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.

Medical school department chair performance improvement: A qualitative study.

INTRODUCTION: In medical education, department chairs should play a significant role. The present qualitative study was conducted to identify factors that influence the performance improvement of department chairs at medical schools in Iran. METHODS: The study was conducted in Iran in 2022 and used a thematic analysis method. Using a purposeful sampling method, 20 participants were invited to participate, including medical school deans and department chairs. Focus group discussion (FGD) was used for qualitative data gathering. Braun and Clarke's thematic analysis was used to analyze data. RESULTS: There were 18 males and 2 females among the participants. The mean age of the participants was 45±4 years. Five overarching themes were formulated: human resource management, organizational behavior management, performance support system, leadership, and financial resources. Also, nine subthemes emerged, including performance evaluation, job and work design, educational and non-educational support, motivational efforts, organization culture, organizational knowledge management, planning for change, and financing. CONCLUSIONS: In this study, we found factors influencing DC performance improvement. Department chairs' effective performance may have a positive impact on department operations, processes, or outcomes.

Teaching-learning in clinical education based on epistemological orientations: A multi-method study.

INTRODUCTION: Teaching-learning is the heart of medical education in the clinical setting. The objective of this research was to develop a conceptual model of effective clinical teaching in undergraduate medical education and conceptualize its operational framework based on the best fit approach. MATERIALS AND METHODS: This research consisted of three sub-studies conducted using a multi-method approach. The first sub-study was conducted using a qualitative meta-synthesis approach. The second sub-study used Clarke's situational analysis approach as a postmodern version of grounded theory. Finally, the third sub-study was designed in two stages. First, it was conducted using the expert panel, in the second step, framework of synthesis based on best fit, and the framework of Ottenhoff- de Jonge et al., which formed the basis of this study. RESULTS: In the first sub-study, qualitative evidence on the factors of effective teaching-learning in clinical education was synthesized into five dimensions. Based on the second sub-study, the clinical teaching-learning situation in undergraduate medical education in Iran was represented in three maps, including situational, social worlds/arenas, and positional. Finally, in the third sub-study, based on model modification and development in the expert panel, the effective teaching-learning dimensions were developed into behavioral, social, pedagogical, technology, contextual, educational leadership, and financial dimensions. In the second step, based on the framework of Ottenhoff- de Jonge et al., a three-dimensional matrix was developed concerning epistemological orientations about teaching and learning. DISCUSSION: Moving from a single teaching-centered and learning-centered orientation to a teaching-learning-centered orientation is required for effective teaching-learning in clinical medical education.

Crossover design in triage education: the effectiveness of simulated interactive vs. routine training on student nurses' performance in a disaster situation.

INTRODUCTION: This study investigates the effectiveness of incorporating simulated interactive guidelines in nursing students' performance during disaster situations, compared to routine training. METHOD: This study was a crossover design with pre-and post-tests for two groups. Each group consisted of 60 students selected using the census method. SIG and routine (Face-to-Face) training sessions were conducted as a crossover design. Triage knowledge questionnaires were used in the pretest to assess triage knowledge. An OSCE test was administered in the posttest to assess student performance, followed by a triage skills questionnaire. Both questionnaires were highly reliable, as indicated by Cronbach's alpha coefficients (0.9 and 0.95, respectively). Statistical analysis was performed using SPSS version 26 software at a significance level 0.05. RESULT: The chi-square test showed that the two groups were homogeneous regarding age. Regarding knowledge level, both groups were homogeneous before the intervention (P = 0.99). Nevertheless, the results of the OSCE test showed that the students in Group A had a higher level of skill than the students in Group B (93% versus 70%). Also, 18% of the students in group B had low skills. DISCUSSION: The study found that student outcomes improved in both groups receiving SIG, suggesting that interaction and simulation improve learning. However, gamification is an ideal precursor to learning and not a substitute for education. Therefore, gamification should not be used as a stand-alone teaching method. CONCLUSIONS: The crossover study found that simulators and games should not be considered stand-alone teaching methods but can contribute to learning sustainability when used alongside instruction.

Identifying dimensions and components of student support system in virtual learning: A scoping review.

A student support system (SSS) has a crucial role in the absorption, retention, and success of students in virtual learning. The purpose of this scoping review was to identify and map the available evidence regarding the dimensions and components of the SSS in virtual learning. This study was conducted in accordance with the methodology of the Joanna Briggs Institute (JBI) for scoping reviews. Our search strategy was based on using search engines, such as MEDLINE, EMBASE, Scopus, WoS, CINAHL, ERIC, PsycINFO, ProQuest, and Google Scholar. The articles were published in renowned medical education journals, including Medical Education, Medical Teacher, and Academic Medicine, and the reference lists of identified and reviewed articles were searched manually. The search results were imported into EndNote X20, and after removing duplicates and screenings, 42 studies met the inclusion criteria and were included in the review. A descriptive- analytical approach was employed, including a numerical count of study characteristics (quantitative) and template analysis (qualitative). Five dimensions were identified in the SSS in virtual learning: types of support, domains of support, stages of support, instigating of support, levels of support, and their components and subcomponents. The findings of this study depict a comprehensive roadmap and have an important contribution to the knowledge body of SSS in virtual learning. We suggest system developers, planners, and higher education officials to improve the quality of virtual learning by applying these findings in their planning and decision-making.

Attitudes of Anesthesiology Postgraduate Residents Toward the Influential Factors in Their Success in the Iranian National Board Exam.

Background: One of the prominent indicators of academic success in postgraduate medical education is the "Residents' Pass Rate" in the "National Board Exam." Objectives: This study was designed and implemented to assess the attitudes of the anesthesiology residents toward factors affecting their success in the National Board Exam. Methods: After the Institutional Review Board (IRB) approval, in an attitude assessment study, 20 of the 21 recently graduated anesthesiology residents were asked about the factors affecting their success quantitatively and qualitatively. A self-administered questionnaire with 19 closed questions and a personal virtual WhatsApp Messenger® interview were used for the study. Results: The respondents' viewpoints demonstrated that a step-by-step multifaceted integrative program in combination with psychological support (both from the family and the department) and individual motivation positively affected their success and their endurance to overcome the high load of the mandatory texts. In contrast, unplanned stressors leading to program shifts (mainly due to COVID-19) had adverse effects on their success. Conclusions: Anesthesiology residents believed that a well-designed and appropriately implemented study plan with psychological support and personal motivating factors could facilitate passing the National Board Exam, and unplanned external stressors could hinder it.

Effectiveness of nursing virtual training courses based on the Kirkpatrick Model.

BACKGROUND: Educational evaluation is one of the most significant programs of any organization. In fact, evaluating training effectiveness allows managers and staff of the organization to get a clear picture of the qualities of training activities. The purpose of this study was to evaluate virtual nursing intensive care training courses at Shariati Hospital based on the Kirkpatrick Model in 2020. METHODS AND MATERIAL: The current cross-sectional study is an evaluation of the outcome-oriented program to evaluate the results of the e-learning course on nursing intensive care at Shariati Teaching Hospital from March 20, 2020 to September 20, 2020. The total number of nurses working in intensive wards was 168, of whom 150 participated in this research study with convenience sampling. The data collection tool consisted of four-part questionnaires including demographic information and three levels of the Kirkpatrick Model. RESULTS: The mean age of participants was 34.41 ± 6.63 years. The mean score of participant satisfaction was 76.77, indicating that they showed good reaction to virtual training courses. Virtual training course for intensive care nurses was statistically significant at the levels of learning (P < 0.0001) and behavior (P < 0.0001). CONCLUSIONS: Virtual training courses are effective educational method based on three levels of Kirkpatrick's Model in intensive care nurses and it can be used along with traditional training approaches.

The Aspects of Running Artificial Intelligence in Emergency Care; a Scoping Review.

Introduction: Artificial Inteligence (AI) application in emergency medicine is subject to ethical and legal inconsistencies. The purposes of this study were to map the extent of AI applications in emergency medicine, to identify ethical issues related to the use of AI, and to propose an ethical framework for its use. Methods: A comprehensive literature collection was compiled through electronic databases/internet search engines (PubMed, Web of Science Platform, MEDLINE, Scopus, Google Scholar/Academia, and ERIC) and reference lists. We considered studies published between 1 January 2014 and 6 October 2022. Articles that did not self-classify as studies of an AI intervention, those that were not relevant to Emergency Departments (EDs), and articles that did not report outcomes or evaluations were excluded. Descriptive and thematic analyses of data extracted from the included articles were conducted. Results: A total of 137 out of the 2175 citations in the original database were eligible for full-text evaluation. Of these articles, 47 were included in the scoping review and considered for theme extraction. This review covers seven main areas of AI techniques in emergency medicine: Machine Learning (ML) Algorithms (10.64%), prehospital emergency management (12.76%), triage, patient acuity and disposition of patients (19.15%), disease and condition prediction (23.40%), emergency department management (17.03%), the future impact of AI on Emergency Medical Services (EMS) (8.51%), and ethical issues (8.51%). Conclusion: There has been a rapid increase in AI research in emergency medicine in recent years. Several studies have demonstrated the potential of AI in diverse contexts, particularly when improving patient outcomes through predictive modelling. According to the synthesis of studies in our review, AI-based decision-making lacks transparency. This feature makes AI decision-making opaque.

Outstanding qualities of a successful role model in medical education: Students and professors' points of view.

Introduction: Role models play a crucial role in determining the professional development of medical trainees. The purpose of this study was to gain in-depth understanding of the outstanding qualities of successful role models. Material and methods: In this qualitative-descriptive study, data were collected through conducting interviews, and the inductive content analysis was performed. The study was done at the school of medicine of Tehran University of Medical Sciences in Iran. Twenty-five medical students, medical graduates, and faculty members participated in 25 interviews from April to December 2019. The participants were recruited via purposive sampling. Results: five categories and 13 subcategories were extracted from the data. The results of this study illustrated five crucial qualities of a good clinical role model including an excellent character, effective coach and mentor, inspiring medical leader, expert clinical teacher, and a professional physician. Our results also highlighted the lasting effects of positive role modeling of clinical teachers on medical trainees' professional careers. Another category in the present study was connected to future consequences of being a role model in a clinical setting. Conclusion: The result of this study illustrated crucial qualities of a good medical role model. This result can assist the leaders to engage with medical educators to better understand the process of role modeling and design the best plan for development of role modeling in medical education.

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 situational analysis of teaching-learning in clinical education in Iran: a postmodern grounded theory study.

BACKGROUND: Clinical teaching-learning is a context-bound phenomenon. One of the problems related to field of medical education research is the lack of sufficient attention to context-appropriate methodologies. The purpose of this qualitative inquiry is to explain and represent teaching-learning in the clinical education of general medicine in Iran using the three types of maps situational, social worlds/arenas, positional, in combination with discourse analysis. METHODS: In this study, the authors used the situational analysis approach as a postmodern version of grounded theory. The data collection was undertaken in three stages. In the first stage, a mini literature review was conducted to highlight a possible gap in applying situational analysis in medical education research and the development of this methodology. In the second stage, the latest and most up-to-date documents of the Ministry of Health and Medical Education (MOHME) of Iran, the general medicine curriculum, and related documents were analyzed. Finally, the remote semi-structured interviews (web-based and telephone) were undertaken in the third stage. Participants in this stage included expert clinical teachers, medical education specialists, and students. In this study, the notes and transcripts were analyzed for the emergence and categorization of sub-themes and themes, represented in three maps. RESULTS: Thirty-one participants were involved in the web-based interviews, while seven participants took part in the telephone interview. Based on this research, the teaching-learning situation in clinical education on general medicine in Iran was represented in three maps; situational, social worlds/arenas, and positional. In addition, the results showed, clinical education of general medicine in Iran in six positions (curriculum; culture, behavior and attitude; management and leadership; environment, space and time; financial; and technology) has serious problems and challenges. Finally, based on the horizontal axis of the positional map, recommendations were provided to develop and support effective clinical teaching. CONCLUSIONS: The clinical learning environment is a complex and multi-layered social environment in which should be considered these numerous social layers, arenas, social worlds, and discourses while developing curricula and teaching.

A Qualitative Study on Continuing Medical Education Programs for Practicing Ophthalmologists in Iran: Changing Previous Norms.

INTRODUCTION: The Continuing Medical Education (CME) programs in the medical community aim to improve the knowledge of practitioners and its effect on changing their performance. Previous studies showed that CME causes minimum changes in physicians' behaviors, so it is important to pay attention to the views of this group. In this regard, this qualitative study aimed to explain the Iranian Ophthalmologists' perceptions and experiences concerning the CME Programs in Iran. METHODS: In this qualitative study, 18 participants, including 10 subspecialists and 8 general ophthalmologists, were recruited to participate in in-depth interviews concerning their experiences with CME. The required data were collected from April 2018 to Feb 2019. Each interview was conducted in medical universities; eye research centers; and the ophthalmology departments, offices, and operating rooms of public and private hospitals. The current study was performed using a content analysis based on the Granheim and Lundman's methods. The codes, sub- categories, categories, and themes were then explored through an inductive process in which the researchers moved from specific to general. RESULT: The data obtained from interviews, and filed notes were analyzed and then classified into the following four themes: "growth and development of the ophthalmology's CME program over time", "challenges of the ophthalmology's CME program", "reasons for the participation of the ophthalmologist in the CME program", and "strategies for improvement". CONCLUSION: Based on the qualitative study's results, in spite of growth and development of the design and implementation of the Ophthalmologic CME programs, we are still facing multiple challenges. Enhancing the interactivity between the providers and participants can also improve the ophthalmology CME 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.

Explanation of medical students' experiences of educational clinical supervision: A qualitative study.

CONTEXT: Clinical supervision is a mechanism that allows medical trainees to learn their profession through the practice of clinical activities alongside more experienced physicians who ensure safe and timely care delivery. Therefore, recognizing of medical students experiences as people who will provide health services to people in future can be an important source for gathering information and planning to improve the quality of clinical education. The aim of this study was to explain the experiences of medical students from clinical educational supervision. METHODS: This study was a qualitative content analysis conducted on 15 interns of the surgery and internal departments of medical and educational centers in Islamic Azad University Najafabad Branchin Isfahan, Iran to discover. The sampling method was purposive, and data were collected through semi-structured interviews in 2019. Data analysis was performed using a qualitative content analysis method with a conventional inductive approach. RESULTS: Five main categories and ninesubcategories were developed. The main categories include fundamental role, relaxed alertness, shadow education, toxic education, and abandoned educational. CONCLUSION: The educational clinical supervisory has an efficient performance in clinical teaching which needs to be more assessed and improved.

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.

COVID-19 Pandemic and E-Learning Satisfaction in Medical and Non-Medical Student: A Systematic Review and Meta-Analysis.

Background: The COVID-19 pandemic has led to a rapid shift in student education style from face-to-face to electronic learning. Since the education satisfaction index is considered as a measure of the quality of educational services, therefore, this study aimed to assess E-Learning Satisfaction (ELS) in medical and non-medical students during COVID-19 pandemic. Methods: Articles that had been published from 22 Dec 2019 to 4 Jan 2021 were identified through searching databases including PubMed, Scopus, Elsevier, Google Scholar, Web of Science and Iranian Scientific Information Database (SID), Health.barakatkns, IranDoc, Civilica and MagIran using the following keywords: "Distance learning", "Virtual learning", "E-Learning", "Satisfaction", "COVID 19". We systematically reviewed all studies that reported ELS. In this study, meta-analysis was used to estimate the pooled ELS. Results: Overall, 184 records were identified by the electronic search, of which 24 relevant studies were included in meta-analysis. The pooled ELS in medical, non-medical and overall were 58.1% (50.5%-65.7%), 70.1% (66.8%-73.5%) and 63.8% (58.9%-68.8%) respectively. Conclusion: According to our results and lower ELS in medical students in comparison with non-medical students, designing new E-Learning methods for medical students has been suggested.

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.

Impact of social problem-solving training on critical thinking and decision making of nursing students.

BACKGROUND: The complex health system and challenging patient care environment require experienced nurses, especially those with high cognitive skills such as problem-solving, decision- making and critical thinking. Therefore, this study investigated the impact of social problem-solving training on nursing students' critical thinking and decision-making. METHODS: This study was quasi-experimental research and pre-test and post-test design and performed on 40 undergraduate/four-year students of nursing in Borujen Nursing School/Iran that was randomly divided into 2 groups; experimental (n = 20) and control (n = 20). Then, a social problem-solving course was held for the experimental group. A demographic questionnaire, social problem-solving inventory-revised, California critical thinking test, and decision-making questionnaire was used to collect the information. The reliability and validity of all of them were confirmed. Data analysis was performed using SPSS software and independent sampled T-test, paired T-test, square chi, and Pearson correlation coefficient. RESULTS: The finding indicated that the social problem-solving course positively affected the student' social problem-solving and decision-making and critical thinking skills after the instructional course in the experimental group (P < 0.05), but this result was not observed in the control group (P > 0.05). CONCLUSIONS: The results showed that structured social problem-solving training could improve cognitive problem-solving, critical thinking, and decision-making skills. Considering this result, nursing education should be presented using new strategies and creative and different ways from traditional education methods. Cognitive skills training should be integrated in the nursing curriculum. Therefore, training cognitive skills such as problem- solving to nursing students is recommended.