Virtual Dissection: an Educational Technology to Enrich Medical Students' Learning Environment in Gastrointestinal Anatomy Course.

Background: Virtual dissection provides a digital experience of medical images to visualize anatomy on touchscreen tables. This study aimed to integrate the virtual dissection table (VDT) into the gastrointestinal anatomy course and assess medical students' intended learning outcomes and satisfaction with this educational technology. Methods: This quasi-experimental study enrolled second-year undergraduate medical students who studied anatomical sciences in the autumn semester of 2021-2022 at a single medical school. In the intervention and control groups, the participants were randomized to study anatomy by VDT or topographical anatomy textbooks. The knowledge tests evaluated the students' learning outcomes of gastrointestinal anatomy, and following the course, students completed a satisfaction survey. Results: The findings indicated that a significant gain occurred, and instructional intervention during which the learning environment was enriched with virtual dissection could enhance the students' learning (F = 13.33, df = 2, P < 0.01, partial η2 = 0.20) and satisfaction (T = 6.10, df = 54, P < 0.01, Cohen's d = 1.63, CI95% = 1.02-2.23). Conclusions: This study demonstrates the potential for virtual dissection to augment anatomical science education. Further research is required to consider the contributing features and apply this educational technology to enhance students' anatomy learning. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01867-z.

Psychometric properties of the persian version of the Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS).

INTRODUCTION: There are numerous cases where artificial intelligence (AI) can be applied to improve the outcomes of medical education. The extent to which medical practitioners and students are ready to work and leverage this paradigm is unclear in Iran. This study investigated the psychometric properties of a Persian version of the Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS) developed by Karaca, et al. in 2021. In future studies, the medical AI readiness for Iranian medical students could be investigated using this scale, and effective interventions might be planned and implemented according to the results. METHODS: In this study, 502 medical students (mean age 22.66(± 2.767); 55% female) responded to the Persian questionnaire in an online survey. The original questionnaire was translated into Persian using a back translation procedure, and all participants completed the demographic component and the entire MAIRS-MS. Internal and external consistencies, factor analysis, construct validity, and confirmatory factor analysis were examined to analyze the collected data. A P ≤ 0.05 was considered as the level of statistical significance. RESULTS: Four subscales emerged from the exploratory factor analysis (Cognition, Ability, Vision, and Ethics), and confirmatory factor analysis confirmed the four subscales. The Cronbach alpha value for internal consistency was 0.944 for the total scale and 0.886, 0.905, 0.865, and 0.856 for cognition, ability, vision, and ethics, respectively. CONCLUSIONS: The Persian version of MAIRS-MS was fairly equivalent to the original one regarding the conceptual and linguistic aspects. This study also confirmed the validity and reliability of the Persian version of MAIRS-MS. Therefore, the Persian version can be a suitable and brief instrument to assess Iranian Medical Students' readiness for medical artificial intelligence.

Are students performing the same in E-learning and In-person education? An introspective look at learning environments from an Iranian medical school standpoint.

INTRODUCTION: This study investigated medical students' intended learning outcomes based on e-learning and in-person education. METHODS: In this cross-sectional comparative analytical study, a group of 126 undergraduate medical students' intended learning outcomes under two different teaching methods, including e-learning and in-person, were repeatedly measured based on the census sampling method. Participants were in the preclinical curriculum phase (physiopathology) at Mashhad University of Medical Sciences (MUMS), Iran. Due to expert panel opinion, the same medical teachers and similar difficulty of lessons were considered in two investigated academic semesters. In addition, difficulty and discrimination indexes of formative and summative assessments were controlled for two study groups. The students' learning outcome index was the knowledge test scores participants received in the relevant lessons of the General Medicine (GM) curriculum preclinical courses. RESULTS: The findings indicated that students learning outcomes were significantly higher during e-learning than in in-person education for all examined variables (P < 0.05). Moreover, the difference between students' Grade Point Average (GPA) categories among the two groups was significant (P = 0.022). Students with a GPA of less than 14 experienced higher increments in their average scores after the e-learning compared to in-person education. Compared to face-to-face courses, improvements in pharmacology, theoretical semiology, and pathology scores after e-learning courses were statistically significant (P < 0.001). The differences in mean scores related to practical pathology and semiology in the two approaches were not statistically significant, P = 0.624 and P = 0.149, respectively. Furthermore, the overall students' average scores increased significantly during e-learning versus in-person education (P < 0.001). CONCLUSION: We concluded that e-learning could be appreciated as a successful method of medical education and can be used as an alternative educational method. However, considering the importance of practical or clinical courses in medical education, further research about the efficacy of the e-learning approach is highly recommended.

Three-dimensional (3D) Visualization Educational Modeling for Ophthalmology Residents' Training: Viewpoints.

Background: Three-dimensional models are used to guide residents and physicians in accessing specific anatomical areas and types of fractures and better diagnosis of anomalies. These models are useful for illuminating complex anatomical areas, such as orbit, especially limited space with sensitive access. The aim of this study was to design a three-dimensional visualization educational modeling for ophthalmology residents' training. Methods: This study is a product-oriented application that uses radiological images of anatomy, anomalies, and orbital fractures based on actual CT scans of patients. These CT scans were carefully selected from the Picture Archiving and Communication System of Ghaem Hospital of Mashhad University of Medical Sciences. Results: To produce twelve 3D models, the CT scan files were converted to 3D printer output. Then, the models were presented to residents at a training session by an ophthalmologist. These models created all major fractures associated with the orbit area and most disorders, anomalies of this area and several normal anatomical. The features of 3D models were mentioned. The strengths and weaknesses of the educational modeling, the level of satisfaction with the use of three-dimensional models, suggestions and criticisms were assessed qualitatively by the residents. Satisfaction was reported 100% by residents. Suggestions for future 3D models were presented, and the only criticism was fear of exams and grades. Conclusion: Real-size 3D modeling help to understand the spatial and mental imagery of anatomy and orbital pathology and to touch different anatomical areas creates a clear image in the minds of residents, especially in the orbit.

3D Printed Models for Teaching Orbital Anatomy, Anomalies and Fractures.

PURPOSE: The aim of this study was to determine the efficacy of using 3D printing models in the learning process of orbital anatomy and pathology by ophthalmology residents. METHODS: A quasi-experimental study was performed with 24 residents of ophthalmology at Mashhad University of Medical Sciences. Each stratum was randomized into two groups. The educational booklets were distributed, and various forms of orbital 3D models were printed from orbital computed tomography (CT) scans. Knowledge enhancement on the topics was measured by comparing pretest and posttest scores. RESULTS: Thirteen residents who were trained using traditional methods were deemed the control group; while 11 residents who were trained using the 3D printed models were classed as the intervention group. The control group was younger than the intervention group (P = 0.047). The results showed that there was a statistically significant difference in the total posttest scores between the two groups. Based on the repeated measures of the analysis of variance (ANOVA), score variables were significant between the two groups (P = 0.008). Interestingly, the use of the 3D educational model was more effective and statistically significant with the year one residents as compared to the year two residents (P = 0.002). CONCLUSION: This study is the first one in Iran quantifying the effects of learning using 3D printed models in medical education. In fact, 3D modeling training is seemingly effective in teaching ophthalmic residents. As residents have never encountered such technology before, their experience using 3D models proved to be satisfactory and had a surprising positive effect on the learning process through visual training.

Polyomavirus Associated Nephropathy: Frequency and Graft Survival Analysis in Northeast of Iran.

BACKGROUND & OBJECTIVE: Polyomavirus-associated nephropathy (PVAN), mainly caused by the BK virus, is one of the most important infectious complications of kidney transplantation. The leading histopathologic characteristics of PVAN is viral cytopathic effects, such as nucleomegaly with smudged or clumped chromatin and intranuclear ground-glass inclusion, mostly in tubular epithelial cells. Moreover, tubular necrosis, tubulitis, interstitial inflammation, atrophy, and fibrosis have been noted. Positive immunohistochemistry (IHC) staining for SV-40 highlights the infected epithelial cells of renal tubules. METHODS: A total of 85 core needle biopsies of transplanted kidneys were evaluated histologically and were stained for SV-40 using the IHC method. In addition, a follow-up of graft failure was performed. RESULTS: Our findings revealed that the frequency of polyomavirus infection in kidney transplant patients in the Northeast of Iran is 4.7%. There was no significant correlation between PVAN and graft rejection. Although a higher rate of graft loss was observed in PVAN patients, in comparison with non-PVAN patients (25% vs. 14.8%), the difference was not statistically significant. Moreover, patients with immunohistochemically confirmed PVAN and those with histopathologic features of viral-like cytopathic effects had significantly lower graft survival in the follow-up period (42.5 vs. 196.8 months and 109.4 vs. 205.7 months, respectively). CONCLUSION: The frequency of polyomavirus infection in kidney transplant patients in the Northeast of Iran is 4.7%. There was no significant correlation between PVAN and graft rejection. Furthermore, we observed that polyomavirus infection accelerates the course of graft loss.

Pathology of General Practice Curriculum from the Viewpoint of Students and Professors.

INTRODUCTION: Based on the needs of the health system, continuous revising and monitoring are essential for General Practice (GP) Curriculum. The present study was conducted to investigate the diseases of GP Curriculum based on the students' and professors' viewpoints. METHODS: This cross-sectional study was carried out at Mashhad University of Medical Sciences in 2018. A total of 80 GP students of internship and 71 professors of the faculty of medicine in clinical and basic science disciplines were enrolled in the study using quota and convenience sampling methods, respectively. Two self-made, reliable, and validated 4-point scale questionnaires (ranging from totally agree to totally disagree) were used to collect the data on the viewpoints of students and professors on the diseases of GP curriculum. The mean score and percentage of agreement between professors and students on the incidence of each disease were calculated. RESULTS: The highest and lowest rates of agreement between the professors and students in terms of the presence of curriculum diseases belonged to the echolalia curriculum with a mean and standard deviation of 1.92±0.68 and the dean denial with a mean and standard deviation of 2.0±6.68, respectively. The results showed a statistically significant difference between the viewpoints of professors and students regarding the diseases of the carcinoma of the curriculum (P<0.001), idiopathic colitis (P<0.001), the schizophrenia of the curriculum (P=0.01), and echolalia curriculum (P=0.01). CONCLUSION: The present study showed that professors and students were all in agreement about 12 out of 13 diseases of the GP curriculum. Thus, educational planners in Iran's medical schools should focus on the continuous evaluation and the necessity of curriculum revision, as one of the priorities of the educational system.

Challenges of OSCE national board exam in Iran from participants' perspective.

BACKGROUND: The national board exam for residents in Iran is held in two parts: Multiple-choice and Objective Structured Clinical Examination (OSCE). The OSCE is a suitable method for evaluation of residents' clinical qualifications. However, it requires experienced human resources, accurate planning, facilities and reliable evaluation tools. OBJECTIVE: To determine the challenges of the OSCE National Board Exam in Iran. METHODS: This cross-sectional study was conducted on all the final-year pediatrics and gynecology residents of Mashhad University of Medical Science, who participated in the board exam in September 2014. A questionnaire was designed to evaluate the residents' opinion on challenges of the OSCE. Data was analyzed with SPSS16. We used U Mann-Whitney test independent t-test, and Pearson correlation coefficient. RESULTS: Fourteen pediatrics and eleven gynecology residents participated. In the gynecology group, there was no significant statistical correlation between the individual marks and questionnaire scores. However, in the pediatrics group, there was a significant correlation (p=0.046, r=-0.763). Based on pediatrics residents' perspective, the main challenge of the OSCE part of the exam was the imbalance and disproportion between the allowed time and the task load in each exam stage. In other words, they believed that the tasks could not be fulfilled in the given time. In the gynecology group, the main challenge reported was the delay in announcing the exam results. In the pediatrics group, the main complaint was the disproportion of the allowed time and the task load in the exam stages. CONCLUSION: Some of the challenges of the board exam were associated with the examiners and the exam environment, and some of them were related to the home university where the candidates had studied. To solve the problems, both aspects should be considered.

Determinants of Social Accountability in Iranian Nursing and Midwifery Schools: A Delphi Study.

BACKGROUND: Revising the medical education programs to meet the needs of society has become both a necessity and an important priority due to the considerable increase of population, changing patterns of diseases, and new health priorities. While this necessity has been highlighted in Iran's Fifth Development Plan as well as its National 2025 Vision Plan, the determinants of social accountability have not been explained yet. This study aimed to develop determinants of social accountability in the Iranian Nursing and Midwifery Schools. METHODS: This classic Delphi study included thirty experts in Nursing and Midwifery Education, Research and Services selected based on purposive sampling and three rounds of Delphi technique and conducted in Nursing and Midwifery School of Mashhad University of Medical Sciences. The primary data were collected using an initial structured questionnaire prepared through extensive review of literature. SPSS 11.5 software was used to analyze the data. The interquartile deviation and percentage of agreement were also used to study the consensus of opinion by experts. RESULTS: Finding obtained from the rounds of Delphi resulted in selecting 69 determinants out of the initial pool of 128 primary determinants of social accountability. The items were selected based on experts' consensus and categorized under three main activities of Nursing and Midwifery School, namely education, research, and service. CONCLUSION: Social accountability determinants were explained by 69 items for Schools of Nursing and Midwifery in Iran. The proposed determinants can be used by managers and authorities of Nursing and Midwifery School, policy makers, and evaluating institutions associated with them to ensure realizing social accountability goals.

An investigation on social accountability of general medicine curriculum.

INTRODUCTION: Experts consider social accountability as a new paradigm in medical education and a cultural change that is necessary to be studied and understood more deeply. One of the problems of medical education is the inadequacy of medicine graduates to meet the social accountability. Therefore, the aim of this study was to examine the general medicine curriculum for social accountability. METHODS: This cross-sectional study was conducted on three groups of experts, faculty members, and general physicians working in health centers in Mashhad in 2014. According to the needs assessment and definition of need as a requirement or preference, the research was conducted in three stages using the Delphi method, in which the opinions of experts, lecturers, and practitioners were collected and classified based on the CARE model in four areas, i.e., clinical activities, advocacy, research, and educational categories, and, ultimately, the percentage of agreement was determined. RESULTS: As indicated by the results of the need analysis, in order to reach social accountability of medical students of Mashhad University of Medical Sciences, the curriculum should cover four major areas, i.e., clinical activities, advocacy, research, and training. We found 38 items for social accountability that are required in the general medical curriculum, including clinical activities (12 items), advocacy (10 items), and scope of research (8 items). The educational area was comprised of 8 items. In this study, from 30 participants, only 19 people participated in the three-step Delphi, and there was a 70% response rate in the first stage and second stage, but 90.47% in the third stage. CONCLUSION: There is a growing interest around the world for social accountability in medical schools and other health-related schools. It is expected that the results will be of interest to planners and policy-makers in this field so that we will observe a promotion in the culture of social accountability in Mashhad University of Medical Sciences.

Prevalence of chronic kidney disease and its risk factors in Gonabad, Iran.

INTRODUCTION: Chronic kidney disease (CKD) is an important health problem in Iran, with an increasing prevalence rate. Knowledge about the prevalence and risk factors of this disease in different health jurisdictions can help in planning to control this condition. MATERIALS AND METHODS: In this cross-sectional study, 1285 individuals aged between 20 and 60 years old were recruited. Participants were selected from the general population residing in Gonabad, Iran, via simple random sampling in 2012. Demographic data were collected. Urine and blood test were performed, and the glomerular filtration rate was estimated based on the simplified Modification of Diet in Renal Disease equation. RESULTS: Sixty-five participants (5.1%) had CKD (5.1% men and 5% women; P = .90). The mean age was significantly higher in the CKD group (P = .001). Hypertension and diabetes mellitus were significantly more prevalent among the participants with CKD than those without CKD (P < .001 for both). Proteinuria was significantly associated with CKD, whereas a history of urinary tract infection, a history of nephrolithiasis, smoking, serum uric acid level, lipid profile, and blood glucose level were not. CONCLUSIONS: Chronic kidney disease has a high prevalence rate in this part of Iran. We suggest further studies in other parts of our country for the better estimation of the prevalence of CKD in Iran and for better planning to prevent and treat this condition.

Quality of bedside teaching in internal wards of Qaem and Imam Reza hospitals in Mashhad.

BACKGROUND: Bedside teaching is a patient-based teaching method in medical education. The present study has been conducted with the aim of investigating the quality of bedside teaching in the internal wards of Qaem and Imam Reza Educational Hospitals. METHODS: This study follows a mixed qualitative-quantitative approach using checklists on educational clinical rounds in Imam Reza and Qaem Hospitals in Mashhad. In the first stage consisting of qualitative study, the parts related to the quality of bedside teaching were recognized and a checklist was designed in three domains of patient comfort (8 questions), targeted teaching (14 questions) and group dynamics (8 questions), and its reliability and validity were verified. In the next step, data were collected and then analyzed using SPSS 16 software through statistical techniques of independent t-test, one-way ANOVA and variance analysis. RESULTS: In total, 113 educational rounds were investigated in this study. Among them, 59 (52.2%) and 54 (47.8%) educational rounds have been investigated in Imam Reza and Qaem Hospitals, respectively. The average total score of bedside teaching was 180.8 out of 300 in the internal wards of both Imam Reza and Qaem Hospitals. CONCLUSION: The results of this study showed that generally the quality of bedside teaching in Imam Reza and Qaem Hospitals of Mashhad is low according to the qualitative standards considered in this study. Holding educational workshops along with more familiarity of the professors with effective bedside teaching strategies could be effective in improving the quality of educational rounds.

Dental Students' Educational Achievement in Relation to Their Learning Styles: A Cross-Sectional Study in Iran.

BACKGROUND & OBJECTIVES: In recent decades, many studies have been carried out on the importance of Kolb experiential learning theory (ELT) in teaching-learning processes and its effect on learning outcomes. However, some experts have criticized the Kolb theory and argue that there are some ambiguities on the validity of the theory as an important predictor of achievement. This study has been carried out on dental students' educational achievement in relation to their dominant learning styles based on Kolb theory in Mashhad University of Medical Sciences (Iran). METHODS: In a cross sectional study, Kolb Learning Style Inventory (LSI Ver. 3.1) as well as a questionnaire containing students' demographic data, academic achievement marks including grade point average (GPA), theoretical and practical courses marks, and the comprehensive basic sciences exam (CBSE) scores were administered on a purposive sample of 162 dental students who had passed their comprehensive basic sciences exam. Educational achievement data were analyzed in relation to students' dominant learning styles, using descriptive and analytical statistics including χ2, Kruskal-Wallis and two-way ANOVA tests. RESULTS: The dominant learning styles of students were Assimilating (53.1%), Converging (24.1%), Diverging (14.2%) and Accommodating (8.6%). Although, the students with Assimilating and Converging learning styles had a better performance on their educational achievement, there was no significant relationship between educational achievement and dominant learning style (P≥0.05). CONCLUSION: Findings support that the dominant learning style is not exclusively an essential factor to predict educational achievement. Rather, it shows learning preferences of students that may be considered in designing learning opportunities by the teachers.

Investigating the key factors in designing a communication skills program for medical students: A qualitative study.

INTRODUCTION: Medical students have a serious need to acquire communication skills with others. In many medical schools, special curriculums are developed to improve such skills. Effective training of communication skills requires expert curriculum design. The aim of this study was to explore the experiences and views of experts and stakeholders in order to design a suitable training program in communication skills for medical students. METHODS: The content analysis approach was used in this qualitative study. Forty-three participants were selected from the faculty, nurses, physicians, residents, and medical students at Mashhad University of Medical Sciences using purposive sampling. The data were collected through focus group discussions and semi-structured interviews. To ensure the accuracy of the data, the criteria of credibility, transferability, dependability, and conformability were met. The data were analyzed by MAXQDA software using the Graneheim & Lundman model. RESULTS: The findings of this study consisted of two main themes, i.e., "The vast nature of the present communication skills training" and "administrative requirements of the training program regarding communication skills." The first theme included the educational needs of students, the problems associated with training people to have good communication skills, the importance of good communication skills in performing professional duties, communication skills and job requirements, the learning environment of communication skills, and the status of existing training programs for communication skills. Strategies and suitable methods for teaching communication skills and methods of evaluating the students in this regard also were obtained. CONCLUSION: The findings of this study were the elements required to design a proper and local model to teach communication skills to medical students through analyzing the concepts of effective communication. The results of this study can be useful for medical faculties in designing a proper program for teaching medical students how to communicate effectively with patients and colleagues.

The association of insulin-like growth factor-1 with severity of coronary artery disease.

AIM: Insulin-like growth factor-1 (IGF-1) has been identified as a valuable indicator for impaired glucose tolerance, and its relationship with the presence of coronary atherosclerosis has been also suggested. A few studies have assessed the relationship between IGF-1 level and severity of atherosclerosis. In the present study, the relationship between IGF-1 and coronary artery disease (CAD) was examined with particular attention to the association between this parameter and Gensini score as a good angiographic marker for determining extension and severity of CAD. METHODS: One hundred and seven patients with suspected CAD consecutively referred for selective coronary angiography at the Shafa Hospital in Kerman between April and September 2010 were prospectively enrolled. Total IGF-1 was measured using radioimmunoassay methods (Diagnostics Systems Laboratory, Iran). Selective coronary angiography was performed for all study patients and the Gensini score is computed by assigning a severity score to each coronary stenosis according to the degree of luminal narrowing and its importance based on location. RESULTS: According to the Spearman correlation analysis, total IGF-I was directly correlated with Gensini score (Spearman's rho = 0.362, P = 0.041). Total IGF-I was slightly related to the number of involved coronary vessels (P = 0.058). Relation between age-adjusted and sex-adjusted mean total IGF-I levels with Gensini score remained significant (P = 0.046); however, the association between IGF-1 and the number of diseased vessels lost statistical significance after this adjustment. CONCLUSION: IGF-1 appears as a positive indicator for severity of CAD assessed by the Gensini score, and thus its concentration may be an important indicator for assessing the extent of coronary artery involvement.

Serum insulin-like growth factor binding protein-1 (IGFBP-1) phosphorylation status in subjects with and without ischaemic heart disease.

BACKGROUND: Insulin-like growth factor binding protein-1 (IGFBP-1) modulates the activity of IGF-I. It exists in serum as phosphorylated and less phosphorylated forms. We wished to measure serum levels of both these forms of IGFBP-1, using a novel assay, in subjects with, or without ischaemic heart disease (IHD). METHODS: We measured serum concentrations of the phosphorylated and less phosphorylated forms of IGFBP-1 in 75 subjects (36 with and 39 without IHD). Two immunoassays were used, one which detects non-, and less-phosphorylated forms (LpIGFBP-1), and another which specifically detects the serine phosphorylated form of IGFBP-1 (pIGFBP-1). RESULTS: LpIGFBP-1 concentrations were significantly higher in subjects without IHD than in those with IHD (5.3+/-0.5 microg/L vs. 2.7+/-0.4 microg/L, p<0.001). pIGFBP-1 levels were also significantly higher in subjects without IHD compared to those with IHD (33.3+/-2.0 microg/L vs. 25.3+/-2.2 microg/L, p<0.01). The correlation between LpIGFBP-1 and pIGFBP-1 for all subjects was (r=0.71, p<0.001). This association was stronger in subjects without IHD (r=0.76, p<0.001) than for those with IHD (r=0.60, p<0.001). A significant negative association was observed between IGF-I and the ratio between the two forms (r=-0.45, p<0.0001). Receiver-Operating Characteristic (ROC) curve showed the highest area under the curve for LpIGFBP-1 (0.75) [95% CI: 0.63-0.86] and optimum cut-off value of 2.83 microg/L with 75% sensitivity and 74% specificity. CONCLUSIONS: We propose that low serum concentrations of IGFBP-1 forms could be a marker of coronary risk, and the LpIGFBP-1:pIGFBP-1 ratio may be an index of biologically active IGF-I.

Communication training and patient satisfaction: A randomized trial study from Mashhad, Iran.

BACKGROUND: In many healthcare systems, client satisfaction has been considered as an important indicator of primary healthcare quality. Hence communication education might be leading to better quality of family planning services and higher client satisfaction. This study aimed to evaluate to what extent the communication skills training program could improve client satisfaction. METHODS: This was a randomized controlled trial undertaken in health centers of Mashhad University Medical Sciences, Mashhad, Iran from July to September 2004. Eligible participants were from two population targets, including healthcare providers and their clients. All 35 health centers were randomly divided into intervention (n = 17) and control groups (n = 18). The healthcare providers were working in intervention centers (n = 24) not in control centers (n = 27) received an additional communication skills training program in spite of routine education. Data regarding communication knowledge, attitude, and skills from healthcare providers and the satisfaction rate from the their clients (n = 47 client for each group) were collected at two time points. RESULTS: This study showed that communication knowledge and skills of health workers improved significantly in the intervention group (P < 0.05). Furthermore the score of client satisfaction was significantly improved in the intervention group after 1 month follow-up (p < 0.05). CONCLUSION: The communication skills training program is an effective intervention and may improve the satisfaction rate of clients.