A cross-sectional study on the role of computer anxiety in students' online learning.

Introduction: Although e-learning has been incorporated in higher education system, students may undergo negative emotions like anxiety using this new mode of learning which ultimately interfere with their learning performance. Hence, the current study aimed to examine the role of computer anxiety in students' online learning. Methods: This is a cross-sectional correlational study, in which a convenient sample of 330 students of Shiraz University of Medical Sciences participated. To collect the data, we used two pre-validated questionnaires. Face, content, and construct validity were used to check the validity of the questionnaires. Cronbach's alpha and composite reliability were also used to check the reliability. Data were analyzed using SPSS 16 and AMOS 6. Results: Confirmatory factor analysis results yielded the underlying factorial structure of the scales. In addition, correlation coefficient results indicated that there was a significantly negative relationship between students' computer anxiety and their online learning (r=-0.59, p<0.001). Conclusion: The results of the present study revealed that a considerable number of students experienced some level of computer anxiety, highlighting that highly anxious students face negative consequences such as inadequate online learning.

Psychometric properties of the persian version of the physician teaching self-efficacy questionnaire.

INTRODUCTION: Theories and numerous empirical studies indicate teaching performance and students' learning progress are affected by teaching self-efficacy. Therefore, the present study examines the psychometric properties of the Persian version of the physician teaching self-efficacy questionnaire. METHODS: The 16-item physician teaching self-efficacy questionnaire was translated from English to Persian and back-translated to English and then administered to 242 medical teachers from six medical universities. To assess construct validity, researchers made use of confirmatory factor analysis. To check the reliability and validity of the physician teaching self-efficacy questionnaire, we used internal consistency, discriminant, convergent, and criterion validity. RESULTS: PLS-SEM results substantiated the original three factor structure of the questionnaire which is dyadic, triadic, and self-regulation. For all sub-scales, internal consistency- measured by Cronbach's alpha and composite reliability, convergent validity- measured by factor loading and AVE, and discriminant validity- measured by cross-loading, Fornell-Larcker, and HTMT metrics- confirmed the construct reliability and validity of the questionnaire. A positive correlation was, also, fund between teaching motivation and experience with the physician teaching self-efficacy questionnaire scales, proving the criterion validity of the questionnaire. CONCLUSION: The Persian version of physician teaching self-efficacy questionnaire is a valid, highly reliable, and multidimensional tool to measure physicians' clinical teaching self-efficacy working in medical universities.

A comparison of the effects of teaching through simulation and the traditional method on nursing students' self-efficacy skills and clinical performance: a quasi-experimental study.

INTRODUCTION: Simulators in a clinical environment provide a space where students can acquire skills and experience under the supervision of their professors without any worries or inflicting any harm on their patients. The current study aimed to compare the effects of teaching through simulation and the traditional method on nursing students' self-efficacy skills and clinical performance. METHOD: The current study was quasi-experimental and adopted a pre-test & post-test design. The population consisted of 122 students of nursing, out of whom 100 students were selected as the sample. Then, they were randomly divided into an experimental and a control group. A questionnaire assessed the students' self-efficacy skills and clinical performance before and after implementing the instructional programs. The data were analyzed using descriptive and inferential statistical techniques in SPSS 23. FINDINGS: The mean of the participants' self-efficacy scores increased significantly after the intervention (from 87.57 to 142.13). Moreover, the mean of the participants' clinical performance increased significantly after the intervention (from 2.16 to 4.57). The findings indicated that simulation teaching significantly affects nursing students' self-efficacy and clinical performance. CONCLUSION: Simulation was recommended as an effective teaching methodology, particularly in nurses' internship wards. In other words, acquiring the essential skills through applying the simulation method is recommended before entering real-world environments.

Exploration the role of a clinical supervisor to improve the professional skills of medical students: a content analysis study.

BACKGROUND AND PURPOSE: Clinical supervision supports learners and paves the way for effective and efficient learning in clinical settings. This study aimed to explain the responsibilities of clinical supervisors in clinical education wards to improve the professional skills of medical students. MATERIALS AND METHODS: In this qualitative study, we used the conventional content analysis approach. The sample consisted of 16 faculty members of medical sciences and medical graduates of Iranian universities. Purposeful sampling and semi-structured interviews were used to collect data. The Graneheim and Lundman method (2004) analyzed the data. RESULTS: From the analysis of interviews, 2 themes, 8 categories, and 18 subcategories were obtained. "Clinical supervisor responsibilities" as a theme includes the categories: "Creating motivation in learner", "Learner's need recognition", "Performance evaluation", "Creating learning opportunities", and "Professional ethics education". And, the sub-categories were: "Creating a supportive atmosphere", "Task assignment","Understanding training needs", "Understanding individual needs", "Periodic evaluation", "Proper feedback', "Reduce work stress", "Learner engagement' , "Learning Facilitation", "Attention to the patient's treatment", and "Ethical observance in relation to patients". As the second theme "Clinical supervisor characteristics" included the categories of: "Scientific competence", "Leading role", and "Ethical model". Their sub-categories are clustered as: "Knowledge of educational concepts", "Mastery of professional concepts", "Effective communication skills", "Understanding managerial concepts", "High resilience", "Career commitment ", and "social commitment" . CONCLUSIONS: The clinical supervisor will improve the professional skills of medical students, which will improve the quality of services provided, train efficient graduates, and provide a safe and relaxing environment that leads to patient satisfaction.

Teaching self-efficacy and its effects on quality of bedside teaching: Findings from a multi-center survey.

Introduction: Evidence suggests that the performance of medical students is affected by the quality of teaching of clinical teachers, and the higher teachers' teaching quality leads to better students' clinical performance. Hence, the present research aimed to investigate the association between teaching self-efficacy and quality of bedside teaching among medical teachers. Methods: This is a cross-sectional study. To this end, 242 medical teachers and 830 medical students from 6 universities in different cities were selected using convenience sampling. The medical teachers filled out Physician Teaching Self-Efficacy Questionnaire (α=0.93), and medical students completed the quality of bedside teaching questionnaire (BST) (α=0.91). Confirmatory factor analysis (CFA), Pearson correlation coefficient, and multiple regression were used to analyze the collected data through SPSS 23 and Smart-PLS3 software. Results: The results of confirmatory factor analysis (CFA) demonstrated that all items and measurement models had adequate reliability and validity to enter the final analysis (α>0.7, CR>0.7 AND AVE>0.50). Furthermore, the results showed teaching self-efficacy (r=0.27, p<0.001) and its components including self-regulation (r=0.24, p<0.001), dyadic regulation (r=0.22, p<0.001), and triadic regulation (r=0.33, p<0.001) had a positive and significant relationship with quality of bedside teaching. Also, the results of multiple regression revealed that among the predictor variables, only the triadic regulation variable could predict the quality of bedside teaching of medical teachers (ß=0.326, p<0.001). Conclusion: According to the findings, as the medical teachers' teaching self-efficacy improves, they can provide high-quality teaching to students, which in turn will lead to better learning and, therefore better performance for medical students.

The mediating role of students' academic resilience in the relationship between self-efficacy and test anxiety.

BACKGROUND: There is growing acknowledgment that medical education can be a stressful experience for students and may have a devastating effect on their psychological well-being. The present article, therefore, aimed at investigating students' academic resilience as a mediating variable in self-efficacy-test anxiety relation. MATERIALS AND METHODS: In this cross-sectional correlational study, a convenience sample of 243 medical students was selected and participated, three prevalidated questionnaires were applied, that is, general self-efficacy questionnaire, academic resilience questionnaire, and test anxiety questionnaire. To analyze the data, Pearson's correlation coefficient as well as structural equation modeling (SEM) were used. RESULTS: According to Pearson's coefficients, self-efficacy was found to be positively correlated with academic resilience (r = 0.437, P ≤ 0.01) and negatively with test anxiety (r = -0.475, P ≤ 0.01). SEM results also indicated that self-efficacy positively impacts on academic resilience (ß = 0.43, P < 0.001) and negatively on test anxiety (ß = -0.37, P < 0.001). In addition, results demonstrated the mediating role of academic resilience in self-efficacy-test anxiety relationship (ß = -0.108, P < 0.001). CONCLUSION: This study showed that academic resilience could play a mediating role in students' self-efficacy-test anxiety relationship.

Challenges and opportunities from the COVID-19 pandemic in medical education: a qualitative study.

INTRODUCTION: Since the onset of the COVID-19 pandemic, many higher education and health centers have faced challenges. Educational leaders have tried to manage the new situation, but the human infrastructure was not ready for such an event. This study aims to explain the challenges and opportunities of the COVID-19 pandemic for medical education. METHOD: This qualitative study used conventional content analysis to collect data from face-to-face and semi-structured interviews. The interviews continued until data saturation was reached. The participants were 12 students and 14 faculty members at Shiraz University of Medical Sciences. To ensure data rigor, we used member checks, peer checks and an external observer. RESULTS: Three main categories and 15 subcategories were extracted. The findings showed that four subcategories, e.g. perception on feasibility of e-learning, standardizing of e-learning, dedicated teaching, and networking and interdisciplinary collaborations, affected the development of medical e-learning. The main opportunities from the COVID-19 pandemic for medical education were classified into five subcategories: attitudes to e-learning and adaptability, preventing students' separation from the educational environment, documentation and monitoring education, take control of own learning, and increasing perceived usefulness. The main challenges were divided into four subcategories, e.g. noncompliance with virtual classroom etiquette, inadequate interactions, time limitations, and infrastructure defects and problems. Finally, participants believed that methods of evaluation in e-learning were more suitable for diagnosis and formative evaluations. Generally, two subcategories were extracted, e.g. formative and summative. CONCLUSION: Medical schools have necessarily moved towards e-learning to compensate for the interruption in classroom education, such that traditional classes have been replaced with e-learning. These rapid, extensive changes in teaching and learning approaches have consequences for medical schools.

Psychometric properties of the Persian version of bedside teaching (BST) Instrument.

INTRODUCTION: Bedside teaching plays a crucial role in acquiring essential clinical skills. Therefore, the main aim of this study is assessing the validity and reliability of the Persian version of German bedside teaching (BST) instrument. This instrument was specially developed for evaluation of bedside teaching. METHOD: The present cross-sectional study was conducted on 150 last year medical students, using convenience sampling. The Persian version of the bedside teaching (BST) was used for data gathering. To calculate the reliability of the questions, Cronbach's alpha was used and to determine the construct validity of the questionnaire, confirmatory factor analysis was used. All analyses were performed in LISREL 10 and SPSS 21 software. RESULTS: Cronbach's alpha indicated excellent reliability for each subscale (α =0.77-0.85). All of the value of the questions are more than a significant number of 1.96 and concluded to be significant. There was an acceptable fit between the hypothetical model and the data and all comparative fit indices (CFI, NFI, RFI, IFI) showed good model fitness. BST is a valid and reliable instrument for the assessment of clinical teaching at bedside. It has 18 items with 5 point Likert scales. CONCLUSION: The findings suggest that the Persian version of the BST questionnaire is a valid and reliable tool for the evaluation of teachers and providing feedback in a clinical setting. However, more studies should be conducted in other cities in Iran.

The predictive role of personality traits on academic performance of medical students: The mediating role of self-efficacy.

Background: Determining the variables influencing students' academic performance is one of the main preoccupations in medical colleges. Therefore, this study examined the effect of the Big Five personality traits on medical students' academic performance, considering the mediating role of self-efficacy. Methods: We applied a cross sectional research design using a PLS-SEM approach. A total of 249 medical students participated in this study. Two valid and reliable questionnaires, including Big Five Inventory (BFI-10) and New General Self Efficacy (GSE) were used. Data were analyzed using both SPSS 18 and PLS2 software. Results: The validity and reliability of the questionnaires were confirmed by confirmatory factor analysis. The results revealed that openness (ß= 0.16, p<0.001), conscientiousness (ß=0.22, p<0.001), agreeableness (ß=0.19, p<0.001), and self-efficacy (ß=0.24, p<0.001) had a significant positive and direct effect on academic performance. Neuroticism (ß=-0.21, p<0.001) had a significant negative and direct effect on academic performance. Also, openness (ß=0.47, p<0.001) and conscientiousness (ß=0.33, p<0.001) had a direct positive effect on self-efficacy. Neuroticism (ß=-0.15, p<0.001) had a direct negative effect on self-efficacy. Moreover, the results showed an indirect positive effect of conscientiousness (ß=0.08, p<0.001) and openness (ß=0.11, p<0.001) on academic performance through self-efficacy. In addition, the results showed that neuroticism (ß=-0.03, p<0.001) had an indirect negative effect on academic performance through self-efficacy. Conclusion: This study discovered the relationships between personality traits, self-efficacy, and academic performance of medical students. The results showed that individual differences in personality traits directly and indirectly play an essential role, through self-efficacy, in contributing to the students' academic performance.

Academic procrastination of medical students: The role of Internet addiction.

INTRODUCTION: The internet is an essential and widely used tool for college students; however, high internet dependency can have negative consequences for students, especially regarding academic careers. Such students may tend to postpone their academic tasks. Hence, the current study examines the effect of Internet addiction on academic procrastination among medical students. METHODS: We applied a cross-sectional correlational research design. 233 medical students of Shiraz University of Medical Sciences were selected through convenience sampling and participated in this study. To collect the data, we used two valid and reliable questionnaires. The first was Young's Internet addiction questionnaire (IAT-20), which consists of 20 items based on a 5-point Likert-type scale. The second was Solomon and Rothblum academic procrastination questionnaire, which consists of 18 items based on a 5 point Likert-type scale. We used Pearson correlation, independent T-test, and One-Way ANOVA to analyze the data in SPSS version 22, and considered a significance level of p < 0.05. RESULTS: Results showed that 57.1% of the respondents were females, and the remaining were males. Findings indicated that 8 (3.43%) of the participants were classified as severe internet-addicted, and 28.85% of them had a high level of academic procrastination. The results indicated that there was a positive and significant correlation between Internet addiction and academic procrastination (r=0.39, with p<0.01). Also, there was a positive correlation between academic procrastination dimensions (writing a term paper, studying for an exam, keeping up with weekly reading assignments, performing administrative tasks, attending meetings and performing academic tasks in general) and Internet addiction (r=0.22, r=0.32, r=0.21, r=0.29, r=0.33, and r=0.23, respectively, with p<0.01). Finally, the results revealed that male students and those living in the dormitory had a higher level of Internet addiction and procrastination compared to female ones and those living at home (p<0.01). CONCLUSION: The findings of the current research reveal that a considerable number of students have levels of Internet addiction and procrastination; the study highlights that students with high levels of Internet addiction are more likely to be at an increased risk of negative outcomes such as insufficiently controlled Internet use.

Relationships between academic self-efficacy, learning-related emotions, and metacognitive learning strategies with academic performance in medical students: a structural equation model.

Recognition of the factors affecting the medical students' academic success is one of the most important challenges and concerns in medical schools. Hence, this study aimed to investigate the mediating effects of metacognitive learning strategies and learning-related emotions in the relationship between academic self-efficacy with academic performance in medical students. METHODS: The present study was carried out on 279 students of medicine studying at Shiraz University of Medical Sciences. The students filled out three questionnaires: academic emotions (AEQ), metacognitive learning strategies, and academic self-efficacy questionnaires. The data were analyzed using SPSS and Smart PLS3. RESULTS: The results of structural equation modeling revealed that the students' self-efficacy has an impact on their learning-related emotions and metacognitive learning strategies, and these, in turn, affect the students' academic performance. Moreover, learning-related emotions influence the metacognitive learning strategies, which in turn mediate the effect of emotions on academic performance. DISCUSSION: The results of this study revealed that metacognitive strategies and learning-related emotions could play a mediating role in the relationship between students' self-efficacy and academic performance.

The Role of Academic Self-Efficacy in Improving Students' Metacognitive Learning Strategies.

INTRODUCTION: Metacognitive strategies play an essential role in students' learning and achievement; therefore, identifying their antecedents should be considered. This study indicated how self-efficacy, as motivational beliefs, affects the meta-cognitive strategies of medical students using a SEM approach. METHOD: The present study was a quantitative cross-sectional research design, using a Smart-PLS 3 approach in which 225 medical students at Shiraz University of Medical Sciences were selected, using simple random sampling. Pintrich and De Groot's (1990) students' self-efficacy for learning and performance questionnaire and metacognitive learning strategies questionnaire developed by Dowson and McInerney (2004) were used to collect data. The collected data were analyzed using SPSS 21 and PLS 3 software. RESULTS: The validity and reliability of research questionnaires were confirmed by confirmatory factor analysis. The results showed self-efficacy had a positive and significant relationship with planning (r=0.24, p<0.001), monitoring (r=0.30, p<0.001) and regulating (r=0.31, p<0.001). Furthermore, self-efficacy had direct, positive and statistically significant effect on metacognitive learning strategies (ß=0.42, p<0.001). CONCLUSION: The findings suggest students who believe they are capable to learn and to do their academic tasks are more effective in adopting meta-cognitive strategies to achieve learning objectives than students who do not maintain such optimistic beliefs. Therefore, it is recommended that the officials of Shiraz University of Medical Sciences provide opportunities for strengthening the students' self-efficacy and metacognitive learning strategies through providing training courses. In these courses students should be explicitly instructed how a specific learning strategy is adopted, why it is important and when and how it applies to the specific task.

Barriers to the implementation of research priorities in medical education from the point of view of medical education experts at Shiraz University of Medical Sciences: A qualitative study.

OBJECTIVE: To determine the barriers to the implementation of research priorities in medical education from the viewpoint of educational experts. METHODS: The qualitative study was conducted at Shiraz University of Medical Sciences, Shiraz, Iran, from April to October 2016, and comprised medical education professors and experts working at the university's Education Development Centre. These professors had Master degree or PhD in medical education. Content analysis method was used after data was collected using semi-structured interviews followed by focus group discussions. RESULTS: There were 22 academicians in the study. Four themes, each with some sub-themes, were extracted out of the 86 codes derived from the interviews. The themes were: general priorities in educational research, lack of a comprehensive educational research database in medical sciences, discrimination among departments concerning budget, and the lack of the research spirit and teamwork were more prominent. Based on these themes, barriers identified fell in the two categories: manpower and financial resources. CONCLUSIONS: The barriers can partly be eliminated through modifying the mentality and attitude toward research and teamwork in the university, proper planning in the budget of the educational field and managing the university research system.

Clinical teachers as positive and negative role models: an explanatory sequential mixed method design.

Today, role modeling is an essential component of medical education that facilitates the students' learning and affects their attitudes and behaviors. Hence, this study aimed to examine the characteristics of positive and negative role models using a mixed method approach. In the quantitative part, data were collected using a questionnaire with 24 items. The research population included medical students who were in their clinical period between May 2017 and December 2018 at Shiraz University of Medical Sciences (n = 750). A total of 282 questionnaires were completed by these students, and in the qualitative part, 26 semi-structured interviews were conducted with them. The most important components of role modeling for students included: individual characteristics, clinical skills and competence, teaching skills and professionalism, in that order. The qualitative analysis confirmed the results of the quantitative analysis. The findings showed that the characteristics of a negative role model can also be classified in four main components. The results demonstrated that 46.8% of the students identified one or more medical teachers as negative models. Students paid attention to not only the positive characteristics of their teachers, but also their negative features, stating that they had been influenced by both. Therefore, it can be concluded that clinical teachers should improve their performance as positive role models through reducing these negative effects and reinforcing positive characteristics.

Medical student's academic performance: The role of academic emotions and motivation.

INTRODUCTION: Identification of the factors that promote academic performance is of importance in the success rate of medical students. This study aimed to find the relationship between emotions, motivation and academic performance of medical students. METHODS: This descriptive-correlative study was conducted among 370 medical students in Shiraz University of Medical Sciences using convenience sampling. Academic emotions questionnaire (AEQ) including 75 items and college student version of work preference inventory including 30 items were used to collect the data. The Cronbach's alpha for the eight types of academic emotions ranged from 0.73 to 0.86, and for the intrinsic and extrinsic motivation it was 0.81 and 0.87, respectively. The data were analyzed using Pearson correlation, multiple regression, independent t-test and one-way ANOVA through SPSS, 14. RESULTS: Results indicated a positive and significant correlation between positive emotions (enjoyment, hope, pride) and students' academic performance (r=0.37, r=0.27 and r=0.39, respectively, with p<0.01). A negative and significant correlation was found between negative emotions (anger, anxiety, hopelessness, shame and boredom) with students' academic performance (r=-0.15, r=-0.24, r=-0.23, r=-0.215 and r=-0.21, respectively, with p<0.01). There was a positive and significant correlation between intrinsic and extrinsic motivation and academic performance (r=0.63, r=0.14, with p<0.01, p<0.05, respectively). Emotions related to enjoyment, hope, pride, hopelessness, boredom and intrinsic motivation were shown as the key predictors of students' academic performance. CONCLUSION: The results of this study showed the key role of motivation and positive emotions in increasing medical students' academic performance.

Medical students' academic emotions: the role of perceived learning environment.

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. METHOD: The research method used was descriptive-correlative. The statistical population consisted of medical students of Shiraz University of Medical Sciences. 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.

Evaluation of information literacy status among medical students at Shiraz University of Medical Sciences.

INTRODUCTION: The information literacy status and the use of information technology among students in the globalization age of course plans are very momentous. This study aimed to evaluate the information literacy status and use of information technology among medical students of Shiraz University of Medical Sciences in 2013. METHODS: This was a descriptive-analytical study with cross-sectional method. The study population consisted of all medical students (physiopathology, externship and internship) studying at Shiraz University of Medical Sciences. The sample size (n=310) was selected by systematic random sampling. The tool of data gathering was LASSI questionnaire (assigned by America research association) with 48 closed items in five-point LIKERT scale. The questionnaire included two distinct parts of demographic questions and the information literacy skills based on the standards of information literacy capacities for academic education. The content validity was acquired by professors' and experts' comments. The reliability was also calculated by Cronbach'salpha (0.85). Data were analyzed in both descriptive (frequency- mean) and analytical level (t-test, analysis of variance) using SPSS 14 software. RESULTS: 60.3% of the participants were females, and the remaining (29.7%) were males. The mean score of information literacy and its five subgroups among the students weren't at a desirable level. The mean scores of information literacy for educational grades from the highest to lowest belonged to the internship, physiopathology and externship. The results showed that the highest average was related to the effective access ability to information among interns (9.27±3.57) and the lowest one was related to the ability of understanding legal and economical cases related with using information among externs (3.11±1.32).The results of ANOVA showed that there wasn't a significant difference between educational grades and information literacy. Finally, the result of independent t-test did not show a significant difference between the two genders in information literacy. CONCLUSION: Regarding the importance of information literacy for medical students and undesirable status of information literacy among students, the current educational plans will need to be revised.

Assessment of the interns' ability based on Dundee model in Shiraz University of Medical Sciences.

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 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.