فهرست مطالب

Advances in Medical Education & Professionalism - Volume:6 Issue: 1, Jan 2018

Journal of Advances in Medical Education & Professionalism
Volume:6 Issue: 1, Jan 2018

  • تاریخ انتشار: 1396/11/18
  • تعداد عناوین: 8
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  • Joseph Fisher, Rebecca Viscusi, Adam Ratesic, Cameron Johnstone, Ross Kelley, Angela M. Tegethoff, Jessica Bates, Elaine H. Situ-Lacasse, William J. Adamas-Rappaport, Richard Amini Pages 1-5
    Introduction
    Medical students’ ability to learn clinical procedures and competently apply these skills is an essential component of medical education. Complex skills with limited opportunity for practice have been shown to degrade without continued refresher training. To our knowledge there is no evidence that objectively evaluates temporal degradation of clinical skills in undergraduate medical education. The purpose of this study was to evaluate temporal retention of clinical skills among third year medical students.
    Methods
    This was a cross-sectional study conducted at four separate time intervals in the cadaver laboratory at a public medical school. Forty-five novice third year medical students were evaluated for retention of skills in the following three procedures: pigtail thoracostomy, femoral line placement, and endotracheal intubation. Prior to the start of third-year medical clerkships, medical students participated in a two-hour didactic session designed to teach clinically relevant materials including the procedures. Prior to the start of their respective surgery clerkships, students were asked to perform the same three procedures and were evaluated by trained emergency medicine and surgery faculty for retention rates, using three validated checklists. Students were then reassessed at six week intervals in four separate groups based on the start date of their respective surgical clerkships. We compared the evaluation results between students tested one week after training and those tested at three later dates for statistically significant differences in score distribution using a one-tailed Wilcoxon Mann-Whitney U-test for non-parametric rank-sum analysis.
    Results
    Retention rates were shown to have a statistically significant decline between six and 12 weeks for all three procedural skills.
    Conclusion
    In the instruction of medical students, skill degradation should be considered when teaching complex technical skills. Based on the statistically significant decline in procedural skills noted in our investigation, instructors should consider administering a refresher course between six and twelve weeks from initial training.
    Keywords: Clinical skills, Assessment, Medical education
  • Maliheh Khalvati, Hossein Fekrazad, Maryam Rafatjah, Leila Ostadhashemi, Hamid Reza Khankeh Pages 6-13
    Introduction
    Identity is formed through our understanding of ourselves and what others perceive of our actions and how we do things. Formation of professional identity includes development, advancement and socialization through social learning of specific knowledge and skills obtained within the context of professional roles, new attitudes and values.
    Methods
    This qualitative study used content analysis approach to explain the professionalization process of 22 social workers working in 14 public hospitals in Tehran based on their experiences. The data were collected through semi-structured interviews, observation and writing in the field.
    Results
    Eleven categories and three themes of entry into the profession, identity formation, and identity ownership were extracted out of data analysis. Revealing the process, barriers and facilitators of professionalization of hospital social workers was the results of this study.
    Conclusion
    Certain individual characteristics were factors for the tendency of participants to choose this profession. The participants’ understanding of their profession was formed, when studying in the university through learning relevant knowledge,skills, views and professional expectations. Achieving a single identity and professional pride and self-esteem are achievements of identity ownership.
    Keywords: Content analysis, Hospital, Social worker, Professionalis
  • Afsaneh Yakhforoshha, Mandana Shirazi, Naser Yousefzadeh, Amin Ghanbarnejad, Mohammadali Cheraghi, Rita Mojtahedzadeh, Behrooz Mahmoodi-Bakhtiari, Seyed Amir Hossein Emami Pages 14-21
    Introduction
    Communication skill (CS) has been regarded as one of the fundamental competencies for medical and other health care professionals. Student’s attitude toward learning CS is a key factor in designing educational interventions. The original CSAS, as positive and negative subscales, was developed in the UK; however, there is no scale to measure these attitudes in Iran. The aim of this study was to assess the psychometric characteristic of the Communication Skills Attitude Scale (CSAS), in an Iranian context and to understand if it is a valid tool to assess attitude toward learning communication skills among health care professionals.
    Methods
    Psychometric characteristics of the CSAS were assessed by using a cross-sectional design. In the current study, 410 medical students were selected using stratified sampling framework. The face validity of the scale was estimated through students and experts’ opinion. Content validity of CSAS was assessed qualitatively and quantitatively. Reliability was examined through two methods including Chronbach’s alpha coefficient and Intra class Correlation of Coefficient (ICC). Construct validity of CSAS was assessed using confirmatory factor analysis (CFA) and explanatory factor analysis (PCA) followed by varimax rotation. Convergent and discriminant validity of the scale was measured through Spearman correlation. Statistical analysis was performed using SPSS 19 and EQS, 6.1.
    Results
    The internal consistency and reproducibility of the total CSAS score were 0.84 (Cronbach’s alpha) and 0.81, which demonstrates an acceptable reliability of the questionnaire. The item-level content validity index (I-CVI) and the scale-level content validity index (S-CVI/ Ave) demonstrated appropriate
    Results
    0.97 and 0.94, respectively. An exploratory factor analysis (EFA) on the 25 items of the CSAS revealed 4-factor structure that all together explained %55 of the variance. Results of the confirmatory factor analysis indicated an acceptable goodness-offit between the model and the observed data. [χ2/df=2.36, Comparative Fit Index (CFI)=0.95, the GFI=0.96, Root Mean Square Error of Approximation (RMSEA)=0.05].
    Conclusion
    The Persian version of CSAS is a multidimensional, valid and reliable tool for assessing attitudes towards communication skill among medical students.
    Keywords: Communication skills, Attitude, Psychometrics
  • Seyedeh Tahereh Faezi, Kamran Moradi, Ali Ghafar Rahimi Amin, Fatemeh Keshmiri Pages 22-30
    Introduction
    We evaluated the effects of implementing Team- Based Learning (TBL) on student engagement, accountability, satisfaction, and preference for lecture or team-based learning. Moreover, we assessed the effect of TBL on knowledge retention and application over time through short answer questions based on clinical scenarios addressing history taking and diagnosis skills in medical students.
    Methods
    The study was conducted in a quasi-experimental design. The study population were all of the third-year medical students (n=84) participating in a course of rheumatology in Shariati Hospital, which is a teaching hospital affiliated to Tehran University of Medical Sciences. We compared TBL with the conventional lecture-based method. The assessments were performed after implementation of TBL by the Classroom Engagement Survey (CES) and Team-Based Learning Student Assessment Instrument (TBL-SAI). The assessment for application of knowledge was conducted in 3 time-points through short answer questions on rheumatic diseases. The comparison of results was made by Student’s t-test and repeated-measures analysis of variance (RMANOVA) using SPSS software, version 16.
    Results
    The CES scores indicated a high level of engagement in TBL (Mean±SD=26.7±3.70, p=0.0001) but not in the lecture-based sessions (Mean±SD=23.80±4.35, p=0.09). The total mean score (SD) for TBL-SAI was 159.68 (14.14) for TBL sessions indicating a favorable outcome (p=0.0001). The student scores obtained from the short answer questions showed that over time the students’ scores had declined significantly less for the TBL sessions in comparison to the lecture-based sessions, F (2, 166)=4.624, p=0.011.
    Conclusion
    The results indicated higher student engagement, satisfaction and long term learning by TBL.
    Keywords: Learning, Team-based learning, Outcome
  • Zeinab Jamalabadi, Sedigheh Ebrahimi Pages 31-36
    Introduction
    Recognition of professional and unprofessional behaviors is the most important and fundamental factor which affects the relationships between the doctors and patients. Therefore, in order to progress in their professional life, doctors are supposed to understand and follow these behaviors.
    Methods
    This is a cross-sectional, descriptive analytical study. All students in teaching hospital of Shiraz University of Medical Sciences were eligible to participate (374 individuals with census method). The data were collected using a questionnaire containing 29 questions about the concept of medical professionalism. Here, participation of medical students in unprofessional behaviors and the relevance of this participation with the perception of these behaviors were considered. Data were analyzed through SPSS version 15, using descriptive statistics, t-test and Pearson correlation test.
    Results
    According to the obtained data, despite the fact that all students (140 students in the junior and 234 in the senior years as interns) had passed the course of professionalism (95.7%), the perception of unprofessional behaviors between the two groups was significantly different (p
    Conclusion
    Medical students’ perception of unprofessional behaviors as acceptable may increase their participation in these behaviors. Thus, medical policy makers should consider approaches beyond simply providing ethical and professional guidelines or policies, and students should be regularly evaluated for their activities; their professional behaviors should be evaluated in order to temper them, when appropriate.
    Keywords: Professional, Behavior, Perception, Teaching, Hospital, Medical student, Clinical medicine
  • Zahra Derakhshandeh, Mitra Amini, Javad Kojuri, Marziyeh Dehbozorgian Pages 37-42
    Introduction
    Clinical reasoning is one of the most important skills in the process of training a medical student to become an efficient physician. Assessment of the reasoning skills in a medical school program is important to direct students’ learning. One of the tests for measuring the clinical reasoning ability is Clinical Reasoning Problems (CRPs). The major aim of this study is to measure psychometric properties of CRPs and define correlation between this test and routine MCQ in cardiology department of Shiraz medical school.
    Methods
    This study was a descriptive study conducted on total cardiology residents of Shiraz Medical School. The study population consists of 40 residents in 2014. The routine CRPs and the MCQ tests was designed based on similar objectives and were carried out simultaneously. Reliability, item difficulty, item discrimination, and correlation between each item and the total score of CRPs were all measured by Excel and SPSS software for checking psycometeric CRPs test. Furthermore, we calculated the correlation between CRPs test and MCQ test. The mean differences of CRPs test score between residents’ academic year [second, third and fourth year] were also evaluated by Analysis of variances test (One Way ANOVA) using SPSS software (version 20)(α=0.05).
    Results
    The mean and standard deviation of score in CRPs was 10.19±3.39 out of 20; in MCQ, it was 13.15±3.81 out of 20. Item difficulty was in the range of 0.27-0.72; item discrimination was 0.30-0.75 with question No.3 being the exception (that was 0.24). The correlation between each item and the total score of CRP was 0.26-0.87; the correlation between CRPs test and MCQ test was 0.68 (p
    Conclusion
    The results of this present investigation revealed that CRPs could be reliable test for measuring clinical reasoning in residents. It can be included in cardiology residency assessment programs.
    Keywords: Cardiovascular, Clinical reasoning, Reliability
  • Ehsan Shamsi Gooshki, Ata Pourabbasi, Hamid Akbari, Nima Rezaei, Ali Arab Kheradmand, Zahra Kheiry, Niloufar Peykari, Fatereh Momeni Javid, Firouzeh Hajipour, Bagher Larijani Pages 43-48
    Introduction
    Academic institutions are the most important organizations for implementation of internationalization policies and practices for integrating an international, intercultural and global dimension in higher education system. Also, a globally increasing demand for higher education has been seen in the past two decades so that the number of students enrolled in higher education institutions in the worldwide nation-states has increased dramatically. The National Plan of International Development of Medical Education was designed with the aim of identifying available potentials in all the universities of medical sciences, encouraging the development of international standards of medical education, and planning for the utilization of the existing capacity in Islamic republic of Iran.
    Methods
    Authors have tried to review the several aspects of international activities in higher education in the world and describe national experiences and main policies in globalization of medical education in Iran within implementation of the National Plan for Development and Innovation in Medical Education.
    Results
    The findings of some global experiences provide the policy makers with clear directions in order to develop internationalization of higher education.
    Conclusion
    The Program for International Development of Medical Education was designed by the Deputy of Education in the Ministry of Health and the effective implementation of this Program was so important for promotion of Iranian medical education. But there were some challenges in this regard; addressing them through inter-sectoral collaboration is one of the most important strategies for the development of internationalization of education in the field of medical sciences.
    Keywords: Medical education, Higher education, Innovation
  • Diya Kapila Pages 49-50
    The importance of role models in medical education cannot be understated. They allow for professional development, aid in career motivation and inspire and educate through example. Unfortunately, I cannot admit knowing more than three female role models throughout my time at medical school, and now as a final year student, I am more disappointed than ever for this deficit.
    My admiration and respect for doctors remains sky high, but from the age of 15, I remember being put off and discouraged from a career in medicine. My first work experience placement was met with disgruntled medicalstudents and doctors warning me to ‘steer clear’ of this career choice. Notably, female doctors would state their reservations about whether they could adequately bring up a stable family together with the demands of this profession. This was an extremely frustrating resolution for me to see as a young, inspired medic- who passionately felt I would work hard to do both. I sought to find out more about the challenges for women in medicine.
    There lies no dispute that having a stable family life and successful career is no easy feat for women. Yet, the mere choice between a family and/or career is far more intricate than it may seem; it is really a question exploring personal life priorities, resolute character traits and, most importantly, equal gender opportunities and the necessity for greater support for women with families (1).
    Gender equity and empowerment are inextricably linked to a woman’s entitlement and contribution to the workplace. Evidently, the endless unpaid hours of bringing up a family need greater recognition- arguably a full time job in itself; some people still don’t deem the demanding work of a mother as a career- illustrated by Catherine Deveny’s Guardian article (2). Women are often invited to defend their life choices, or fulfil gender expectations. Maybe, as women we need to alter our own insight into what it means to be a successful career woman and mother. What defines doing ‘well’ when describing family life, a subjective word for such a prevalent aspiration.
    The deplorable deluge of negative headlines after the report from the Royal College of Physicians (2009) stating women will predominate the workforce in 2017 inflamed public perception with assertions including, “Women docs weaken medicine” (3). This was a shocking flavour of negativism for women in medicine- and added to both my curiosity and anger at the situation.
    The apparent vulnerability of women is particularly evident amongst certain geographical populations; for example, in Iran, there are palpable traditional differences between genders, rendering unequal social rights, salaries and employment opportunities (4), with further significance on health status. Article 158, of the Third Development plan, instigated a resolute initiative for increasing awareness and incorporation of women in society, which included the promotion of job opportunities for women (5). Furthermore, accessibility of advanced surgical training is highly limited, with Dr Sakineh Pari, born in 1902, being the first Iranian female surgeon (6). Despite the evolution of greater gender equality in Iranian medical employment, it is clear that we need further progress towards true equality.
    I want to pose a note of reflection: why do these negative perceptions still exist even in 2017? We need to act now to ensure the women of the future have confidence that they can both cultivate a great family and career; it is possible, with the appropriate communication, support and flexibility that are essential to both motherhood and top career posts, especially within countries where gender inequalities are rife.