Trend of tendency to critical thinking among medical students in Tehran University of Medical Sciences, 2010-2015: A longitudinal study.

BACKGROUND: Critical thinking is one of the goals of education. It is a criterion for academic accreditation in medical education by concentration on students' soft skills. Due to lack of basic information on critical thinking tendency in undergraduate medical program, this study aimed to determine the trend of tendency toward critical thinking of medical students in two phases: basic science (year 1) and preinternship (year 5) at Tehran University of Medical Sciences. MATERIALS AND METHODS: This longitudinal descriptive-analytic study has been conducted in two phases (2010 and 2015); all 105 medical students were selected by accessible sampling method. Years of entrance to college was the inclusion criterion. The psychometric properties of The California Critical Thinking Dispositions Inventory (CCTDI) were confirmed, and then, the instrument was completed twice by participants. Data were analyzed by SPSS: 16 using student t-test, and paired t-tests. RESULTS: There was a significant difference between genders of students (P < 0.05). Males were more disposed toward critical thinking than females. The significant increase was found between mean of truth-seeking in the second test compared to the first test; instead, the mean of inquisitiveness, analyticity and self-confidence and inquisitiveness was significantly decreased (P < 0.05). However, in other subscales, there were no significant differences between the 1st and the 5th year students (P > 0.05). The total score of the test in the second phase was lower than the first phase, which was not significant. CONCLUSION: According to the findings, there is necessary to consider the critical thinking dispositions in medical students training programs and break down the barriers. Tendency toward critical thinking seems to be as prerequisite of critical thinking skills in undergraduate medical program.

Applying the American Dental Education Association (ADEA) tool on action on professionalism in dental education in Iran and applying in a cross-sectional study.

Background: Professionalism is a multidimensional concept, defined as conducting oneself with responsibility, integrity, accountability, and excellence. This study aimed to contextualize American Dental Education Association (ADEA) tool on action on professionalism in dental education in Mashhad and apply it in a cross-sectional study. Materials and Methods: This descriptive-analytic study was conducted on all students of Mashhad School during 2018-2019. The ADEA tool for action on professionalism in dental education was applied. It was firstly contextualized, validated, and its reliability was confirmed by test-retest and Cronbach's alpha. Then, it was applied in a cross-sectional study. Data were analyzed using Lisrel, and SPSS: 16. ANOVA and Tukey's honestly significant difference tests were used to compare the study variables. Results: The tool was valid and reliable for applying in the Iranian context (x2/df <3, RMSEA ≈ 0.1 and indices of comparative fit index, incremental fit index, goodness-of-fit index, and adjusted GFI are >0.7). In the cross-sectional study for measuring professionalism, the mean score of 1st-year dental students was significantly higher than 3rd-year dental students (F = 2.75, P = 0.002). Furthermore, the mean score of 1st-year dental students was also significantly higher than 6th-year students (F = 4.53, P = 0.001). The comparison of the component of professionalism among 1st-to 6th-year students showed that there was no statistically significant difference between the total score of males and females. In addition, no statistically significant difference was found between the total score of local and nonlocal students. Conclusion: The Tool is valid and reliable for applying in the Iranian context. Dental students need to be trained and also practice professional behaviors during their senior years of college.

Inter-cultural and cross-cultural communication through physicians' lens: perceptions and experiences.

OBJECTIVES: This study aimed to explore Swedish physicians' perceptions regarding physician-patient communication in an Iranian context and to obtain a deeper understanding of their lived experience when encountering Middle Eastern and Swedish patients in their daily work. METHODS: This is a multi-method study, including conventional content analysis in combination with phenomenological methodology. A triangulation approach to data collection and analysis was used. Serving the purpose of the study, twelve Swedish physicians with previous experience of Middle Eastern patients were purposely selected to participate in the study. They watched a video showing simulated patient encounter in an Iranian context. The video served as a trigger. Semi-structured interviews were conducted focusing on the participants' perceptions of the video and their lived experiences. Constant comparative analysis was used for a deep understanding of the data. RESULTS: The core themes were cultural diversity, doctor-centeredness, and patient-centeredness. Cultural diversity was a convergent theme and included trust, interpersonal interaction, context, and doctor dominancy. Patient-centeredness and doctor-centeredness were divergent themes and included doctors' authority, equity, the experience of illness, and accountability. CONCLUSIONS: The participants confirmed large cultural differences in doctor-patient communication when encountering Iranian and Swedish patients. Inter-cultural and cross-cultural competencies were made visible. To be able to appreciate other cultures' health values, beliefs, and behaviors, increased cultural competence in health care is of importance.

Evaluation of desmoglein 1 and 3 autoantibodies in pemphigus vulgaris: correlation with disease severity.

BACKGROUND: Pemphigus is an autoimmune blistering disease of the skin and mucous membranes caused by autoantibodies against desmoglein 1 (Dsg1) and desmoglein 3 (Dsg3). Pemphigus vulgaris (PV) is the most common form of pemphigus. The aim of this study was to assess the correlation between the levels of anti-desmoglein 1 and 3 autoantibodies and the severity of PV disease. MATERIAL AND METHODS: Nineteen newly diagnosed patients with pemphigus vulgaris were enrolled in this study. The titers of Dsg in subjects by using enzyme-linked immunosorbent assay (ELISA) were done at diagnosis time-point, 4th and 8th weeks after the initiation of treatment, and the correlation of antibodies with the oral and skin disease severity was evaluated. RESULTS: The severity of cutaneous lesions was significantly correlated with anti-Dsg1 titer in all visits and the severity of mucosal lesions was correlated with the titer of Dsg3 in the third visit (<0.001, 0.001, 0.016 and 0.015 P value, respectively). CONCLUSIONS: Anti-Dsg-1 autoantibodies titers seem to be more useful in showing the extent of the disease and activity in pemphigus with mucocutaneous lesions. Key words:Pemphigus vulgaris, Desmoglein (Dsg), Enzyme-linked immunosorbent assay (ELISA).

Contextualization and psychometrics of interprofessional collaboration checklist in Iranian community health-care setting.

INTRODUCTION: Assessment interprofessional collaboration (IPC), in community health-care setting usually has been neglected due to the lack of standard tools and assessors. In the present study, the IPC checklist extracted from CANMEDS collaborator toolkit for teaching and assessing the collaborator role is contextualized in Iranian community healthcare. MATERIALS AND METHODS: According to CANMEDS Toolkit, an instrument extracted for IPC assessment. Using Chavez' toolkit, face and content validity were studied through two rounds of Delphi by 12 experts of TUMS. Qualitative content validity including content validity index (CVI), and content validity ratio (CVR) were assessed following watching a standard video about IPC by them. Construct validity was studied by confirmatory factor analysis through LISREL software. To check reliability, Cronbach's alpha was calculated, and the other 12 experts completed checklists in test-retest process with a 2-week interval. RESULTS: Face and qualitative content validity were confirmed using the Delphi method. CVI and CVR were calculated as 0.61 and 0.86. In factor analysis, x2/df and RMSEA were calculated as 1.363 and 0.036; CFI, IFI, GFI, and AGFI were >0.7, and hence, the construct validity was confirmed. Cronbach's alpha was 0.953 for internal consistency. Test-retest was also calculated as 0.918 indicated to confirm reliability. CONCLUSION: CANMEDS framework as an assessment tool for evaluating IPC in community health setting is not only valid and reliable in the Iranian context but also it is easy to use for respondents resulted from the rational number of items in community.

Effect of Capparis spinosa Extract on Metabolic Parameters in Patients with Type-2 Diabetes: A Randomized Controlled Trial.

BACKGROUND: Experimental studies have reported beneficial effects of Capparis spinosa L., a perennial shrub from the Capparidaceae family, on the glycemic status and serum lipids in diabetic animals. OBJECTIVE: The aim of the present randomized triple-blind placebo-controlled clinical trial was to investigate the safety and efficacy of C. spinosa oxymel on blood glucose, lipid profile, and other diagnostic indexes of metabolic syndrome in patients with poorly controlled type 2 diabetes. METHOD: The C. spinosa oxymel was prepared by adding hydroalcoholic extract of C. spinosa fruit to simple oxymel (a mixture of grape vinegar and lactulose). Thirty diabetic patients with metabolic syndrome whose glycemic status was not controlled despite receiving full doses of oral hypoglycemic agents did not want to start insulin therapy and were randomly allocated to three groups to receive placebo, simple oxymel, or C. spinosa oxymel (10 mL/thrice daily for 3 months). All patients continued conventional therapy with hypolipidemic, antihyperlipidemic, and antihypertensive drugs during the study. RESULTS: C. spinosa oxymel significantly decreased the body weight and body mass index at the end of the study compared to the baseline. While the patients in the placebo and simple oxymel groups displayed further increase in the level of FBG or PPBG, administration of C. spinosa oxymel inhibited the progression of hyperglycemia. Nevertheless, there was not a significant difference between placebo and intervention groups regarding HbA1c at the end of the study. C. spinosa oxymel had no significant effect on the serum cholesterol but inhibited the progression of hypertriglyceridemia during the study. There were no significant changes in creatinine, microalbuminuria, AST, ALT, and ALP values following C. spinosa treatment, suggesting that it had no unwanted effects on kidney and liver function. CONCLUSION: The results suggest that although C. spinosa oxymel cannot enhance the effects of hypoglycemic and hypolipidemic drugs, it can prevent further increase of blood glucose and triglycerides in patients with poorly controlled diabetes.

Exploring experience of Iranian medical sciences educators about Best Evidence Medical Education: A content analysis.

BACKGROUND AND OBJECTIVE: Applying the Best Evidence Medical Education (BEME) in real educational arena is a necessity in medical education. As to the literature, there are enough evidence; however, their application by educators and policymakers has been still failed. Therefore, this study conducted to explore the experience of educators about applying BEME in Iranian context. MATERIALS AND METHODS: Qualitative approach using content analysis method was utilized for exploring 25 participants involved with medical education in different levels, introduced the study using purposeful sampling. Data were collected through a semi-structured interview by which they answered to researcher's questions in around 45 min about how they apply evidence in their educational setting. To make more clarification, probing questions were used. Interviews were recorded and transcribed and then analyzed by coding paradigm immediately. RESULTS: Three categories were emerged as: applying different levels of evidence, substitution of evidence-based medicine for BEME, and variation of understanding BEME. The first category includes subcategories of using personal experience, textbooks, and filtered papers. The second contains lack of knowledge about BEME elements, time and motivation as well as no priority for applying available medical education evidence; and third, using different terminology and having some problems in applying process, based on individual understanding and using papers with or without modification. DISCUSSION: For effective evidence application, it is necessary to operationalize BEME terminology and overcome any ambiguity surrounded it. It is also important to suggest educators to apply the appraised evidence as well as teach them how they search and appraise evidence independently. Certainly, in the first steps, supervision and providing a proper context for BEME applications are crucial.

Linking medical faculty stress/burnout to willingness to implement medical school curriculum change: a preliminary investigation.

RATIONALE, AIMS AND OBJECTIVES: Balancing administrative demands from the medical school while providing patient support and seeking academic advancement can cause personal hardship that ranges from high stress to clinically recognizable conditions such as burnout. Regarding the importance of clinical faculties' burnout and its effects on different aspects of their professional career, this study was conducted and aimed to evaluate the relationship between willingness to change teaching approaches as characterized by a modified stage-of-change model and measures of stress and burnout. METHODS: This descriptive analytic study was conducted on 143 clinical faculty members of Tehran University of Medical Sciences in Iran. Participants were asked to complete three questionnaires: a modified stages of change questionnaire the Maslach Burnout Inventory and the General Health Questionnaire. Data were analysed by SPSS: 16 using non-parametric statistical tests such as multiple regression and ICC (intra-class coefficient) and Spearman correlation coefficient test. RESULT: A significant relationship was found between faculty members' readiness to change teaching approaches and the subscales of occupational burnout. Specifically, participants with low occupational burnout were more likely to be in the action stage, while those with high burnout were in the attitude or intention stage, which could be understood as not being ready to implement change. There was no significant correlation between general health scores and stage of change. CONCLUSIONS: We found it feasible to measure stages of change as well as stress/burnout in academic doctors. Occupational burnout directly reduces the readiness to change. To have successful academic reform in medical schools, it therefore would be beneficial to assess and manage occupational burnout among clinical faculty members.

Evidence-based abstracts: what research summaries should contain to support evidence-based medicine.

The practice of evidence-based medicine involves the integration of individual clinical expertise with the best available external clinical evidence from the systematic retrieval of the most current literature. Clinicians need to conduct a critical appraisal of the medical articles they access. However, clinicians in developing countries usually lack access to the best resources for evidence-based practice (EBP). The abstracts of 100 of the most recently published randomised controlled trials were used in the present study. These abstracts were critically appraised using a new questionnaire. Questions 1 to 8 were answerable by 38%, 26%, 52%, 23%, 12%, 53%, 36% and 12%, respectively, of the examined summaries. EBP requires better access to medical resources. Therefore, the summaries of relevant studies should be complete and self-sufficient to support EBP. This means a research summary should adequately report the findings of a clinical trial without needing to access the full text.