Use of simulated patients for formative assessment of moral competence in medical students.

BACKGROUND: During the course of their education, medical students must attain moral competence. The current study aims at designing a formative structured examination that would create the opportunity for learners to practice and interact with simulated patients under expert supervision. MATERIALS AND METHODS: This article reports an experience in developing and implementation of a formative assessment of moral competence and the point of view of medical students. In this study, the formative structured examination of medical ethics for 80 medical students in 2 rounds with eight stations was designed. In each station, a scenario was proposed, and the opportunity was provided to the learners to interact with a simulated patient under the supervision of a medical ethics expert. Then, the learners would receive structured feedback in accordance with their performance. All learners expressed their experience in reflective writing, and their opinions were put under content analysis. RESULTS: The content analysis of this reflective writing revealed three main categories, namely "Deeper understanding of ethical subjects," "Collaborative thinking and synergy with peers," and "Effective feedback of supervisors." CONCLUSION: Within the framework of a formative structured examination of medical ethics, a safe space was created for interacting with simulated patients and practicing ethical reasoning, as well as dimensions of moral competence.

The main indicators for Iranian hospital ethical accreditation.

INTRODUCTION: The application of organizational ethics in hospitals is one of the novel ways to improve medical ethics. Nowadays achieving efficient and sufficient ethical hospital indicators seems to be inevitable. In this connection, the present study aims to determine the best indicators in hospital accreditation. METHODS: 69 indicators in 11 fields to evaluate hospital ethics were achieved through a five-step qualitative and quantitative study including literature review, expert focus group, Likert scale survey, 3 rounded Delphi, and content validity measurement. Expert focus group meeting was conducted, employing Nominal Group Technique (NGT). After running NGT, a three rounded Delphi and parallel to Delphi and a Likert scale survey were performed to obtain objective indicators for each domain. The experts were all healthcare professionals who were also medical ethics researchers, teachers, or PhD students. Content validity measurements were computed, using the viewpoints of two different expert groups, some ethicists, and some health care professionals (n=46). RESULTS: After conducting NGT, Delphi, Likert survey, 11 main domains were listed including:  Informed consent, Medical confidentiality, Physician-patient economic relations, Ethics consultation policy in the hospital, Ethical charter of hospital, Breaking bad medical news protocol, Respect for the patients' rights, Clinical ethics committee, Spiritual and palliative care unit programs in the hospitals, Healthcare professionals' communication skills, and Equitable access to the healthcare. Also 71 objective indicators for these 11 domains were listed in 11 tables with 5 to 8 indicators per table. Content Validity Ratio (CVR) measurements were done and 69 indicators were highlighted. CONCLUSION: The domains listed in this study seem to be the most important ones for evaluating hospital ethics programs and services. Healthcare organizations' accreditation and ranking are crucial for the improvement of healthcare services. Ethics programs would also motivate hospitals to improve their services and move towards patients' satisfaction. In this regard, more involvement of bioethicists can help healthcare organizations to develop ethics programs and ensure ethics-based practice in hospitals.

Needs assessment and evaluation of a short course to improve faculties teaching skills at a former World Health Organization regional teacher training center.

INTRODUCTION: In the design of educational programs, much attention has been paid to teaching methods, needs assessment, an important part of the development of educational programs, generally is neglected. Another important aspect in educational program design is assessing effectiveness. The aims of this study were to design a formal needs assessment program to define the core contents of a faculty development program, and to determine whether participation in the faculty development program reinforced new teaching skills. METHODS: A teacher-training program was designed at Shiraz University of Medical Sciences to help medical instructors boost their teaching skills. Needs assessment was done with nominal group technique followed by a 5-point Likert scale questionnaire. The program, imparted in workshop format, covered effective teaching methods, feedback, assessing knowledge and time management. Instruction was in the form of lectures, group discussions, case simulations, video presentations and role-plays. The program was evaluated in several phases using data triangulation and multi-item assessments of overall program quality in three major dimensions: Kirkpatrick program evaluation model, evaluation of the educational environment and qualitative analysis with open-ended questions. All participants in the study belonged to the academic staff of Shiraz University of Medical Sciences (n=396). RESULTS: Seven main categories were derived from nominal group techniques and questionnaires. After the program, participants rated the quality of the program highly. They felt that the educational intervention was appropriate and had a positive impact on their knowledge of effective teaching methods, feedback, knowledge assessment and time management. Assessment of the effectiveness of the program showed that participants reported significant improvements in their teaching abilities. CONCLUSIONS: Our faculty development program  have a significant positive effect on medical university teaching staff members' competencies. Further research is needed to investigate whether the faculty development program actually results in improved teaching performance.