Challenges of the ward round teaching based on the experiences of medical clinical teachers.

BACKGROUND: Holding educational sessions in a clinical environment is a major concern for faculty members because of its special difficulties and restrictions. This study attempts to recognize the challenges of the ward round teaching through investigating the experiences of clinical teachers in 2011. MATERIALS AND METHODS: This qualitative research is carried out through purposive sampling with maximum variation from among the clinical teachers of major departments in Isfahan University of Medical Sciences (9 persons). The sampling continued until data saturation. Data were collected through semi-structured interview and analyzed through Collaizzi method. Data reliability and validity was confirmed through the four aspects of Lincoln and Guba method (credibility, conformability, transferability, and dependability). RESULTS: Three major themes and their related sub-themes (minor themes) were found out including the factors related to the triad of clinical teaching (patient, learner, and clinical teacher) (concern about patient's welfare, poor preparation, lack of motivation, ethical problems), factors related to the educational environment (stressful environment, humiliating environment and poor communication) and the factors related to the educational system of the clinical environment (poor organizing and arrangement of resources, poor system's monitoring, bad planning and inadequate resource). CONCLUSION: Ward round teaching has many concerns for teachers, and this should be recognized and resolved by authorities and teachers. If these problems are not resolved, it would affect the quality of clinical teaching.

A model for evaluation of faculty members' activities based on meta-evaluation of a 5-year experience in medical school.

BACKGROUND: There is a global interest for deploying faculty members' activities evaluation systems, however implementing a fair and reliable system is a challenging issue. In this study, the authors devised a model for evaluation of faculty members' activities with regard to their viewpoints and meta-evaluation standards. MATERIALS AND METHODS: The reliability of the current faculty members' activities metrics system was investigated in Medical School of Tehran University of Medical Sciences in 2014. Then authors conducted semi-structured interviews regarding meta-evaluation standards and designed a questionnaire based on interviews' results which were delivered to faculty members. Finally, they extracted the components of the model regarding interviews' content analysis and questionnaire's factor analysis and finalized them in a focus group session with experts. RESULTS: Reliability of the current system was 0.99 (P < 0.05). The final model had six dimensions (mission alignment, accuracy, explicit, satisfaction, appropriateness, and constructiveness) derived from factor analysis of the questionnaire and nine factors (consensus, self-reporting, web-based system, evaluation period, minimum expectancies, analysis intervals, verifiers, flexibility, and decision making) obtained via qualitative content analysis of the interviews. CONCLUSION: In this study, the authors presented a model for faculty members' activities evaluation based on meta-evaluation of the existing system. The model covered conceptual and executive aspects. Faculty members' viewpoints were the core component of this model, so it would be acceptable in a medical school to use the model for evaluating their activities.

Using TOSCE (Team Objective Structured Clinical Examination) in the second national medical sciences olympiad in Iran.

INTRODUCTION: Second National Medical Sciences Olympiad was done in Shiraz in August 2010 with aim of indentifying scientifically talented individuals, motivating students and orienting extracurricular activities. This Olympiad was done in 3 areas, basic sciences, clinical sciences and management. In clinical sciences, we used TOSCE (Team Objective Structured Clinical Examination). In this article we report the details of this exam and participants' satisfaction. MATERIALS AND METHODS: This Olympiad in Clinical Medical Sciences was held in 2 levels: Individual and team. In the team stage, 9 teams from 9 universities participated. We used TOSCE for measuring clinical competency of teams. Each team consisted of 3 students. We designed 12 stations based on emergency medicine in medical and surgical fields. The time considered for each station was 15 min, after doing this exam the view of students was measured using a valid and reliable questionnaire. RESULTS: Most of the students believed that TOSCE was a useful examination for measuring competency. More than 50% of students reported that success in this exam needs clinical competency, team work and problem solving ability. Nearly, half (48.1%) of students believed that 15 min is not enough for each station and they need more time. CONCLUSION: The results of this study showed that this kind of exam is useful for measuring clinical competency from students' viewpoint.

Educational leadership in education development centers: A qualitative study.

BACKGROUND: Education development centers (EDCs) have a vital role in improving the quality of medical education. This study was conducted with the aim of discovering educational leadership characteristics in EDCs. MATERIALS AND METHODS: This study was carried out with a qualitative approach and using a conventional content analysis method. The sampling was purposive. Twenty-four faculty members, managers, and experts of EDCs in the universities of medical sciences included 13 males and 11 females participated in this study. Semi-structured interviews were utilized for data collection. The conventional content analysis approach was utilized to analyze the data. RESULTS: From the data analysis, two categories included "personality characteristics" and "job characteristics" and six subcategories included reliabilism, humanness and altruism, accountability, decisiveness, dynamism and perfectionism, and knowledge, experience, and expertise and 24 codes were extracted. CONCLUSION: Results obtained in the present study will help to increase the awareness of the educational leaders of the EDCs in improving their personality and job skills and this will lead to the qualitative development of educational leadership.

Barriers to Occupational Therapy Fieldwork Education in Iran: The Perspectives of Fieldwork Educators and Students.

BACKGROUND: Clinical education is a vital factor in the process of learning in medical sciences universities. The aim of the present study was to explore the perspectives of fieldwork educators and students concerning barriers to occupational therapy fieldwork education in Iran. MATERIALS AND METHODS: A qualitative research was conducted from May 2019 to April 2020 to address the study objectives. The data analysis was performed using conventional content analysis based on Graneheim and Lundman's approach. Purposive sampling was used to enroll 12 educators and 14 students of various backgrounds (physical disabilities-adult, physical disabilities-pediatrics, psychosocial-adult, and psychosocial-pediatrics) in the study. RESULTS: The findings indicated that the main themes were related to fieldwork educators, fieldwork settings, educational planning, students, and educational regulation. CONCLUSIONS: It can be concluded that the perspectives of students and occupational therapy educators regarding the field of clinical education are not only important but also useful for the attainment of effective clinical education and the development of knowledge related to rehabilitation nursing education. Therefore, educational planners should develop effective programs based on these themes.

Challenges and Expectations of Diabetic Foot Care from the Patients' Point of Views.

INTRODUCTION: Diabetic foot ulcer (DFU) as a common complication of diabetes needs a multi-disciplinary care approach in which the patient suffering from DFU is considered as a member of the care team. According to the effective role of patients in DFU prevention and management, this study was an attempt to explore patients' views and expectations regarding provision of DFU preventive and therapeutic care to facilitate the process of care and management. METHODS: A qualitative research approach, using two focus group discussions, was conducted with patients suffering from diabetes and DFU. The questions designed to encourage the discussion were focused on the patients' experience of foot and DFU care. We continued the discussions until we reached data saturation. The participants' responses were recorded via a recorder and by taking notes. Afterwards, the discussions were transcribed and common themes were identified and categorized. RESULTS: Initially, fifty-seven codes were extracted which were then summarized and classified. Afterward, three themes and six sub-themes were determined as follows: defective education and ineffective communication("a defect in the patient education system", "impaired communication"), multi-faceted challenges of wound healing ("out of pocket expenses, treatment compliance", "non-physical injury"), and full support ("empathy" and "patient-centeredness"). CONCLUSION: According to patients' views, patients' concerns, and their socioeconomic conditions should be taken into consideration in designing an effective DFU care plan. In this regard, a strong communication with the patients to prepare a holistic care intended for patients' full support would be essential.

Clinical teachers' attitudes toward the efficacy of evidence-based medicine workshop and self-reported ability in evidence-based practice in Iran.

INTRODUCTION: Evidence-based medicine (EBM) has been introduced in medical schools worldwide, but there is little known about effective methods for teaching EBM skills, particularly in developing countries. This study assesses the impact of an EBM workshop on clinical teachers' attitudes and use of EBM skills. METHODS: Seventy-two clinical teachers attended two half-day workshops on EBM. Participants completed precourse and postcourse questionnaires using a 5-point Likert scale. Nonparametric 2-sample Wilcoxon rank-sum tests were performed to compare responses. RESULTS: Attitudes about EBM improved (3.2 precourse vs 3.4 postcourse), as did self-reported EBM skills (3.1 vs 4.4, p < .0001). DISCUSSION: An EBM workshop may improve clinical teachers' abilities and skills in using EBM. However, carefully designed studies are required to evaluate the long-term effects of EBM curricula in changing behaviors, practice patterns, and patient care outcomes.

Lived Experiences of Educational Leaders in Iranian Medical Education System: A Qualitative Study.

INTRODUCTION: High quality educational systems are necessary for sustainable development and responding to the needs of society. In the recent decades, concerns have increased on the quality of education and competency of graduates. Since graduates of medical education are directly involved with the health of society, the quality of this system is of high importance. Investigation in the lived experience of educational leaders in the medical education systems can help to promote its quality. The present research examines this issue in Iran. METHODOLOGY: The study was done using content-analysis qualitative approach and semi-structured interviews. The participants included 26 authorities including university chancellors and vice-chancellors, ministry heads and deputies, deans of medical and basic sciences departments, education expert, graduates, and students of medical fields. Sampling was done using purposive snowball method. Data were analyzed using conventional content analysis. FINDINGS: Five main categories and 14 sub-categories were extracted from data analysis including: quantity-orientation, ambiguity in the trainings, unsuitable educational environment, personalization of the educational management, and ineffective interpersonal relationship. The final theme was identified as "Education in shadow". CONCLUSION: Personalization and inclusion of personal preferences in management styles, lack of suitable grounds, ambiguity in the structure and process of education has pushed medical education toward shadows and it is not the first priority; this can lead to incompetency of medical science graduates.

A comprehensive test of clinical reasoning for medical students: An olympiad experience in Iran.

BACKGROUND: Although some tests for clinical reasoning assessment are now available, the theories of medical expertise have not played a major role in this filed. In this paper, illness script theory was chose as a theoretical framework and contemporary clinical reasoning tests were put together based on this theoretical model. MATERIALS AND METHODS: This paper is a qualitative study performed with an action research approach. This style of research is performed in a context where authorities focus on promoting their organizations' performance and is carried out in the form of teamwork called participatory research. RESULTS: Results are presented in four parts as basic concepts, clinical reasoning assessment, test framework, and scoring. CONCLUSION: we concluded that no single test could thoroughly assess clinical reasoning competency, and therefore a battery of clinical reasoning tests is needed. This battery should cover all three parts of clinical reasoning process: script activation, selection and verification. In addition, not only both analytical and non-analytical reasoning, but also both diagnostic and management reasoning should evenly take into consideration in this battery. This paper explains the process of designing and implementing the battery of clinical reasoning in the Olympiad for medical sciences students through an action research.

An innovative method to assess clinical reasoning skills: Clinical reasoning tests in the second national medical science Olympiad in Iran.

BACKGROUND: Clinical reasoning plays a major role in the ability of doctors to make a diagnosis and reach treatment decisions. This paper describes the use of four clinical reasoning tests in the second National Medical Science Olympiad in Iran: key features (KF), script concordance (SCT), clinical reasoning problems (CRP) and comprehensive integrative puzzles (CIP). The purpose of the study was to design a multi instrument for multiple roles approach in clinical reasoning field based on the theoretical framework, KF was used to measure data gathering, CRP was used to measure hypothesis formation, SCT and CIP were used to measure hypothesis evaluation and investigating the combined use of these tests in the Olympiad. A bank of clinical reasoning test items was developed for emergency medicine by a scientific expert committee representing all the medical schools in the country. These items were pretested by a reference group and the results were analyzed to select items that could be omitted. Then 135 top-ranked medical students from 45 medical universities in Iran participated in the clinical domain of the Olympiad. The reliability of each test was calculated by Cronbach's alpha. Item difficulty and the correlation between each item and the total score were measured. The correlation between the students' final grade and each of the clinical reasoning tests was calculated, as was the correlation between final grades and another measure of knowledge, i.e., the students' grade point average. RESULTS: The combined reliability for all four clinical reasoning tests was 0.91. Of the four clinical reasoning tests we compared, reliability was highest for CIP (0.91). The reliability was 0.83 for KF, 0.78 for SCT and 0.71 for CRP. Most of the tests had an acceptable item difficulty level between 0.2 and 0.8. The correlation between the score for each item and the total test score for each of the four tests was positive. The correlations between scores for each test and total score were highest for KF and CIP. The correlation between scores for each test and grade point average was low to intermediate for all four of the tests. CONCLUSION: The combination of these four clinical reasoning tests is a reliable evaluation tool that can be implemented to assess clinical reasoning skills in talented undergraduate medical students, however these data may not generalizable to whole medical students population. The CIP and KF tests showed the greatest potential to measure clinical reasoning skills. Grade point averages did not necessarily predict performance in the clinical domain of the national competitive examination for medical school students.

Investigation of risk factors for surgical wound infection among teaching hospitals in Tehran.

This prospective study was carried out to investigate the risk factors and incidence of surgical site infection (SSI) among patients in surgical wards of five hospitals affiliated to Iran University of Medical Sciences. Data was collected in a register card filled by specially trained staff. Nine-hundred and eighteen patients admitted in surgical wards were followed 30 days postoperatively for SSI during 1 April 2003 to 30 September 2003. A total of 77 patients were identified among 918 cases included in the study, with a resulting overall SSI rate of 8.4%. The risk of SSI was increased by age older than 60 years (OR = 3.9; P < 0.0001), diabetes mellitus (OR = 4.9; P < 0.0001), smoking (OR = 3.1; P < 0.0001), obesity (OR = 4.1; P < 0.0001) and wound drain (OR = 2.2; P < 0.0001). There were significant statistical difference in duration of anaesthesia (131.6 vs. 177 min, P < 0.001) and duration of surgery (99 vs. 140.5) between patients without SSI and patients with SSI. In conclusion, identification of the risk factors for SSI will help physicians to improve patient care and may decrease mortality and morbidity and hospital care costs of surgery patients.