How to create a successful mobile learning strategy for medical education during lockdowns?

BACKGROUND: Mobile learning has played an important role during the COVID-19 pandemic and medical schools now consider it as an effective educational method in current and future crises. In this qualitative study, an attempt was made to demonstrate the principles of designing a mobile learning strategy in medical education from the perspective of experts. MATERIALS AND METHODS: The study was conducted by the qualitative content analysis method. The data were collected from July 2022 to Feb 2023. Twelve participants were included in this study from Iran's medical universities, consisting of two members of the Higher Council of Virtual Education, three educational directors, three clinical faculty members, two faculty members specializing in e-learning and medical education, an educational vice, and a dean. Data were collected using semi-structured interviews and analyzed by Granheim and Lundman's (2004) method. RESULTS: Out of twelve participants in the study, eight (66%) were males and four (44%) females. Data were classified into eight categories and one theme. Based on the participants' experiences, the main theme, that is, "the principles of medical education design in mobile learning," included pedagogical component, interactive design, effective and comprehensive analysis, achieving objectives with the mobile learning platform, generating micro- and interactive e-content, teaching-learning interactive methods, course implementation and interactive evaluation at both micro- and macro-levels. CONCLUSION: Data analysis revealed that in addition to the eight principles in the medical education design in mobile learning, the participants prioritized the two principles of pedagogical component and interactive design over other principles in educational design. Using a successful mobile learning strategy in situations of restrictions limiting physical presence may improve the quality of medical education.

Perceived clinical competence and predictive role of time management in nursing students.

AIM/OBJECTIVE: The purpose of this study was to determine the association between perceived clinical competence and time management among nursing students. BACKGROUND: Given the close relationship between clinical competence and nursing care quality, it is important to investigate the nursing students' status in relation to the acquisition of nursing skills. Time management also as a framework for planning, setting goals, prioritizing goals and activities can be regarded as an important factor contributing to the clinical competence of nursing students. DESIGN: A cross-sectional and correlational study SETTINGS/PARTICIPANTS: This study included 221 undergraduate nursing students in Ahvaz Jundishapur University of Medical Sciences in Iran in the 2022-2023 academic year. METHOD: The data were collected online through a demographic information questionnaire, the clinical competency inventory, and the time management questionnaire. RESULTS: Students' mean scores for the clinical-competency, and time management were 120.38 ± 22.15, and 77.91 ± 15.15, respectively. Regression models showed that overall time management (ß = 0.454, p < 0.001) and interest in the field of nursing (ß = 0.171, p = 0.004) were predictors for overall clinical competence in nursing students. This model explained 25 % of the variance in clinical competence (F= 38.707, p < 0.001). CONCLUSION: Time management can affect nursing students' competence in providing quality nursing care to patients. Therefore, it seems that holding training workshops on time management skills for nursing students can be an effective and pioneering step in improving these skills.

Improvement of the clinical skills of nurse anesthesia students using mini-clinical evaluation exercises in Iran: a randomized controlled study.

PURPOSE: The present study aimed to investigate the effect of a mini-clinical evaluation exercise (CEX) assessment on improving the clinical skills of nurse anesthesia students at Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. METHODS: This study started on November 1, 2022, and ended on December 1, 2022. It was conducted among 50 nurse anesthesia students divided into intervention and control groups. The intervention group's clinical skills were evaluated 4 times using the mini-CEX method. In contrast, the same skills were evaluated in the control group based on the conventional method­that is, general supervision by the instructor during the internship and a summative evaluation based on a checklist at the end of the course. The intervention group students also filled out a questionnaire to measure their satisfaction with the miniCEX method. RESULTS: The mean score of the students in both the control and intervention groups increased significantly on the post-test (P<0.0001), but the improvement in the scores of the intervention group was significantly greater compared with the control group (P<0.0001). The overall mean score for satisfaction in the intervention group was 76.3 out of a maximum of 95. CONCLUSION: The findings of this study showed that using mini-CEX as a formative evaluation method to evaluate clinical skills had a significant effect on the improvement of nurse anesthesia students' clinical skills, and they had a very favorable opinion about this evaluation method.

Effect of a smartphone-based online electronic logbook to evaluate the clinical skills of nurse anesthesia students in Iran: a randomized controlled study.

PURPOSE: This study was conducted to evaluate a smartphone-based online electronic logbook used to assess the clinical skills of nurse anesthesia students in Iran. METHODS: This randomized controlled study was conducted after tool development at Ahvaz Jundishapur University of Medical Sciences in Ahvaz, Iran from January 2022 to December 2022. The online electronic logbook involved in this study was an Android-compatible application used to evaluate the clinical skills of nurse anesthesia students. In the implementation phase, the online electronic logbook was piloted for 3 months in anesthesia training in comparison with a paper logbook. For this purpose, 49 second- and third-year anesthesia nursing students selected using the census method were assigned to intervention (online electronic logbook) and control (paper logbook) groups. The online electronic logbook and paper logbook were compared in terms of student satisfaction and learning outcomes. RESULTS: A total of 39 students participated in the study. The mean satisfaction score of the intervention group was significantly higher than that of the control group (P=0.027). The mean score of learning outcomes was also significantly higher for the intervention than the control group (P=0.028). CONCLUSION: Smartphone technology can provide a platform for improving the evaluation of the clinical skills of nursing anesthesia students, leading to increased satisfaction and improved learning outcomes.

Introducing a mobile learning model in medical education during COVID-19; a critical review.

Introduction: Mobile learning is one of the innovative teaching techniques that help medical students gain knowledge and skills. One of the factors that expanded the use of this strategy was the COVID-19 pandemic. However, the educational pedagogy of such technology has been neglected. This article aimed to critically review available mobile learning models in medical education to suggest a comprehensive model in the field of mobile learning. Methods: We conducted this critical review based on the five steps of the Carnwell and Daly method. For a comprehensive systematic search from 2000 to April 2021, the following keywords were used: Personal Digital Assistant, m learning, Mobile learning, Ubiquitous learning, U learning, medical students, and medical education. 3176 studies in PubMed, Scopus, ERIC, Magiran, and Web of Science were identified. In total, 8 articles entered the study. Results: Eight models of mobile learning in medical education were identified. The key features of each model were extracted and integrated into the new model for the successful design and implementation of mobile learning. This model includes three main elements of mobile learning: 1-stakeholders, 2-interaction, and 3-technology, which are influenced by external factors including Mobiquette, legitimacy, and awareness. Conclusion: The results of this study are an important contribution to the knowledge collection in mobile learning in medical education. We introduced a comprehensive model of mobile learning including specific characteristics of strategies in the context of medical education.

The Accuracy of Electrical Impedance Tomography for Breast Cancer Detection: A Systematic Review and Meta-Analysis.

Introduction: Incidence of breast cancer (BC) in 2020 is about 2.26 million new cases. It is the first common cancer accounting for 11.7% of all cancer worldwide. Disease complications and the mortality rate of breast cancer are highly dependent on the early diagnosis. Therefore, novel human breast-imaging techniques play an important role in minimizing the breast cancer morbidity and mortality rate. Electrical impedance tomography (EIT) is a noninvasive technique to image the breast using the electrical impedance behavior of the body tissues. Objectives: The aims of this manuscript are as follows: (1) a comprehensive investigation of the accuracy of EIT for breast cancer diagnosis through searching pieces of evidence in the valid databases and (2) meta-analyses of the results. Methods: The systematic search was performed in the electronic databases including PubMed, Web of Science, EMBASE, Science Direct, ProQuest, Scopus, and Google Scholar without time and language limitation until January 2021. Search terms were "EIT" and "Breast Cancer" with their synonyms. Relevant studies were included based on PRISMA and study objectives. Quality of studies and risk of bias were performed by QUADAS-2 tools. Then, relevant data were extracted in Excel form. The hierarchical/bivariate meta-analysis was performed with "metandi" package for the ROC plot of sensitivity and specificity. Forest plot of the Accuracy index and double arcsine transformations was applied to stabilize the variance. The heterogeneity of the studies was evaluated by the forest plots, χ2 test (assuming a significance at the a-level of 10%), and the I2 statistic for the Accuracy index. Results: A total of 4027 articles were found. Finally, 12 of which met our criteria. Overall, these articles included studies of 5487 breast cancer patients. EIT had an overall pooled sensitivity and specificity of 75.88% (95% CI, 61.92% to 85.89%) and 82.04% (95% CI, 69.72% to 90.06%), respectively. The pooled diagnostic odds ratio was 14.37 (95% CI, 6.22% to 33.20%), and the pooled effect of accuracy was 0.79 with 95% CI (0.73, 0.83). Conclusions: This study showed that EIT can be used as a useful method alongside mammography. EIT sensitivity could not be compared with the sensitivity of MRI, but in terms of specificity, it can be considered as a new method that probably can get more attention. Furthermore, large-scale studies will be needed to support the evidence.

Comparison of the level of critical thinking skills of faculties and medical students of Ahvaz Jundishapur University of Medical Sciences, 2021.

BACKGROUND: One of the main tasks of educational institutions, in addition to developing students' professional competencies, is to develop decision-making and problem-solving skills, which are themselves influenced by critical thinking that should be developed by instructors at the university. The aim of this study was to compare the level of critical thinking skills in students and faculties of Ahwaz Jundishapur University of Medical Sciences. MATERIALS AND METHODS: In this cross-sectional descriptive study, the sample consisted of 81 medical students and 52 faculty members of the medical school who were teaching and studying in 2021. The research method was descriptiveanalytical and the data collection tool was the California Critical Thinking Questionnaire Form B. SPSS-18 software and t-test were used to analyze the data. RESULTS: The mean score of students' critical thinking skills was 12.49 ± 4.43 and that of faculties was 12.44 ± 3.76 and no significant difference was observed between the scores of the two groups (P = 0.94). CONCLUSION: The findings of the study show that the level of critical thinking skills in both faculties and students is below the standard and poor. The results of the study indicate the weakness of critical thinking in students and faculties in all dimensions, which indicates the need to teach critical thinking skills at the university level. Therefore, educational planners and faculty officials should pay more attention to developing critical thinking skills in their educational programs.

Comparing the effect of traditional and role-play training methods on nursing students' performance and satisfaction in the principles of patient education course.

BACKGROUND: Education is considered as one of the most important well-known roles of nurses, which is based on the patients' needs and awareness level. Thus, training the skill to nursing students is highly prioritized. The present study aimed to compare traditional and role-play training methods on nursing students' performance and satisfaction in the principles of patient education course. MATERIALS AND METHODS: The present quasi-empirical study was conducted in 2019 among 36 fourth-semester nursing students at the School of Nursing in Borujen branch. In this regard, the students were randomly divided into experimental (n = 18) and control (n = 18) groups and trained through role-play and traditional methods, respectively. The data were collected using demographic questionnaire, training method satisfaction form, and student performance evaluation checklist (30 items), among which the two last ones were researcher made. Then, data were analyzed by SPSS software version 19 and using descriptive and analytical statistical tests such as Chi-square and Mann-Whitney. RESULTS: The results demonstrated a statistically significant difference (P < 0.05) between the mean score of students' satisfaction with teaching method in the control (17.15 ± 0.89) and experimental groups (19.03 ± 1.49), as well as between that of their performance in the control and experimental groups (115.31 ± 2.07 and 118.28 ± 3.59, respectively). CONCLUSION: Based on the results, role-play training method affected nursing students' performance in the principles of patient education course higher. Thus, using the method in training students and in-service training for nursing personnel is recommended to education planners and nursing education authorities for improving the skill.

Relation between stress, time management, and academic achievement in preclinical medical education: A systematic review and meta-analysis.

Identifying the learners' problems is important. Besides, many factors are associated with academic failure, among which time management and stress are more important than any others based on evidence. By using a systematic review and meta-analysis, this study aims to synthesize the findings of studies about the correlation of time management and stress with academic failure to suggest a more in-depth insight into the effect of these two factors on academic failure. Four databases were searched from the inception of January 2018. Publication bias was evaluated visually using funnel plots and sized up by Egger's test. Ninety-four articles were found to be qualified for inclusion after full-text review and additional manual reference made. Of these, 8 were studies of educational interventions that were reviewed in this paper. Regarding the relation of stress and academic performance, the Funnel plot (results not shown) and Egger's test showed no publication bias in the studies (P = 0.719). Based on this result, the estimated pooled correlation (reverted by hyperbolic tangent transformation) between stress and academic performance was found to be -0.32 (95% confidence interval: -0.38--0.25). In conclusion, the review recognized a series of potentially mutable medium-to-large correlates of academic achievement, time management, and stress. It would be essential to have experimental data on how easily such self-regulatory capacities can be altered, and these interventions could help students enhance their potential, providing empirical tests for offered process models of academic achievement.

The trend of critical thinking disposition in medical students and its relationship with their academic performance.

BACKGROUND: Critical thinking is one of the important skills required for medical students. It is considered as a main component in medical education and training competent physicians. The current study aimed to investigate the trend of critical thinking disposition of medical students and its association with their academic performance. MATERIALS AND METHODS: This descriptive cross sectional study was conducted in 2019 on 315 medical students of Ahvaz Jundishapur University of Medical sciences. A two-section questionnaire was used for data collection. The first section dealt with demographic characteristics and the second section included Ricketts critical thinking disposition inventory using t-test, analysis of variance, and Pearson correlation coefficient. RESULTS: Mean and standard deviation of critical thinking disposition of medical students was 121.85 ± 11.32. No significant difference was observed between the mean score of critical thinking disposition and years of study (P = 0.74, F = 0.590). Pearson correlation test also showed no significant association between critical thinking disposition and the students' grade point average (P = 0.89, r = 0.007). CONCLUSIONS: The results of the current study showed that medical students' level of critical thinking disposition is above average, and there is no significant correlation between critical thinking disposition and years of study and academic performance of the students. It seems that the educational process in medical school has not been effective in improving the level of students' critical thinking disposition.

Distance learning strategies in medical education during COVID-19: A systematic review.

The current outbreak of coronavirus disease 2019 (COVID-19) across the world forced universities to suspend learning to limit the spread of the virus. Many medical schools have shifted to online education as an information delivery mechanism where the educator and learner are separated in space and potentially also in time. This systematic review aims to explore and understand the variety of distance learning strategies in medical students in the contexts of COVID-19. A systematic review was conducted in Web of Sciences, PubMed, Educational Resources and Information Center, and Scopus from December 2019 to July 2020. Eight sets of terminology were used, combining "Distance learning" AND "Medical education" AND "Pandemic." Studies were reviewed independently by two reviewers. Data were extracted and quality appraised using QualSyst tools, and synthesized by performing thematic analysis. A total of 473 articles were identified after removing duplicates and 314 records were screened, of which 125 were included in this study. The primary articles were 52 primarily qualitative articles. Five learning strategies consisted of technology-enhanced learning (TEL), simulation-based learning, technology-based clinical education, mobile learning, and blended learning. Tools, methods, and learning resources associated with these five learning strategies were extracted from the articles. Our review highlights that TEL and simulation-based learning were more commonly used than others in distance learning in medical education during the COVID-19 pandemic. These strategies have the potential to improve learners' level of knowledge and performance through making online learning resources such as Massive Open Online Courses, virtual clinical cases, and blended sources accessible.

A qualitative content analysis of "problem students": how can we identify and manage them?

OBJECTIVES: Problem students is one of the important issues in medical education. This study aimed to identify the problem students and the ways for managing these students from the educational experts view. Purposive sampling was used, and data collection continued until data saturation was achieved. Data analysis was performed by the content analysis method based on the Heidegger approach. We interviewed 12 educational experts who had a history of dealing with "problem students". RESULTS: After data analysis, five main themes and 28 categories, and 164 codes were extracted. The reasons for changing a student to a problem students was: student self-regulation skills, multilayer interactions, curriculum failure, identification policy and supportive solutions. The results indicated that despite revision in the curriculum, there were shortcomings in identification and management of problem students. According to participants, existence of a comprehensive system and a capable counseling center can identify the problem student sooner. On the other hand by improving self-regulation skills, active teaching methods and frequent formative evaluation and the use of supportive strategies, problem student can be encouraged to complete their education successfully. This study emphasized faculty development, reviewing the faculty member recruitment, strengthening counseling centers, improving the exams.

Prevalence of Suicidal Ideation in Multiple Sclerosis Patients: Meta-Analysis of International Studies.

The aim of this study is to estimate the worldwide prevalence of suicidal ideation in multiple sclerosis patients. Two researchers selected words such as "epidemiology" or "prevalence" or "incidence" and "suicidal ideation in multiple sclerosis" and searched them as relevant keywords in international databases such as PubMed, Web of Science CINAHL, Embase, Psyc INFO, and Scopus. A point prevalence with 95% confidence interval was estimated. The variances of each study were calculated using the binomial distribution formula. Heterogeneity among the studies was tested by a Q-Cochran test with a significance level less than 0.1. Index of changes attributed to heterogeneity (I2) was assessed. From among the 170 total articles found from 2011 to February 2019, we pooled and analyzed the data of eight final eligible studies, based on the inclusion criteria. The prevalence of suicidal ideation in multiple sclerosis patients was estimated as 13% (CI 95% = 0.09-0.17). A subgroup analysis was conducted based on the type of countries; it revealed that prevalence is higher in developed countries (15%; CI 95% = 0.1-0.2). Pooled worldwide prevalence of suicidal ideation in the MS population was calculated at 13% by random effect. It is recommended that training, counseling, and psychological support be used to help these patients.

Challenges and opportunities of acquiring scientific authority in medical sciences: determination of the experts' views based on qualitative content analysis.

INTRODUCTION: Capability is built upon knowledge and wisdom, and scientific progress and development is associated with wealth production, national and international authority, and independence. To promote scientific development, as a prerequisite to the country's progress in other areas, there is a need for strategic planning and creating scientific capacities. Today's world is facing a rapid growth and development in science and technology, and universities and higher education centers have an important role in the society's development and progress in the areas of human resources training, science and technology production, and solving different problems. Considering the Iran's health scientific road map and communication of innovation and reform plans, and since universities are required to identify the areas of authority, this study was conducted to determine the challenges of scientific authority promotion and proper courses of action. METHODS: In this study, content analysis was used as a qualitative research method. The triangulation method was applied for data collection. Purposive sampling was done to select the participants for focused group discussion and data collection continued until data saturation was achieved. The participants were 19 higher education experts and MOHME policymakers. The ATLAS.ti software version 5.2 was used for analysis of data. RESULTS: The results of the analysis of transcripts obtained from FGD with higher education experts and MOHME policymakers showed 4 themes, 10 categories and 43 sub-categories. The resulting themes included: "Experienced perceptions of scientific authority", "Requirements of scientific authority", "Challenges of scientific authority", and "Strategies for promoting scientific authority". CONCLUSION: Universities and governmental sectors do not represent all the capacities, and there are much more capacities that can be exploited with participation of different sectors and institutions, especially inter-sectoral and inter-university collaborations. Many advances in new sciences have occurred in interdisciplinary majors, and these collaborations help to take solid steps towards scientific authority.

Educational intervention to improve preclinical academic performance: A systematic review.

INTRODUCTION: One of the major problems of higher education centers is the students' academic failure. Increased monitoring, counseling, or remediation may tax the resources of both the program and the faculty. The present review study gathered evidence highlighted by the experimental studies on the educational intervention with the purpose of improving preclinical medical performance. MATERIALS AND METHODS: To achieve the intended studies, databases of PubMed, Web of Knowledge (Thomson Reuters), Educational Resources and Information Center, and the Scopus were searched. The inclusion criteria were being an interventional study and assessing the educational intervention to preclinical academic performance. The study was carried out as a systematic literature search published between January 1987 and January 2018. Based on valid tool through the best evidence medical education review, after assessing the quality of the studies. RESULTS: Ten studies were enrolled in the review for final evaluation. The Kirkpatrick Model was employed to analyze and synthesize the included studies. CONCLUSION: Reviewing the conducted studies showed that medical students had positive responses and attitudes toward new teaching methods, self-monitoring skills, and attention to physiological needs. The results also indicated that new teaching strategies, attention to self-monitoring skills, and sleep hygiene in medical education could positively affect learning in two domains of Bloom's Taxonomy.

Factors related to academic failure in preclinical medical education: A systematic review.

INTRODUCTION: Identifying the learners' problems early enough and providing advice from the beginning is definitely an important investment in the training and progress of future practitioners. The current review aimed at examining factors related to academic failure of the preclinical medical students. METHODS: The study was carried out as a systematic search of publications in the following databases published from January 1987 to January 2018: PubMed, Web of Knowledge, Educational Resources, Information Center and Scopus. No language limitation was set for searching the resources. As a comprehensive search, the following keywords were used for the abstract, title and keyword sections: academic performance, academic failure, academic achievement, drop out, academic engagement, learning disorder, medical student, struggle student and problem learner. A valid tool (STROBE) was used to determine the quality of the articles. RESULTS: Most articles discussed personal causes, 7 discussed learning style, 7 discussed personality traits, 6 discussed motivational strategies and self-efficacy, 4 discussed quality of sleep, 4 discussed the effect of stress, 9 discussed demographic factors, 3 discussed physical activity, 1 discussed coping strategies, 2 discussed class attendance and 4 discussed study strategy. Twenty-five articles described instructional design cause, 3 described teaching strategies, 2 described course assessments, 1 described the course structure, 3 described critical thinking, 3 described blended learning, 13 described predictive courses, 14 described admission tests, 1 described the learning environment, 2 described curriculum planning and 3 described the pre-matriculation program. CONCLUSION: Medical teachers often do not know which students are problem learners or what causes academic failure. The goal of this systematic review was to determine the origin of problems in learning to identify problem learners. The results indicates that managers, policymakers, instructors and counselors can monitor student academic achievement by careful planning of instructional design, attention to an educational environment, use of active teaching methods, continuous assessment of students and consideration of personal factors.

The level of safety standards in implementing therapeutic and caring procedures by emergency department personnel.

AIM: The present study aimed to determine the level of applying safety standards in treatment and therapy processes. DESIGN: In the present descriptive study, 120 cases of nasogastric intubation, bladder catheterization and intramuscular and intravenous injections done by emergency staff were randomly selected. METHODS: The data were collected by a two-section checklist including demographic features and four sheets of observation. Then, the data were analysed based on descriptive statistics. RESULT: The results indicated that the level of compliance with safety standards was 63.3% in intramuscular injection, 86.7% for intravenous injection, 90% for bladder catheterization and 80% for nasogastric intubation. In addition, no statistically significant difference was observed between these processes and the variables such as ages, education and experience and work shift.