Assessment of the Educational Environment of Plastic Surgery Training Programs in Iran using the PHEEM Questionnaire: A Cross-sectional Study.

Background: Clinical educational environments play a substantial role in the teaching of medical residents and fellows. In order to improve the quality of clinical education, its status should be evaluated. Therefore, we aimed to inquire about the educational environment of Plastic Surgery fellows in two teaching hospitals in Tehran, Iran using the Postgraduate Hospital Educational Environment Measure (PHEEM). Method: In this descriptive cross-sectional study, Plastic Surgery fellows studying in two teaching hospitals in Tehran, Iran, in 2022 were included. The Persian version of the PHEEM questionnaire was applied for assessing the clinical educational environment. The collected data were analyzed by SPSS software version 22. Results: Twenty six Plastic Surgery fellows were studied, 15.4% of whom were women (n=4) and 84.6% were men (n=22). The mean total score of the PHEEM questionnaire was 89.68±26.02. The highest mean score was in the teaching dimension (35.08), while the lowest mean score was in the social support dimension (25.42). Conclusion: Most dissatisfaction among Plastic Surgery fellows were in the field of social support. It is necessary to adopt proper educational policies to improve the supportive resources for Plastic Surgery fellows.

Identifying dimensions and components of student support system in virtual learning: A scoping review.

A student support system (SSS) has a crucial role in the absorption, retention, and success of students in virtual learning. The purpose of this scoping review was to identify and map the available evidence regarding the dimensions and components of the SSS in virtual learning. This study was conducted in accordance with the methodology of the Joanna Briggs Institute (JBI) for scoping reviews. Our search strategy was based on using search engines, such as MEDLINE, EMBASE, Scopus, WoS, CINAHL, ERIC, PsycINFO, ProQuest, and Google Scholar. The articles were published in renowned medical education journals, including Medical Education, Medical Teacher, and Academic Medicine, and the reference lists of identified and reviewed articles were searched manually. The search results were imported into EndNote X20, and after removing duplicates and screenings, 42 studies met the inclusion criteria and were included in the review. A descriptive- analytical approach was employed, including a numerical count of study characteristics (quantitative) and template analysis (qualitative). Five dimensions were identified in the SSS in virtual learning: types of support, domains of support, stages of support, instigating of support, levels of support, and their components and subcomponents. The findings of this study depict a comprehensive roadmap and have an important contribution to the knowledge body of SSS in virtual learning. We suggest system developers, planners, and higher education officials to improve the quality of virtual learning by applying these findings in their planning and decision-making.

Attitudes of Anesthesiology Postgraduate Residents Toward the Influential Factors in Their Success in the Iranian National Board Exam.

Background: One of the prominent indicators of academic success in postgraduate medical education is the "Residents' Pass Rate" in the "National Board Exam." Objectives: This study was designed and implemented to assess the attitudes of the anesthesiology residents toward factors affecting their success in the National Board Exam. Methods: After the Institutional Review Board (IRB) approval, in an attitude assessment study, 20 of the 21 recently graduated anesthesiology residents were asked about the factors affecting their success quantitatively and qualitatively. A self-administered questionnaire with 19 closed questions and a personal virtual WhatsApp Messenger® interview were used for the study. Results: The respondents' viewpoints demonstrated that a step-by-step multifaceted integrative program in combination with psychological support (both from the family and the department) and individual motivation positively affected their success and their endurance to overcome the high load of the mandatory texts. In contrast, unplanned stressors leading to program shifts (mainly due to COVID-19) had adverse effects on their success. Conclusions: Anesthesiology residents believed that a well-designed and appropriately implemented study plan with psychological support and personal motivating factors could facilitate passing the National Board Exam, and unplanned external stressors could hinder it.

Translation and psychometric evaluation of the reflective capacity scale in Iranian medical education.

BACKGROUND: Examining the reflective capacity in medical students is a principal step for the development of effective educational strategies to improve it. Reflection scales available in Iran are inadequate due to the lack of focus on students' willingness and tendency to participate in reflection. This study aimed at translation and psychometric evaluation of "Reflective Capacity Scale" in Iranian medical education. METHODS: This methodological research was completed in two parts: translation and psychometric evaluation. After getting permission from the main developer of the tool, the translation process was done based on Polit and Yang model in Persian language. Then, face validity and content validity of the tool were established using a qualitative method. Construct validity was surveyed with exploratory and confirmatory factor analysis via completing the questionnaire by 320 medical students, who were selected using convenience sampling. The reliability of the tool was also checked with two methods of internal consistency and stability. The gleaned data were analyzed with SPSS20 and AMOS. RESULTS: "Reflective Capacity Scale" includes 16 items that were retained after cross-cultural translation. Face validity and content validity were acceptable. By performing exploratory factor analysis, four factors were identified that accounted for 63.79% of the total variance. In the confirmatory factor analysis, the values of the fit indices confirmed the appropriate fit of the model. The internal consistency reliability of the whole tool was equal to 0.83 and the intra-class correlation coefficient was equal to 0.98. CONCLUSION: The translated and validated "Reflective Capacity Scale" provides a robust tool for assessing reflective capacity among Iranian medical students. Its validity and reliability underscore its potential for measuring the reflective capacity of medical students.

Medical students' reflective capacity and its role in their critical thinking disposition.

BACKGROUND: Developing reflective capacity and critical thinking is one of the prerequisites of education in health professions, especially medicine. This study aimed to determine the reflective capacity of medical students and its role in their critical thinking disposition. METHODS: In this cross-sectional descriptive research, conducted in 2022, a total of 240 medical intern students were selected using the convenient sampling method. Data were collected using a reflective capacity questionnaire and critical thinking disposition questionnaire and analyzed with descriptive and inferential statistics using SPSS20. RESULTS: The mean reflective capacity was 4.53 ± 0.50, and mean critical thinking disposition was 127.52 ± 10.85. Among the dimensions of reflection, "active self-appraisal (SA)" and "reflective with others (RO)" had the highest and lowest means, respectively. The dimensions of critical thinking disposition with the highest and lowest means were related to innovation and intellectual maturity, respectively. Reflective capacity and its dimensions were found to have a direct and statistically significant relationship with critical thinking disposition and its dimensions. Regression analysis results showed that reflective capacity accounts for 28% of students' critical thinking disposition. CONCLUSION: The relationship between students' reflective capacity and their critical thinking disposition has rendered reflection as one of the necessary components of medical education. Thus, determining the learning activities by considering the reflection process and models will be very effective in creating and strengthening critical thinking disposition.

Development of higher-order thinking in health profession education: A comprehensive toolkit for medical educators.

BACKGROUND: Higher-order thinking (HOT) is widely recognized as an essential objective of health profession education (HPE). Based on Lipman's three-dimensional model of thinking, we investigated strategies for the development of HOT including critical thinking (CT), creative thinking, and caring thinking in HPE in three consecutive studies. Fostering students' CT is regarded as an outcome of HPE. However, there is the limited level of consensus on educational interventions for CT development. In view of some of the controversies surrounding the development of CT skills and dispositions in HPE, the aim of this study was to determine educational interventions affecting CT development in HPE. MATERIALS AND METHOD: This study employed the best-fit framework synthesis design. The frameworks recommended by Abrami et al. were used as a basis for the synthesis. The priori themes were extracted from the selected best-fit frameworks. Then, Google Scholar, PubMed, SID, and ProQuest databases were searched for the literature related to the development of CT skills and dispositions in HPE students. Derived data from the HPE literature were coded against the priori themes, extracted from the best-fit frameworks. Interpretation and restructuring of the new themes derived from HPE literature, and the preexisting priori themes resulted in the final framework of the interventions affecting CT development in HPE students. RESULTS: The themes extracted from the HPE studies (including reflection, discussion, simulation, role-playing, questioning, and explicit expression of CT goals in curriculum) were similar to the a priori themes derived from the studies by Abrami et al. The new themes of experiential learning, art-based learning, argument mapping, concept mapping, and creating appropriate educational atmosphere were obtained by constant comparison of the data among the studies. CONCLUSION: The comprehensive framework of CT development methods provides a toolkit for medical educators. According to the results of the current study, the mixed approach, where CT is taught as an independent track, along with the discipline-specific CT development, seems to be more effective, compared to the immersion approach. Creating learning moments in the context of practice through experiential learning is noteworthy in the development of CT skills and dispositions. Further research is needed to evaluate the efficacy of the newly developed strategies, such as art-based learning and concept mapping.

Medical students' satisfaction level with e-learning during the COVID-19 pandemic and its related factors: a systematic review

PURPOSE: This review investigated medical students' satisfaction level with e-learning during the coronavirus disease 2019 (COVID-19) pandemic and its related factors. METHODS: A comprehensive systematic search was performed of international literature databases, including Scopus, PubMed, Web of Science, and Persian databases such as Iranmedex and Scientific Information Database using keywords extracted from Medical Subject Headings such as "Distance learning," "Distance education," "Online learning," "Online education," and "COVID-19" from the earliest date to July 10, 2022. The quality of the studies included in this review was evaluated using the appraisal tool for cross-sectional studies (AXIS tool). RESULTS: A total of 15,473 medical science students were enrolled in 24 studies. The level of satisfaction with e-learning during the COVID-19 pandemic among medical science students was 51.8%. Factors such as age, gender, clinical year, experience with e-learning before COVID-19, level of study, adaptation content of course materials, interactivity, understanding of the content, active participation of the instructor in the discussion, multimedia use in teaching sessions, adequate time dedicated to the e-learning, stress perception, and convenience had significant relationships with the satisfaction of medical students with e-learning during the COVID-19 pandemic. CONCLUSION: Therefore, due to the inevitability of online education and e-learning, it is suggested that educational managers and policymakers choose the best online education method for medical students by examining various studies in this field to increase their satisfaction with e-learning.

Impact of educational interventions on the prevention of influenza: A systematic review.

Introduction: Seasonal influenza, a contagious viral disease affecting the upper respiratory tract, circulates annually, causing considerable morbidity and mortality. The present study investigates the effectiveness of educational interventions to prevent influenza. Methods: We searched PubMed/Medline, Embase, and Cochrane Controlled Register of Trials (CENTRAL) for relevant clinical studies up to March 1 2022. The following terms were used: "influenza," "flu," "respiratory infection," "prevent," "intervention," and "education." Results: Out of 255 studies, 21 articles satisfied the inclusion criteria and were included in our study: 13 parallel randomized controlled trials (RCT) studies, two cross-over RCT studies, two cohort studies, and four quasi-experimental studies. A total of approximately 12,500 adults (18 years old or above) and 11,000 children were evaluated. Educational sessions and reminders were the most common interventions. The measured outcomes were vaccination rates, the incidence of respiratory tract infection (RTI), and preventive behaviors among participants. Eighteen out of 21 articles showed a significant association between educational interventions and the outcomes. Conclusions: The included studies in the current systematic review reported the efficacy of health promotion educational interventions in improving knowledge about influenza, influenza prevention behaviors, vaccination rates, and decreased RTI incidence regardless of the type of intervention and the age of cases.

Medical education in cyberspace: critical considerations in the health system.

INTRODUCTION: Over the past few decades, two revolutionary approaches have emerged as a new form of medical education: Electronic Medical Education and Web-based Medical Education. A number of well-known medical institutions, such as Harvard and Johns Hopkins used a wide range of cyberspace capabilities to increase their competitiveness. Researchers have expressed that cyberspace will change health system's main objective of training physicians and medical education. We conducted this study to identify the health system critical considerations on core issues, involving the development of medical education on cyberspace. METHODS: In order to conduct this study, we observed the steps of a critical literature review, combined with the 'Four-phase method' adopted by Carnwell and Daly. We focused on particular literature on health and cyber system functions; it was associated with systemic approach. RESULTS: We developed a six-level taxonomy, Cyber level, Governance level, Ministerial level, Organizational level, Program level and Performance level, as a key solution that can be applied for the success of medical education on cyberspace. The results were summarized and appraised in more details. CONCLUSION: Medical education on cyberspace is a complex interdisciplinary system. It is important that all aspects of the health systems be involved as integral to the development of cyber based medical education; without this convergence, we will be confused by the decisions made by others within the system. Health system should also communicate with those external sectors that are critical to achieving better learning on cyberspace. Integrated planning, governance and management of medical education in cyberspace are pivotal elements for the promotion.

Discharge against Medical Advice among Inpatients with Heart Disease in Iran.

BACKGROUND: Discharge against medical advice (DAMA) is a relatively common problem worldwide. We sought to determine the prevalence of and reasons for DAMA among inpatients of our cardiac center. METHODS: From a total of 20289 discharges from our cardiac teaching hospital, 992 (4.9%) patients at a minimum age of 18 years were cases of DAMA. After excluding 49 cases due to missing data, we retrospectively analyzed our prospectively collected data from 943 patients, who were DAMA cases. Patients' characteristics, including demographic details, reason for discharge, insurance status, and length of stay before discharge, were examined. RESULTS: The mean age of the study patients was 60.7 ± 13.0 (range, 18-94 years) with a male-to-female ratio of 2.1/1. Lack of consent to surgery or other invasive procedures was the reason cited for DAMA in 31% of the patients, followed by personal or family issues (17%). No reason for DAMA was reported in 26 (2.8%) of the patients. Women compared to men were more likely to cite "lack of consent to surgery or invasive procedures" as the reason for DAMA (p value = 0.005), whereas men more prevalently stated "personal or family issues" as the reason for DAMA (18.7% vs. 12.7%, p value = 0.022). CONCLUSION: The most frequent self-reported reason for DAMA in our cardiac patients was lack of consent to surgery or invasive procedures. This may be because of fear of undergoing invasive procedures such as revascularization. Explaining the stages of a given invasive procedure to patients and comparing its risks versus benefits may lessen impulsive decision-making and DAMA.

Study of patient complaints reported over 30 months at a large heart centre in Tehran.

OBJECTIVES: To determine the rate and nature of complaints and the outcomes of the complaint management at a large heart centre in Tehran. DESIGN: A retrospective review of all verbal and written complaints recorded over 30 months. SETTING: A large heart centre in Tehran, Iran. Population All 312,105 admissions (47,041 inpatients, 138,842 outpatients and 126,222 ambulatory services) between July 2005 and January 2007 at Tehran Heart Centre, during which the hospital received 1642 verbal and written complaints. MAIN OUTCOME MEASURES: Proportion of admissions with verbal and written complaints, type of complaints and outcomes of the complaint management. RESULTS: A total of 1642 (5.2 per 1000) complaints were received, of which 1457 (4.64 per 1000) were verbal, and 185 (0.56 per 1000) were in written format. 34.7% of the complaints were related to admission procedures, followed by 34.1% communication, 13.8% waiting time, 6.8% delay and 4.1% ignoring the standards of clinical care. Over 90% of complaints were resolved by explanation or verbal apology, 2.1% of them led to a change in the process or procedure, and 4.8% were deemed disapproved claims. CONCLUSIONS: The majority of patient complaints in Tehran Heart Centre are related to admission procedures or communication; most of them are verbal and resolved in the early stage as an explanation or apology. The hospital complaint management system has the potential to resolve the majority of such complaints in an early stage.

Comparison of compression stocking with elastic bandage in reducing postoperative edema in coronary artery bypass graft patient.

The removal of the saphenous veins in coronary artery bypass graft (CABG) surgery may cause leg edema. Compression therapy is often used to prevent postoperative edema. The objective of this study was to compare the efficacy of medical compression stocking (TED) and elastic bandage-type on donor limbs after CABG. The peripheries of lower limbs were measured at four regions (A: end of tarsal bones, H: heel , B: immediately above the ankle, C: largest circumference of the calf) at admission in 295 patients how CABG candidates and differences in these measurement points at discharge compared to measurements at admission time were calculated. The difference was considered as a measure of the effectiveness of two types of compression to prevent postoperative edema in donor limbs after CABG. The alterations of 396 donor limbs of 295 patients were examined after CABG at admission and discharge time. In 101 patients veins for graft were taken from both lower limbs. After analysis, if subjects had worn TED stockings, the peripheries of donor limbs at discharge were less than at admission time in the A and H regions compared to elastic bandage group (P(A) = 0/009), (P(H) = 0/012). The conclusion reached was that using the kind of knee length compression stocking (TED stocking , Kendall Co.) is more effective edema at foot and heel regions in donor limbs after CABG than elastic bandages.