A Framework for Future Analysis of Ophthalmology Fellowships in Iran: Call for Action, Implications and Recommendations.

Ophthalmology fellowship is focusing on the educational advancement, medical research progress and academic productivity by transforming general ophthalmologists into superior clinical capacities in ophthalmology. There is a vast majority of ophthalmologists who wish to undertake fellowship degrees. The fellowship programs have several benefits for ophthalmologists and medical institutions. However, the expansion of ophthalmic fellowships has resulted in a greater number of ophthalmology visits, the possibility of unnecessary subspecialty eye examinations, induced demand and increasing eye-care costs. Moreover, sub-specialized ophthalmic services are not accessible to patients in remote regions. This can lead to a degree of inequity in the provision of healthcare services in the healthcare system. The massive expansion of fellowships in ophthalmology is revitalizing the necessity for evaluation of the need for post-residency education and providing effective planning for the future of the ophthalmic human-resource for eye health. This narrative review includes an integration and descriptive summary of the existing evidence on trends and different aspects that affect the future of ophthalmic fellowship education. Moreover, we pinpointed challenges such as maintaining standards in fellowship education, keeping an efficient production of graduates, and improving productivity in both patient care and education. We explored potential solutions to overcome these challenges. The 7-step framework for future analysis suggested here includes Determining educational needs and desired outcomes, Evaluating the current status of fellowship education, determining the gaps, and appropriate solutions, analyzing possible future trends and their impact on ophthalmology practice, investing in virtual educational technology, developing new educational horizons by foresight expert panels, and human-resource planning.

A conceptual framework to incorporate fundamental values in the health and medical education system in Islamic Republic of Iran.

Background: A 1985 law in the Islamic Republic of Iran integrated all health-related educational institutions into the Ministry of Health and established the Ministry of Health and Medical Education to set policies. Aims: We aimed to classify the value concept of the policies that prioritized and to develop a conceptual value-based framework, for the Islamic Republic of Iran's healthcare and medical education systems. Methods: We conducted this qualitative study using a critical, thematic content analysis of value-based statements and policy documents on health and the development of medical education published from 2009 to 2019 in the Islamic Republic of Iran. A total of 210 documents were reviewed and 7 were critically analysed. Value concepts were identified and coded. Results: A total of 69 value concepts were classified into 28 subthemes and 5 main themes: mission values, principal values, procedural values, implementation values, and outcome values. We identified the pattern of the fundamental values to present our conceptual framework. Conclusion: This comprehensive value-based framework can help establish a supportive value-based culture among policymakers, identify under- and over-emphasized issues, and enhance the incorporation of fundamental values across the health and medical education system.

COVID-19 Impact on Modern Virtual Pathology Education: Challenges and Opportunities.

BACKGROUND & OBJECTIVE: Pathology education conventional methods have been disrupted by the Corona-Virus Disease 2019 (COVID-19) outbreak, compelling a re-evaluation of the means of educational interactions from the undergraduate to the postgraduate level. This commentary explores how the COVID-19 outbreak has challenged pathology education. METHODS: We reviewed the current challenges and determined the potential implications of virtual technologies on modern pathology education for the future of pathology competency learning and assessment. RESULTS & CONCLUSION: The challenges are partly due to transferring from in-person teaching to a virtual education. Other reasons are shifting away from discipline-based teaching to organ-system based in medical curriculum and additional pressures on pathology faculties, such as increased demand for pathology services, lack of time, and learning resources. Keeping the national standards in pathology education even in the constant disruptions from pandemic outbreaks are current challenges. Pathology expertise will need to use emergent technologies in providing educational material to ensure quality pathology education. However, virtualization of pathology education produces a value of digital pathology and web-based pathology training materials. Medical students could review clinical cases remotely with their supervisors and gain the pathology competencies necessary for clinical practice. We need new innovative strategies, and we suggested the following steps to take advantage of the current opportunity to meet the challenges: evaluating the available digital training materials for formal pathology education, investing in the virtual infrastructure for competency-based pathology education, expanding student/residents exposure to pathology educational cases through virtual platforms; applying digital pathology solutions for virtual pathology education.

Fundamental Values of the Healthcare and Medical Education System: Evolution of the Iranian-Religious Progress Model.

Iranian culture and religious teachings lead to a unique value-laden model in health and medical education systems. This research aimed to determine these fundamental values. To identify the health system values in the religious context of Iran, a mixed critical analysis-synthesis method was conducted. Furthermore, a focus group discussion with experts was conducted. Finally, we determined the fundamental values for the Iranian-religious progress model of health care and medical education. God centeredness, spirituality, divine and religious belief, ethical virtues, health centeredness and promoting all dimensions of human health, justice, protecting the human dignity, protecting health-related rights, social accountability, community centeredness, and scientific authority (excellence) are the values that should be considered to complete the value statement of the Iranian-religious progress model of health care and medical education.

Obstetrics-Gynecology Educational Achievements in Iran (1979-2017): Trends, Consequences and Future Implications.

BACKGROUND: To study the current trends in Obstetrics-Gynecology (Ob-Gyn) education and workforce in Iran since 1979 and to discuss the consequences and implications. METHODS: This descriptive-analytical study was conducted to describe the Ob-Gyn residency and fellowship growth and workforce profile in Iran (1979-2017).The first-hand data gathered from MOHME and Iran's Medical Council. The Obstetrician-Gynecologist (Ob-Gyns) per 100000 populations' ratio and the percentage changes calculated and the trends analyzed. RESULTS: Between 1979 and 2017, the proportion of trained Ob-Gyns at national universities increased by 86.27%, the number of certified Ob-Gyns increased by 333% and, female Ob-Gyns increased by 1142%.The ratio of active gynecologists per 100,000 people was 5.0 in 1979 and 8.05 in 2017, represents an increase of 70%. Since 1979 the number of active gynecologists has increased by 278 and the number of active female gynecologists has increased by 996%. Since 1990 the maternal mortality per 100,000 live births decreased by 79.9% in Iran. However, since 1980 the Cesarean proportion increased by 203% in Iran. CONCLUSION: Ob-Gyn education has undergone remarkable growth. Ongoing research should focus on Ob-Gyn's geographic distribution, and potential implications of female Ob-Gyns practice pattern and technologies on women's health.

Simulations and Virtual Learning Supporting Clinical Education During the COVID 19 Pandemic.

Currently, the COVID-19 pandemic has a critical impact on clinical education, and it has resulted in the widespread disruption of clinical assessment. Clinical mentors and students in all the health professions are working within the most troublesome of circumstances in the hospital-based educational settings. Medical educationists ought to concentrate on the health and the safety of the students and communities. The safety issues have prompted the Ministry of Health to suggest that schools develop action plans for the adoption of available technologies to keep medical education moving forward with high quality, active, and interactive learning for more demanding tomorrow. A key challenge for medical educators is to simulate the clinical encounters at this unprecedented time, and this emphasized the necessity of applying virtual simulation-based educational tools in clinical education. This commentary explores how COVID-19 has challenged medical education. It also has discussed the future implications and potencial challenges of incorporating simulation-based virtual learning technologies into the medical curriculum, for the future of clinical education, and students' or residents' competency evaluation.

COVID-19 impact and virtual medical education.

The Corona-Virus Disease 2019 (COVID-19) Pandemic has had a tremendous effect on medical education. It is also challenging the medical educationists' ability to adapt to this whole unique situation. Considering the hospital-based education, clinical mentors, and students in all health professions are potential carriers. However, the current crisis is revitalizing the necessity for online learning opportunities and virtual education. Most medical schools are following reacting to lockdown with a shift to live online or video-based learning. Maintaining standard in medical education, keeping the clinical learning on stream, and minimizing the assessment disruption are unprecedented challenges under pandemic conditions. Adaptation to this new situation is necessary to prepare future clinicians for practice. This commentary discusses how this pandemic may affect medical education. In this commentary, the author highlights the importance of virtual education and the potential implications of integrating virtual simulation technologies into medical education for the future of clinical competency learning and assessment.

Health Care and Medical Education to Promote Women's Health in Iran; Four Decades Efforts, Challenges and Recommendations.

BACKGROUND: The aim of this paper is to present a synthesis of solutions for post-graduate medical education (PGME) and the health-care system in addressing challenges in relation to women's health. METHODS: A critical review was conducted within three themes: women's health status, women's preferences for female physicians, and women in surgery. The study was conducted in two phases that consisted of an analysis of the trends of Iranian women's health and women's participation in PGME since 1979 followed by a thematic analysis to assess the current challenges and their implications on medical education. RESULTS: Our analysis revealed important trends and challenges. Since 1979, life expectancy has increased by 29% in Iranian women, while female adult mortality rate has decreased by 78%, and maternal mortality rate has decreased by 80%. The number of female medical specialists has increased by 933% , while the number of female subspecialists has increased by 1700%. According to our review, ten major challenges regarding women's health were identified: 1) Increase in chronic disease; 2) Increase in cancer cases; 3) Preference for same-gender physicians in sensitive procedures; 4) Delayed care-seeking due to lack of female surgeons; 5) Lack of gender-concordance in clinical settings; 6) Underestimating female surgeons' capabilities; 7) Female physicians' work-family conflicts; 8) Male-dominancy in surgical departments; 9) Women's under-representation in higher rank positions; and 10) Lack of women in academic leadership. CONCLUSION: We identified different solutions to bridge these gaps. Community-based education, Gender- concordant considerations, and empowering women in surgical departments could help medical education policy makers to address the challenges.

Preference for Patient -Urologist Gender Similarity and Its Implications for Urology Departments: A Systematic Narrative Review and Thematic Analysis

PURPOSE: To evaluate the evidence that could help health system policy makers to approach the preference for same-gender urologists. METHODS: We performed this systematic narrative review according to the PRISMA guidelines. We searched MEDLINE, Web of science, EMBASE, CINAHL and Google Scholar for articles focused on the  preference for patient-urologist gender similarity in the male-dominated department from 1999-2019. Finally, a narrative synthesis of studies meeting the inclusion and quality criteria was conducted in accordance with the nature of the evidences. We applied a thematic analysis using inductive approach for synthesizing studies employing heterogeneous research methods and designs. Results: Of 208 titles and abstracts screened, 23 were included and three major themes including Reasons, Impacts, and Implications were identified. Overall, patients with urologic problems prefer same gender urologists and females were more likely to prefer the same gender urologist than males. Many women delays care due to a perceived lack of female urologists. The major identified reasons for the same-gender preference are religious believe, cultural background, emotional relationship, past experiences, and sensitive examinations. The results indicate that the urologists-patients gender similarity improves the quality of primary care. Our review reveled that Urologists prefer to perform more same gender-specific procedures. Beside, Female urologist and residents perceived to underestimate from their male counterparts. Conclusion: This study could help health system to honor the patient's preference for same gender urologist. The findings may help medical education and health policy makers to move the male-dominated urology departments towards a culture supportive of female urologists.

Preference for Patient -Urologist Gender Similarity and Its Implications for Urology Departments: A Systematic Narrative Review and Thematic Analysis.

PURPOSE: To evaluate the evidence that could help health system policy makers to approach the preference for same-gender urologists. METHODS: We performed this systematic narrative review according to the PRISMA guidelines. We searched MEDLINE, Web of science, EMBASE, CINAHL and Google Scholar for articles focused on the preference for patient-urologist gender similarity in the male-dominated department from 1999-2019. Finally, a narrative synthesis of studies meeting the inclusion and quality criteria was conducted in accordance with the nature of the evidences. We applied a thematic analysis using inductive approach for synthesizing studies employing heterogeneous research methods and designs. RESULTS: Of 208 titles and abstracts screened, 23 were included and three major themes including reasons, impacts, and implications were identified. Overall, patients with urologic problems prefer same gender urologists and females were more likely to prefer the same gender urologist than males. Many women delays care due to a perceived lack of female urologists. The major identified reasons for the same-gender preference are religious believes, cultural background, emotional relationship, past experiences, and sensitive examinations. The results indicate that the urologists-patients gender similarity improves the quality of primary care. Our review reveled that urologists prefer to perform more same gender-specific procedures. Besides, female urologist and residents perceived to underestimate from their male counterparts. CONCLUSION: This study could help health system to honor the patient's preference for same gender urologist. The findings may help medical education and health policy makers to move the male-dominated urology departments towards a culture supportive of female urologists.

Ophthalmic Education and Ophthalmologists Growth Trends in Iran (1979-2016).

PURPOSE: To analyze the growth trends in ophthalmic education in Iran since 1979, and to discuss their implications on the profession. METHODS: This comprehensive national study was performed by the Academy of Medical Sciences of I.R. Iran. The data were gathered from the Specialty Training Council of the Ministry of Health and from the Medical Council of Iran. RESULTS: Our analysis revealed ten important current growth trends and seven future trends and implications. Between 1979-80 and 2015-16, the number of residents annually admitted to ophthalmology increased from 21 to 84 and related fellowships and from 0 to 34. The number of ophthalmologists graduating in the country increased from 21 (45%) in 1979 to 69 (98%) in 2015. The ratio of ophthalmologists per 100,000 people averaged 1.91 in 1979 and 3.00 in 2016. Considering migrant and retired ophthalmologists, there are approximately 2400 active ophthalmologists in Iran. In 1979, there was one active ophthalmologist per 52,112 people; in 2014, there was one per 33,333 people. This represents a per capita increase of 57%. Since 1979, the number of active ophthalmologists has increased by 234%. The number of active women ophthalmologists has increased by more than 600%, from 65 (9%) in 1979 to 470 (20%) in 2016. CONCLUSION: Equitable geographic distribution and balanced combination of ophthalmologists (women/men and specialists/fellowships) are necessary to optimize community eye health. We propose further studies on the effects of fellowship training growth and work patterns of female and male ophthalmologists.

Growth trends in medical specialists education in Iran; 1979 - 2013.

Over the past 35 years Iran had significant quantitative progress in postgraduate medical education; and growth in specialist's physician workforce supply. Health and medical education policy makers have struggled with many issues related to physician supply, such as determining the sufficient number of physicians workforce and the appropriate number to train; establishing new medical schools; the diversity of specialty programs; efforts to increase the supply of physicians in specialty level in remote and rural areas; and the growing number of female physicians and its impact on health services. After establishment of Ministry of Health and Medical Education (MoHME) in Iran, expansion of medical specialty education was a priority. Since then, great advances have been made in training of new specialty programs. Despite of these brilliant advances during the last decades in Iran, there has been no integrated and comprehensive documentation of previous and current growth trend, yet. To understand where Iranian physician supply and specialty training is headed, we examined the Iranian medical specialist's trends from 1979 to 2013 in a national study by support of Iranian academy of medicine. This paper documents the growth trend of medical specialist's workforce over the past 35 years. Examining the health manpower growth trends allow health and medical education policy makers to plan innovative strategies for the purposeful development of postgraduate medical education to ensure that in future there would be sufficient physicians supply, with the right skills, in the right places in response to population demands.

Achievements in postgraduate urologic education in Iran: a quantitative study.

PURPOSE: The study focus is on the quantitative achievements in urology education and growth trends in urologic surgical workforce and fellowships by gender since 1979. MATERIALS AND METHODS: This comprehensive national quantitative study was performed in Iranian Academy of medical science. The first hand data gathered from The Iran Specialty Training Council of and also from Medical Council of Iran. RESULTS: Over the period 1979 to 2012, the numbers of resident's admission in urology/ fellowships have increased from 5 to 51 and from 0 to 24 respectively, and graduated urologists of national programs has grown from 5 (14%) in 1979 to 47 (100%) in 2012. Iranian urologists workforce haves increased from 315 in 1979 to 1637 in 2012. In 1979, there was 1 urologist for every 117,460 population, while in 2012 there was 1 urologist for every 46120 population. Iran Urologists to population rate is 1:46120. These statistics represents significant improvement from 34 years ago. Number of female urologists has progressively increased from 1 in 1979 (0%) to 110 (7%) in 2012. Urology fellowships are offered in 6 fields since 1994 in Iran. The number of trained fellowships grew sharply and reached to 221 in 2012. CONCLUSION: The current urology training is successful to improve urology health care. Along with expansion of urology and fellowship training, the number of Iranian female urologists significantly increased. To our knowledge Iran had the greatest growth rate of female urologist training in the Middle East, and is comparable with those in the most progressed countries in the world.