A systematic review of faculty development programs based on the Harden teacher's role framework model.

BACKGROUND: Despite the changing roles of faculty in the health professions over the past two decades, none of the reviews has been paid enough attention to the impact of the faculty development programs on these roles. The objective of this review is to synthesize the existing evidence that addresses the questions: "What are the types and outcomes of faculty development programs based on the Harden teachers' role framework and which of the areas described by Harden and Crosby are the authors referring to?" METHODS: This review was conducted according to the guidance for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. In 2020, a literature search was conducted in MEDLINE/PubMed, Scopus, ERIC, ScienceDirect, Google Scholar, Magiran and SID databases. The review included 119 studies (between 1990 and 2020) that met the review criteria. Data were extracted using a modified coding sheet. We used the modified Kirkpatrick model to assess the educational outcomes of faculty development programs. RESULTS: The majority of faculty development programs were workshops (33.61%) with various durations. Most programs focused on the domain of information provider and coach (76.47%), followed by the facilitator of learning and mentor (53.78%) and assessor and diagnostician (37.81%). Only five faculty development programs focused on the domain of role model. The majority (83.19%) of outcomes reported were at level 2B, level 1 (73.95%) and level 2A (71.42%). Gains in knowledge and skills related to teaching methods and student assessment were frequently noted. Behavior changes included enhanced teaching performance, development of new educational curricula and programs, improved feedback and evaluation processes, new leadership positions, increased academic output and career development. The impact on the organizational practice continued to be underexplored. CONCLUSION: Based on the review findings, broadening the scope of faculty development programs beyond the traditional roles of the faculty members by utilizing a competency-based framework for developing a comprehensive faculty development program is recommended. Attention to individualized form of faculty development programs and incorporating more informal approaches into the design and delivery of faculty development programs is also needed.

Developing a generic model of program accreditation in Iran.

INTRODUCTION: Higher education plays an important role in the development of countries in social, economic, cultural, and scientific aspects. Also, the field of healthcare is changing rapidly, and to provide better care, health professional students need to be trained at a higher level. This situation has placed demands on academic and clinical settings responsible for training professional health students. The main objectives of this research project can be defined as 1 -to investigate important issues of accreditation and assessment process of health professional education worldwide and 2-to design and develop a uniform, transparent, and scientific accreditation framework for health professional programs in Iran. METHODS AND MATERIAL: The research methodology for the design of a generic accreditation framework in health professional education is outlined by the following step-by-step (1 to 7) procedure according to the developmental research methodology and three phases considering analysis, development, and evaluation. RESULTS: The findings of the analysis phase showed that there is no specific structure and process for accreditation in Iran compared to other countries. The three most common actions of the accreditation include the following: 1. self- assessment, 2. peer-review and site visits, and 3. evaluation and reports. A review of the relevant literature and websites indicate that various assessment frameworks have been developed regionally, as well as internationally, to accredit professional health programs. However, most of these frames seem to be non-uniform, too complex, and non-transparent. In addition to these results, three themes were extracted from the interview analysis, "accreditation barrier," "theoretical foundation of accreditation," and "specific structure and process of accreditation" which indicates the need for education at various levels of educational managers and faculty members. Therefore, these issues were taken into consideration in the design of the accreditation framework of health professional educational programs. After two stages of evaluation from the point of view of specialists and experts of the educational secretariats of the Ministry of Health and Medical Education, the final version of the program's accreditation framework and policy will be finalized. CONCLUSION: In Iran, despite the challenges and valuable activities in different educational secretariats, there was no coherent process that can be considered accreditation. In this study, self-study evaluation guide, external evaluation, standard development, and ethical guide for the programs accreditation were developed. The results of this study can help the educational secretariats of the Health and Medical Education Ministry that is based on the documents developed and operationalize their accreditation process and structure.

Identifying the challenges of holding comprehensive exams in the Ph.D. programs of Iranian medical universities: A protocol for qualitative research.

BACKGROUND: The purpose of Ph.D. education is to train students equipped with science in a particular area and familiar with research methods and the most recent foundations of education and research to apply their knowledge, creativity, and innovation in research and scientific areas to meet the needs of the society, extending the frontiers of knowledge in their special field, and reach undetected areas in the world of science, especially health. One component of evaluating Ph.D. students in medical universities is the comprehensive exam that aims to assess Ph.D. students' skills, knowledge, and experiences in both educational and research areas. However, the process sometimes encounters substantial administrative challenges and problems. MATERIALS AND METHODS: In this study protocol, we will interview. Ph.D. students, members of the examining committees of comprehensive exams, and educational practitioners involved in the administration of the comprehensive exam in District 7 of Iran's medical universities (Isfahan, Kashan, Yazd, and Shaherekord)) as one of the 10 major districts of medical education in the country (Iran). RESULTS: Thus, the present study will identify the challenges of the comprehensive exam to find ways to eliminate them and offer suitable solutions to increase the effectiveness of the exam. CONCLUSION: Indeed, what is expected from this study is to help educational practitioners and policymakers in medical universities detect the strengths and weaknesses of administering the comprehensive exam and help educational practitioners and policymakers detect potential alternatives for the present comprehensive exam.

Qualitative content analysis of the highly cited articles in medical education: Trends and characteristics associated with citation of published studies in medical education research.

PURPOSE: To explore and describe the highly cited articles' themes of research in medical education and to provide an insight into and reflection on which the elites of medical education society invested their energies from 2009 to 2018. METHODS: An in-depth content analysis as a research technique for the objective, systematic, and quantitative description of the manifest content of communication was used to quantitatively assess subject interests, methods, and other characteristics associated with citation of published studies in medical education research. Meaning units were compacted and coded with labels and categories in two phases. RESULTS: Among a variety of topics, methods, and strategies, 764 codes, 24 descriptive themes, and seven categories were extracted from the content analysis as the most prominent. Categories of medical education research were: modern technologies updating in medical education; learner performance improvement; sociological aspects of medical education; clinical reasoning; research methodology concerns of medical education; instructional design educational models; and professional aspects of medical education. CONCLUSIONS: Commitment to continuous revision of educational emphasis and concerns on technological, sociological, and methodological concerns were the most repeated components of the highly cited articles that were ascertained through increased structure course designs and instructional strategies of the flipped classrooms to realize clinical reasoning and performance improvement.[Box: see text].

Structural empowerment of midwifery students following simulation-based training of management of obstetric emergencies.

BACKGROUND: Having the ability of managing obstetric emergencies is the necessary capability for providing care during labor and delivery.Simulation is considered to be a valuable strategy for empowering midwifery students in managing emergencies. So, this study was conducted to determine the structural empowerment of midwifery students following the simulation-based training of management of midwifery emergencies. METHODS: This semi-experimental research was conducted from August 2017 to June 2019 in the Faculty of Nursing and Midwifery, Isfahan, Iran. 42 subjects of the third-year midwifery students were included in the study through convenience sampling method (n = 22 in the intervention group, n = 20 in the control group). Six simulation-based educational sessions were considered for the intervention group. Conditions for Learning Effectiveness Questionnaire, was used at the beginning of the study, one week after it and one year later. Repeated measures ANOVA was used to analyze the data. RESULTS: In the intervention group, the significant difference was observed between the mean score of the students' structural empowerment before and after the intervention (MD=-28.41, SD = 3.25) (p < 0.001), before and one year after the study (MD=-12.45, SD = 3.47) (p = 0.003), and immediately after and one year after the study (MD = 15.95,SD = 3.67) (p < 0.001). In the control group, no significant difference was observed. Before the intervention, there was no significant difference between the mean score of the students' structural empowerment in the control and intervention groups (MD = 2.89, SD = 3.50) (p = 0.415); but, immediately after the intervention, the mean score of structural empowerment in the students of the intervention group was significantly higher than those of the control group (MD = 25.40, SD = 4.94 ) (p < 0.001). One year after the study, there was no significant difference between the two groups in terms of the mean score of the structural empowerment (MD = 6.89, SD = 3.58 ) (p = 0.061). CONCLUSION: Simulation contributed to the structural empowerment of midwifery students by providing the opportunity for personal and professional growth and strengthening of the formal and informal power in the area of midwifery emergency management but these benefits were not seen at one year.

Components of curriculum supervision regarding the accountability of universities of medical sciences.

BACKGROUND: This study was conducted on accountability, aiming to design components for monitoring the curricula of universities of medical sciences. MATERIALS AND METHODS: This study was a developmental one, conducted in Isfahan University of Medical Sciences with the document and literature review, a focus group, and a survey from 2018 to 2020. The first version of the components was designed by the library research and content analysis method. Following developing the initial tool, its validity was evaluated with a focus group, and the questionnaire was prepared according to face and content validity. RESULTS: In this study, 73 components were designed in eight domains for curriculum supervision, including requirements (12), needs and goals (6), content (10), teaching-learning strategies (10), educational materials and resources (5), educational time (2), educational setting (10), and evaluation (18). CONCLUSION: The components of curriculum supervision were designed due to their importance in the evolution and innovation of medical sciences, particularly accountability in the education system, and lack of relevant research. With these components, the current and optimal status of curricula can be determined in universities.

Hidden Curriculum in Medical Residency Programs: A Scoping Review.

Introduction: Hidden curriculum is important in medical education and has numerous, long-lasting effects on medical residency. The present scoping review seeks to investigate, identify, and plot the main concepts relating to hidden curriculum and its dimensions, domains, impacts and factors in medical residency courses based on the main references and evidence. Methods: Scoping review methodology was used to guide a search of electronic databases for relevant papers. Of the 394 abstracts initially identified, after screening of both abstracts and full-text papers, 43 studies were selected for inclusion in this review. Following abstraction of key information from each study, a content analysis was undertaken. Results: Eleven themes were identified from the content analysis: 1) Organizational Issues (13.77%), 2) Socio-cultural Issues (10.5%), 3) Professional Issues (13.41%), 4) Communicational Factors (8.7%), 5) Educational Issues (22.83%), 6) Resident Personal Characteristics (21.01%), and 7) Resident Educational Characteristics (9.78%). Among the extracted effective hidden curriculum factors, the role modeling had the highest frequency and was emphasized in the studies. Conclusions: Although this study explained and identified the components, elements and also the preparation of the initial format of the hidden curriculum framework of the medical residency program, its results can reduce the negative effects of the hidden curriculum on it. More extensive and in-depth studies with different qualitative methods or mixed methods related to the hidden curriculum in different contexts and disciplines of medical residency are recommended to define characteristics of a constructive hidden curriculum of medical residency programs.

What competencies do environmental health graduates need to manage social determinants of health?

BACKGROUND: Graduates of environmental health engineering should be able to manage Social Determinants of Health (SDH) and acquire the essential competencies during their studies at university. This study was performed to determine the expected competencies of environmental health graduates in a way to be able to manage environmental and Social Determinants of Health according to their job description. METHODS: This descriptive cross-sectional study was performed using Delphi technique. First, the literature review was done and the Delphi technique was performed in three rounds. The purposeful sampling was used and 50 people were selected among the specialists in the field of environmental health engineering and SDH. Participants answered an open-ended question, for the first round. Then, a questionnaire with 8 areas was designed based on the results of the first round and distributed for the second round. Data analysis was performed using descriptive statistics. The third round was done to reach the agreement on final items. RESULTS: The agreement on the items of the third round of Delphi was more than 70%. The final results showed eight competency areas under which 29 competencies were defined. Competency areas included expert knowledge, reasoning and planning, advocacy, system-based practice, professionalism, instructional expertise, social and personal skills and, research and self-development. The first three priorities of the required competency areas were expert knowledge (4.46 ± 0.55), professionalism (4.42 ± 0.64), and advocacy (4.32 ± 0.77). CONCLUSIONS: It is necessary that environmental health engineers achieve necessary competencies regarding managing SDH, upon their graduation. It is suggested to integrate these competencies into the curriculum of environmental and health engineering in Iran universities.

Diamond goals not graphite! A triangulation approach to clinical teachers' needs assessment.

Background: Clinical faculty development plays a significant role in the professional empowerment of future physicians. Identification of educational needs is an important step in planning faculty development. This study identified the educational needs of medical faculties in the clinical setting. Methods: This cross-sectional needs assessment study was conducted in Iranian medical universities during 2016-2018 using a triangulation paradigm. A total of 384 medical clinical faculties, 54 medical education specialists, and 194 faculty evaluation forms completed by medical residents participated in the study using a convenient randomized sampling method. The data were gleaned with a researcher-made questionnaire with 14 areas developed on the basis of clinical education goals and contexts and were analyzed with SPSS16 using descriptive statistic indices such as mean, standard deviation, and frequency percentile. Analytical tests including independent t-test, chi-square and Cramer's V were also applied (p<0.05). The content validity, face validity, and reliability were approved. Results: The response rate was %59 (227) for clinical faculties, %77 (42) for medical education specialists, and %58 (110) for residents. Professionalism was the first priority of needs from the viewpoint of clinical faculties and faculty development planners. The clinical teachers' highest level skills, in their own perspective and also students' perspective, were procedure training and grand round, whereas their lowest level skills were emotional intelligence and morning report. The greatest gap existed between the current skill and the need is management and leadership in the clinical setting. Cramer's index ranged between 0.18 and 0.34 (p<0.05); hence, there was a correlation between the current status and the announced needs in all subjects. Conclusion: Designers of faculty development programs ought to pay due attention to areas of professionalism, management, and leadership and carry out accurate and comprehensive planning to enable students to become competent future physicians in the roles of therapist, manager, teacher, supporter, and researcher.

Providing a model for validation of the assessment system of internal medicine residents based on Kane's framework.

BACKGROUND: Kane's validity framework examines the validity of the interpretation of a test at the four levels of scoring, generalization, extrapolation, and implications. No model has been yet proposed to use this framework particularly for a system of assessment. This study provided a model for the validation of the internal medicine residents' assessment system, based on the Kane's framework. MATERIALS AND METHODS: Through a five stages study, first, by reviewing the literature, the methods used, and the study challenges, in using Kane's framework, were extracted. Then, possible assumptions about the design and implementation of residents' tests and the proposed methods for their validation at each of their four inferences of Kane's validity were made in the form of two tables. Subsequently, in a focus group session, the assumptions and proposed validation methods were reviewed. In the fourth stage, the opinions of seven internal medicine professors were asked about the results of the focus group. Finally, the assumptions and the final validation model were prepared. RESULTS: The proposed tables were modified in the focus group. The validation table was developed consisting of tests, used at each Miller's pyramid level. The results were approved by five professors of the internal medicine. The final table has five rows, respectively, as the levels of Knows and Knows How, Shows How, Shows, Does, and the fifth one for the final scores of residents. The columns of the table demonstrate the necessary measures for validation at the four levels of inferences of Kane's framework. CONCLUSION: The proposed model ensures the validity of the internal medicine specialty residency assessment system based on Kane's framework, especially at the implication level.

Development and psychometric evaluation of a reflection on clinical practice questionnaire for nursing students.

BACKGROUND: Reflection on clinical practice is the core of education for nursing students. Evaluating reflection on clinical experiences requires a tool which accurately measures reflection skills. The present study aims to develop and test the psychometric properties of a tool for measuring nursing students' reflection on clinical practice. METHODS: Based on a mix-method exploratory approach, the study was carried out in two stages: in the first stage (the qualitative phase), the concept of reflection on clinical practice was established. In the second stage (the quantitative phase), the psychometric properties of the developed scale were evaluated. RESULTS: Based on the results of the exploratory factor analysis and the verification process, the final version of the scale came to consist of 36 items and 6 dimensions. The dimensions were: professional competence, internal sources of motivation, challenging situational clinical setting, dynamic organizational atmosphere, reflection-based self-management, and dynamic professional growth. Overall, 6 factors accounted for 62.79% of the variances. The factor loadings of the items ranged between 0.62 and 0.94, all of which were significant. The total intraclass correlation (ICC) of the scale was found to be 0.94. Also, evaluation of the reliability of the scale as measured through internal homogeneity yielded a total Cronbach's alpha of 0.90. CONCLUSION: The findings show that the developed scale for evaluation of nursing students' reflection on clinical practice possesses satisfactory validity and reliability, and nursing professors can use this instrument to assess students' reflection skills.

An analysis of the challenges in recruiting clinical teachers in Iranian medical universities: A qualitative analysis.

BACKGROUND: Employing appropriate and deserving staff is goal of human resource management (HRM). A group of staff at medical science universities are clinical teachers. Considering the position and importance of these peoples, this study addresses the challenges of recruiting clinical teachers. MATERIALS AND METHODS: This is a qualitative study of the conventional content analysis done in Isfahan medical university in 2018. The participants were selected through intensity sampling of purposive sampling method, and data were obtained through semi-structured interviews conducted to survey 23 experts and clinical faculty members concerning the challenges involved in employing clinical teachers. Data were analyzed using conventional content analysis method and OneNote 2013. RESULTS: Two main categories and ten subcategories were classified as follows: HRM inadequacy in educational departments with six subscales such as indefiniteness of the workforce status for HR managers, reluctance of educational departments to increase human resources, nonproportionality of the teacher-student ratio, recruitment of faculty based on the needs in the treatment sector, weakness of the infrastructure to use nonfaculty teachers, and reduced public interest in employment as a faculty and weakness of the selection process with four subscales based on data analysis such as undesirable manner of selection, recruitment based on the score given by the national board of medical examiners, purpose-based calls to recruit predefined individuals, and personal and emotional issues, rather than managerial standards, governing cooperation with teachers. CONCLUSION: Recruitment process is part of HRM tasks. Employment system in a medical sciences university must be considered to improve the clinical faculty recruitment. HRM inadequacy in educational departments and weakness of the selection process are challenges that affect the employment system. According to these findings, it is necessary to review the regulations and tasks of HRM in medical sciences universities.

Entrustability levels of general internal medicine residents.

BACKGROUND: Entrustable professional activities (EPAs) are those activities that a health professional can perform without direct supervision in a defined environment. Bridging the gap between competencies and learning objectives, EPAs have made assessing the performances of health professional more realistic. The main objective of the present study was developing and customizing EPAs for Iranian Internal Medicine Residency Programs. RESULTS: After reviewing the publications, residency curricula and logbooks, and collecting experts' ideas, the initial list of EPAs was developed. Then, in a focus group, the list was refined, the entrustability level of each residency year was determined, and finally, the EPA-competency cross-tab was established, and in the next step, through a one- round Delphi, the results were validated. Twenty-eight EPAs were developed. Some of them were definitely suitable for the higher levels of residency, such that they had to be accomplished under direct supervision until the end of the program. On the other hand, some of EPAs were those that residents, even from the first year, are expected to perform independently or under indirect supervision. Most of the EPAs cover a wide range of competencies. CONCLUSION: Determining the entrustability level of each residency year in each EPA as well as the competency- EPA matrix has crucial effect on the quality of the graduates. It seems that our findings are applicable in developing countries like Iran.

Challenges and strategies of clinical rounds from the perspective of medical students: A qualitative research.

INTRODUCTION: Clinical rounds provide opportunities for medical students to acquire essential skills to practice medicine in the real world. Although this kind of training is one of the most important components of medical education, it is replete with barriers in its effective implementation. This study aimed to investigate medical students' experiences concerning the barriers and strategies of clinical rounds in Kerman University of Medical Sciences (KMU). MATERIALS AND METHODS: This qualitative research was conducted on 12 medical students in KMU in 2017. Purposive sampling was used and participants in three grades (stagers, interns, and residents) were selected, and individual semi-structured interviews were conducted until data saturation. The average of the interview time differed among the three batches (stagers, 51 min; interns, 38 min; and residents, 31 min). Content analysis using deductive approach was used for data analysis. MAXQDA version 10 was used for data analysis. RESULTS: Data analysis yielded the identification of six themes related to the system of clinical education, fields of clinical education, clinical environment, educational program, medical teachers, and medical students concerning the barriers and five themes related to the strategies for clinical rounds. CONCLUSIONS: Findings revealed a deeper understanding of medical students' experiences. Our investigation identified multiple challenges embedded in our context and strategies to overcome them. As teaching in clinical rounds is invaluable, there is a need to take into account the identified challenges and overcome them. Thus, more effective rounds with higher efficacy toward students' professional development can be implemented.

A core competency model for clinical informationists.

OBJECTIVES: Access to high-quality information improves the quality of patient care, but lack of time and sufficient skills in information seeking can prevent access to information by clinicians. To solve this problem, clinical informationists can provide high-quality, filtered information for clinical team members. This study identified the core competencies that clinical informationists need to effectively fulfill their roles on clinical teams. METHODS: Participants were selected purposefully from clinicians and medical librarians. Data were collected through semi-structured interviews and analyzed using qualitative content analysis. RESULTS: The authors identified six competencies-communication, research, education and training, domain knowledge, information services, and technology-which together were used to develop a "CREDIT" model of core competencies for clinical informationists. CONCLUSIONS: The CREDIT model can be used as criteria for evaluating the performance of clinical informationists as well as for developing and assessing clinical informationist educational programs and curriculums.

The role of narrative medicine program in promoting professional ethics: perceptions of Iranian medical students.

Narrative medicine (NM) is an educational tool that can be used to promote the professional competencies of medical students. This study aimed to investigate Iranian medical students' perceptions of the first NM program offered in 2019. The study was conducted on 69 medical interns who participated in the weekly NM program that was part of the professional ethics course for two months. We used a questionnaire to determine medical interns' perceptions and personal attitudes toward NM. Three experts confirmed the validity of the questionnaire in Persian, and its reliability was verified by internal consistency (α = 0.879). The independent t-test was used to compare the differences in the total scores of students' perceptions. Data analysis was conducted using SPSS 23 software (P < 0.05). The response rate to the questionnaire was 95.65%. The results showed overall students' perceptions of the program were found to be positive. Furthermore, the scores showed a significant difference in terms of gender (P = 0.014), but none in terms of marital status (P = 0.936). According to the results, NM was effective in improving students' reflections and their empathy with patients. Therefore, it is recommended to include NM in professional ethics education.

Key educational and research factors affecting the future of medical education discipline in Iran: A qualitative study.

CONTEXT: Along with the evolutions of medical sciences education, the importance of medical education discipline has gained more attention for keeping up with these evolutions. Therefore, paying attention to policymaking regarding the development of this discipline and its position in universities is very necessary. AIMS: This study has been done with the aim of investigating key educational and research factors affecting the future of medical education discipline in Iran. SETTINGS AND DESIGN: This is a qualitative study with directed content analysis approach, which has been conducted in eight medical sciences universities having medical education department (Tehran, Iran, Shahid Beheshti, Isfahan, Mashhad, Shiraz, Tabriz, and Kerman) in 2018-2019. SUBJECTS AND METHODS: A total of 25 participants (professors, students, and graduates) of medical education discipline were selected by purposeful sampling and with maximum diversity. Data were collected through semi-structured interviews. Interviews were analyzed using MAXQDA software. RESULTS: After analyzing the data, a number of 1561 initial codes were obtained, of which 914 codes were extracted after removing repetitious codes and merging similar codes. Finally, the obtained results from content analysis were classified into two main categories including key educational and research factors and ten subcategories. CONCLUSIONS: Among the most important key educational and research factors affecting the future of medical education discipline, it can be mention to the role of the discipline curriculum and need to revise it, the need to monitor the graduates and their status , globalization, the role of medical education centers and departments, and the role of theses. It is recommended that future studies investigate other key factors affecting the future of the discipline.

Evaluation of health experts' education program for becoming multiprofessionals (family health caregiver) regarding health system transformation plan: An application of CIPP model.

BACKGROUND AND OBJECTIVES: This study was conducted to evaluate the health experts and professionals' education program in order to become multiprofessionals regarding health system transformation plan by a descriptive and educational evaluation method based on the context, input, process, and product (CIPP) evaluation model in 2018. MATERIALS AND METHODS: The statistical population included managers and experts of health deputy (13 people), managers and authorities in health networks (32 people), teachers (251 people), and learners (1914 people). Data were collected by four researcher-made questionnaires based on the CIPP model and evaluation checklist of facilities and equipment. The view of experts was used to measure the face validity and content validity of the questionnaire, and Cronbach's alpha coefficient was used to determine reliability. Data were entered into SPSS 23 software, and data were provided using descriptive statistics (frequency, mean, and standard deviation). RESULTS: The evaluation indicators of the educational course in the field of context were evaluated desirable by province's managers and experts (95% questions), city managers (100% questions), teachers (95% questions), and health caregivers (80% questions). In the field of input, it was evaluated desirable by managers and experts' input of province (60% questions) and city managers (70% questions) and it was evaluated semi-desirable by teachers (78.95% questions) and health caregivers (88.24% questions). In the field of process, it was evaluated desirable by province's managers and experts (73.68% questions) and city managers (66.67% questions) and it was evaluated semi-desirable by teachers (66.67% questions) and health caregivers (94.4% questions). In the field of product, it was evaluated semi-desirable by managers and experts of province (63.63% questions), teachers (81.81% questions), and health caregivers (100% questions) and it was evaluated desirable by city managers (72.72% questions). CONCLUSION: Holding initial service education course of health caregivers has been necessary, and the public health, family, and midwifery disciplines needed to be educated in a university appropriate to the description of tasks of health caregivers.