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Background:After the introduction of the Rome IV criteria for the diagnosis of irritable bowel syndrome [IBS], studies on the clinical significance of the new criteria in the settings of a large study has been scarce
Objective: Herein we used the infrastructures provided by one the largest cohort studies in Iran to evaluate the epidemiological features related to IBS
Methods:A total of 9264 participants, were enrolled in the initial registry. Diagnosis of IBS was done using the Rome IV criteria. Individuals with IBS were compared with a control group. Since the study included a large sample size of patients, we used the penalized smoothly clipped absolute deviation [SCAD] regression analysis to construct a model for the evaluation of factors associated with IBS
Results:Overall, data of 9163 participants entered the final analysis. In total, 1067 [11.6%] individuals were diagnosed with IBS, among which 57 [5.3%] were diarrhea dominant [IBS-D], 380 [35.6%] were constipation dominant [IBS-C], and 630 [59%] did not mention having any of the two [IBS-U]. In the regression model, back pain/arthralgia [OR: 1.98, 95% CI: 1.65 - 2.40], insomnia [OR: 1.65, 95% CI: 1.40 - 1.93], depression [OR: 1.64, 95% CI: 1.38 - 1.95], female sex [OR: 1.58, 95% CI: 1.27 - 1.96], anxiety [OR: 1.43, 95% CI: 1.21 - 1.69], and being married [OR: 1.23, 95% CI: 1.03 - 1.48], were associated with higher rates of IBS. We found that IBS prevalence displays a peak at the age of 41 years for both men and women
Conclusion:The present study provides a background for follow-up studies to be conducted in order to evaluate causality between IBS and some major diseases such as liver disease. We also found that opium use, although not statistically significant, in addition to sex, education, back/joint pain, depression, insomnia, anxiety, and marital status might be a contributing factor in IBS
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Introduction: clinical reasoning is one of the most important skills in the process of training a medical student to become an efficient physician. Assessment of the reasoning skills in a medical school program is important to direct students' learning. One of the tests for measuring the clinical reasoning ability is Clinical Reasoning Problems [CRPs]. The major aim of this study is to measure psychometric properties of CRPs and define correlation between this test and routine MCQ in cardiology department of Shiraz medical school
Methods: this study was a descriptive study conducted on total cardiology residents of Shiraz Medical School. The study population consists of 40 residents in 2014. The routine CRPs and the MCQ tests was designed based on similar objectives and were carried out simultaneously. Reliability, item difficulty, item discrimination, and correlation between each item and the total score of CRPs were all measured by Excel and SPSS software for checking psycometeric CRPs test. Furthermore, we calculated the correlation between CRPs test and MCQ test. The mean differences of CRPs test score between residents' academic year [second, third and fourth year] were also evaluated by Analysis of variances test [One Way ANOVA] using SPSS software [version 20][alpha=0.05]
Results: the mean and standard deviation of score in CRPs was 10.19 +/- 3.39 out of 20; in MCQ, it was 13.15 +/- 3.81 out of 20. Item difficulty was in the range of 0.27-0.72; item discrimination was 0.30-0.75 with question No.3 being the exception [that was 0.24]. The correlation between each item and the total score of CRP was 0.26-0.87; the correlation between CRPs test and MCQ test was 0.68 [p<0.001]. The reliability of the CRPs was 0.72 as calculated by using Cronbach's alpha. The mean score of CRPs was different among residents based on their academic year and this difference was statistically significant [p<0.001]
Conclusion: the results of this present investigation revealed that CRPs could be reliable test for measuring clinical reasoning in residents. It can be included in cardiology residency assessment programs
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Introduction: nowadays according to competency based curriculum, selecting an appropriate assessment method is inevitable. This study aimed to investigate application of Direct Observation of Procedural Skills [DOPS] in undergraduate medical students
Methods: this is a cross sectional study conducted during emergency ward rotation in last year medical students using consensus sampling method. Each student performed 2 procedures at least twice under the observation of 2 assessors using modified DOPS rating scales designed for each procedure simultaneously. Correlation between DOPS score and final routine exam was measured. Face and content validity was determined by the panel of experts. Moreover, through the test-retest and interrater reliability, the correlation of each score and total score was investigated. The spent time was calculated too. The statistical analysis was carried out using SPSS version 18
Results: totally 60 students did 240 procedures under DOPS. The face and content validity confirmed by an expert panel. The findings showed that there was a significant correlation between the scores of each test and the total DOPS score [r1=0.736**, r2=0.793**, r3=0.564**, r4=0.685**; p<0.001]. There was a significant correlation between the first and second scores of doing the same procedure [Pearson Cor.=0.74, p<0.001] and also between the scores of the two individual examiners when observing the same procedure [Pearson Cor.=0.84-0.94, p<0.001]. The results showed that there was no correlation [Pearson Correlation=0.018, p<0.89] between the scores of this test and the final routine ward exam scores. The average time for doing DOPS test and the average time for providing feedback were 11.17 +/- 7.5 Max and 9.2 +/- 4.5 Min, respectively
Conclusion: the use of novel performance assessment methods such as DOPS is highly beneficial in order to ensure the adequacy of learning in medical students and assess their readiness for accepting professional responsibilities. DOPS as a practical and reliable test with acceptable validation can be used to assess clinical skills of undergraduate medical students
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Introduction: Teaching renal physiology for undergraduate medical students in an understandable way using methods which improve their deep learning has always been a problem. In this study, Early Clinical Exposure [ECE] was used in teaching renal physiology for the second year medical students in Shiraz Medical School. This article aims to introduce and develop this program and also measure the attitude of medical students toward ECE in learning renal physiology
Methods: This is a mixed method study conducted on 120 second year undergraduate students. After performing the course, both qualitative and quantitative methods were used for measuring the viewpoints of the students. In the qualitative part, 10 high rank medical students were selected. These students participated in brain storming sessions to express their opinion about the program based on the strengths and weaknesses. For trustworthiness of the qualitative part, member check and peer check were done. In the quantitative part, a researcher-made questionnaire was used based on the objectives of the program in a 4 point Likert scale. The validity of questionnaire was determined by medical education experts and reliability was determined after a pilot study
Results: Based on the results of the quantitative part of the study, 98 percent of the students stated that the ECE program was generally a useful program. In the qualitative part, the students' comments were obtained. The benefits of the program were summarized in 4 main themes. These themes are "understanding of renal physiology", "Integration of basic and clinical knowledge", "Improvement of attitude toward importance of physiology", and "encouragement to study". In response to the questions about negative aspects of this program in qualitative part, the two main themes were insufficient time and large group size
Conclusion: Students reported that ECE was useful, but they stated that they needed to have more encounter with patients and more hospital teaching. The results also reveal that this ECE program is an excellent approach to strengthen learning in a difficult subject like renal physiology. This approach is adjustable to other basic science topics and subjects as well
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Introduction: Medical students should be familiar with the end of life ethical issues and its considerations. For teaching end of life care to medical students, literature is a source of excellent narratives of patients with experiences of terminally ill condition in their journey through suffering and one of the most favourite bioethics literature readings has been the death of Ivan Ilych by Tolstoy. We used this novel to show medical students end of life events and suffering and asked them to write a reflective essay on it. We aimed to find what students think about terminally ill patients and their journey to death.
Methods: In an inductive qualitative content analysis model, 350 essays, collected by homogenous sampling, were analyzed. The fourth year medical students were provided with the Death of Ivan Ilych novel to read. They were asked to write a reflection essay based on the reflective stages defined by Sandars. These essays served as the unit of analysis, each being read several times and a coding model was formed according to main topics. The related concepts in each unit were named as themes and each theme was abstracted to a code and the related codes were compared and developed as categories
Results: Qualitative content analysis of 350 essays of fourth year medical students revealed three major categories in students' reflection on reading Death of Ivan Ilych as an end of life human body. These included: 1] Emotional experience, 2] Empathy and effective communication, 3] Spirituality and dignity. Analysis of essays showed that this reflection activity may help medical students have a deeper idea of the end of life situation and feelings
Conclusion: This project suggests that literature can be used as an example to introduce new ethical concepts to less experienced medical trainees. The students acquired the concept of the story and reflected the major aspects of the suffering of a human being in their essays. Having used and evaluated the effect of literature on facilitating ethical insight in the teaching end of life care, we strongly recommend this method and specially the novella, Death of Ivan Ilych
Subject(s)
Female , Humans , Male , Students, Medical , Education, Medical , Writing , Death , Terminally IllABSTRACT
Introduction: Research shows that there is a relationship between students' perceptions of classroom and learning environment and their cognitive, affective, emotional and behavioral outcomes, so, in this study the relationship between medical students' perception of learning environment and academic emotions was examined
Methods: The research method used was descriptive-correlativeÒ Stratified sampling method was used to select 342 participants. They completed self-report questionnaires of Dundee Ready Educational Environment Measure [DREEM] and Achievement Emotions Questionnaire [AEQ]. All descriptive statistics, Pearson's correlations and simultaneous multiple regression were performed using SPSS 14 software
Results: Simultaneous multiple regression of the students'perceived learning environment on their academic achievement emotions showed that the perceived learning environment predicts the students' academic emotions
Conclusion: The results of this study revealed that caring for and supportive learning environment can increase the students'positive emotions and decrease their academic negative emotions [i.e. anxiety, shame, and hopelessness]. Implications of the results are discussed
Subject(s)
Female , Humans , Male , Students, Medical , Learning , Environment , Self Report , Surveys and QuestionnairesABSTRACT
Background: Education is a process beginning with informing, followed by attitude-making and finally leading to appropriate behavior and performance in trainees. Breastfeeding self-efficacy, as a term, is originated from the social cognitive theory structures of Bandura. This theory refers to one's beliefs and confidence in her/his ability to perform health behaviors like exclusive and successful breastfeeding
Methods: In this study, 270 pregnant women with gestational age over 30 weeks were selected among those referring to health centers by cluster sampling method. The subjects were randomly divided into 3 groups. One group was considered as the control group and the two other groups were educated through either face to face or small-group methods. Data were collected using a demographic questionnaire, performance assessment check list, and breastfeeding self-efficacy questionnaire. The collected data were analyzed using appropriate statistical tests in SPSS
Results: Data analysis on breastfeeding self-efficacy showed that there was no significant difference between 3 groups before training. The mean scores of women attending face to face and small-group education were 2.89 and 2.88, which increased to 4.73 and 4.18, respectively. There was a significant difference between the intervention groups after education [P < 0.001]. Self-efficacy mean scores after delivery showed that face to face education is more efficient. The results showed that there was a significant association between self-efficacy and performance in mothers [P < 0.001]
Conclusions: Face to face education method has positive effects on infant feeding pattern, mother performance, breastfeeding satisfaction and beliefs as well as self-efficacy
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Introduction: Responsive medicine is an appropriate training method which trains the graduates who can act effectively in initial and secondary aspects of health issues in the society
Methods: This was a cross-sectional descriptive-analytic study which was done using quantitative method. The target population of this study was all the students of the Nutrition and Health School of Shiraz University of Medical Sciences. The sample was randomly selected in this study and 75 students were selected based on the methodologist's comments and similar studies and randomnumber table from a list obtained from the school's department of education. This questionnaire was a researcher-made one which consisted of 23 questions in 2 sections with 21 closedended questions and 2 open-ended questions; 70 questionnaires were completed correctly. The closed-ended questions had 4 aspects [completely agree to completely disagree] answered in 5-point Likert scale type. Its face validity was confirmed by 4 faculty members. The construct validity of the questionnaire was analyzed by factor analysis test and its reliability was assessed by a pilot on 20 students with a Cronbach's alpha of 0.85. The data were analyzed using descriptive statistical tests [mean, standard deviation, ] and the Pearson coefficient [p<0.001]
Results: The results of this study showed that the maximum mean score was 3.58 +/- 0.65 which was related to the context of these courses and the minimum mean was 2.66 +/- 1.14 which was related to the logbook implementation. The 2 open-ended questions indicated that the most important strengths were the use of logbooks as a guide and determining the minimum training; of the weaknesses was the mismatch between the theoretical education and the practical activities. Also, developing the minimum training that an expert should know and using the common topics related to theoretical education were the most important points mentioned by the respondents
Conclusion: The educational planning of the authorities for keeping the balance of the theoretical training with the practical activities and giving opportunities to the trainee or intern to face diseases and the common problems of the community seems to be necessary
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Objective: to evaluate the effect of advance trauma life support [ATLS[registered sign]] training on general surgery residents clinical reasoning skills using the national boards-style objective structured clinical examination [OSCE]
Methods: this cross-sectional single-center study was conducted in Shiraz University of Medical Sciences including 51 surgery residents that participated in a mandatory national board style OSCE between May 2014 and May 2015. OSCE scores of two groups of general surgery residents including 23 ATLS[registered sign] trained and 28 non-ATLS[registered sign] trained were compared using Mann-Whitney U test. The exam was graded out of 20 points and the passing score was >/=14 including 40% trauma cases
Results: there were 8[15.7%] women and 43[84.3%] men among the participants with mean age of 31.12 +/- 2.69 and 33.67 +/- 4.39 years in women and men respectively. Overall 7 [87.5%] women and 34 [79.07%] men passed the OSCE. The trauma section OSCE score was significantly higher in the ATLS[registered sign] trained participants when compared to non-ATLS[registered sign] [7.79 +/- 0.81vs.6.90 +/- 1.00; p=0.001]. In addition, the total score was also significantly higher in ATLS[registered sign] trained residents [16.07 +/- 1.41 vs. 14.60 +/- 1.40; p=0.001]. There was no association between gender and ATLS[registered sign] score [p=0.245] or passing the OSCE [p=0.503]
Conclusion: ATLS[registered sign] training is associated with improved overall OSCE scores of general surgery residents completing the board examinations suggesting a positive transfer of ATLS learned skills to management of simulated surgical patients including trauma cases
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Introduction: evaluation of nurse-patient communication skills have been strongly emphasized in order to ensure the possibility of effective communication as well as assessment of the effect of communication skills training programs. Reaching this goal requires the use of standard instruments which is based on the native culture of the target group. Due to the absence of native instruments in this field, the aim of this study was to design and assess the validity and reliability of interpersonal communication skills, among nurses at Shiraz Educational Hospitals
Method: a mixed method [Qualitative, Quantitative] was used in two phases. The first phase was designing a descriptive questionnaire for nurse-patient communication skills [consisting of "brain storming" and "Delphi quantitative Research Method"]. The next phase was defining the validity and reliability of the questionnaire based on confirmatory factor analysis and Cronbach's alpha. The target population for the first phase was 15 faculty members of Shiraz University of Medical Sciences and for the second phase, 130 members of nursing staff of both educational and private hospitals of Shiraz. The data were analyzed using SPSS 14 and LISREL software after fulfilling the questionnaires
Results: the findings of the study demonstrated the reliability of the nurse-patient communication skills questionnaires [alpha=0.810]. Except for question No. 17, the others had a significant relationship with the agent based on their validity and T-value
Conclusion: like other clinical skills, communication requires the theoretical knowledge, evaluation and practice. The findings of this study are the most important indicators from the nurses' view point which can be assessed in terms of communication skills. These options, as demonstrated, had an acceptable reliability and validity
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Introduction: The script concordance test [SCT] is one the best tools used to evaluate clinical reasoning in ill-defined clinical situations. The aim of this study was to demonstrate SCT application in otolaryngology residency training
Methods: A 20 item otolaryngology SCT containing 60 questions was administered to 26 otolaryngology residents. The test was prepared by two otolaryngologists familiar to medical education. These questions have been validated by otolaryngology experts. The panel consisted of 9 academic staff in the field of otolaryngology. Pearson correlation test was used to assess the reliability of the test
Results: The obtained mean scores were 68.4 +/- 5.8 [out of 100] for residents and 78.2 +/- 6.4 [out of 100] for experts. There was a significant difference between the two scores [p<0.005]. Cronbach's alpha value was 0.80
Conclusion: The SCT is a reliable tool to evaluate clinical reasoning in otolaryngology residents. It should be included in otolaryngology residency training
Subject(s)
Humans , Reproducibility of Results , Surveys and Questionnaires , Internship and Residency , Education, MedicalABSTRACT
Introduction: The importance of medical profession and the role of the physician in society is no secret to anyone. Skills and competencies in clinical practice are necessary for the medical profession. In fact, in patient care, doctors require practical skills in addition to scientific knowledge. This study examines the potentials of medical school students in three areas of doing the right thing, doing the right thing in an intermediate range, and doing the right thing by the right person
Methods: This study was done in a descriptive-analytical and sectional model. The population of this study was all interns of Shiraz University of Medical Sciences who were passing internship at Internal Medicine, Surgery, Pediatrics, Obstetrics and Emergency wards. About 100 persons were selected were selected by simple randomization. In order to collect data, a questionnaire with 12 questions was designed in two parts. The questionnaire was approved by 7 Faculty members of Clinical Medicine and Medical Education, and its reliability was approved by test-retest method on 20 medical students in the form of a pilot study and through Cronbach's alpha [82%]. Collected data were analyzed by SPSS software version 14 using descriptive statistical methods
Results: Results showed that within the inner circle, interns evaluated their skills in surgery, internal medicine, and gynecology wards, intermediate and at other wards as weak. Also within the center circle, interns evaluated adequate educational evidence-based training in the field of medicine, and sufficiency of educational training in the field of clinical decision making and clinical care as suitable
Conclusion: According to the results, it seems that medical interns' skills in performing most medical skills are moderate. So teaching students by new educational methods and workshop techniques, using experienced teachers will be effective. The use of clinical skills training centers and objective assessment methods for the students' skills, especially before entering the clinical departments, is very important
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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 Ph.D 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 ethicsbased practice in hospitals
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Accreditation , Hospitals , Ethics , Delphi Technique , Surveys and QuestionnairesABSTRACT
Introduction: The majority of countries have brought the quality of higher education into focus in the past few years. They have tried to improve the quality of their own higher education. The studies show that Iranian Universities are not at an accepted level in terms of quality. They have encountered several problems which have diminished their quality level. This study aimed at assessing the quality of medical education program as viewed by general practitioners graduated from Shiraz, Fasa and Jahrom Medical Universities
Methods: This is a cross-sectional study. 215 subjects were selected based on a census of all the general practitioners graduated from Shiraz, Fasa and Jahrom Universities during 2011-2013. The questionnaire used for collecting the data was that of the Association of Graduates from American Medical Colleges.The collected data were then analyzed using SPSS 14 through which such descriptive and bivariate statistics as percentage, means, Standard Deviation and ANOVA were used. The level of significance was set to 0.05
Results: The questionnaire return rate was 97%. As to the graduates' preclinical experiences, five indices were studied which were assessed as "average" in graduates' views. However, with respect to their clinical experiences five indices were equally studied, among which such indices as "Communication" were evaluated as "desirable" in view of the graduates from the very three universities. On the contrary, the quality of clinical experiences and technological skills was evaluated as "almost weak"; furthermore, the integration of basic science with required clinical experience was also considered "weak"
Conclusion: It seems essential to set up an annual assessment of general practitioner education program and a review of the medical education program in Iran based on the global medical advancement and international standards
Subject(s)
Humans , Male , Female , Cross-Sectional Studies , Surveys and Questionnaires , Evaluation Studies as Topic , General PractitionersABSTRACT
Background and Objective: Due to increasing rate of medical knowledge volume and depth, introducing new tasks and roles for general practitioners, and restriction of time and resources in medical education, it is essential to follow educational priorities especially in teaching medical doctors. The aim of this study was to determine the conformity of educational programs of ophthalmology department in Shiraz school of medicine, Shiraz, Iran, with the required educational priorities in medical doctor [MD] curriculum
Methods: In this research, we focused on two aspects of theoretical education of ophthalmology theoretical classes and final examinations. First, the topic discussed in the class or asked in final examinations was determined and its priority was graded according to a grading scale of A to D used in comprehensive study of Shahid Beheshti University of Medical Sciences, Iran. Then, after calculating sum of priorities, the rate of conformity with the expected priorities was determined using chi-square test
Results : In both theoretical classes and final examinations, significant difference was observed between educational materials and the expected educational priorities [P < 0.05]
Conclusion: In some cases, the priority "A" had been paid less attention and priorities "B", "C", and "D" had been paid more attention than the expected rates. Since the priorities considered in this study were based on those in Shahid Beheshti University of Medical Sciences comprehensive study that is approved by faculty members of Shiraz University of Medical Sciences, revision of the educational priorities seems to be required
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Cost-benefit analysis is a scientific method which helps policy makers to select a project among other projects, with the same defined goal, making sure that the chosen project has the maximum benefit with a fixed cost or the minimum cost with a fixed level of benefit. Therefore, universities should consume the resources more carefully and efficiently. This survey was conducted to provide documents for evidence based decision making for policymakers. Having the cooperation of the admission office, the number of medical students was extracted and then with the assistance of university budgeting manager, total costs were extracted regarding education, research, cultural-recreational affairs and management emphasizing on medicine field. Finally, data was analyzed with Excel. Our findings showed that the per capita cost in education was 268.3 million rials, in research, it was 13.25 million rials, and as for cultural-recreational affairs and management, it was 7.4 and 14.45million rials respectively. The sum of per capita costs was 303.4 million rials The calculated cost is fivefold the amount which was allocated as a per capita cost. The total cost of the university was more than the amount allocated by the management and planning organization; this necessitates further revisions in allocating recourses to universities by management and planning organization
Subject(s)
Humans , Decision Making , Health Policy , Students, Medical/education , Policy Making , Budgets , Family Practice , Education, Medical, UndergraduateABSTRACT
This study was performed to provide the curves of weight and height of 0-2 year-old children in Jahrom, Southeastern Iran. In a prospective study, 597 children born in Jahrom entered our study from April 2001 to December 2002. The height and weight of these children were recorded 18 times from one month to two years of age. Healy-Rasbash-Yang [HRY] method was used to estimate age related smoothed centiles. This method was implemented for the World Health Organisation as GROSTAT computer package. The mean weight of male newborns, except for one-month olds, was more than that of females. Before two months of age and among 2-year-olds, there was no significant difference between the weight of males and females. The mean height of male newborns, except for one month of age, was more than that of females. No more than cubic polynomials were needed to smoothly fit height for age and weight for age of children. The height of male and female children showed an increase by age up to two years. The weight of male and female children also increased by age but the speed of increase to six months was more than that of six months to two years of age. Our findings show that height and weight of children under two years of age in Jahrom were lower than those of National Center for Health Statistics [NCHS]. It is therefore deemed necessary to provide and establish a corresponding standard curve for this region. According to the NCHS measurements, some children may be considered thinner or shorter for no obvious reason