criteria. RESULTS: The mean ± standard deviation (SD) hospital LoS was 8.32 ± 4.11 days in the presented group and 10.46 ± 4.92 days in the control group (p = 0.045). Mean ± SD hospitalisation costs per patient were significantly lower in the presented group (US$553.43 ± 92.16) than the control group (US$1621.93 ± 353.14) (p = 0.004). Although costs for paraclinical services were similar, there were very significant reductions in costs for medications used during hospitalisation and bed-days (p = 0.002). CONCLUSIONS: Discussing clinical aspects of patient cases in morning report sessions facilitates the management process and has a significant effect on LoS and hospitalisation costs in patients admitted to hospital.