فهرست مطالب

  • Volume:7 Issue:4, 2019
  • تاریخ انتشار: 1398/07/24
  • تعداد عناوین: 10
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  • ISSAM TANOUBI*, IHEB LABBEN, SALMA GUÉDIRA, PIERRE DROLET, ROGER PERRON, ARNAUD ROBITAILLE, MIHAI GÉORGESCU Pages 159-164
    Introduction

    Experiential learning, followed by debriefing, is at the heart of Simulation-Based Medical Education (SBME) and has been proven effective to help master several medical skills. We investigated the impact of an educational intervention, based on high-fidelity SBME, on the debriefing competence of novice simulation instructors.

    Methods

    This is a prospective, randomized, quasi-experimental, pre- and post-test study. Sixty physicians without prior formal debriefing expertise attended a 5-day SBME seminar targeted on debriefing. Prior to the start of the seminar, 15 randomly chosen participants had to debrief a spaghetti and tape team exercise. Thereafter, the members of each team assessed their debriefer’s performance using the Debriefing Assessment for Simulation in Healthcare (DASH)© score. The debriefing seminar that followed (intervention) consisted of 5 days of teaching that included theoretical and simulation training. Each scenario was followed by a Debriefing of the Debriefing (DOD) session conducted by the expert instructor. At the end of the course, 15 randomly chosen debriefers had to debrief a second tower building exercise and were re-evaluated with the DASH score by their respective team members. The Wilcoxon signed-rank test was used to compare pre- and post-test scores. Statistical tests were performed using GraphPad Prism 6.0c for Mac.

    Results

    A significant improvement in all items of the DASH score was noted following the seminar. The debriefers significantly improved their performance with regard to “maintaining an engaging learning environment” (Median [IQR]) (4[3-5] after the pre-test vs. 5.5[5-6] after the post-test, P<0.001); “structuring the debriefing in an organized way” (5[4-5] after the pre-test vs. 5[5-6] after the post-test, p=0.002); “provoking engaging discussion” (4[3-5.75] after the pre-test vs. 6[5-6] after the post-test, P<0.001); “identifying and exploring performance gaps” (5[4-6] after the pre-test vs. 6[5-6] after the post-test, P=0.014); and “helping trainees to achieve and sustain good future performance” (4[3-5] after the pre-test vs. 6[5-6] after the post-test, P<0.001).

    Conclusion

    A simulation-based debriefing course, based mainly on DOD sessions, allowed novice simulation instructors to improve their overall debriefing skills including, more specifically, the ability to foster engagement in discussions and maintain an engaging learning environment.

    Keywords: Faculty, Learning, Feedback
  • ZAHRA ABEDINI, SOROOR PARVIZY* Pages 165-173
    Introduction

    Academic incivility is one of the major concerns among nursing student that disrupts the learning process and influences the quality of nursing care. Investigating a useful strategy can be a crucial action in reducing the problem. The purpose of this study was to evaluate the nursing student’s perceptions of using scenario-based education to improve civility.

    Methods

    An explanatory mixed method approach was employed. Nursing students who were studying in the second and third years participated in research (N=81). Eight sessions were designed for discussion regarding the scenarios that were directed by a faculty leader. Changes in the students’ perception were evaluated four weeks after the sessions by a questionnaire. Data were analyzed using paired t-test and calculation of mean scores. Ten focus groups were conducted and content analysis identifed two themes and four subthemes. Both the qualitative and quantitative data were analysed separately and the findings were merged in the discussion.

    Results

    There was a significant difference between the student’s perceptions for the perceived level and occurrence rate of incivility before and after the intervention (P<0.05). The major themes found included awareness of the importance of incivility and capability to change uncivil behavior. The results from the mixed method study showed that the program increased awareness and capability to change uncivil behaviors.

    Conclusion

    This research provided an extended understanding of the outcomes of the scenario- based education on nursing student’s perceived behaviors and strengthened their beliefs and capabilities about civil behaviors. It can be applied as an effective strategy to raise the perception of the program value and use.

    Keywords: Incivility, Scenario, Problem based, Nursing student, Education
  • MOHAMMAD REZA MANSOORIAN, MOHAMMAD JALILI, SHAHLA KHOSRAVAN, MOHAMMAD SHARIATI* Pages 174-181
    Introduction

    Learning procedural skills is one of the essential aspects of undergraduate medical education. However, learning procedural skills in clinical settings is less widely considered. This study aimed to explore the Iranian undergraduate medical students’ perception of learning procedural skills and its outcomes in three universities of medical sciences in Iran.

    Methods

    A descriptive exploratory qualitative methodology with an in-depth unstructured, face-to-face interview, and content analysis was used in this study. Sixteen students in clinical phases of general medical education programs from educational hospitals were selected using purposive sampling. According to the preferences of the participants, the interviews were conducted in medical schools or in hospitals.

    Results

    The students participating in this study included 7 females and 9 males (totally 16 people) with a mean age of 23.7 years old with a range of 21-27 years. The three main themes of this study were “the gap of transferring formal teaching from skill lab to clinical placement”, “learning self-leading procedural skills in clinical settings”, and “students’ dissatisfaction with patients’ vulnerability” with 8 subthemes which were extracted and explained based on the students’ perception.

    Conclusion

    Unsupervised and self-learning by medical students and weakness in controlling the learning process have undesirable results for patients and students

    Keywords: Skills, Learning, Qualitative research, Medical students
  • SOOLMAZ ZARE, NIKOO YAMANI*, TAHEREH CHANGIZ Pages 182-189
    Introduction

    Medical professionalism as a main ability of physicians is very important just like its teaching and learning. This study investigated medical professionalism experts’ perspectives and experiences about professionalism as a step towards developing a medical professionalism curriculum.

    Methods

    A qualitative approach was adopted for this study. The data were obtained from 10 semi-structured interviews with medical professionalism experts with a variety of experiences in Iran between June and September, 2016. All sessions were audio-recorded, transcribed and analyzed using inductive content analysis.

    Results

    The participants expressed their experiences on professionalism and its features. The data analysis revealed two main categories: 1) teaching and learning strategies including three categories of learning outcome, teaching and learning and evaluation of medical professionalism, 2) role of context with three sub-categories of rules and regulations to develop professionalism, strengthening the hidden curriculum and executive resources.

    Conclusions

    To address the development of professionalism in medical students, the main factors, i.e., teaching and learning strategies and context with their categories and subcategories should be considered and revised. To sum up, designing a formal medical professionalism curriculum would be necessary and the notion of professionalism must be integrated with all its phases. Employing effective learning and assessment methods by means of qualified teachers and staff in a supportive learning environment provides students with valuable experiences and facilitates the process of teaching.

    Keywords: Professionalism, Medical professionalism, Curriculum
  • SHAHABEDDIN ABHARI, HOSSEIN MONEM, ALI GARAVAND, PEIVAND BASTANI, Rita Rezaee* Pages 190-203
    Introduction

    Today, progressing science and technology at all domains, including education and research, will bring new opportunities to resolve the communication and interaction problems. The aim of this study was to determine potential factors affecting the thesis supervision and provide a web-based solution.

    Methods

    This is a developmental study conducted in two theoretical and technical phases at the Shiraz University of Medical Sciences in 2017. The theoretical phase was performed in three stages, including literature review and investigating the existing studies and Delphi’s study based experts’ view as well as identifying the thesis supervision status based on 200 postgraduate students’ point of view. The technical phase had two stages, including to draw processes and to design the physical and logic schemes of the system. The Thesis Tele-Supervision software named SAHPAD was designed by C# and ASP. NET programing languages.

    Results

    The results showed that out of 40 potential factors specified at the first stage of theoretical phase by using experts’ opinion, 13 items were selected as the main factors. According to the results obtained from the students’ views at the third stage, the factor of “accessibility” had the minimum score, i.e. 3.15 mean of four, which was the worst status.

    Conclusion

    The designed system covered from the beginning to the end of the thesis workflow at its electronic frame with its various capabilities such as the interaction of the research team to decide the title, draft the proposal, prepare for thesis defense,etc.

    Keywords: Distance education, Medical education, Educational technology, Software
  • ALI ASGHAR HAYAT, KARIM SHATERI* Pages 204-211
    Introduction

    Metacognitive strategies play an essential role in students’ learning and achievement; therefore, identifying their antecedents should be considered. This study indicated how self-efficacy, as motivational beliefs, affects the meta-cognitive strategies of medical students using a SEM approach.

    Method

    The present study was a quantitative cross-sectional research design, using a Smart-PLS 3 approach in which 225 medical students at Shiraz University of Medical Sciences were selected, using simple random sampling. Pintrich and De Groot’s (1990) students’ self-efficacy for learning and performance questionnaire and metacognitive learning strategies questionnaire developed by Dowson and McInerney (2004) were used to collect data. The collected data were analyzed using SPSS 21 and PLS 3 software.

    Results

    The validity and reliability of research questionnaires were confirmed by confirmatory factor analysis. The results showed self-efficacy had a positive and significant relationship with planning (r=0.24, P<0.001), monitoring (r=0.30, P<0.001) and regulating (r=0.31, P<0.001). Furthermore, self-efficacy had direct, positive and statistically significant effect on metacognitive learning strategies (β=0.42, P<0.001).

    Conclusion

    The findings suggest students who believe they are capable to learn and to do their academic tasks are more effective in adopting meta-cognitive strategies to achieve learning objectives than students who do not maintain such optimistic beliefs. Therefore, it is recommended that the officials of Shiraz University of Medical Sciences provide opportunities for strengthening the students’ self-efficacy and metacognitive learning strategies through providing training courses. In these courses students should be explicitly instructed how a specific learning strategy is adopted, why it is important and when and how it applies to the specific task

    Keywords: Self-efficacy, Meta cognition, Medical students
  • BEATRIZ NISTAL NUÑO* Pages 212-218
    Introduction

    Many criteria such as USMLE scores, applicant resumes, Dean’s letters, recommendation letters, personal discussions, interview scores and medical school transcripts can be used to predict the success of a medical trainee in the USA. This information is either relatively objective, or subjective. It would be valuable if we had some objective measures that might predict a successful resident performance early in the process or on the other side to allow remediation or redirection. Actual performance of a resident or fellow is based upon his or her ability to execute sound judgments within the complex healthcare setting. The Hartman Value Profile (HVP) evaluates the structure and the dynamics of an individual value system. This study has the primary goal of determining whether specific indices on the HVP correlate with the management’s evaluation of the residents established by the Department of Anesthesiology at Yale University.

    Methods

    The protocol developed uses univariate correlations between residents’ HVP subscales and their performance scores, which will be determined with the Pearson correlation coefficient or Spearman rank coefficient as appropriate. Demographic and clinical variables will be reported descriptively. A two-sided alpha value of 0.05 will be used for identifying statistically significant findings.

    Conclusion

    The potential benefits are that obtaining specific indices on the HVP would enable management to better engage and work with residents. Experience gained from incorporating the HVP into the residency selection process suggests that it may add objectivity in predicting resident performance during training. Given the potential impact, it could be implemented as an adjuvant tool to the traditional evaluation process.

    Keywords: Correlation, Educational assessment, Judgment
  • DINESH KUMAR. V*, ANEESH BASHEER Pages 219-222

    Although mentoring has been regarded as an essential component in the developmental phase of medical students, it is the nature of hierarchical relationship and the quality of emotional exchange which determine its sustainability. With great enthusiasm, we had launched our mentoring program for the new entrants of our medical school. After an initial faculty development workshop on mentoring, we framed our guidelines for implementing the program. To measure the relationship satisfaction on both sides and self-efficacy, we used relationship satisfaction scales. As the winds offered us the beginner’s fortune, our program went on well for the first six months. Slowly, the colour of the mentorship program began to fade. Students began to find excuses for not meeting their mentors and the sessions truncated into a “hay- how do you do – bye” meetings. Through this commentary, we would like to introspect the factors which would have dampened the interest. Would it be the asynchronous agency support or lack of motivation / self-efficacy or roadblocks in Communication Bridge or lack of adequate matching or lack of need? The outcomes of our introspection would be of help for others who run the mentorship programs or who wish to install in their own institutes.

    Keywords: Mentoring, Medical school, Medical students
  • FATEMEH BAKOUE*I, SHABNAM OMIDVAR, SEYED JALIL SEYEDI ANDI, SAREH BAKOUEI Pages 223-228
    Introduction

    Universally, the number of students attending the university education is high and increasing. The future of academic graduates is affected by their academic achievement. The purpose of the research was to assess the correlation among academic achievement and healthy lifestyle behaviors in university students.

    Methods

    This cross-sectional research was conducted on 262 university students studying in the selected faculties of Babol University of Medical Sciences based on multi stage sampling technique. The students were categorized to low and high academic achievement groups according to grade point average (GPA) score at the end of the semesters. The health-promoting lifestyle profile with six domains was applied to determine healthy lifestyle behaviors. To investigate the adjusted correlation among the health promoting lifestyle’s domains and academic achievement, the multi-variable logistic regression was used.

    Results

    The average age of the university students was 21.36 ± 2.28 years. According to the results, some domains of healthy lifestyle behaviors between the low and the high academic achievement groups were different significantly. The results demonstrated that the spiritual growth (the only domain of healthy lifestyle behaviors) (P=0.002) and living situation (P=0.043) were significant factors affecting academic achievement.

    Conclusion

    The findings suggest that the public health and education professionals should try to improve the students’ academic achievement through holding periodic training workshops to promote the their spiritual growth and also consider more quotas for native students to the universities.

    Keywords: Healthy lifestyle, Behaviors, Academic achievement, Students
  • ANAHITA SADEGHI, ALI ALI ASGARI, NEZARALI MOULAEI, VAHID MOHAMMADKARIMI, SOMAYEH DELAVARI, MITRA AMINI*, SETAREH NASIRI, ROGHAYEH AKBARI, MOJGAN SANJARI, IRAJ SEDIGHI, PARISA KHOSHNEVISASL, MANOUCHEHR KHOSHBATEN, SAEED SAFARI, LEILY MOHAJERZADEH, PARISA NABEIEI, BERNARD CHARLIN Pages 229-233
    Introduction

    Clinical reasoning as a critical and high level of clinical competency should be acquired during medical education, and medical educators should attempt to assess this ability in medical students. Nowadays, there are several ways to evaluate medical students’ clinical reasoning ability in different countries worldwide. There are some well-known clinical reasoning tests such as Key Feature (KF), Clinical Reasoning Problem (CRP), Script Concordance Test (SCT), and Comprehensive Integrative Puzzle (CIP). Each of these tests has its advantages and disadvantages. In this study, we evaluated the reliability of combination of clinical reasoning tests SCT, KF, CIP, and CRP in one national exam and the correlation between the subtest scores of these tests together with the total score of the exam.

    Methods

    A total of 339 high ranked medical students from 60 medical schools in Iran participated in a national exam named “Medical Olympiad”. The ninth Medical Olympiad was held in Shahid Beheshti University of Medical Sciences, Tehran, Iran, under the direct supervision of the Ministry of Health and Medical Education in summer 2017. The expert group designed a combination of four types of clinical reasoning tests to assess both analytical and non-analytical clinical reasoning. Mean scores of SCT, CRP, KF, and CIP were measured using descriptive statistics. Reliability was calculated for each test and the combination of tests using Cronbach’s alpha. Spearman’s correlation coefficient was used to evaluate the correlation between the score of each subtest and the total score. SPSS version 21 was used for data analysis and the level of significance was considered <0.05.

    Results

    The reliability of the combination of tests was 0.815. The reliability of KF was 0.81 and 0.76, 0.80, and 0.92 for SCT, CRP, and CIP, respectively. The mean total score was 169.921±41.54 from 240. All correlations between each clinical reasoning test and total score were significant (P<0.001). The highest correlation (0.887) was seen between CIP score and total score.

    Conclusion

    The study showed that combining different clinical reasoning tests can be a reliable way of measuring this ability.

    Keywords: Education, Medical assessment, Medical students