A psychometric evaluation of inter-professional education competency tool in nursing and medicine students.

INTRODUCTION: Collaboration between nurses and doctors is necessary for offering care to patients. Using team performance assessment tools and surveying them can be effective in promoting inter-professional collaboration, and the lack of a credible tool to assess inter-professional collaboration competency between the two groups is a major challenge in the healthcare sector. The present study aimed to translate and conduct a psychometric investigation on the inter-professional education collaboration (IPEC) tool for the students of medicine and nursing. METHODS: The present study was a cross-sectional one conducted as a psychometric investigation of the IPEC tool at the Iran University of Medical Sciences in 2022. The initial tool contained 42 items developed according to a 5-point Likert scale, which was translated into Persian with the consent of the original researcher. The validity index and the content validity ratio were investigated by a panel of 11 specialists in medical and clinical education, and its construct validity was evaluated using confirmatory factor analysis. Also, the second population of the study included medical and nursing students of Iran University of Medical Sciences and simple random sampling method. Moreover, the reliability of the instrument was investigated using internal consistency, Cronbach's Alpha, and test-retest methods. RESULTS: Based on the indicators calculated to perform a psychometric investigation over the above tool, it had acceptable reliability and validity according to the specialists. The tool evaluates inter-professional collaboration competency between the students of medicine and nursing across four areas (values and ethics, roles and responsibilities, inter-professional communication, and team-based care and teamwork). Moreover, Cronbach's Alpha coefficient for the tool was determined at 0.84. CONCLUSION: The results of the study showed that the above tool could evaluate inter-professional competency as a valid and reliable questionnaire, and its results could be utilized in planning and education.

The Trends of Attitude Change and Interprofessional Collaboration Competencies among Medical and Nursing Students of Iran University of Medical Sciences.

Background: Nurses' and physicians' collaboration is a precedent for patient care. This study examined attitude change and interprofessional collaboration competencies among medical and nursing students of Iran University of Medical Sciences. Methods: This study was quantitative cross-sectional. The study tools were two questionnaires, Attitudes Toward Interprofessional Education and IPEC Interprofessional Collaborative Competencies, which were completed by 211 medical and nursing students in online or in-person forms. The collected quantitative data were analyzed by SPSS 19 software. Results: The results showed that nurses and physicians constituted 35.5% and 64.5% of the sample. The results of the independent T-test displayed no statistically significant difference in the mean age of both groups (P = 0.054). There was a statistically significant difference in the participants' attitudes toward interprofessional learning, and the medical group (46.68) obtained a higher mean score than the nurse group (34.92) (P = 0.001). The two groups with varying mean scores (179.34 for medical students and 131.72 for nursing students) were significantly different in their interpersonal collaboration competencies (P = 0.001). Considering Mauchly's test, there were statistically significant differences among medical students of varying academic years in their attitudes toward interprofessional education (P < 0.001). Nursing students were also different in their attitudes toward interprofessional education based on their academic years. Conclusion: The results of this study showed that the attitude of nursing students towards interprofessional education and interpersonal collaboration competencies should be increased in line with medical students in order to improve the quality of medical and health services.

Explaining Internal Medicine and Surgery Residents' Perceptions of Mentor as a Role Model: A qualitative Study.

Background: Role modeling is the essence of the teaching process and one of the important functions of educators and clinical instructors. In clinical education situations, many clinical instructors are responsible as mentors. On the other hand, clinical instructors, although not obvious, are seen as role models. This study is aimed at explaining the internal medicine and surgery residents' perceptions of mentors as role models. Methods: This qualitative (content analysis) study was carried out using purposive sampling and conducting semi-structured interviews with 18 medical residents (internal medicine and surgery departments) at Iran University of Medical Sciences. The resulting data were analyzed using inductive qualitative content analysis. Results: Based on the results of the analysis of the transcribed interviews, 60 initial codes, 31 subthemes, and 5 main themes were identified. The dimensions of the mentor's role modeling were as follows: structural, executive, managerial, ethical, and scientific. Conclusion: Role modeling is a very effective learning method, especially for medical students. Role modeling in clinical learning environments seems to be valuable to facilitate students' learning. Using the role of clinical instructors as an educational model is one of the important ways of teaching professional ethics in clinics.

To use or not to use? an ethical analysis of access to data and samples of a deceased patient for genetic diagnostic and research purposes.

Using genetic tests on deceased patients' samples for diagnostic purposes affects the family members' health and lives but raises some ethical issues in today's practice of medicine and research. In this paper, we address a common ethical dilemma of clinicians regarding whether to perform genetic tests on a deceased patient's sample upon a request from first-degree relatives against the patient's wishes in the last days of life. In this paper, a real case scenario is presented that echoes the above-mentioned ethical challenge. Reviewing the genetic basis of the case, the ethical arguments for and against the reuse of genetic material in a clinical context are discussed. An ethico-legal analysis of the case is proposed based on Islamic medical ethics resources. As reusing stored samples of expired patients without their consent also challenges the researchers in the field of genetics, a debate is included on the post-mortem use of genetic data and samples for research. Finally, defining the special features of the presented case and positive benefit-risk ratio, it is concluded that reusing the patient's sample may be justified if the first-degree family members insist on genetic testing and are comprehensively informed about the benefits and harms.

Comparison of Students' Attitudes about the Effectiveness of Algorithm-based Education with Lecture-based Education.

Background: Training is a complex process, especially when the students are being prepared for patient's management. Therefore, the development of effective teaching methods is critical for to improvement of learning and communication between the content and concepts. In algorithm-based education, more focus is placed on more involvement of students in the subject, thereby providing a better understanding of the concept. In this study, we compared students' attitudes about the effectiveness of algorithm-based education (education based on the patient's complaints and symptoms) with lecture-based education in the learning ability of the medical students presented in the clinical course of the orthopedic group. Methods: This research is a single-group quasi-experimental study; we assessed the students' attitudes on a five-point Likert scale questionnaire with confirmed validity and reliability. The scores of two teaching methods were assessed after the training course, which was presented using the algorithmic method for selective titles and lectures for the other titles. Data were analyzed on SPSS software using a paired t-test. Results: A total of 220 internship medical students, including 58.7% of girls with a mean age of 22.9 ± 1.19 years, participated in the study. The mean score of the questions was 3.92±0.54 and 2.17±0.58 in the algorithmic and the lecture training, respectively. After comparing the results with a paired t-test, there was a significant difference between students' attitudes toward the two teaching methods (p ˂ 0.001), so the students' attitude was more positive toward the algorithm-based method. Conclusion: For the education of medical students, algorithm-based training is more efficacious compared to traditional methods such as lecture-based training.

Ethical considerations and interdisciplinary approach to research on COVID-19 pandemic: The response of Iran University of Medical Sciences.

Background: Research ethics committees are comprised of policymakers, supervisors, and decision-makers and aim at increasing adherence to professional ethics standards in conducting health-related research. The existential philosophy of these committees is to preserve the patients' health, maintain and promote public trust in health care providers, protect the rights of both patients and health care providers, and promote organizational ethics. However, this task can be complex and challenging during a public health emergency. Research ethics committees set the standard of research in the emergency situations through defining which research has the potential to promote the quality of response to a public health emergency. Methods: This study aims at collecting and classifying the valuable experiences of the research ethics committee members and reviewers during the early days of the COVID-19 epidemic in Iran University of Medical Sciences, one of the major universities in Tehran. It provides a basic understanding of the key concepts and challenges in reviewing and approving research by research ethics committees and the recommendations to overcome these challenging issues. Results: To accelerate the review process of COVID-19 research proposals, the scientific, methodological and ethical review panel was integrated as a large committee called 'IUMS Corona Research Team'. The first meeting was held on March 7, two weeks after the official announcement of the first case of the disease and is continued once a week. A total of 130 projects have been discussed and evaluated in this committee, among which 83 proposals were approved after modification. Conclusion: An interdisciplinary approach supports a flexible and effective scientific and ethical review of research leading to more protection of research subjects as well as promotion in the treatment and management of the pandemic ahead.

Confidentiality challenges surrounding plasma therapy during the COVID-19 pandemic: a case discussion in Iran.

Maintaining confidentiality, both in national and international codes of ethics, is considered an important principle in healthcare and the medical profession for both patients and physicians. This case-report article focused on a real case. Based on the request of the Iranian Blood Transfusion Organization (IBTO) for plasma donation from recovered COVID-19 patients, we asked the names and personal information of those patients from hospitals affiliated with Iran University of Medical Sciences (IUMS) and arranged for the subjects to be referred to the Medical Ethics Department of IUMS for consultation during the COVID-19 pandemic. Various ethical and legal aspects of this case were discussed in a special meeting, and practical solutions were then provided considering the limits of confidentiality and conditions for ethical access to patients' information during a pandemic. Since plasma therapy is not a definitive cure for COVID-19 and considering the ethical and legal points presented in this article, it is not recommended to announce the names of patients in the early stages. Given the potential impacts of the procedure and the possibility of patients being cured, however, their consent should be obtained in different situations and, if necessary, providing information to patients or educating them should be considered.

Application of data mining techniques for predicting residents' performance on pre-board examinations: A case study.

CONTEXT: Predicting residents' academic performance is critical for medical educational institutions to plan strategies for improving their achievement. AIMS: This study aimed to predict the performance of residents on preboard examinations based on the results of in-training examinations (ITE) using various educational data mining (DM) techniques. SETTINGS AND DESIGN: This research was a descriptive cross-sectional pilot study conducted at Iran University of Medical Sciences, Iran. PARTICIPANTS AND METHODS: A sample of 841 residents in six specialties participating in the ITEs between 2004 and 2014 was selected through convenience sampling. Data were collected from the residency training database using a researcher-made checklist. STATISTICAL ANALYSIS: The analysis of variance was performed to compare mean scores between specialties, and multiple-regression was conducted to examine the relationship between the independent variables (ITEs scores in postgraduate 1st year [PGY1] to PG 3rd year [PGY3], sex, and type of specialty training) and the dependent variable (scores of postgraduate 4th year called preboard). Next, three DM algorithms, including multi-layer perceptron artificial neural network (MLP-ANN), support vector machine, and linear regression were utilized to build the prediction models of preboard examination scores. The performance of models was analyzed based on the root mean square error (RMSE) and mean absolute error (MAE). In the final step, the MLP-ANN was employed to find the association rules. Data analysis was performed in SPSS 22 and RapidMiner 7.1.001. RESULTS: The ITE scores on the PGY-2 and PGY-3 and the type of specialty training were the predictors of scores on the preboard examination (R 2 = 0.129, P < 0.01). The algorithm with the overall best results in terms of measuring error values was MLP-ANN with the condition of ten-fold cross-validation (RMSE = 0.325, MAE = 0.212). Finally, MLP-ANN was utilized to find the efficient rules. CONCLUSIONS: According to the results of the study, MLP-ANN was recognized to be useful in the evaluation of student performance on the ITEs. It is suggested that medical, educational databases be enhanced to benefit from the potential of DM approach in the identification of residents at risk, allowing instructors to offer constructive advice in a timely manner.

Validity, reliability and acceptability of Professionalism Mini-Evaluation Exercise (P-MEX) for emergency medicine residency training.

Professionalism is a core competency in the medical profession. In this paper, we aimed to confirm the validity, reliability and acceptability of the Professionalism Mini-Evaluation Exercise (P-MEX) instrument for the emergency medicine (EM) residency program. Twenty-two EM attending physicians completed 383 P-MEX forms (the Persian version) for 90 EM residents. Construct validity was assessed via structural equation modeling (SEM). The reliability coefficient was estimated by the generalizability theory, and acceptability was assessed using two researcher-made questionnaires to evaluate the perspectives of residents and assessors. There was a consensus among the participants regarding the content of P-MEX. According to the results of SEM, the first implementation of the original model was associated with a moderate fit and high item loadings. The model modified with correlated error variances for two pairs of items showed an appropriate fit. The reliability of P-MEX was 0.81 for 14 occasions. The perception survey indicated high acceptability for P-MEX from the viewpoint of the residents and increasing satisfaction with P-MEX among the assessors over time. According to the results of the research, P-MEX is a reliable, valid, and acceptable instrument for assessing professionalism in EM residents.

Design of formative assessment model for professional behavior using stages of change theory.

Background: Professionalism is a core competency of physicians. This study was conducted to design a model for formative assessment of professional commitment in medical students according to stages of change theory. Methods: In this qualitative study, data were collected through literature review & focus group interviews in the Tehran University of Medical Sciences in 2013 and analyzed using content analysis approach. Results: Review of the literature and results of focus group interviews led to design a formative assessment model of professional commitment in three phases, including pre-contemplation, contemplation, and readiness for behavior change that each one has interventional and assessment components. In the second phase of the study, experts' opinion collected in two main categories: the educational environment (factors related to students, students' assessment and educational program); and administrative problems (factors related to subcultures, policymakers or managers and budget). Moreover, there was a section of recommendations for each category related to curriculum, professors, students, assessments, making culture, the staff and reinforcing administrative factors. Conclusion: This type of framework analysis made it possible to develop a conceptual model that could be effective on forming the professional commitment and behavioral change in medical students.

Developing an ethical guideline for clinical teaching in Tehran University of Medical Sciences.

Clinical education is an essential part of medical trainees' education process, and curriculum planners agree that it should be based on ethical standards and principles in the medical field. Nevertheless, no explained and codified criteria have been developed for ethics in clinical teaching. This study was aimed to develop an ethical guideline for medical students and teachers as the first and most important step in respecting patients' rights in educational centers. The initial draft included the codes of ethics in clinical education and was developed based on library studies. Subsequently, it was improved through a qualitative study using semi-structured interviews and focus group sessions with medical students, patients, and medical teachers in educational hospitals affiliated to Tehran University of Medical Sciences. The improved draft was reviewed and validated by a medical expert panel to prepare the final draft. The codes derived from this study included patients' choices and rights in purely educational procedures, and special considerations for a) obtaining informed consent for educational procedures; b) performing procedures on deceased persons, patients under anesthesia and those lacking decision making capacity; c) educational visual recordings of the patients; and d) safety monitoring in clinical education. The guideline developed in this study incorporates codes of ethics into clinical training. Therefore, in addition to providing efficient education, the interests of patients and their rights are respected, and the ethical sensitivity of learners in primacy of patients' best interests will be preserved and enhanced.

Assessing validity and reliability of Dundee ready educational environment measure (DREEM) in Iran.

BACKGROUND: If an institute is looking for improvement of its learning environment, a reliable and valid assessment tool is needed for measurement of the educational environment .The Dundee Ready Educational Environment Measure (DREEM) has been used in various studies to evaluate the educational environment. However, psychometric evaluations of the instrument seem necessary, for all known versions of the instrument. The aim of this study was to investigate the reliability and validity of Persian version of the DREEM in the major clinical wards in teaching hospitals affiliated to Iran University of Medical Sciences. METHODS: This descriptive - analytical study, involved medical students (clinical stagers and interns) in 4 major clinical wards. In this study, DREEM questionnaire was reviewed in content, face validity and construct validity through confirmatory factor analysis. The reliability was calculated according to test - retest and the internal consistency was measured using Cronbach's alpha coefficient. RESULTS: A total number of 267 questionnaires were completed by medical stagers (60%) and interns (40%) including 181 females and 82 males. The mean age of stagers and interns were 23.60 ± 1.27 and 25.45 ± 1.22 years, respectively. The total mean of the questionnaire was calculated as 96.15 (93.5375, 98.7547) out of 176, with 95% confidence interval. The face validity of the questionnaire was confirmed. The mean of content validity ratio (CVR) was calculated as 0.35, and 6 questions were omitted in this step. The content validity index (CVI) was 0.39. The reliability coefficient mean was 0.71. In confirmatory factor analysis five factors were confirmed that changed the orientation of some questions. The Cronbach's alpha coefficient of the whole questionnaire was obtained as 0.914. CONCLUSION: The modified and validates DREEM questionnaire in Persian language with 44 items and appropriate psychometric attributes is capable of being used in assessment of clinical education environments in Iran.

Travelling fellowship program for football medicine; report on an experience.

Football medicine has developed in the world in recent years. AFC Medical Committee, established the idea of football medicine travelling fellowship two years ago and provided high-level healthcare services to football players in Asian countries. This is a report on my one month experience in a travelling fellowship program for football medicine which is attempting to tell the reader about the interesting event that I experienced. This course has been held between Jan 15 to Feb 10, 2012 in 3 Asian countries: Qatar, Thailand and Malysia. The experience provided me with the valuable suggestions for future travelling fellowship periods.

Etiopathophysiological assessment of cases with chronic daily headache: A functional magnetic resonance imaging included investigation.

BACKGROUND: Chronic daily headache (CDH) has gained little attention in functional neuro-imaging. When no structural abnormality is found in CDH, defining functional correlates between activated brain regions during headache bouts may provide unique insights towards understanding the pathophysiology of this type of headache. METHODS: We recruited four CDH cases for comprehensive assessments, including history taking, physical examinations and neuropsychological evaluations (The Addenbrooke's Cognitive Evaluation, Beck's Anxiety and Depression Inventories, Pittsburg Sleep Quality Index and Epworth Sleepiness Scale). Visual analogue scale (VAS) was used to self-rate the intensity of headache. Patients then underwent electroencephalography (EEG), transcranial Doppler (TCD) and functional magnetic resonance imaging (fMRI) evaluations during maximal (VAS = 8-10/10) and off-headache (VAS = 0-3/10) conditions. Data were used to compare in both conditions. We also used BOLD (blood oxygen level dependent) -group level activation map fMRI to possibly locate headache-related activated brain regions. RESULTS: General and neurological examinations as well as conventional MRIs were unremarkable. Neuropsychological assessments showed moderate anxiety and depression in one patient and minimal in others. Unlike three patients, maximal and off-headache TCD evaluation in one revealed increased middle cerebral artery blood flow velocity, at the maximal pain area. Although with no seizure history, the same patient's EEG showed paroxysmal epileptic discharges during maximal headache intensity, respectively. Group level activation map fMRI showed activated classical pain matrix regions upon headache bouts (periaqueductal grey, substantia nigra and raphe nucleus), and markedly bilateral occipital lobes activation. CONCLUSION: The EEG changes were of note. Furthermore, the increased BOLD signals in areas outside the classical pain matrix (i.e. occipital lobes) during maximal headaches may suggest that activation of these areas can be linked to the increased neural activity or visual cortex hyperexcitability in response to visual stimuli. These findings can introduce new perspective towards more in-depth functional imaging studies in headaches of poorly understood pathophysiology.

Chronic meningitis as the first presentation of sarcoidosis: an uncommon finding.

We describe a 40-year-old woman presenting with headache, nausea, episodic amnesia and blurred optic disc. Brain MRI disclosed diffuse leptomeningeal enhancement. CSF analysis showed aseptic meningitis with elevated ACE level. Neurosarcoidosis was diagnosed based on granulomatosis changes on tissue biopsy.