Community-engaged medical education is a way to develop health promoters: A comparative study.

BACKGROUND: Although the importance of health promotion and empowerment of the community has been recognized for many years, there are still many barriers to adopting health promotion in the world. One of the solutions is socially accountable medical education and community engagement. OBJECTIVE: This study aimed to compare the medical programs of five medical schools that practiced community-engaged medical education to medical education in Iran. MATERIALS AND METHODS: This comparative study has been performed in 2022 by the four-stage Bereday method, including description (the educational programs of the selected medical schools were examined), interpretation (a validated checklist was prepared according to community-based strategies), proximity (similar and different information was identified), and comparison (solutions were recommended to improve health promotion and community engagement in Iran's medical education program. The purposive sampling method was used to select five universities. RESULTS: Although successful initiatives have been attempted to integrate public health promotion and community orientation into the Iranian curriculum, they do not appear to be sufficient in comparison to leading countries. The main distinction is that the community is actively engaged in all stages of curriculum design, implementation, and evaluation. CONCLUSIONS: Although Iran's medical education program has a long way to go in terms of social accountability, by including more community-oriented initiatives into the curriculum, health needs of the community can be met and physician shortages in poor areas can be alleviated. It is recommended to implement modern teaching methods, to recruit diverse faculty and community members, and to increase the community placement in medical education.

Explanation of the professional development process of general surgery residents in the operating rooms: A situational analysis.

Introduction: Numerous factors and elements are effective in the professional development of any field of study, including the educational structure, the individual characteristics of learners, and the educational atmosphere prevalent in the educational environment. Understanding each of these factors and elements and the relationships among them can guide educational system administrators in the direction of professional development. Surgical residents' professional development is no exception to this rule. As a consequence, the present research sought to explain and suggest a model for surgical assistant professional growth in Iranian operating rooms. Methods: The present research was a grounded theory study based on a post-positivist approach, in which data analysis was performed using Clark's situational analysis methodology by drawing three maps, situational map, social worlds/arenas map, and positional map. Results: In the presence of human and non-human factors, cultural, political, historical, and social components, the ordered situational map demonstrated the complexity of the operating room learning environment. The social worlds/arenas map confirmed the existence of several communities of practice wherein surgical residents were present with different power roles, and the positional map showed role of the educational level in the acquisition of the competence in the professional development pathway. Finally, the Triple Helix model of professional development was extracted, which has three components: psychological identity, social identity, and surgical competency. Conclusion: The surgical residents' professional development in operating rooms occurs due to the acquisition of surgical competency along with the growth of individuals and socialization. As a result, all factors and components impacting the residents' competence development process in this learning environment must be identified and their linkages clarified.

Exploring the surgical residents' experience of teaching and learning process in the operating room: A grounded theory study.

BACKGROUND: Despite the development of valuable teaching methods and assessment tools in the field of surgery education, yet unpreparedness for independence practice by surgical residents remains a problem in most of the countries. AIMS: This study aims to explain the surgical residents' experience of the teaching and learning process in the operating rooms in Iran. MATERIAL AND METHODS: This study is a qualitative research that was done from May 2019 to June 2020 in Tehran and eight other cities in Iran. The selected methodology was constructivist grounded theory. The study setting was 11 teaching hospitals. Data were collected through 36 in-depth interviews and 132 h of observation. Participants were selected initially by purposive sampling and then by theoretical sampling for covering gaps and completing categories. RESULTS: Findings showed that the confused educational system was the main concern of the residents' experience of the teaching and learning process in the operating room. This concern is investigated by dividing into four subcategories: Education in the shadow of treatment, inefficient education, patient safety versus trusting residents for independent practice, and unstructured assessment. CONCLUSION: Based on residents' experience about challenges such as inefficient education, the influence of patient safety versus trusting residents for independent practice, and unstructured assessment, the surgical residents' education in the operating rooms needs to revise.

Surgical residents' challenges with the acquisition of surgical skills in operating rooms: A qualitative study.

INTRODUCTION: Training in operating rooms is challenging. Specifically, surgical residents often experience a stressful environment in training arenas that, in turn, might affect their ability in the acquisition of the required qualifications. This study aims at the qualitative explanation of how the surgical residents acquire the surgical skills in operating rooms. METHODS: This qualitative study was conducted in 2019-2020 using the conventional content analysis method. Participants were selected using purposive sampling. Data were collected through 25 semi-structured in-depth interviews. Then, the interview transcriptions were analyzed in MaxQDA2 software using the content analysis method. RESULTS: The data were classified into two main categories, namely challenges/obstacles and strategies for dealing with the challenges. The data in the first category were further classified into four subcategories, including burnout, confusion in technique selection, unequal learning opportunities, ignorance, and responsibility misassignment. Similarly, four subcategories of establishing communication channels with chief residents and faculty members, learning by the non-surgeon pathway, covert progress in the learning path, and taking advantage of force from a position of power in the learning path were considered for the second category. CONCLUSION: Based on the findings of the study, surgical residents face serious challenges and obstacles in their training course. To address these challenges, the curriculum of the surgical course needs to be improved with the emphasis on the balanced responsibility assignment and enhanced human communication.

Developing a protocol for determining the competitive advantage of clinical specialty and sub-specialty mission differentiation in Iran.

INTRODUCTION: The differentiation as a process occurs when new functions emerge in a system, and for this reason the university system is bound to diversify. With the advancement of knowledge and increase in competition, it has become a challenging issue and an inevitable necessity. This study aimed at identifying the dimensions of the differentiation of Iran's medical sciences universities through determining a protocol of the competitive advantage and scientific strength of clinical specialty and sub-spatiality departments of research activities. METHODS: This was a mixed-methods study; the qualitative study was carried out using a conventional content analysis method. We held a focus group discussion to develop a protocol of scientific strength and competitive advantage for mission differentiation. We used purposive sampling, in February 2019. The sessions were audio-taped. We analyzed the data by considering the verbatim transcribed document of the audio recorded discussions using conventional content analysis method for theme development. In the second stage, we implemented the proposed protocol in the first stage through the Scientometrics System for all 66 colleges and universities of the Ministry of Health and Medical Education. RESULTS: The results of the first stage includes a protocol, 4 indices and two formulae for scientific strength and competitive advantage proposed by the expert participants and an executive model designed to clinical specialty and sub-specialty of the college and universities of medical sciences in the research activities. In the second stage, the scientific strength and competitive advantage was calculated for all universities of medical sciences. The results indicated that some universities, for instance, Tehran, Shahid-Beheshti, Iran, Shiraz, Isfahan, etc. had the most competitive advantages among the academic clinical specialty and sub-specialty departments. CONCLUSION: Besides teaching and research, universities should contribute to local socio-economic development, in the growing conviction that scientific research results and educational skills are crucial for the economic growth of nations. The enhancement of high-quality education and excellence in teaching will be consistent and sustained in research-intensive universities. It should strongly promote the integration and relatedness of teaching and research as an essential characteristic of the university.

Implementing Clinical governance in Iranian hospitals: purpose, process and pitfalls.

INTRODUCTION: Clinical governance as an approach to improving the quality and safety of clinical care has been run in all Iranian hospitals since 2009. This study aimed to provide a comprehensive overview of the processes and challenges faced in implementing clinical governance (CG) in acute-care hospitals in Iran. METHODS: We conducted an in-depth, qualitative, multi-case study using semi-structured interviews with a range of key stakeholders and review of relevant documents. This study was conducted in 2011-2012 in six governmental hospitals affiliated with Tehran University of Medical Sciences. The data were analyzed using framework analysis. RESULTS: The interviewees, predominantly senior managers and nurses, expressed generally positive attitudes towards the benefits of CG. Four out of the six hospitals had a formal strategic plan to implement and execute CG. The emergent barriers to the implementation of CG included insufficient resources, the absence of clear supporting structures, a lack of supportive cultures, and inadequate support from senior management. The main facilitating factors were the reverse of the barriers noted above in addition to developing good relationships with key stakeholders, raising the awareness of CG among staff, and well-designed incentives. CONCLUSIONS: There is a positive sense towards CG, but its successful implementation in Iran will require raising the awareness of CG among staff and key stakeholders and the successful collaboration of internal staff and external agencies.

A total quality management approach to healthcare waste management in Namazi Hospital, Iran.

BACKGROUND: Healthcare waste comprises all wastes generated at healthcare facilities, medical research centers and laboratories. Although 75-90% of these wastes are classified as household waste posing no potential risk, 10-25% are deemed to be hazardous, representing a potential threat to healthcare workers, patients, the environment and even the general population, if not disposed of appropriately. If hazardous and non-hazardous waste is mixed and not segregated prior to disposal, costs will increase substantially. Medical waste management is a worldwide issue. In Iran, the majority of problems are associated with an exponential growth in the healthcare sector together with low- or non-compliance with guidelines and recommendations. The aim of this study was to reduce the amounts of infectious waste by clear definition and segregation of waste at the production site in Namazi Hospital in Shiraz, Iran. MATERIALS AND METHODS: Namazi Hospital was selected as a study site with an aim to achieving a significant decrease in infectious waste and implementing a total quality management (TQM) method. Infectious and non-infectious waste was weighed at 29 admission wards over a 1-month period. RESULTS: Before the introduction of the new guidelines and the new waste management concept, weight of total waste was 6.67 kg per occupied bed per day (kg/occupied bed/day), of which 73% was infectious and 27% non-infectious waste. After intervention, total waste was reduced to 5.92 kg/occupied bed/day, of which infectious waste represented 61% and non-infectious waste 30%. The implementation of a new waste management concept achieved a 26% reduction in infectious waste. CONCLUSION: A structured waste management concept together with clear definitions and staff training will result in waste reduction, consequently leading to decreased expenditure in healthcare settings.