Journal of Medical Education
Volume:15 Issue: 2, May 2016

Background and The literature review over the past few decades is a reflection of a global specific move towards the competency and evaluation of outcomes based education and the importance of this type of education is to the extent that Harden introduced "competency-based education" through a focus on outcomes and competencies as the most important trend in the medical education in the past decade. Due to the particular importance of competency-based education and the need to review the competency -based curriculum to be based on the competencies, the need to review the design of the curriculum is completely evident. But a question arises here that "Is there a comprehensive model that can be drawn for the development of competency in order to design new curriculum based on it?"In this study, we have tried to develop models to assess and synthesize existing development models, achieve to design a comprehensive meta-model for competency development.
Meta-ethnography is a useful method for the synthesis of qualitative researches which is used in order to develop models that interpret findings in several studies. Considering that the aim of this study was finally to provide a meta-model of competency development, in the first step of meta-ethnography, first three steps and also a criticism was conducted on the available competency development models, for this purpose, literature review was also done to achieve competency development models. The models obtained by search were studied precisely and the models were presented based on first hand description of the by the developer(s), then offering critiques were extracted from the literature and the critical of researcher was finally provided.
After determination of the research question and characterization of synthesis focus, inclusion criteria and quality assessment of search were conducted and eight competency development models were selected and a precise investigation has been done on each.
Considering the importance of competency-based training at the global level and the urgent need to review the existing curriculum and competency-based curriculum design, the analyzed models can provide the basis for synthesis of a meta-model for competency development and curriculum.

Background and Respecting confidentiality of documents and medical information about individuals, as one of the most important issues in medicine, guarantees patient's trust in the health system. Therefore, this study is an attemp to design a valid and reliable tool to assess knowledge and attitudes of medical students about the principles of confidentiality and disclosure of patient information.
To design the questionnaire, a comprehensive review of literature was conducted. Since to the best of our knowledge, there was no valid and reliable tool, a 34-questions questionnaire consisting of two sections of knowledge and attitude was designed. Then, face and content validity of the questionnaire was investigated by expert opinion. Finally, content validity index (CVI), content validity ratio (CVR) and item usability index (IUI) were calculated, and the reliability of the instrument was measured by Cronbach’s Alpha. Then, the final questionnaire was assessed by faculty members of ethics and medical education (n=10) for simplicity, relevance, and clarity of the questions. Lastly, the questionnaire was distributed among medical interns (n=40)and its reliability was examined. Afterwards, the questionnaire was distributed among 160 medical interns, and the reliability and validity of its structure was evaluated.
The designed questionnaire CVI and CVR were 0.80 and 0.81 for knowledge and 0.78 and 0.83 for attitude sections. All the questions were confirmed as valid and reliable. The validity of the questionnaire for knowledge and attitude sections were 0.79 and 0.82, respectively.
Validity and reliability of all the designed questions (17 in each section) were confirmed.

Background and Midwifery importance is obvious due to its role in the health of mothers and children. For this reason, educating human resources trained in midwifery field as an effective measure to promote natural parturition and upgrade health services to mothers and children is attended in many countries worldwide. Ensuring efficient staffs that are capable to respond to the health needs of the target population is necessary, and education in this field is considered as a serious and crucial issue. Educational programs in this field shall be designed such that, in addition to the intellectual development of students, a platform is provided for achieving clinical skills and conversances and prepare midwives to perform tasks and skills acquisition and achieve professional independence. Some evidence indicates that there are disorganizations in maternal and child care system that, the root of many of them can be directly or indirectly traced in education for midwifery students.
In this qualitative study designed with content analysis method, 14 participants (including policy-makers, faculty members and alumni of Midwifery) were interviewed. Selection method of key informants was based on purposive sampling and, information were collected and implemented based on the experiences of participants in the study using semi-structured individual interviews. Interviews were gradually continued until data saturation. Using the methodology of content, thematic analysis of meaning units, primary codes, and then sub-themes and finally the main themes were extracted.
About 300 primary codes were extracted from the transcript of the interview that, after reduction were finally summarized to 10 sub-themes and three main themes. The main theme was " weakness of educational program " which included a sub-themes entitled: inadequate educational environment, failure of practical skills, lack of appropriate training sources and inappropriate ways of teaching. The second main theme was entitled "insufficient ability of the educators" with sub-themes as: conservatism of educators, insufficient knowledge and experience of the instructor and insufficient support for the educator and, the third main theme of "failure of field of study" was presented from the perspective of the participants with sub-themes of the Graduate Curriculum restrictions, limitations and lack of diversity in postgraduate and dissatisfaction of studying.
The findings of this study showed that there are challenges in education system for midwifery students that, the recognition of these challenges is essential to promote this field of study and needs for the attention of educational planners to resolve these challenges. Otherwise, a great group of graduates of the country is failing to serve the target groups and the public health takes away from their goals due to the ongoing conflict with existing educational challenges.

Background and Medical education is a laborious program which may give negative consequences on the physical and psychological health of medical students. The aims of this study were to evaluate psychological distress among Malay medical students and to assess its relationship with their lifestyle.
A cross-sectional study was conducted among 221 Malay medical students. Psychological distress and lifestyle were assessed using Depression, Anxiety and Stress Scale (DASS-21) and Health-Promoting Lifestyle Profile II (HPLPII) respectively.
About 30.8% of Malay medical students had mild to extremely severe depressive symptoms, 62.9 % showed mild to extremely severe anxiety symptoms, and 34.9% of them had mild to extremely severe stress. The depressive subscale was significantly higher among female than male students (Z=-2.613, P=0.009). There was a significant negative correlation between total psychological distress and spiritual growth (r=-0.217, P=0.001). Depression was found not only negatively correlated with spiritual growth (r =-0.328, P=0.000) but also interpersonal relationship (r=-0.161, P=0.016). Stress was inversely correlated with physical activity (r =-0.172, P=0.011). Preclinical students had significantly better scores in health responsibility (Z=-2.301, P=0.021), interpersonal relationship (Z=-2.840, P=0.005), stress management (Z=-2.339, P=0.019), spiritual growth (Z=-2.483, P=0.013) and nutrition and diet (Z =-2.456, P=0.014) than clinical students.
Malay medical students had significant symptoms that indicate psychological distress that related to their lifestyle. This warrants further psychiatric evaluation and management for them to be good and safe future doctors.

Background and The medical educational environment is increasingly becoming the focus of research globally. It is commonly understood that educational environments are an important factor for efficient learning. The present study was done with the aim to evaluation of clinical phase student's perception of learning environment of our teaching hospital and comparing it with the previous study and other similar studies of other medical teaching centers in Iran and other countries.
The Persian version of DREEM questionnaire was submitted to clinical phase medical students consisted of stagers and interns educating in internal medicine and infectious diseases, dermatology and urology wards rotations of Razi teaching hospital.
Among 5 domains,the best scored domain by stagers and interns was “student's perception of teachers” (57.75%) and the least scored domain was “student perception of learning“ (52.43%). The total mean score of our study (110.42±19.44) and the mean scores of all 5 domains in our study were higher than previous study. The increase of score in 1 domain: student perception of learning was statistically significant.
The present study shows that our clinical educational environment has improved as perceived by medical students in comparison to previous study, but we need more effort to improve our clinical educational environment to approach to other excellent education centers around the world.

Empathy is a cognitive but not emotional trait that consists of understanding (and not sensing), experiences, concerns and views ofpatients and the capacity to share this understanding. Some medical educationists believe that clinical education may have a negative effect on medical students and residentsempathy and steps should be taken for teaching empathy to medical students.Our main aim in this studywas to assess the status of empathy in Iranian medical educationprogram and how it is taught within this program. In this regard, byinvestigating and studying this program, we found that although there are some brief references to empathy, no proper program has been suggested for reaching this goal. It seems that the medical students’ (and probably other healthcare personals) training programs should be revisedin order to develop implement empathy in Iran’s healthcare system.

Background and Determined outcomes in education are based on the ultimate expectations from the medical graduates.
One hundred and two medical school graduates of the last 4 years of universities located in a city were asked in 2015 to self-evaluate themselves according to 42 expected skill outcomes. These 42 procedures were approved in 2007, by expert panels of Iranian Ministry of Health and Medical Education.
Mean score of 42 procedures according to self-evaluation in overall respondents (n=102) was 11.5±2.1. Just in 31% (13 out of 42 procedures), the scores were in the acceptable range of above 15.
Graduates evaluate themselves weak in 69% (29 out of 42 procedures). If their self-evaluation is real, clarifying the causes might be a key to educational improvement.