Journal of Medical Education
Volume:16 Issue: 3, Aug 2017

Systems-based practice (SBP) is one of the six competencies introduced to assess the competency of physicians in America. In this study, we aimed to define the characteristics of SBP for general practitioners in Iran using content analysis in order to gain maximum qualitative data.
A qualitative content analysis was conducted and the units of analysis were ministry documents, interviews with four managers, one expert and five general and family physicians. Inductive analysis process was mainly performed by open coding, abstraction, categorization, and definign themes using the iterative method.
65 codes were placed in 16 sub-categories and 7 categories. Three themes emerged: Effective role playing in inter-professional team, balanced decision between patient needs and system goals, and acting
for system improvement. These themes were accompanied by meaning units that clarified their meaning.
The exact definition of these themes in Iran could facilitate SBP training as well as evaluation.

Clinical reasoning plays an important role in the ability of physicians to make diagnoses and decisions. It is considered the physician’s most critical competence, but it is an ambiguous concept in medicine that needs a clear analysis and definition. Our aim was to clarify the concept of clinical reasoning in medicine by identifying its components and to differentiate it from other similar concepts. It is necessary to have an operational definition of clinical reasoning, and its components must be precisely defined in order to design successful interventions and use it easily in future research.
McKenna’s nine-step model was applied to facilitate the clarification of the concept of clinical reasoning. The literature for this concept analysis was retrieved from several databases, including Scopus, Elsevier, PubMed, ISI, ISC, Medline, and Google Scholar, for the years 1995– 2016 (until September 2016). An extensive search of the literature was conducted using the electronic database. Accordingly, 17 articles and one book were selected for the review. We applied McKenna’s method of concept analysis in studying clinical reasoning, so that definitional attributes, antecedents, and consequences of this concept were extracted.
Clinical reasoning has nine major attributes in medicine. These attributes include: (1) clinical reasoning as a cognitive process; (2) knowledge acquisition and application of different types of knowledge; (3) thinking as a part of the clinical reasoning process; (4) patient inputs; (5) contextdependent and domain-specific processes; (6) iterative and complex processes; (7) multi-modal cognitive processes; (8) professional principles; and (9) health system mandates. These attributes are influenced by the antecedents of workplace context, practice frames of reference, practice models of the practitioner, and clinical skills. The consequences of clinical reasoning are the metacognitive improvement of reasoning and tacit knowledge production.
The present concept analysis tries to clarify the concept of clinical reasoning in medicine and reduces the ambiguity of this concept to design successful interventions and use it easily in future research.

The aim of our study was to introduce and evaluate a practicable model for tuition fee calculation of each medical field in universities of medical sciences in Iran.
Fifty experts in 11 panels were interviewed to identify variables that affect tuition fee calculation. This led to key points including total budgets, expenses of the universities, different fields’ attractiveness, universities’ attractiveness, and education quality. Tuition fees were calculated for different levels of education, such as post-diploma, Bachelor, Master, and Doctor of Philosophy (Ph.D) degrees, Medical specialty, and Fellowship. After tuition fee calculation, the model was tested during 2013-2015. Since then, a questionnaire including 20 questions was prepared. All Universities’ financial and educational managers were asked to respond to the questions regarding the model’s reliability and effectiveness.
According to the results, fields’ attractiveness, universities’ attractiveness, zone distinction and education quality were selected as effective variables for tuition fee calculation. In this model, tuition fees per student were calculated for the year 2013, and, therefore, the inflation rate of the same year was used. Testing of the model showed that there is a 92% of satisfaction. This model is used by medical science universities in Iran.
Education quality, zone coefficient, fields’ attractiveness, universities’ attractiveness, inflation rate, and portion of each level of education were the most important variables affecting tuition fee calculation.

Knowledge of clinical practice guidelines for Implantable Cardioverter Defibrillator (ICD) therapy is a pre-requisite for effective application of this life-saving technology. The level of trainee familiarity with these guidelines is unknown. The objective of this study was to assess trainee familiarity with clinical practice guidelines for ICD therapy.
This study surveyed 32 clinicians of varying training levels in internal medicine and cardiology at a large VA medical center. This is a survey study conducted from a population of all trainees in internal medicine at the medical center; the sample included trainees from PGY-1 through PGY-7 as well as attending physicians in internal medicine. Analysis of the collected survey data was performed using either Chi-square tests for comparison of categorical variables or unpaired t-tests for
comparison of means.
Of all respondents, 69% reported that they were familiar with published guidelines, and consistent with previously published data. Cardiologists were significantly more likely to report familiarity than internists (85% vs 42%, P=0.01). Most respondents (75%) reported satisfactory or better knowledge of published guidelines, though only 34% self-reported their knowledge as good or very good. The majority of respondents (86%) underestimated the usual cost of ICD implantation, while most respondents (78%) agreed that implantation of an ICD was cost-effective for secondary prevention, cardiologists were far more likely to agree than internists (95% vs. 50%, P There are considerable knowledge gaps evident among trainees with regard to clinical practice guidelines for ICD therapy. This likely represents a modifiable barrier to ICD implantation. Structured education for medical trainees on the appropriate use and referral practices consistent with practice guidelines may reduce knowledge gaps and increase appropriate ICD implantation.

Medical education research is of great relevance as it ultimately reflects patient care. Research in this field is neglected for varied reasons. Hence, the present study was undertaken to explore the perceptions, awareness and practices of medical teachers for conducting research in medical education and analyzing the challenges towards conducting research in medical education.
A cross sectional observational survey was done using a structured, validated, self administered questionnaire on 108 medical teachers working in a medical college A total of 83% of teachers were aware of research in medical education but only 22% were involved in research in medical education. 38% had undergone training in Medical Education Technology and 23% in research in medical education methodology. Lack of Training (78%) and lack of knowledge in education research (73%) were cited as the most frequent challenges in research in medical education. Problem Based Learning / Case Based Learning (73%) and Teaching Learning methodology (71%) are the most frequently cited areas for conduction of research in medical education.
Managers /administrators and policy makers should take measures to promote research in medical education by organizing awareness and training in educational research methodology, as well as in providing adequate grants for conducting research in this field.

Students’ perceptions of their learning environments influence their approaches to learning and the learning outcomes, and reflect a programme’s effectiveness. In Africa, literature on the learning environments of medical and health sciences education is scanty, and the issues impinging on effective education are not well documented. The objective of this study was to determine learners’ perceptions of the issues in the learning environment of undergraduate physiotherapy education at the University of Zambia.
Undergraduate physiotherapy students in years 2 to 5 were stratified according to level of study and randomly sampled. They were provided written information about the study, and consenting students were allowed to complete the DREEM questionnaire unassisted. Completed questionnaires were rated using a recommended guideline and their responses analysed quantitatively. Global, subscale, and item mean scores were calculated, and Cronbach’s alpha was determined as a measure of data reliability and internal consistency. The study was approved by ethics committees of two universities.
Ninety-three students participated in the study. The response rate was 88.4 %. All classes rated the learning environment as ‘more positive than negative,’ with a mean global score of 123.2/200 (61.6 %). Scores within subscales (55.7–70.4 %) were comparable across the classes. Nine items scored below 2.0/4.0 indicating dissatisfaction. These included inadequate social support, teacher authoritarianism, and factual overload. Cronbach’s alpha for global scores was 0.896, and between 0.616 and 0.820 for subscale scores.
Though total DREEM scores showed overall positive perception of the learning environment by the students, item analysis showed students’ dissatisfaction with several aspects. This analysis of undergraduate students’ perceptions of the Physiotherapy learning environment provided insight into the phenomena in the programme and adds to the literature on learning environments of Physiotherapy education in Africa.