clinical practice

One of the main problems in medical and paramedical fields is the lack of alignment and gaps between theoretical knowledge and practical competencies of the graduates. The gap between theoretical education and clinical performance has been an important issue of concern for professors, staff, and students. Therefore, the present study was conducted with the aim of investigating solutions to reduce the gap between theoretical knowledge and clinical performance in the operating room field.

 The present research is a descriptive-analytical study of the cross-sectional type that was conducted in the form of a census of 132 operating room students of Birjand University of Medical Sciences in 2020-2021. The data collection tool was a researcher-made questionnaire that, after verifying the validity and reliability, investigated ways to reduce the gap between theoretical knowledge and the quality of clinical practice in seven domains. After collecting the data, it was analyzed through descriptive and analytical statistics including independent t-test, Pearson's correlation coefficient, and one-way ANOVA.

The results showed that among the examined areas, the domains of ​​theoretical professor with an average of 2.17 ± 0.73, and educational planning with an average of 2.17 ± 0.79 are the most important among the solutions to reduce the gap between theoretical knowledge and the quality of clinical practice.

Taking appropriate strategies in the dimensions of instructor and educational planning to eliminate or reduce the gap between theoretical knowledge and clinical performance in the operating room field seems necessary.

Except for the palms and soles, the majority of the human skin surface is covered by hair follicles (HF). Hair follicles mostly produce thin and tiny hair stalks that are hardly visible to the naked eye and have a diameter of less than 30 micrometers, which are called unwanted hairs. Other human HFs, which have a lower percentage than the previous type, produce thicker hair shafts with a diameter of 60 µm, known as terminal hairs, and are located in androgen-dependent areas such as the scalp, armpits, and pubic areas. Unlike other mammals, the role of human hair in thermal and shock insulation is insignificant, and the most likely main role of hair follicles in human skin is not the production of hair stems, but participation in functions such as skin homeostasis and wound healing response to surface skin damage. Easy access to hair follicles in humans and their unique feature in the cycle of self-destruction and self-renewal make this microorganism very valuable for stem cell biologists. Hair follicle stem cells (HFSCs) are located in the protruding region of the external root sheath and dermal papilla of the hair follicle and are considered slow cycle cells that have the potential of multilineage differentiation and high proliferation capacity. The normal morphology and periodic growth of HFSCs play an important role in normal skin function, wound healing and skin regeneration. Hair follicle is a powerful enhancer for wound healing, but the application of this new idea in clinical practice is still in its early stages.

Despite the importance of clinical evaluation in performance-oriented fields of medical sciences, this field is still facing a challenge, one of the most important obstacles of which is the lack of familiarity with the evaluation goals of tools or methods and criticism of these tools and methods. The present study was conducted with the aim of introducing the tools and procedures for evaluating the clinical performance of medical students and the advantages and limitations of each of these tools and methods.

This systematic review is based on PRISMA 2020 guidelines and by searching for evidence in external and internal databases PubMed, Web of Science, CINAHL, Irandoc, Magiran and SID and Google scholar search engine using the keywords Clinical performance, Clinical evaluation, Clinical appraisal, Clinical examination, OSCE, Assessment tool, assessment standards, clinical assessment practices, medical sciences students and their Persian equivalents were carried out until 2023. The inclusion criteria included: high-quality articles (based on the risk of bias tools, ROB 2 and STORBE), English or Persian language, descriptive, quasi-experimental and interventional studies, qualitative or letter to the editor, studies focused on clinical evaluation methods or tools, and full-text studies. Finally, the clinical performance evaluation tools and methods extracted from the evidence were summarized and categorized.

A total of 2031 article titles were determined, after screening and removing duplicates, 22 articles were included in the study for final analysis. The most common tools of evaluating students' clinical performance included: 1- structured observation and assessment of clinical performance (SOAP) (n=126), 2- Competency Inventory of Nursing Students (CINS) (n=4) and 3- Clinical Nursing Competence Questionnaire (CNCQ) (n=3). Also, the most common methods of evaluating students' performance and clinical skills included: 1- Objective structured clinical examination (OSCE) (n=2166), 2- Logbook (n=722) and 3- Direct observation of procedural skills (DOPS) and Mini Clinical Evaluation Exercise (Mini-CEX) (n = 53) that each of these tools and methods has unique objectives, advantages and limitations.

Considering the purpose of evaluation, psychometric characteristics, and the advantages and limitations of each method or tool, each or a combination of them can be used to evaluate students. Of course, it is suggested to modify these methods and tools by conducting studies in a way that is more practical for the clinical evaluation of students and facilitates its use.

The quality of nurses' clinical performance has always been one of the concerns of the health system. Therefore, the aim of this study was to determine the relationship between information literacy and clinical performance of nurses working in special departments of selected hospitals of Tehran University of Medical Sciences in 1402.

The current research is descriptive-cross-sectional and is a type of correlational study. The statistical population of this research includes nurses working in the special departments of Imam Khomeini Hospital Complex affiliated to Tehran University of Medical Sciences. In this research, 265 questionnaires were analyzed, descriptive statistics such as absolute and relative frequency and mean and statistical tests such as Pearson's correlation coefficient were used in SPSS software version 25 for data analysis. The tool for data collection was a three-part questionnaire including personal information, level of information literacy and measuring the quality of health care provision.

The results showed that the majority of the studied units had average clinical performance, and the information literacy of the participants was weak and moderate. The average performance score of the research units was 59.3±11.3 and their average information literacy was 53.3±7.2. The results of the present study showed that there is a significant positive relationship between information literacy and clinical practice (P < 0.05) as well as a significant relationship between information literacy and the areas of clinical judgment, care activities, clinical review and facilitation in learning clinical practice.

The results showed that there is a significant relationship between information literacy and nurses' clinical performance. Information literacy is a comprehensive element in the clinical practice of nurses, and in fact, improving information literacy is necessary to improve the clinical practice of nurses.

Improving the knowledge and Practices of the residents has a significant impact on the quality of care provided by them. this study was conducted with the aim of determining the knowledge and practice of Residents of Bushehr Province Regarding Risk factors of cardiovascular diseases and their prevention strategies in Bushehr province in 2016.Practice.

This is a descriptive-analytical cross-sectional study. The researched population was the Residents in the health centers of Bushehr province (391 people) who were included in the study by census method.  The demographic information, knowledge, and practices questionnaires were used by the self-report method. After entering the SPSS 19 statistical software, the data were analyzed using Descriptive and analytical tests (Mann-Whitney, Kruskal-Wallis, and Pearson correlation coefficient).

The Results showed that 62.42% (244 people) people had good knowledge, 35.54% (139 people) had average knowledge, and 2.04% (8 people) had poor knowledge. Also, most of the people had good performance, 86.68% (338 people), 10.74% (42 people) had average performance, and 2.58% (11 people) had poor performance. The lowest and highest knowledge and practice are in the area of (smoking and blood pressure) and (smoking and diabetes).

Our study showed that the average score of the knowledge and practices of residents regarding the control of cardiovascular disease is higher than the average score. Considering the priority of educational needs in the field of knowledge and practices, which is related to the knowledge of Residents about the risk factor of tobacco and the Practices of Residents in the field of encouraging patients to be more physically active, Therefore, it is recommended to design and implement retraining courses for the prevention of cardiovascular diseases and the risk factors.

The coronavirus pandemic has caused fear and anxiety worldwide, especially amongst nurses. Examining the psychological effects of this disease on the mental health of nurses involved in the care of patients with this infection is critically important. This study aimed to investigate the relationship between the nurses’ psychology capital and their views on mental security, job satisfaction and clinical performance.

One hundred consenting nurses from a university general hospital in Arak, Iran, completed three well-established questionnaires that asked about their psychology knowledge, views on mental security and clinical performance. The data were analyzed statistically, using confirmatory factor analysis and partial least squares method. Also, the path analysis test, t-test and regression beta coefficient were used to test the study’s four hypotheses on psychological capital and security.

The findings indicated that there were significant relationships, based on the theoretical model, amongst the nurses’ views on their psychology knowledge (or capital) and that it had a positive and significant effect on nurses' psychological security for working with COVID-19 patients. Also, the knowledge positively impacted their clinical performance and professional efficacy, while improving their sense of optimism, patience and hope for future.

There were positive interactions between the nurses’ psychological capital and the clinical performance, mental security, optimism and hope. Nurses with psychology capital had less worries on these subjects than those who lacked it. Such nurses believed they were more resourceful and able to provide better care to patients with coronavirus infection than those who lacked the knowledge.

The mismatch between theoretical training and clinical practice leads to a decline in the quality of clinical service. This study aimed to investigate the strategies which reduce the gap between theoretical knowledge and clinical practice from the viewpoint of students.

This Descriptive - cross - sectional study was performed in winter 2021 on 330 medical, nursing, midwifery, operating room and anesthesia students of Jiroft University of Medical Sciences. The participants were selected through census sampling and the data were collected using a questionnaire with the focus on the gap between theoretical knowledge and clinical practice. The data were analyzed using statistical measures such as mean and standard deviation, along with t-tests and Pearson correlation coefficient at the inferential level.

In the areas under study, factors related to the students, educational planning and the instructors were ranked first to third respectively. Among the factors related to professors and instructors, “clinical experience of professors and instructors” (mean 2.50± 0.90), among the factors related to the students, “interest in the field of study” (mean 2.87 ± 0.88) and among the factors related to planning, “the specificity of the clinical curriculum” (mean 2.47± 0.92), were introduced as the most significant factors affecting the reduction of theoretical and practical knowledge of students.

Numerous factors are effective in reducing the gap between theoretical and practical knowledge in medical education. Therefore, it is recommended that these factors be considered by education officials to educate medical students in the most optimal way.

 

Nursing students usually experience incivility in the clinical environment and in relation to nurses. The aim of this study was to determine the incivility of staff nurses towards baccalaureate nursing students of Hamadan University of Medical Sciences.

In this descriptive-analytical cross-sectional study, 330 undergraduate Nursing students of Hamadan University of Medical Sciences were enrolled in the census method in 2021. To collect information, a two-part questionnaire was used, the first part of which included demographic characteristics and the second part was the Iranian version of Uncivil Behavior in Clinical Nursing Education tool. Data analysis was performed by SPSS software version 24 and t-test and analysis of variance.

Based on the results, in general, the mean of non-civility behaviors was 11.76±10.60. There was a statistically significant difference between the mean scores of incivility behaviors towards students with age, academic semester, internship department and grade point average (P<0.05).

Based on the findings, students reported the most incivil behaviors of nurses in the dimension of deprivation behaviors such as being ignored and not being allowed to participate in care decisions, which shows the difference between the actual and expected views of nursing students about Support and respect in the clinical setting.

Although clinical research and clinical practice are closely related, distinguishing the boundaries between them is an important issue debated by contemporary bioethicists. Some commentators have criticized drawing a sharp line between research and practice (1, 3 & 4), but most experts and policy makers in the field of biomedical ethics, believe that the distinction between the two in clinical settings leads to increased scientific credibility of research and greater protection of patientschr('39') rights and safety (2, 18). They argue that blurring the boundaries between clinical practice and clinical research is an ethical mistake (6, 7). Despite significant efforts that have been undertaken in recent years to implement and enforce research ethics in Iran, the need to training in the field of basic concepts of research ethics and ethical justifications for the codes and guidelines of research ethics exists yet.  The purpose of this study is to address this gap in the literature. The first part of this paper deals with a brief history of research ethics that gave rise to the formation of boundaries debates and led to the publication of the Belmont Report. Then, a set of relevant definitions and criteria required to conceptually and practically distinguish between research and clinical practice are presented. Finally, the ethical dimensions of this distinction are reviewed as an argument in favor of the moral requirement to maintain the boundaries between clinical research and clinical practice for the various parties involved in clinical research.

Relevant publications were selected through a MEDLINE search. The key phrases used were clinical research or clinical practice plus distinction, boundaries or distinguishing. The main textbooks of research ethics and medical ethics, both electronic and paper types, were included in the search. International and national research ethics documents and guidelines were obtained via the organizational websites. 

This study has yielded several results with possible implications for the different parties involved in clinical research. First, through a close look at the nature of unethical human research studies that took place in the 1970s and prompted the U.S. policymakers to rethink research ethics governance and gave rise to creation of the Belmont Report (5, 8), it can be concluded that the mere issuing of research ethics guidelines in the absence of ethical oversight of research leads to a failure in protection of human subjects in clinical research. Recognizing and maintaining a sharp boundary between research and practice is the basic requirement of a thorough research oversight and providing precise definitions for the terms, clinical research and clinical practice, is the prerequisite to distinguish this boundary (14). Secondly, Activities that are designed initially with the aim of producing or contributing to the production of “generalizable knowledge” and have the form of a research methodology that have been described in an research proposal and have been scientifically (14, 15), methodology and ethically validated can be labeled as research. These research activities are deemed clinical research If they involve a human participant (7, 13). Such interventions that are intended to increase the well-being of a patient without undergoing a peer-review, although considered to generate “new knowledge”, are still considered as clinical practice because the knowledge gained is not generalizable, even though new (7). Thirdly, the issue of research-practice distinction can be discussed from various ethical aspects. On the practical level there are several issues involving both the physician/researcher and the patient/research participant. The roles and responsibilities of the physician and that of the researcher cannot be a single set of roles and responsibilities, as these two roles each have their own moral implications and duties, which may be in conflict at times (17, 18). Clinicians are committed to make clinical decisions according to the best interests of the patients, while researchers commit themselves to the research protocol (2, 6, and 7). Adopting distinct approaches to clinical research and clinical practice will also help physicians better distinguish their dual role of physician and researcher and manage potential conflicts of interest. Blurred boundaries between research and practice also leads to therapeutic misconception for Patients /research participants. Therapeutic misconception is a situation in which patients do not recognize that they are participating in a clinical research although being disclosed by the clinician/researcher (19). The therapeutic misconception may also occur to the minds of the clinicians, and the result is their reluctance to disclose to the patients that they are participating in a clinical research, when feeling far from regulatory agencies.  As research interventions are often unapproved, they pose an increased risk to research participants, as well as additional burden and cost. So, failure to understand the research process seriously infringes the patients’ rights to safety, quality care, and autonomy (10). How research and practice are distinguished also affects the actions taken on the policy level. It is of great importance that research ethics committees and policy making bodies make distinction between research and practice in clinical settings. Historically the most important trigger to acknowledge the issue of separate clinical research and clinical practice was the need to clearly define which activities should undergo oversight in the clinical realm where the professional norms does not require oversight on the practice of licensed clinicians (6). The general rule originally stated in the Belmont report is that whenever there is a research component in an activity, that activity should be monitored for the protection of human subjects (14). National Research ethics guidelines play an important role in shaping the attitudes of different parties involved in clinical research, toward their roles and responsibilities in research. As research ethics scholars have argued, using the notion of “therapeutic research” in the early versions of the declaration of Helsinki by the World Medical Association led to a "misunderstanding" in clinical research ethics and the violation of patientschr('39') rights (1). Although “therapeutic research” was a common concept in the classical research community, but also was reinforced by policy-making institutions; this conceptual error according to Howard Brady, an expert in the field of medical ethics, had prevented a correct and ethical understanding of "research with human subject" for years (11). A review of national biomedical research ethics guidelines issued by the “National Committee for Ethics in Biomedical Research” at the Iranian Ministry of Health and Medical Education, reveals a lack of basic definitions and clarifications. In some instances, like in the “General ethics guidelines for medical research including human subjects,” some provided definitions increase the ambiguity; however, some criteria for distinguishing between research and practice can implicitly be derived from the text. Codes number 10, 11, 26, and 28, which explain the researcherchr('39')s ethical responsibilities toward the participants - a responsibility that is not defined for clinicians- implicitly set out the criteria for research-practice distinction (16).

The issue of boundaries between research and practice in clinical settings is ethical in nature.  Although considerable efforts have been made to develop national biomedical research ethics guidelines in Iran, a comprehensive approach to providing the definitions of basic concepts and the underlying theoretical framework in the field of biomedical research ethics still seems lacking.

 Despite the increasing number and quality of dental research, many dentists are not adequately informed about the results of the studies and don’t use it at clinic. The aim of study to evaluated obstacles in use of research results from the perspective of dental specialists of Shahid Sadoughi University of Medical Sciences in Yazd.  In this descriptive cross-sectional study, all dental specialists of the faculty member of Shahid Sadoughi University of Medical Sciences in Yazd in 2016 were studied by census method. 57 people were evaluated. Data were collected by a questionnaire,that consisted of demographic information and 22 items derived from the Funk questionnaire, measured by 5 scale Likert. Data were analyzed by SPSS 17 software and descriptive statistics.  Participation rate was 100%. Among the different domains of not being possible to use the results in the clinic, the area of communication and access to research findings with a mean and standard deviation of 21.42±3.04 and among the barriers, the lack of a plan by the relevant authorities to apply the results of the research in operation with the mean and standard deviation of 4.09±0.80 were the most important domain and most important barrier respectively.   In order to increase the application of the results of research into clinical practice, many efforts are needed to establish a systematic program with continuous follow up by relevant authorities and to increase the scientific ability and confidence among professors, dental students and graduates of this field.