مجله ایرانی آموزش در علوم پزشکی
سال هشتم شماره 2 (پیاپی 20، پاییز و زمستان 1387)

Training breast self-examination by peers provides an appropriate situation in order to form proper health behaviors during the adolescence age. The aim of this study was to compare the effect of training breast self-examination by peers and health care personnel on student's knowledge and attitude. In this quasi-experimental study, 112 students from two schools of dentistry and management of Shiraz University of Medical Sciences were selected randomly and were allocated in two groups. They were taken a pre-test and two post-tests. Data gathering tool was an assessment test evaluating their knowledge about breast cancer and self-examination and their attitude toward breast self-examination. Four or five students from each class were selected and trained as peer instructors. Students of the first group were trained by peers and the students in the second group were instructed by health care personnel separately using booklet. At the end of educational sessions, the first post-test, and after 6 weeks, the second post-test were taken. Statistical analysis was performed using paired t-test and independent t-test, repeated measure ANOVA, and factor analysis test. There was a significant difference between knowledge and attitude scores of the two groups immediately after education, so that, the mean score of knowledge in the group trained by peers was higher than the one educated by health care personnel. But, no significant difference was observed between the attitude scores of the two groups, 6 weeks after education. Comparing the knowledge and attitude scores, before, immediately after and 6 weeks after education showed a significant difference in each group. The efficacy of training breast self-examination by peers is higher than by health care personnel. It is recommended to employ this educational method more, especially in training self-examination.

The appropriateness of nurse's educational program to their tasks in clinical practice is an inevitable fact. This study was performed to investigate the viewpoints of nurses employed in hospitals affiliated to Hamedan University of Medical Sciences towards the applicability of nursing curriculum presented during Bachelor of Nursing course.

In this descriptive cross-sectional study, 172 graduated nurses who were employed in hospitals affiliated to Hamedan University of Medical Sciences and met the inclusion criteria, were selected. A questionnaire containing demographic data and nursing educational programs was used for data gathering. This information included basic, main, specialized, and training courses as well as field training in nursing curriculum. After completing the questionnaires by nursing personnel, the data was analyzed by SPSS software.

The highest and the lowest mean scores belonged to physiology (2.97), and vital statistics and research methods (1.62) in basic courses pharmacology (3.45), and principles of epidemiology(2.58), in main courses medical surgical diseases nursing 1 & 3 (3.46), and community health nursing 1 (2.34) in specialized courses, respectively. The highest and lowest mean scores in training courses belonged to medical surgical diseases 1 (3.38) and community health nursing (2.33), respectively. Regarding the field training course, the highest and the lowest mean scores belonged to medical surgical diseases 3 & 4 (3.38), and community health nursing (2.35), respectively.

Based on the results of this study and considering the fact that most graduated nurses would be employed in medical surgical and critical wards at the beginning of their jobs in hospitals, it is recommen-ded to pay more attention to medical surgical and critical courses in future curriculum planning in addition to conducting more studies in this field.

Performance evaluation (PE) of nurse faculty members is complicated and difficult but seems necessary. Deans of the faculties, their educational assistants, and faculty member nurses are responsible for planning, performing, and revising evaluation. Finding their common views in developing PE is of special importance. The aim of this study was to elucidate and describe PE of nurse faculty members. In this qualitative study, the required data was gathered through two methods of semi-structured interview with experts and examining the existing policies, procedures, and evaluation documents. Totally, the contents of 22 individual interviews and 26 series of subject materials went under qualitative content analysis using arbitrary approach. Purposive sampling and census methods were used for selecting the interviewees and evaluation documents, respectively. Participants had a wide-ranging perspective toward the PE of faculty member nurses. Having the analysis done, these perspectives and the content of the existing documents were placed in three major themes: individual qualifications of faculty member, performance process, and practice outcome. The items which were not in the concept of PE but had an effect on it were categorized as organizational factors. Findings of the current study confirms the suggestions of the experts, who agree a combination of individual attributes, behavior, and result-based systems for PE. But, it considers the qualifications of faculty members which are improvable and modifiable instead of individual attributes. Besides, paying attention to some organizational factors which affect PE is a matter of importance

Diagnosis and management of specialty choice indecision is an important part of career guidance and support for medical students. Determining causes of indecision and resolving them helps students to make an optimum decision. The aim of this study was to determine the psychometric properties of a Persian version of the specialty indecision scale as an on-line questionnaire for medical student and graduates of Isfahan University of medical sciences, and also to determine the attitude of the participants towards this questionnaire. In this cross-sectional study, using Richard's specialty indecision questionnaire, the Iranian version of the questionnaire for clinical specialty indecision was developed. Face validity and cultural validity were confirmed by educational experts, and translation, back translation method, respectively. Then, the participants completed the online version of the questionnaire. Afterward, the questionnaire's items were factor analyzed. At the end, Subjects were asked about the questionnaire (clarity of the questionnaire, attractiveness of the website, user friendliness of the questionnaire, number of personal questions). Fifty eight subjects participated in this study. The reliability of the questionnaire was acceptable (0.84). Two questions were omitted and five were revised. Items were grouped in 4 factors (general indecisiveness, postponing, barriers, and lack of determination) one of which (barriers) was similar to the American version. The subjects were also satisfied with online questionnaire and 100% of them thought completion of the tool was useful. This study showed that conducting a web based specialty indecision questionnaire is possible. It had differences with the American version both in number of factors and the items placement. These differences are justifiable in terms of the differences in cultural backgrounds and residency admission processes in the two countries. Also, lack of attention to translating the questions and inadequacy of sample size could be other reasons for these differences. With regard to the fact that there are no career counselors in Iranian universities, operating a web based career guidance system, along with introducing a counselor, may help medical students in specialty choice decision making.

The trend of medical education is going toward ambulatory medicine and clinics and the effect of physical environment on teaching-learning process is undeniable. This study was performed to determine the frequency distribution of physical environment indices in educational clinics of hospitals affiliated to Isfahan University of Medical Sciences.

In a descriptive study, all educational clinics affiliated to Isfahan University of Medical Sciences (33 clinics) were investigated through census sampling method. The data gathering tool was a researcher-made checklist including features of a clinic and its qualitative and quantitative characteristics. Clinics were directly observed by the researcher. The data was analyzed by SPSS software and reported through descriptive indices.

The highest frequencies in the clinics under investigation belonged to the domains of light (100%), facilities (78.8%), and arrangement of seats (84.8%). The lowest frequency percentages belonged to the existence of anti-acoustic walls (0%), access to educational resources such as internet and computers (3%), and access to reference books (6.1%).

The physical environment of the investigated clinics was evaluated as weak regarding access to educational resources, as average regarding the existence of internal room, conditioning and access to facilities, and as very good in regard to the amount of light. Due to the lack of study in the field of physical environment, especially in clinical education, it is recommended to conduct further studies.

In recent years, premarital programs are considered important in order to promote the quality of married life. This study was performed to determine the educational needs in premarital stages from the viewpoints of married couples referring to health care centers of Mashhad. This descriptive cross-sectional study was performed on 223 couples (n=446) referring to health centers in Mashhad during the years 2006-2007. The data gathering tool was a questionnaire containing 2 forms. The first form included 8 demographic questions and 4 questions related to sample's viewpoints about the way of holding sessions. The second form included 47 questions on 7 areas including fertility, family planning, congenital diseases, prevalent cancer prevention, sexual relationships, relationship with spouse and family, and Islamic and legal issues and 2 open questions were dedicated to other viewpoints of couples. Descriptive statistics and t-test were used for analyzing the data. The need to education in all areas was higher than average in both groups. Comparing the scores in 7 areas showed no significant difference between males and females. The most important need in both groups was concerning the relationship with spouse and family (3.970.067 in females and 3.950.077 in males). Couples have a tendency for more education in the field of relationship with spouse and family, and are willing to increase the number of educational sessions to 3 or 4. Males and females had felt the need for providing educational programs in the mentioned priorities.

One of the most appropriate methods for needs assessment is to assess learner's needs and arrange the educational programs based on their viewpoints. The aim of this study was to determine the topics and content of Continuing Medical Education (CME) programs in five selected subjects by medical education experts and target group, based on the real needs of General Practitioners (GPs) in order to revise CME national programs. In this cross-sectional applied study, 700 GPs covered by Medical Sciences Universities in Tehran province were studied. A questionnaire consisting of two parts of demographic features and 80 scientific questions regarding their knowledge in five domains of clinical pharmacology, skin diseases, toxicology, emergencies, and forensic medicine was used. The questionnaires were delivered to physician's offices by trained personnel using a list or by direct referral to offices and then gathered. Three topics in each subject and 15 standard educational contents in total were developed for the target group. There was almost a complete relationship between the opinion of experts and target group in forensic medicine. Some of the first five priorities of the two groups overlapped in skin diseases, forensic medicine, and emergencies. No common viewpoints were observed between experts and target group in pharmacology. In toxicology, there was no common viewpoint in the first three selections of the two groups. Real educational needs of GPs in receiving new information in order to promote their competencies and knowledge were different from those considered by experts. It is recommended to design the educational content for the target groups in the health care field based on their real deficiencies in knowledge and practice and by assessing their views and knowledge.

Evaluating the educational programs from the viewpoints of graduates may identify the weaknesses of such programs and provide the opportunity for their improvement. This study was performed to determine the appropriateness of educational programs for professional needs from the viewpoints of graduates of Khorramabad School of Nursing and Midwifery. This descriptive cross-sectional study was performed in the years 2006-2007 on 407 nursing and midwifery graduates who had graduated during 1999-2005. A questionnaire containing items about demographic data, appropriateness of educational programs objectives for professional needs, and factors influencing the quality of educational programs was sent to participants by mail and completed by them. The data was analyzed by SPSS software using descriptive statistics and Chi-square. Most of the nursing (72.9%) and midwifery (72.4%) graduates evaluated their competencies in taking care of patients as high. They also evaluated the training courses more effective on professional efficacy compared to practical and theoretical courses. From the graduate's points of view, the acquired skills during their academic years fulfilled their professional needs moderately, and lacking the essential skills made the nurses more strained than the midwives (37.1% and 22.4%, respectively). Factors affecting the quality of educational programs were reported by the graduates to be qualified faculty members and instructors, facilities for clinical education, educational environment, used teaching methods, educational facilities of the school, and the availability of scientific resources. professional needs of nursing and midwifery graduates are not fully covered by educational programs. It seems necessary to change the educational programs and provide required means and facilities in order to achieve the professional objectives and train skilled and productive human resources.

One of the most important barriers for using IUD (Intra Uterine Device) is inadequate provision of appropriate counseling. Since, employing new training methods is necessary for enhancing midwives` roles in providing appropriate counseling, this study was performed to compare the effect of two methods of traditional training and role playing on students’ skills in counseling. In this experimental study, 62 midwifery students were randomly allocated in role playing and traditional training groups to participate in a 4 hour workshop about counseling skills for IUD clients. Before and after the workshop student's skills in counseling were assessed. The data gathering tools included a self evaluation form and evaluation checklists for assessing students’ performance in counseling before and after IUD insertion. Comparisons were made using Chi square, Fisher exact text, t-student, Man-Whitney, paired t-test, and Wilcoxon by SPSS software. The mean of student's score in counseling before and after IUD insertion was not different between the two groups in pretest, but the post-tests of the 2 groups in both skills were significantly different. There was a significant difference between pretest and posttest scores in both groups regarding the two skills. Teaching by role playing leads to a better learning of counseling skills. Employing this educational method is recommended for training counseling skills to students.

Reporting medication errors leads to saving patient's wellbeing and safety and also is counted as a valuable information source for preventing further mistakes in future. The aim of this study was to determine the causes for refusing to report medication errors from the viewpoints of nursing students. All nursing students of Arak University of Medical Sciences (n=76) were selected to participate in this descriptive cross- sectional study. Using a 17 item questionnaire based on 5-point Lickert scale, nursing student's viewpoints toward refusal in reporting medication errors were investigated. This questionnaire included 3 domains of fear from reporting consequences (10 items), administrative factors (4 items), and reporting procedure (3 items). Data was analyzed by SPSS software. Nursing students estimated that 75% of medication errors were reported by them. Among all causes under investigation," fear from reporting consequences" had the highest score (4.13) among all. From 10 existing items in the domain of "fear from reporting consequences", "fear from evaluation score", and "academic consequences", were main causes for refusing to report medication errors. Among 4 items in the domain of "administrative factors", students had most agreement with the item of "lack of appropriate feedback following reporting medication fault". Some medication errors are not reported by the students and fear from reporting consequences and administrative factors are two main factors for refusing to report medication errors in nursing students. With regard to the fact that reporting medication errors could enhance the patient's immunity, nursing instructors should react positively towards the reports of medication errors by nursing students.

The situations affecting teaching and learning nursing fundamental course may influence acquiring competencies in primary clinical skills. Several reasons have been mentioned for this problem. The aim of this study was to describe the experiences and viewpoints of nursing students and instructors on nursing fundamental course. This was a qualitative study using thematic analysis method. Fifteen nursing students, 4 nursing instructors, the head nurse of operating ward, and two nurses graduated from the university in which the study was performed, were selected through purposive sampling and interviewed. All interviews were transcribed, analyzed. Using thematic analysis, a significant number of preliminary themes and 7 main themes each having few other sub-themes, were extracted. The main themes included educational factors, not respecting the standards in performing the techniques, the gap between theory and practice, motivation, human resources, communications, management staff, equipments, and physical environment. These main themes and other sub themes have been explained in the main article using direct statements of study samples. The results of this study revealed problems in communication in educational environment and interaction between instructor and students as well as lack of motivation among nursing instructors and students. These are the main principles of the appropriate teaching and learning. It is recommended that nursing education administrators pay more attention to these aspects of educational process and remove the causing factors.

Physical and emotional changes during pregnancy, could lead to family arguments and violence which may cause untimely delivery, premature neonate, and post partum depression. This study was performed to determine the effect of educating about common changes of pregnancy period and coping with them on marital satisfaction of pregnant women referring to health centers of Shahrbabak. This quasi-experimental study was performed using one group design, with pre and post tests. Data was gathered by Enriching, Relationship, Issues, Communication and Happiness (ENRICH) question-naire from 112 pregnant women who met the entrance criteria and were selected by random stratified sampling method from three health centers. The intervention was as introducing an educational pamphlet. The marital satisfaction was evaluated before and one month after intervention. Then, the data was analyzed using descriptive statistics indices, Wilcoxon, t-test, Mann Whitney U test, ANOVA, and Kruskal Wallis test. Comparing the mean scores demonstrated a significant enhancement after receiving information, so that the marital satisfaction score increased from 168.828 into 187.318.2 points. In comparing the mean differences based on variables of gravidity, gestational age, employment status of pregnant woman and her spouse, beauty concerns, and enjoying familial support also a significant difference was observed. The results of this study signify the necessity of couple's awareness about common changes during pregnancy period. Hence, by doing so, health providers can play an active role in increasing marital satisfaction.

In 2007 and the years before, the Ministry of Health and Medical Education invited MS volunteers in different disciplines such as rehabilitation management and medical education for interview in addition to written exam. This study tried to determine the role of interview in student's admission in medical education and rehabilitation management during the years 2006 and 2007 and also the association between interview and written exam. In this study, the scores of interview, written exam, total exam, and written exam materials were extracted separately. Then, statistical parameters such as mean, standard deviation, and correlation between scores were calculated by MINITAB-15 software. It was tried to investigate the medical education and rehabilitation management examination results using correlation coefficient and frequency distribution. This study also investigated the association between interview and written exam and their role in student's admission. The correlation coefficient between interview and written exam scores in medical education examinations was higher than the ones for rehabilitations management which demonstrates a closer linear correlation between interview score and written exam score in medical education examination. Correlation coefficient and frequency distribution in rehabilitation management examination, showed no logical relation-ship between interview and written exam scores. Considering non-equivalent changes appeared in medical education and rehabilitation manage-ment examinations, we can learn about lack of coordination in interviews of different groups. Therefore, it seems that it is better to change the interviews more toward structural, multi-aspect, and individual instead of accumulative and qualitative.

The effects of teaching communication skills using a specific model on nursing student's skill in communicating with mental patients has less been a subject of investigation. The aim of this study was to determine the effect of a communication skill's teaching model on nursing student's communicating with mental patients. This quasi-experimental study was conducted as pretest-posttest design, on 49 senior nursing students in two groups of control (24 students) and experiment (25 students). After performing the pretest of communication skills, both groups spent 12 days of clinical education for communication skills. The experiment group was taught using the mentioned model and the students of control group had the traditional training. After finishing the educational course, student's progress in communication skills in the two groups was compared. An integrated checklist was used for gathering data. Student's skills in interviewing mental patients were observed and the results were analyzed by SPSS software using Wilcoxon and MannWittney tests. Both methods of training improved student's communication skills with mental patients. Comparing the two methods, the mentioned training model showed a significantly higher level of improvement in nursing student's communication skills. In spite of the significant effect of the mentioned model on improving nursing student's communi-cation skills, due to the lack of enough evidence in this regard, conducting further studies in this area is recommended.

Fostering critical thinking and Metacognition is one of the most important objectives in nursing education. This study was designed to investigate the effect of guided reciprocal peer questioning on nursing student's critical thinking and Metacognition skills.

In this quasi experimental study, the experiment group included 30 nursing students in their 6th semester in Birjand Islamic Azad University. Two credit courses were presented in this group using guided reciprocal peer questioning. In the control group which included 28 nursing students, those two credit courses were presented using the routine lecture method. California Critical Thinking Skills Test (CCTST) (form B) was used for evaluating critical thinking skills, and metacognition was evaluated before and after interven-tion by metacognitive awareness questionnaire. The statistical analysis was done by SPSS software. Descrip-tive statistics, t-independent test, paired t-test Chi-square, Mann Whitney, and Kappa were used in this study.

Performing guided reciprocal peer questioning led to a significant increase in critical thinking skills scores in the experiment group compared to the control group. In spite of the increase in the mean score of metacognitive awareness of the experiment group, comparing the mean difference of pre and post tests in the two groups showed no significant difference.

Using guided reciprocal peer questioning in the education of nursing students may lead to developing critical thinking skills as one of the important missions of higher education.

Clinical education is a complicated process which is affected by several factors and variables. Thus the aim of this study was to determine the stressing factors in clinical education from the viewpoints of students of Boushehr University of Medical Sciences. In this descriptive cross-sectional study, 334 students of Boushehr University of Medical Sciences were selected thorough census. The data gathering tool was a researcher-made questionnaire. This question-naire consisted of two parts of demographic data and 60 questions about stressing factors in clinical educa-tion in five areas. Data was analyzed by SPSS software using frequency distribution, mean, standard devia-tion, and Chi², variance analysis test. The humiliating experiences, educational environment, clinical experiences, unpleasant emotions, and interpersonal relationships areas were high stressing factors respectively. The most stressing factors were as teacher's notification in front of personnel and physicians, lack of facilities in ward, watching patients suffering from pain, solicitude about contagious disease transmission, and lack of teacher support respectively. Medical students are exposed to a variety of stressor factors. Thus establishing a supportive system during the first academic year and improving it throughout clinical education is necessary to equip medical students with effective coping skills.