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.

Implementation of a flexible visiting policy in intensive care unit: A randomized clinical trial.

BACKGROUND: Visitation is one of the most critical needs of patients in intensive care units (ICUs). Clinicians should enable a more flexible visitation policy to prevent the adverse effects of a restricted approach. AIM AND OBJECTIVES: This study aimed at investigating the relationship between increasing visitation time and patients' physiological parameters in intensive units. Additionally, nurses' beliefs and attitudes towards visiting is examined in this research. DESIGN: Parallel randomized clinical trial. METHODS: This study was conducted in four general medical ICUs in Iran. In total, 60 patients and 57 nurses participated in this study. The patients' physiological parameters were measured at particular times in both groups. Moreover, the nurses responded to the questionnaire on beliefs and attitudes towards visitation in intensive units before and after the intervention. RESULTS: Among all the physiological parameters, systolic and diastolic blood pressure and heart rate had a significant decrease within the normal range 10 and 30 minutes after visiting in the intervention group (P < .05), and nurses' beliefs and attitudes score were at the middle of the survey scoring range (0-120). However, no significant difference was found between nurses' belief and attitude score and intervention in any groups (P > .05). CONCLUSION: The findings indicate that increasing visitation times can lead to a positive effect on the stability and balance of patients' physiological parameters. RELEVANCE TO CLINICAL PRACTICE: A more flexible visiting policy can provide a therapeutic environment where not only patients' physiological disorders are minimised as much as possible but also a higher level of patients' health and satisfaction are reached.

Experiences of what influences physical activity adherence in Iranian patients with heart failure: A qualitative study.

BACKGROUND: Heart failure (HF) is becoming one of the important health care problems around the world. Physical activity as the foundation of the cardiac rehabilitation program is poorly adhered by patients with HF. This study aimed to understand the experiences of patients with HF in terms of adherence to physical activity. MATERIALS AND METHODS: This study was conducted using conventional qualitative content analysis. Data were collected by semistructured telephone interviews with 25 patients with HF through open-ended questions. Data were collected from patients with HF in Birjand and Mashhad hospitals and heart departments from December 2021 to March 2022. Data were analyzed using Max-QDA10 and data analysis was continuous, comparative, and simultaneous with data collection. RESULTS: After data analysis, three main categories were identified: (1) patient-related barriers and facilitators, (2) support system-related barriers and facilitators, and (3) environmental barriers and facilitators. These categories were subdivided into two main themes: (1) threatening disease and (2) challenging disease. CONCLUSION: The results showed that beyond patient-related, support system-related, and environmental categories, perceiving the disease as a challenge or a threat is crucial in the activity of patients with HF. Nurses and other health care providers can train problem-solving behaviors to patients with HF to improve their physical and mental well-being. It is suggested that theoretical-behavioral approaches can be used in future clinical trials to improve adherence to physical activity.

The Conflict between the Beliefs of the Health Care Providers and Family Caregivers in the Use of Traditional Medicine in Pediatric Oncology: An Ethnographic Study.

Introduction: Traditional medicine are popular treatments among families of children with cancer. This study was designed to identify the behaviors, beliefs, and values of families and health care providers for the use of traditional medicine in pediatric oncology. Methods: This study was conducted with a focus on ethnography approach in the oncology department of a pediatric subspecialty hospital in northeastern of Iran from September 2021 to June 2022. A total of 20 key informants were observed and interviewed formally and informally. The Miles and Huberman (1994) approach was used for data analysis. Results: Finally, two main cultural themes were emerged, including the blame of traditional herbal medicine and the synergy of rituals with modern therapies. Families use traditional medicine based on values passed down from generation to generation, while health care providers make evidence-based decisions. Conclusion: The results of the present study represent the conflict between health care providers and families in the use of medicinal herbs. The findings allow care providers to be aware of the beliefs and values of children caregivers to make the right decision about traditional medicine use.

Mental Health Triage from the Viewpoint of Psychiatric Emergency Department Nurses; a Qualitative Study.

Introduction: Mental health triage is a new nursing practice concept that is less studied and defined, especially among Iranian nurses. Therefore, this study aimed to explain the concept of mental health triage from the perspective of psychiatric emergency department (ED) nurses. Methods: This qualitative study collected data using semi-structured interviews with psychiatric ED nurses. Sampling was purposive and continued until data saturation. Analysis was conducted using conventional content analysis, as described in Griesheim and Landman approach. Results: 15 psychiatric ED nurses with the mean age of 35.13 ± 8.44 years were interviewed (60% male). Finally, two themes, five categories, and 16 sub-categories emerged from data analysis. Two themes emerged, including mental health triage meaning and mental health triage structure. The former included two categories of the nature and characteristics of mental health triage, and the latter consisted of three categories of mental state exploration from surface to depth, safety control measures, and the degree of emergency. According to the "degree of emergency" category, nurses could not make triage decisions based on their perceptions in an acceptable way. Conclusion: Psychiatric ED nurses have an appropriate understanding of mental health triage meaning. However, according to these nurses, its structure is associated with shortcomings that limit the provision of mental health triage services and reduce their quality.

Oropharyngeal Decontamination for Prevention of VAP in Patients Admitted to Intensive Care Units: A Systematic Review.

Introduction: Oropharyngeal colonization with pathogenic organisms contributes to the development of ventilator-associated pneumonia (VAP) in intensive care units (ICUs). Oral hygiene care (OHC) is a very effective method for reducing the risk of VAP in these patients. This study aimed to evaluate recent OHC strategies to decrease VAP. Methods: Randomized clinical trials (RCTs) published in the PubMed, Scopus, Embase, Cochrane Library, and Web of Science databases from inception to September 10, 2020 were reviewed to compare the effects of selective oropharyngeal decontamination (SOD) on the incidence of VAP in adult patients requiring mechanical ventilation. Results: Out of a total of 1098 articles reviewed, 17 eligible studies were included for final analysis. The results showed that the use of chlorhexidine for oropharyngeal decontamination reduces the incidence of VAP. However, it had a small effect on gram-negative resistant bacteria. Also, it was observed that the combined use of colistin and chlorhexidine was more effective than chlorhexidine alone in preventing VAP. The results of studies on the use of toothbrushes to reduce the incidence of pneumonia are unclear since they used chlorhexidine at the same time. However, tooth brushing is one of the best ways to maintain oral hygiene. Using povidoneiodine, Nanosil, and non-absorbable topical antibiotics reduced the incidence of VAP, while Iseganan did not show a significant effect in this regard. Conclusion: The prophylactic use of topical bactericidal agents in critically-ill patients is effective in reducing the incidence of VAP. However, the use of non-absorbable topical antibiotics is more effective than other methods in oropharyngeal decontamination.

Challenges of objective structured clinical examination in undergraduate nursing curriculum: Experiences of faculties and students.

BACKGROUND: Assessment of clinical competence of nursing students is necessary to ensure safe practice and the realization of professional clinical standards. An Objective Structured Clinical Examination (OSCE) is commonly used internationally in nursing education programs to assess clinical competence, but is a new process in Iranian nursing curricula. OBJECTIVE: The aim of this study was to explore and describe challenges associated with OSCE implementation based on the experiences of faculty members and nursing students, with the objective of further improving the assessment of clinical competence in nursing education. DESIGN: This study used a qualitative approach that included thematic analysis of the transcribed interviews. SETTING: Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences (TBZMED), Tabriz, Iran. PARTICIPANTS: Purposive sampling was used to select eighteen faculty members and fifteen students from those interested. These participants represent a reasonable cross-section of those who had participated in the OSCE. METHODS: A pre-developed interview guide was used to inform semi-structured in-depth interviews. These were recorded and analyzed using the 6-phase thematic analysis method as described by Braun and Clarke (2013). Themes were independently verified. RESULTS: Challenges identified by participants around OSCEs as part of undergraduate nursing education were extracted from the interview data. Two main themes were evident from the data: 1) shortcomings in executive and technical infrastructure, 2) shortcomings in educational infrastructure. These themes reflected both student and faculty experiences. These also aligned with themes that commonly emerge in related literature. CONCLUSION: The study findings illustrate several key challenges associated with organizing and implementing OSCEs and so provides unique insights into the development of strategies to implementing and promoting OSCEs in nursing education. We recommend that managers and authorities in nursing education focus on these challenges and explore processes to successfully introduce this exam for assessment of nursing student capacity.

Educational concern of surgical technology students in the operating room: A grounded theory study.

INTRODUCTION: Bachelor's program in surgical technology is a major of medical science, in Iran. Learning and adapting to different skills and roles in the operation room environment is a daunting work. The complexity of this environment needs to bring together researchers in this field to work on different aspects. The aim of this qualitative study was comprehensively understanding of clinical teaching process in surgical technology. MATERIALS AND METHODS: The present study was conducted based on the qualitative research design of the grounded theory approach (Corbin and Strauss, 2008). This study was conducted at schools of nursing and paramedical in five academic settings. Study participants in the present study include 14 students, seven educational instructors, six staff of operation room, one dean of faculty, three surgeon assistants, one instructor, and four head nurses of operation room. A semi-structured interview method and a memo were conducted using theoretical and purposive sampling. Constant comparative analysis was used for data analysis. RESULTS: Findings showed that the nonacceptance of student by surgical team was identified as the main concern of the students. The "gaining clinical competence and approval" was found the central process (strategy) in response to main concern of clinical education, and the "interactive and dynamic nature of the operation room environment" was defined as the context for this major concern. Strategies that students used to address this concern included individual efforts to overcome distrust, learning in the shadow of surgical team members, and seeking help and support of the instructor. CONCLUSION: Accepting the students of surgical technology as a member of surgical team creates opportunities for students to learn, gain experience, and enhance their professional qualifications and abilities.

Information need, learning need and educational need, definitions and measurements: A systematic review.

BACKGROUND: There are various definitions and tools for Information Need (IN), Learning Need (LN) and Educational Need (EN) which are used interchangeably in the patient education. OBJECTIVE: Clarifying the definitions of IN, LN and EN as well as comparing item generation methods and the dimensions of the available tools to be used appropriately. METHODS: We searched PubMed/Scopus/Embase/Science Direct databases from 1960 to 2019. Two reviewers selected studies and extracted data independently. RESULTS: We identified 22 tools comprised of 14 IN, 5 LN and 3 EN tools. The Patient Learning Needs Scale (PLNS) was the only general tool. The content of tools includes anatomy, physiology, diagnostic tests, symptoms, treatments, medications, diet, activity and self-care. No difference was found between EN/LN/IN tools in terms of item generation and dimensions according to their concept definitions. Seven tools assessed all 7 domains of patient education components. CONCLUSION: The EN, LN and IN are different concepts, but using these concepts in the tools is not based on their definitions and they have been used interchangeably. IN and LN tools were more complete and comprehensive. PRACTICAL IMPLICATIONS: The findings of this review can help researchers and clinicians to use EN, LN and IN tools more appropriately.

Perceived Challenges Faced by Nurses in Home Health Care Setting: A Qualitative Study.

BACKGROUND: Home care has gradually become a nursing model for nursing care. The nurses' experiences of challenges they have in home care have remained unknown. The aim of this study was to explore the hidden aspects of challenges related to home care in Iran. METHODS: This study was conducted to explore the challenges of home nursing care using a qualitative content analysis method. Purposeful and snowball sampling methods were used for sampling. The study was conducted from September 2016 to September 2017 in the provinces of Khorasan and Tehran in Iran. Semi-structured interviews were conducted on 33 nurses who were providing home care. After data saturation, the data were analyzed. RESULTS: The data analysis led to the development of five main categories of "difficult instances ", "economic problems", "professional barriers", "social difficulties", and "bureaucratic tension". CONCLUSION: The results of this study showed how nurses faced with a variety of challenges in home care and how they were different from hospitals. Facilitating the nursing processes, supporting home care, and recruiting nurses that had the potential to cope with the existing stressful factors and economic incentives can increase the quality of home care.

Preferred Learning Styles among Ophthalmology Residents: An Iranian Sample.

PURPOSE: This study was performed to assess the learning styles of a sample of Iranian residents through Kolb's and VARK questionnaires. METHODS: In this descriptive-analytical study, 45 ophthalmology residents of Mashhad University of Medical Sciences were enrolled. Kolb's and VARK questionnaires were provided, and residents were oriented and guided on how to complete them. RESULTS: Forty-three out of the forty-five ophthalmology residents completed the questionnaire (95.5% response rate). The preferred learning style among ophthalmology residents was assimilative (51.2%), followed by convergent (37.2%), accommodative (7.7%), and divergent (4.7%), based on Kolb's questionnaire. According to the results of the VARK questionnaire, most ophthalmology residents were auditory learners (34.9%), followed by multimodal learners (30.2%). In addition, there was no significant relation between genders, stage of residency, and Kolb's and VARK learning styles (P > 0.05 for all). CONCLUSION: The most preferred learning styles of ophthalmology residents were assimilative and auditory. Considering the dominant learning styles of learners and incorporating various teaching methods are recommended to enhance the learning among residents.

Can nurse teachers manage student incivility by guided democracy? A grounded theory study.

INTRODUCTION: Managing incivility in academic settings is among the basic concerns and challenges of most educational systems, including nursing education. Incivility management cannot be considered devoid of disruptive behaviors. However, incivility management is a complexphenomenon upon which few studies are conducted. OBJECTIVES: The present study aims at discovering teachers and students' experiences regarding incivility and developing an approach to manage nursing students' incivility. DESIGN: The present study was conducted based on the qualitative research design of the grounded theory methodology. SETTINGS: This study was conducted at schools of nursing in academic settings in Iran. PARTICIPANTS: Study participants in the present study include nurse teachers (N=20) and nursing students (N=9). METHOD: In-depth semi-structured interviews were conducted using theoretical and purposive sampling. Constant comparative analysis was used for data analysis. RESULTS: The results include four main categories; (1) deterioration of learning; (2) dominant individual and organisational culture; (3) guided democracy; and (4) movement toward professionalism. Guided democracy is recognised as the main basic psychosocial process for incivility management. CONCLUSIONS: Incivility management is pursued to help learners develop professional performance. As indicated by the results of the present study, guided democracy is an effective strategy for incivility management in nursing education.

Faculty-Student Caring Interaction in Nursing Education: An Integrative Review.

Introduction: Faculty- student caring relationship in nursing education has been offered as enhancing students' learning experiences to care , desire to care for others and self-actu-alization. This review therefore was carried out to analyze faculty-student caring interactions in nursing education. Methods: This concept analysis of caring in the nursing education was conducted based on Broom methodology of integrative review. The literature was consisted of two books from two known theorists, and 47 relevant articles. They retrieved from English data bases including MEDLINE, CINAHL, ERIC, SCOPUS, and SID, with based on the keywords of caring and "nursing education", during the period 2005-2014. Results: Caring in nursing education refers to faculty-student interaction based on ethical and human values. The development of values and moral principles in education, flexibility in educational processes, application of objective patterns in learning, and dynamism in educational processes are identified as caring concept attributes in teaching-learning process. This requires environmental support, constant human relationship, and knowing. Internalization of values, achieving self-esteem, peace, and towards human evolution were the main achievements of the concept of caring in nursing education. Conclusion: The details obtained from the dimensions of "caring" concept in this study could be utilized by nursing education researchers and designers in order to develop content and structure for educational programs.

Exploring Iranian ß-Thalassemia major patients' perception of barriers and facilitators of adherence to treatment: A qualitative study.

Background: Despite the clinical importance of adherence to treatment in ß-Thalassemia Major (ß-TM) patients, poor adherence remains a prevalent and persistent problem in these patients. Objective: The aim of this study was to explore Iranian ß-TM patients' perception regarding the barriers and facilitators of adherence to their treatments. Methods: In this qualitative study, data were collected using purposeful sampling and semi-structured interviews with 18 ß-TM patients, 3 family members and 5 healthcare professionals (total=26) in Sari, northern Iran, between August 2015 and May 2017. Data were analyzed using conventional content analysis with the support of MAXQDA software. All the interviews were transcribed verbatim. Data were coded and grouped under specific categories. Results: We identified and classified the perceived barriers of patients' adherence to treatment into six main categories including: (I) long distance challenges, (II) delayed occurrence of complications, (III) fatigue of healthcare providers, (IV) staff workload, (V) insufficient follow-up of healthcare workers, and (VI) busy everyday life. Also, nine main categories emerged as facilitators including: (I) concern of appearance changing, (II) outcomes of treatment, (III) good awareness, (IV) parental monitoring, (V) fear of complications, (VI) social activity, (VII) marriage as a facilitator, (VIII) friendly interaction with the medical staff, and (IX) trusting the medical staff. Conclusion: Our findings provide a broad range of context-specific facilitators and barriers to treatment adherence perceived by Iranian ß-TM patients. These factors improve our understanding of the complex and multifactorial nature of adherence to treatments. Health care providers can use these findings in designing and implementing appropriate interventions to promote ß-TM patients' adherence to treatment.

Strategies for Managing Nursing Students' Incivility as Experienced by Nursing Educators: a Qualitative Study.

INTRODUCTION: Students' incivility is an impolite and disturbing behavior in education and if ignored could lead to behavioral complexities and eventually violence and aggression in classrooms. This study aimed to reveal the experiences of Iranian educators regarding the management of such behaviors. METHODS: In this qualitative study, qualitative content analysis method was used to evaluate the experiences and perceptions of nursing educators and students. A total of 22 persons (14 educators and 8 students) were selected through purposive sampling and individually interviewed. RESULTS: Categories of unification of educators regarding behavioral management, teaching-learning strategy, friendship strategy and training through role playing, authority, appropriative decision-making and freedom, stronger relationships between students, reflection, and interactive educational environment were some strategies used by teachers for management of incivility. CONCLUSION: Educators suggested some strategies which could be used depending on uniqueness of behaviors and given situation. Educators and managers of medical fields can use these approaches in their classrooms to control uncivil behaviors.

Iranian Novice Nursing Faculty Experiences on Their New Roles in Relation to IT Literacy.

In recent years, there has been a fast spread of using new technologies and software in health management areas. Nursing education should be accommodated with this change to provide qualified nurses. There are little studies on novice nursing faculty challenges to perform their new roles in relation to IT literacy, specifically in Iran. Qualitative approach may provide first hand data to understand novice nursing faculty perceptions on their new roles that can be used to develop an actual empowerment program. A qualitative design was applied to explore novice nursing faculty experiences to perform their new roles in Mashhad nursing school (Iran). Data were gathered by in depth unstructured interviews from nine eligible participants. Two main themes related to IT competencies emerged from data as: "Efficiency concern" and "Importance of support". Findings support that novice faculty should be familiarized with new systems and software in health management.

Patient education among nurses: bringing evidence into clinical applicability in Iran.

OBJECTIVE: The aim of this study was to present a comprehensive review of the literatures describing barriers and facilitators of patient education (PE) perceived by Iranian nurses in order to explain clinical applicability of patient education. METHODS: Review of the literature was undertaken using the international databases including PubMed/Medline, Scopus, ScienceDirect, as well as Google Scholar. Also, Persian electronic databases such as Magiran, SID and IranMedex were searched. Electronic databases were searched up from conception to September 2014 using search terms: "patient education", " patients education", "patient teaching", "patient training", "nurse", " nurses", " nursing", " and "Iran". Only studies were included that were related to barriers and facilitators of PE among Iranian nurses. RESULTS: Twenty-seven studies were included. The main influential barriers were categorized into three major areas: 1) Nurse-related factors: nursing shortage 2) Administration-related factors: unsupportive organizational culture, and 3) Patient-related factors: low compliance. The most perceived facilitators were recognized as "increasing, selecting and training special nurses for providing PE" and "providing PE courses for nurses and appropriate facilities for PE". CONCLUSION: Iranian nurses encounter barriers in PE, and the most frequently encountered barriers were related to administration factors. These findings have implications for administrators and managers in health settings. In order to promote PE among nurses, administrators should create a supportive environment and use effective strategies to smooth the progress of PE by nurses in their practice in order to ensure optimal outcomes for patients.

Causes of Incivility in Iranian Nursing Students: A Qualitative Study.

BACKGROUND: Incivility among nursing students is a common academic problem. Knowing the causes of students' incivility will enable the faculty members and academic institutions to select correct strategies to deal with this problem. This study was conducted to explore the causes of incivility among nursing students from both educators' and students' points of view. METHODS: gThis qualitative content analysis study was applied in order to explore experiences and insights of 17 nursing lecturers and 9 nursing students who were selected through purposeful sampling and interviewed on the causes of incivility. Participants were selected among students and lecturers of nursing schools in Khorasan Razavi. The inclusion criteria for the students were having passed one educational term and for the lecturers having one year experience of teaching respectively. Data gathering was done using deep semi-structured interviews starting from March 2014 to March 2015. RESULTS: Three main categories extracted from the data were student related factors, teacher related factors, and organizational factors. Non-educational engagement, attracting attentions, lack of motivation, students' personality, and lack of experience were the subcategories of student related factors. Subcategories of teacher related factors included lack of skills, teachers' personal qualities, lack of experience, and incivility of teachers. Finally, the subcategories of organizational factors included no evaluation system for teachers and lack of understanding the organizational rules and regulations. CONCLUSION: The results of this study indicated that factors related to students, teachers, and organization may lead to nursing students' incivility and clarified its dimensions. In order to develop a civil environment in nursing college, managers and educators' awareness should be promoted via various ways such as workshops.

Principle-based concept analysis: Caring in nursing education.

INTRODUCTION: The aim of this principle-based concept analysis was to analyze caring in nursing education and to explain the current state of the science based on epistemologic, pragmatic, linguistic, and logical philosophical principles. METHODS: A principle-based concept analysis method was used to analyze the nursing literature. The dataset included 46 English language studies, published from 2005 to 2014, and they were retrieved through PROQUEST, MEDLINE, CINAHL, ERIC, SCOPUS, and SID scientific databases. The key dimensions of the data were collected using a validated data-extraction sheet. The four principles of assessing pragmatic utility were used to analyze the data. The data were managed by using MAXQDA 10 software. RESULTS: The scientific literature that deals with caring in nursing education relies on implied meaning. Caring in nursing education refers to student-teacher interactions that are formed on the basis of human values and focused on the unique needs of the students (epistemological principle). The result of student-teacher interactions is the development of both the students and the teachers. Numerous applications of the concept of caring in nursing education are available in the literature (pragmatic principle). There is consistency in the meaning of the concept, as a central value of the faculty-student interaction (linguistic principle). Compared with other related concepts, such as "caring pedagogy," "value-based education," and "teaching excellence," caring in nursing education does not have exact and clear conceptual boundaries (logic principle). CONCLUSION: Caring in nursing education was identified as an approach to teaching and learning, and it is formed based on teacher-student interactions and sustainable human values. A greater understanding of the conceptual basis of caring in nursing education will improve the caring behaviors of teachers, create teaching-learning environments, and help experts in curriculum development.

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.