فهرست مطالب

Journal of Medical Education
Volume:22 Issue: 1, Dec 2023

  • تاریخ انتشار: 1402/05/09
  • تعداد عناوین: 17
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  • Kazem Aryaei Moghadam, Hamdollah Jayervand *, Behnam Makvandi Page 1
    Background

     Academic burnout, in addition to affecting different aspects of the students' personal lives, can have many negative impacts on their academic and family conditions.

    Objectives

     The present study aimed to investigate the relationships between academic burnout and hope for the future through examining the mediating role of stress in medical students.

    Methods

     The statistical population of this descriptive-correlational study included all students at Ahvaz University of Medical Sciences in 2022. Multistage cluster sampling was used to select 301 students. The research instruments included the Academic Burnout Questionnaire, the Attitudes towards Education and Career Prospects Scale, and Medical Student Stressor Questionnaire. The proposed model was evaluated using structural equation modeling (SEM).

    Results

     The results showed that the direct path from hope for the future to stress was significant (P < 0.001). The indirect path from hope for the future to academic burnout was significant with the mediation of stress (P < 0.001), while the direct path from hope for the future to academic burnout was not significant.

    Conclusions

     Stress mediated the relationship between hope for the future and academic burnout. It was also found that the proposed model had a desirable goodness of fit and may have been considered a major step in identifying the factors responsible for academic burnout in medical students. Given that stress was a central factor in academic burnout, it was suggested that policymakers should appreciate the necessity of providing the stressed students with support from family members and instructors.

    Keywords: Academic Burnout, Hope, Stress, Medical Students
  • Sadaf Jazayeri *, Hamid Akbari Javar, Ali Namaki, Soleiman Ahmady ** Page 2

    Context: 

    During the COVID-19 pandemic and challenges, medical education with insight toward training competent students with a global vision has highlighted the necessity of a robust approach toward sustainable development (SD) on internationalization. Inevitable transformations in medical education and its internationalization component due to the COVID-19 pandemic have not yet been investigated. Accordingly, the objective of this study was to assess the current situation and propose the operational framework of internationalization for medical education with a global vision toward SD.

    Evidence Acquisition:

     A critical review was conducted on English papers extracted from Google Scholar, Scopus, PubMed, and Elsevier databases using the following search terms: Sustainable development, operational approach, educational environment, management strategies, internationalization, and COVID-19. Boolean operators were used to eliminate inappropriate hits with a focus on research goals. Ineligible studies were excluded by screening titles and abstracts. The knowledge management was applied to the related findings of the internationalization of medical education components.

    Results

     Evidence presents a new order of internationalization components of internal and external dimensions with an educational paradigm shift to virtual programs. Assessing these dimensions indicated the requirement of implementing SD. The suggested pathway should initiate from the internal institution dimensions (facilities and budget component with generating income), followed by the external institution dimensions (sociocultural element and nation-building).

    Conclusions

     The COVID-19 pandemic has forced educational institutions to shift to virtual education. The designed framework highlights educational activities toward virtual education and earning income, empowering faculties, and meeting social needs in medical education to achieve SD.

    Keywords: Sustainable Development, Operational Approach, Educational Environment, Management Strategies, Internationalization, COVID-19
  • Nasim Gheshlaghi Azar *, Shahram Yazdani, Zohreh Khoshgoftar Page 3

    Context: 

    Critical thinking (CT) has been recognized as a key learning outcome in health profession education (HPE). A holistic, well-defined process for initiating CT is essential to promote critical problem-solving in HPE students. Various perceptions of CT have emerged from different paradigms and disciplines. Integration of this variability into the CT process could be beneficial for medical educators to develop CT in learners. This study aimed to outline the CT process in view of the multiple conceptualizations of CT.

    Evidence Acquisition: 

    In this narrative review, SID, Google Scholar, and PubMed databases were searched. After studying 35 selected articles, the CT process was formulated based on the multiple conceptualizations of CT.

    Results

     Multiple perceptions of CT, emerged from disciplines and paradigms, should be incorporated into the CT process to achieve strong CT. In view of this multiplicity, not only the CT skills but also its dispositions are of key importance in the CT process. Furthermore, the essential role of the context in which the CT takes place, one’s own creativity, metacognition over the thinking process, social construction of meaning, caring to others, and seeking problems through challenging the systems should be considered.

    Conclusions

     We outlined the CT process, grounded from multiple conceptualizations of CT, and advocated for the use of it by HPE students to promote critical problem-solving in facing complex challenges during their professional careers.

    Keywords: Critical Thinking Critical Thinking, Skills Critical Thinking Dispositions, Critical Thinking Process, Health Profession Education
  • Nakisa Rahmani, Faezeh Davoodabadi, Robab Noormohammadi, Farzaneh Karamitanha, Azin Nourian * Page 4
    Background

     Many educators have developed an interest in an emerging new concept called entertainment education (edutainment). Edutainment is a kind of tool that, in this age of technology, can be easily incorporated into education.

    Objectives

     This study aimed to use edutainment for teaching orthodontic lateral cephalometric and dental cast analysis as well as to evaluate the dental students’ attitudes towards it.

    Methods

     In this cross-sectional study, the multimedia-enhanced with edutainment was designed using Articulate Storyline version 3.5. To evaluate the students’ attitudes, 52 ninth-semester dental students doing their second semester in 2019 - 2020 were included in the study. Then they were asked to complete a standard questionnaire with a 7-point Likert scale from strongly disagree to strongly agree and including 26 items in eight domains of perceived self-efficacy, perceived satisfaction, understanding usefulness, behavioral concept, e-learning system quality, interactive learning activities, e-learning effectiveness, and multimedia instructions. Data were analyzed and expressed using independent sample t-test, one-way ANOVA, and descriptive statistics.

    Results

     The majority of the students had positive attitudes towards the areas of perceived self-efficacy (83.3%), perceived satisfaction (90.4%), perceived usefulness (96.8%), behavioral intention (91.7%), e-learning system quality (75%), interactive learning activities (73.1%), e-learning effectiveness (88.5%), and multimedia education (85.3%).

    Conclusions

     In sum, the students’ attitudes towards learning were positively and significantly influenced by the designed educational multimedia enhanced with edutainments to teach lateral cephalometric analysis in orthodontics. It was found that the application of edutainment as an educational tool together with traditional training may have been an effective method for teaching and, therefore, it was recommended that edutainment should be used as an alternative to traditional methods during crises such as the COVID-19 pandemic.

    Keywords: Orthodontics, Education, Multimedia, Gamification
  • Mohsen Masoumian Hosseini, Manijeh Hooshmandja *, Toktam Masoumain Hosseini Page 5
  • Firouzeh Majidi *, Shahram Yazdani, Hamed Dehnavi, Snoor Bayazidi Page 6

    Context: 

    Universities are among the best places to foster innovation and provide services, as they are in close contact with clients. In order to offer the best possible services, they need to be innovative in their respective fields. Service innovation is widely recognized as one of the three strategic research priorities of service institutions. Given the vast number and types of services available, various models are adopted to achieve this goal.

    Evidence Acquisition: 

    This article aims to provide a critical review of the available service innovation models and propose a comprehensive service innovation model. To achieve this objective, relevant keywords were used to conduct a literature search in databases. Initially, 1504 studies were obtained, and after a screening process, only 10 studies that were most relevant to the study's purpose were selected.

    Results

     The model proposed in this study is an integrated form of service innovation models, encompassing the process, dimensions, required infrastructures, capabilities, and the types and outcomes of service innovation, which are discussed separately in other models.

    Conclusions

     Service innovation is a complex and resource-intensive activity with potential long-term benefits for firms in both service and manufacturing industries. If a service company aims to establish a more sustainable strategic position based on innovation, it should examine its management process for physical, organizational, and intellectual resources.

    Keywords: Service Innovation, Service Innovation Concept, Service Innovation Framework, Services Innovation Model
  • Sanna Luokkamäki *, Marja Härkänen, Susanna Saano, Kukka-Maaria Kokkonen, Katri Vehviläinen-Julkunen Page 7
    Background

     Health professionals should receive lifelong education to maintain competency in medication administration and ensure safe medical practice. Game-based education is one way to enhance and ensure health professionals’ medication competency.

    Objectives

     This study aimed to describe registered nurses’ experiences of the Imagine 3D game and their views of the effectiveness of this game-based education program in improving their medication competency.

    Methods

     This qualitative interview study included eight registered nurses who completed an education program based on the 3D game Imagine, which aims to strengthen medication administration competency. Data were collected via semi-structured interviews between March and April 2019 and analyzed using content analysis.

    Results

     Three themes were extracted from the study with the following concepts: (1) experiences of playing; (2) the usability of the game in verifying nurses’ medication competency; and (3) the game’s effectiveness in fostering registered nurses’ medical competency. On analyzing the nurses’ personal experiences, the game-based education program was valuable in training nurses to enhance their medication administration competency. Participants reported that the game was comfortable to play and useful in repeated medication administration tasks, and it increased their self-reflection and even changed their actions based on learning. The nurses reported that the game was most beneficial to nursing students and recent graduates and was used especially during the introductory period. Moreover, based on the interviews, the game was also useful in continuing education; therefore, it should be applied in all healthcare professionals’ training.

    Conclusions

     This study shows that a 3D computer game can be useful for nurses to foster their knowledge and expertise in medication administration tasks.

    Keywords: Nurses, Clinical Competence, Interview, Gamification
  • Alexander James Harper *, Kyriacos Gregoriou, Caitlin Patterson, Prashant Kumar Page 8
    Background

     Teaching undergraduate medical students clinical skills in a child health setting is a particular challenge for clinical educators. Students spend less time with pediatric patients and have fewer opportunities to practice clinical skills. The coronavirus (COVID-19) pandemic further reduced students’ opportunities to observe and practice skills in the workplace. This has necessitated a greater shift towards teaching skills in a "skills lab" setting, which allows for simulated practice in a safe environment. This study reports the design, implementation, and evaluation of a standardized course that utilizes the "skills lab" to train undergraduate medical students in five clinical skills important to child health.

    Objectives

     This study aimed to implement and evaluate a standardized undergraduate clinical skills course for child health and improve students' confidence in performing child health clinical skills.

    Methods

     Evaluations were carried out over approximately one academic year, with a total of 174 participants from a single medical school in the United Kingdom. Qualitative and quantitative data were collected, examining students' self-reported confidence (pre- and post-course) along with free-text course evaluations. A paired t-test was used to calculate the mean difference in students' pre- and post-course confidence scores. Qualitative evaluations were analyzed for themes using framework analysis.

    Results

     The students had greater confidence in all measured learning outcomes following the course. Qualitative data, examined using framework analysis, suggested that the course was valued by students, who felt it was relevant to their future practice. Numerous written comments suggested particular content and teaching methods that were strengths of the course, including practical elements, small group teaching, and feedback from tutors.

    Conclusions

     Implementing a child health clinical skills course in a skills lab setting is feasible and valued by students. The course increased the self-reported confidence of the studied cohort and might therefore support them in practicing these skills with actual patients. Further studies are required to determine whether these effects demonstrate longevity and whether they translate to increased competence in performing the taught skills.

    Keywords: Clinical Competence, Procedural Skills, Child Health, Simulation, Medical Students, Pediatrics, Undergraduate Medical Education
  • Soleiman Ahmady, Bahareh Abshari, Amin Habibi *, Masomeh Kalantarion Page 9
    Background

    Clinical education is a vital component of physician education, where medical students learn by attending to patients and applying their knowledge and reasoning to solve their problems. However, many medical students struggle to acquire procedural skills, the ultimate goal of clinical education. Procedural skills are expected to be learned by the residents according to their academic year and are essential for providing better health services to children and families.

    Objectives

    This study evaluates the status of the training provided and the level of learning the necessary procedural skills in pediatric residents based on standards.

    Methods

    This research was a descriptive cross-sectional method from 1998 to 99. In the first part of the researcher-made questionnaire, the implementation of the educational program on all pediatric residents (115) of Mofid Children's Hospital was evaluated. In the second part, the residents' views on the current state of their learning of essential procedural skills were determined.

    Results

    All residents from years one to four participated in the study. After assessing the status of skills acquired by residents with a questionnaire and comparing the average of each skill acquisition procedure with the desired standards, the average of all skills in all three methods was under the standards approved by the Ministry of Health, except for independent subcutaneous, intramuscular and intravenous injection skills and the skill of working with a ventilator. Also, according to the Friedman test, the lowest score for gaining skills in performing procedures was related to NG tube placement skills and subcutaneous, intramuscular, and intravenous injection skills. According to the statistical results obtained from the Spearman coefficient in all procedures, the level of subcutaneous, intramuscular, and intravenous injection skills had a significant correlation with independent skills.

    Conclusions

    According to the specialized assistants of children participating in this study, the current training program of essential procedural skills implemented at Shahid Beheshti University of Medical Sciences was generally useful and effective. But there were also obstacles and limitations. Therefore, it is recommended to review the implementation of the training programs and implement effective measures, including providing more exposure conditions for independent procedures.

    Keywords: Pediatric Assistants, Cross-sectional Study, Procedural Skills, Clinical Evaluation
  • Adrian Hang Yue Siu *, Damien Gibson, Xin Mu, Ishith Seth, Alexander Chi Wang Siu, Dilshad Dooreemeah, et al Page 10
    Background

    The growing interest in artificial intelligence (AI) has spurred an increase in the availability of Large Language Models (LLMs) in surgical education. These LLMs hold the potential to augment medical curricula for future healthcare professionals, facilitating engagement in remote learning experiences, and assisting in personalised student feedback.

    Objectives

    To evaluate the ability of LLMs to assist junior doctors in providing advice for common ward-based surgical scenarios with increasing complexity.

    Methods

    Utilising an instrumental case study approach, this study explored the potential of LLMs by comparing the responses of the ChatGPT-4, BingAI and BARD. LLMs were prompted by 3 common ward-based surgical scenarios and tasked with assisting junior doctors in clinical decision-making. The outputs were assessed by a panel of two senior surgeons with extensive experience in AI and education, qualitatively utilising a Likert scale on their accuracy, safety, and effectiveness to determine their viability as a synergistic tool in surgical education. A quantitative assessment of their reliability and readability was conducted using the DISCERN score and a set of reading scores, including the Flesch Reading Ease Score, Flesch-Kincaid Grade Level, and Coleman-Liau index.

    Results

    BARD proved superior in readability, with Flesch Reading Ease Score 50.13 (± 5.00), Flesch-Kincaid Grade Level 9.33 (± 0.76), and Coleman-Liau index 11.67 (± 0.58). ChatGPT-4 outperformed BARD and BingAI, with the highest DISCERN score of 71.7 (± 2.52). Using a Likert scale-based framework, the surgical expert panel further affirmed that the advice provided by the ChatGPT-4 was suitable and safe for first-year interns and residents. A t-test showed statistical significance in reliability among all three AIs (P < 0.05) and readability only between the ChatGPT-4 and BARD. This study underscores the potential for LLM integration in surgical education, particularly ChatGPT, in the provision of reliable and accurate information.

    Conclusions

    This study highlighted the potential of LLM, specifically ChatGPT-4, as a valuable educational resource for junior doctors. The findings are limited by the potential of non-generalizability of the use of junior doctors' simulated scenarios. Future work should aim to optimise learning experiences and better support surgical trainees. Particular attention should be paid to addressing the longitudinal impact of LLMs, refining AI models, validating AI content, and exploring technological amalgamations for improved outcomes.

    Keywords: Surgical Education, Medical Education, Large Language Models, Artificial Intelligence, COVID-19 Pandemic, Decision Aids
  • Amin Habibi, Babak Sabetavatar, Masomeh Kalantarion* Page 11
  • Soleiman Ahmady, Nasrin Khajeali, Poorandokht Afshari * Page 12
    Background

     Learning clinical skills on “real patients” not only endangers patient safety but also raises many ethical concerns.

    Methods

     This is a qualitative study designed and implemented using the content analysis method. The studied population included all midwifery students of Ahvaz Jundishapur University of Medical Sciences who had recently passed the course: “Introduction to the Principles and Techniques of Patient Care at Clinical Skill Centers (CSC)”. Data were analyzed by conventional content analysis method.

    Results

     Overall, 156 codes were extracted from the research data, which were organized into 9 categories and 28 subcategories after removing or merging similar codes. The midwifery students’ experience of attending CSC was reflected in the form of three main themes (i.e., self-regulation, mentoring, and support management) and nine sub-themes (reinforcing intrinsic motivation in students, building self-confidence in students, mentor as a model, proper formulation and implementation of rules in CSC, training communication skills, the need to apply modern training methods, revising the structure, practice, and schedule of student groups).

    Conclusions

     According to the findings of the present study, it could be concluded that primary education in CSC plays a very important role in reducing the stress of working with patients, professionalism, increasing self-confidence, and teaching clinical skills to students. Of course, achievement of this goal heavily relies on the crucial role of teachers of this course, who act as mentors responsible for planning, organizing, and modeling in addition to teaching.

    Keywords: Content Analysis, Clinical Skill Center (CSC), Midwifery students
  • Mohsen Masoumian Hosseini, Toktam Masoumain Hosseini *, Karim Qayumi Page 13
  • Arezoo Shayan, Mansoureh Refaei *, Seyedeh Zahra Masoumi, Hassan Ahmadinia Page 14
    Background

     The utilization of effective educational methods is crucial for enhancing the clinical skills of health sciences students.

    Objectives

     This study aimed to assess the impact of a blended teaching approach involving videos and demonstrations in clinical skills training on midwifery students’ performance and satisfaction.

    Methods

     This quasi-experimental study was carried out with 41 midwifery students from Hamadan University of Medical Sciences, Hamadan, Iran, using a census sampling method within 2018 to 2019. The experimental group received training through a combination of video presentations and demonstrations; nevertheless, the control group received training solely through demonstrations. The data were collected using a demographic questionnaire, a satisfaction scale, and the objective structured clinical examination (OSCE). Data analysis was performed using the Mann-Whitney U test and chi-square test with SPSS software (version 16).

    Results

     The experimental group exhibited significantly higher mean scores in vital signs assessment, intravenous therapy, injection techniques, urinary catheterization, application and removal of sterile gloves, and prepping and draping for normal delivery (P < 0.001). There were no significant differences in the mean scores for hand washing (P = 0.380) and oxygen therapy (P = 0.604) between the two groups. The combined group achieved notably better scores in the OSCE, with scores of 18.25 (1.58) compared to 16.60 (1.60) in the control group (P = 0.002). Additionally, the combined group expressed higher satisfaction with the training method, scoring 86.10 (9.50) compared to 75.52 (16.07) in the control group (P = 0.027). Moreover, the combined group reported significantly higher levels of satisfaction regarding the facilitation of educational content transfer and overall satisfaction with the training course (P < 0.05).

    Conclusions

     Employing instructional videos and demonstrations as a combined teaching method for basic clinical skills training results in improved student performance and satisfaction.

    Keywords: Clinical Competence, Teaching, Instructional Film, Video, Students
  • Neda Mahdieh, Farzaneh Hooman *, Saeed Bakhtiarpour, Parviz Asgari Page 15
    Background

     The identification of the factors influencing the academic progress and performance of students can be a suitable basis for planning and developing educational programs to achieve the best possible results in line with educational development.

    Objectives

     The present study aimed to investigate the mediating role of stress in the relationship of mindfulness and self-construal with the academic performance of medical sciences students.

    Methods

     This was a descriptive correlational study in which the convenience sampling method was used to select 301 medical students from Jondishapur University of Ahvaz, Iran, in 2022. The participants completed the mindfulness, self-construal, and stress questionnaires. In addition, academic performance was measured based on the grade point average (GPA) in the previous semester. Structural equation modeling (SEM) and bootstrapping were also employed to examine the fit of the proposed model and indirect relationships between the variables, respectively.

    Results

     The mean of academic performance, mindfulness, self-construal, and stress were obtained as 16.57, 57.6, 140.53, and 29.72, respectively. The results showed a significant relationship between all research variables (P < 0.05) except for the relationship between mindfulness and academic performance. The results also indicated that stress was a mediator in the indirect relationship of mindfulness and self-construal with academic performance (P < 0.001). The fit indices of the Tucker–Lewis index (TLI), comparative fit index (CFI), relative fit index (RFI), normed fit index (NFI), and Root Mean Square Error of Approximation (RMSEA) in the final model were 0.94, 0.96, 0.92, 0.94, and 0.077, respectively.

    Conclusions

     The results confirmed the proposed model’s goodness of fit. Therefore, this model can be used for identifying the factors affecting the academic performance of medical students and developing programs to prevent academic failure and stress among these students.

    Keywords: Academic Performance, Mindfulness, Stress, Students, Medical
  • Mahdi Zangi, Mohammad Eftekhari, Hossein Asgharian, Morteza Saeedi, Elnaz Vahidi * Page 16
    Background

     The coronavirus disease 2019 (COVID-19) pandemic has negatively influenced several aspects of medical education (ME).

    Objectives

     We aimed to assess the perception of emergency medicine (EM) residents of COVID-19 impacts on the quality of ME and their wellness.

    Methods

     This descriptive study was conducted in Tehran, Iran. A questionnaire consisting of 33 questions (5 on hospital experience, 5 on clinical experience, 12 on education, and 11 on wellness) and 1 open-ended question were designed based on the elements found in the existing literature. Face and content validity were determined by an expert panel. The baseline and demographic data were recorded, and the viewpoints of EM residents about different items in the questionnaire (ME and wellness) were evaluated.

    Results

     The mean age of residents was 36.4 ± 7.3 years, and 64.8% and 71.8% of the participants were female and married, respectively. Most residents (81.7%) had a previous history of COVID-19 infection (mainly mild and outpatient). We observed that 90.1% of the residents had concerns about transmitting the virus to their families. Most residents agreed on the negative impacts of COVID-19 on the EM residency program and routine clinical care in hospitals. COVID-19 led to a decrease in the diversity of other diseases and bedside learning opportunities. They added that virtual learning and online programs were comfortable and flexible despite some unpleasant outcomes. EM residents experienced anxiety and stress due to the change in physical and social activities and sleep habits during the COVID-19 pandemic.

    Conclusions

     EM residents declared that despite the positive attitudes developed after the pandemic, COVID-19 had non-negligible and negative effects on ME. They were also exposed to greater anxiety and worriedness during the mentioned period.

    Keywords: COVID-19, Medical Education, Wellness, Emergency Medicine
  • Zohreh Khoshgoftar, Arian Karimi Rouzbahani, Mohammad Hoseinzadeh, Somaye Sohrabi * Page 17