مجله ایرانی آموزش در علوم پزشکی
سال یازدهم شماره 7 (پیاپی 36، بهمن 1390)

Continuous investigation of educational stressors, and managing them is essential for quality improvement of clinical education. This study investigated stressors of clinical education from the perspective of nursing, midwifery and operating room students at Kurdistan University of Medical Sciences during year 2010.

This descriptive study was performed on all 230 students of nursing, midwifery and operating room who had passed at least one clinical course. Data gathering tool was a researcher made questionnaire. The mean scores to each five domains of stressors (including inter-personal communication, humiliating experiences, educational environment, clinical experiences, and unpleasant emotions) were calculated (the range of scores was 1 to 5). Data was analyzed using descriptive statistics, ANOVA and Tukey post hoc.

Among all students, midwifery students gave the highest total stress score in these 5 domains (3.52±. 45), and the highest domain score belonged to unpleasant emotions(3.61±. 75). After that, the highest tensive domain in nursing group was the educational environment (3.34±. 82). In operating room students also, the most tensive domain was unpleasant emotions again (3.29±.86). The results of comparing clinical education stressors in study groups using one-way ANOVA indicated a significant difference among all domains except humiliating experience. Tukey test showed a significant difference between clinical education stressors of midwifery and operating room groups.

Students of different fields of medical sciences are exposed to several stressors throughout the clinical education processes. Determining these factors could play an important role in reducing this stress. Considering the fact that unpleasant emotions was the most intensive stressor in this study, paying attention to this issue and exploring its dimensions to implement appropriate strategies seems to be necessary.

Students as main customers of educational services judge service quality by making a comparison between their expected services and the services that they receive. Differences between expectations and perceived performance are referred to as ‘quality gap’. Regarding educational services, this gap is related to managers’ failure to recognize and respond to the students’ needs. The first step to reduce the gap is identifying students’ perceptions and expectations. The aim of this study was to determine the quality gap of educational services in the dentistry school of an Iranian university of medical sciences.

All 220 dentistry students of a university of medical sciences were surveyed in this cross sectional study in 2009. A self-administrated questionnaire based on the SERVQUAL questionnaire, which proved to be valid and reliable, was used for data collection. The gap between perceptions and expectations in five dimensions of educational services quality (i.e., service reliability, responsiveness, assurance, empathy, and tangibles) was assessed. Descriptive statistics and Friedman and Wilcoxon tests were applied.

There was a negative gap in all dimensions. The maximum gaps were related to tangibles (-0.70) and responsiveness (- 0.55) dimensions of quality of educational services (p = 0.001). As for items, the maximum gap (-1.93) was related to the appeal of physical facilities such as buildings, chairs, and resting rooms in tangibles dimension.

The negative gap between all dimensions of educational services quality implies students’ dissatisfaction. So it is necessary for managers to make use of the viewpoints of the students to decrease the gap.

The importance of clinical education in personal and professional development of nursing students and their clinical skills is undeniable, so any weakness in clinical education can decrease the efficacy of nursing graduates. One of the most important factors affecting clinical education is clinical teachers and their quality of teaching. The purpose of this study was to determine the perspective of clinical teachers and nursing students on the characteristics of an efficient clinical teacher in nursing. This study is a qualitative research based on content analysis. Data were separately collected by conducting semi-structured interviews with 12 nursing clinical teachers who had 3 years of clinical teaching experience, and 15 nursing students passing fifth term or more of education. Data analysis was done after each interview through content analysis. The accuracy of data collection and analysis was achieved by external check (member and peer check). From the viewpoint of clinical nursing teachers, efficient clinical teachers had two themes: extra-personal and personal characteristics, while nursing students opted for only one theme: personal characteristics. The extra-personal theme had two subthemes including system encouraging effective clinical teachers, and support for clinical teacher; and personal characteristics according to the teachers included management characteristics, moral characteristics, educational skills, and emotional characteristics. According to the students, personal characteristics were managemerial, mora and emotional characteristics, educational skill, appearance and their supportive role. Clinical teachers and students had the same idea about efficient clinical teachers on most characteristics, but the main differences lay in the viewpoints of teachers on some characteristics that affect the educational process and were out of their control; and also students pointed to the teachers’ appearance and supportive role. The result of this study identifies some characteristics of efficient clinical teachers and can be used as a guideline in clinical management and education.It is also suggested that more studies be done to support the application of these characteristics in clinical education.

The aim of effective clinical education is promoting critical thinking and increasing students’ confidence in their ability to perform professional responsibilities. Despite numerous quantitative studies, this concept still is not clearly defined. This study aimed to investigate nursing student's perception of the effective clinical education concept. A qualitative research using conventional content analysis was applied. Data were collected using in-depth semi-structured interviews and focus groups with 23 nursing students. The participants were recruited by purposeful sampling of nursing students at Urmia nursing and midwifery school. Qualitative content analysis demonstrated three original categories from nursing student's perspective about effective clinical education: 1- factors related to clinical instructor 2- factors related to learning environment 3- factors related to the learner. Each category contained subcategories. Effective clinical education requires provision of facilities and the necessary equipment for the clinical environment, application of communication skills, and availability of knowledgable and competentable clinical instructors with managerial skills who implement theoretical content in practice and motivate nursing students and promote their self- confidence.

Considering the importance of promoting nursing education and benefits of new teaching methods, especially group discussion, this study aimed to compare the effects of group discussion combined with the nursing process and traditional method on learning and satisfaction of nursing students in clinical situations. A quasi-experimental study was conducted during 2009 on 28 nursing students in Kashan's Nursing faculty who had taken their clinical course of medical surgical nursing II. The students were divided into 2 groups of intervention (teaching based on nursing process and group discussion) and control (traditional method) groups. The instrument for data gathering consisted of demographic questions, a question on the students’ satisfaction of the teaching method and a series of multiple-choice questions carried out one and three weeks after the end of clinical course. Data analysis was conducted using independent and paired t-test and Smirnov Kolmogorov through SPSS. The mean scores were higher in group discussion method than in the traditional method (16.8±1.9 vs. 13.26±.25). The mean scores were higher in the third week than in the first week (p=0.05). Students were more satisfied with the group discussion method. Teaching based on nursing process and group discussion could result in a better and more durable learning at least for three weeks after the clinical courses. This method can be used by clinical nursing teachers to activate students and stabilize their learning.

Student assessment in clinical settings is an important subject in nursing education. Reviewing students’ clinical skills, some problems put forward which manifest in students` complaints and frequent meetings between them and their instructors to discuss these problems. Despite some efforts in this area, it is still a major challenge for nursing students. In this regard, nursing students as evaluatees are important sources to identify these challenges. The aim of this study is to determine nursing students` viewpoints toward their clinical evaluation challenges.

This is a descriptive qualitative study performed in year 2010 on a population of students of 4th to 8th semesters who were selected from three major Medical Universities in Tehran. Purposeful sampling method was used for the study and focus group sessions were held for data gathering which was continued to the point of data saturation. Totally 40 students participated in 6 focus group discussions. Data was analyzed using latent content analysis.

During analysis 4 themes and 10 subthemes were emerged including evaluation performers` issues (instructor’s professional characteristics, self evaluation, and clinic-education relationship), evaluation requisites (instrument’s efficiency, practical evaluation), evaluation process (goal-oriented evaluation, clarity of evaluation method, evaluation time and type), and emotional environment in evaluation (relationships, self esteem).

The results showed numerous challenges which nursing students are confronted while being evaluated clinically. Individuals who play role in evaluation, employed strategies, the evaluation process, and the psychological atmospehere of evaluation were issues emphasized by students as the factors affecting clinical evaluation. It seems that process of assessing nursing students to assure their achievement of clinical learning objectives needs an overall revision. This would facilitate the accomplishment of students into efficiency, skillfulness, and certainty in providing health care for patients.

Universities are the most important setting for science production and organizing academic research is one of the most effective strategies in society development. The main idea of this study was identifying the internal barriers to academic research from viewpoint of faculties in Shiraz University of Medical Sciences. Main question was which obstacles affect research activity from facultie's point of view. This descriptive study was conducted in 2008. Through stratified random sampling in eight college and research centers, 227 faculty members were selected, all responded to the survey. Researcher-made research tool was designed in six areas including finance, facilities, professional, research competency, individual & organization-management obstacles in the four-item Likert scale. Data analysis was done by t test, MANOVA, ANOVA and Tukey post hoc test. Barrier scores were significantly higher than the average (62.5). All obstacles were proved from faculties point of view (P<0.01). Financial barriers had the most average (86.216.5) and scientific barriers had the lowest average (79.119.1). Mean of facilities, professional, individual barriers, and organization-management obstacles were 80.218.2, 82.319.2, 81.518.6, 82.618.2 respectivly. However, faculties attitude about obstacles was not correlated with their research activities rate (P>0.05). In addition, a significant difference was observed among facultie's view and sex, scientific degree, discipline & having management responsibility (P<0.05), but this relationship was not observed about experience years (P>0.05). Different barriers affect research activities based on facultie's point of view. Reviewing the approval process for research projects, empowerment of human resources, attention to research utility, designing of communication and information system can also be effective in solving problems and barriers to research.

Curriculum in higher education plays a key role and can affect the efficiency, quality and effectiveness of the educational system. It is important to change curricula for meeting social needs and reflecting the latest scientific achievements. The present study aims to identify barriers to change curricula in Shahid Beheshti University and Shahid Behehsti Medical University. In this descriptive-survey study, a sample of 130 faculty members from the above-mentioned universities was randomly selected through multi level cluster sampling method. Data was collected by using a researcher-made questionnaire, with 30 items related to 5 areas of main obstacles in curriculum change. The validity of the questionnaire was determined by curriculum studies scholars; the reliability was calculated 0.88 by using the alpha correlation. Data was analysed using descriptive and inferential statistics including sample T-test, independent T-test and Friedman test according to the variables. One sample T- test showed that both groups had considered all the designed items as the barriers to curriculum change. Friedman test prioritized five areas studied from the perspective of the faculty members of Shahid Beheshti University as internal barriers, external barriers, economic & financial barriers, motivational & human barriers, and professional & career barriers; and from the view point of faculty members of Shahid Beheshti Medical University as internal barriers, external barriers, economic & financial barriers, professional & career barriers, and motivational & human barriers. According to the barriers to change, strategies such as holding appropriate workshops and reviewing the curricula, creating a structure that will delegate reviewing the curricula and will institutionalize it in university and providing adequate funding to promote faculty members curricula in the process of change and reforming academic curricula are recommended for the elimination of the barriers.

Development of student's critical thinking abilities is one of the greatest challenges for nursing educators. Identifying its barriers and resolving them can help to improve critical thinking. The aim of this research was to assess and compare Critical Thinking Disposition (CTD) and its relationship with State Anxiety (SA) in baccalaureate nursing students of Islamic Azad University of Yazd. This descriptive cross-sectional study performed on a census sample of 188 nursing students of Islamic Azad University of Yazd. Data was collected with questionnaire; the questionnaire consisted of three parts: demographic characteristics, the California Critical Thinking Disposition Inventory (CCTDI), and Spielberg State Anxiety Inventory. Data was analyzed by SPSS software using descriptive and inferential (ANOVA and Pearson).statistics. There was no significant difference in critical thinking disposition score by academic year. However results showed that critical thinking is negatively correlated with SA (r= -0.426, p=0.0001). Students with lower anxiety had a more favorable disposition to critical thinking. Therefore, it is necessary to improve stressful environment of clinical education, and methods of coping with the stresses should be taught to students in order to develop critical thinking in nursing students and achieve educational objectives.

The Main challenge in training about breaking bad news is selection of appropriate educational method. This study was performed to assess the results of role-playing method versus group discussion in training about this skill. This was an interventional double blind study, performed in 2009-2010 in Jahrom University of Medical Sciences. 30 medical students were involved in this study (15 students in each group). At first, their breaking bad news skills were evaluated with an Objective Structured Long Examination Record (OSLER1). Then the first group participated in group-discussion workshop and the second one participated in role playing workshop. Their breaking bad news skills were re-evaluated by OSLER2 after the course. The score of OSLER1 and OSLER2 of both groups were compared. Results were analyzed by T test and paired T test. there was no significant difference in OSLER scores between groups before intervention (p=27.42). The mean score of the first group before workshop (10.5 3.44) was significantly different from it after (19.8 5.44) training (p=.000). Also the mean score of the second group before (27.70 0/833) and after (27.70 0.833) training were significantly different (p=0.000). There was significant difference between two groups’ scores after training (p=0.000). Our training intervention was effective in producing significant change in medical students’ breaking bad news skills, but training by Role-playing method was more effective than group discussion method.

Morning report along with clinical rounds and ambulatory teaching are three common, useful and valuable methods (Gold Standards) in clinical education. This program has some characteristics and standards that, when properly applied, will play an effective role in students’ clinical learning. The main aim of this study is to determine the characteristics of morning report sessions in internal medicine wards affiliated to Tehran University of Medical Sciences, and also to assess students’ view points on the benefit and satisfaction from the content of these programs and the related factors. In this cross- sectional study, the structural characteristics of morning report sessions and the students’ rate of benefit from their content were investigated in year 2010. A sample 300 internship and clerkship medical students were asked to fill out a researcher- made questionnaire. The validity and reliability were confirmed by experts and the calculation of Cronbach’s alpha respectively. The structural characteristics of the sessions were as follows: The average starting time of the sessions was at 8 a.m., the average duration of sessions was one hour, the average number of meetings was 5 times a week, the patient presenter in most cases was an intern, the cases presented were complicated and difficult ones, the average number of cases presented in each session was three, the average time for presenting each case was 20 minutes. Air conditioning, temperature, lighting, and sound quality were favorable. Faculty members usually sat in the front row and with their back to the audience. The main audience at the sessions were not defined and usually the experts of other fields such as pharmacists, nutritionists, pathologists or radiologists were absent. Total benefit rate according to the students was: 55 people (18.3%) high, 152 people (50.7%) moderate and 93 people (31%) low. There was a significant correlation between their benefit rate and most of the structural parameters of morning report sessions (P<0/005). Despite the structural conformity of the morning report sessions in internal medicine wards of Tehran University of Medical Sciences with those in most similar studies, some more efforts should be spent on promoting the students’ satisfaction.

After heart diseases, traffic accidents are the main leading cause of mortality in the country. This is while seat belt use can significantly decrease the risk of mortality up to 41 to 50 percent. The rate of seat belt use among Iranian drivers is reported to be 3 to 56 percent. This study aimed to determine the predictive factors of seat belt use among drivers of Sabzevar based on Health Belief Model (HBM) and Theory of Planned Behavior (TPB). A clustered (10×35) sample of 340 drivers in Sabzevar town was surveyed in this descriptive analytical study. Data was collected using a self-administered questionnaire designed according to TPB and HBM. An experts panel approved its validity, and its reliability was verified by Cronbach Alpha test (α=0.65%-0.83%). Data was analyzed using Spearman coefficient, ANOVA, t test, and path analysisvia regression. The subjects’ self-reported mean score of seat belt use was 63% of maximum score of the scale. Significant difference was found in seat belt use among different educational levels; as the higher the educational level, the more score for seat belt use. A significant correlation was observed between variables of TPB and HBM (except perceived severity) and intention to wear sealt belt (p<0.01). The variables of TPB explained the variance of intention of seat belt use better (37.9%) than that of HBM (15.4%). Among variables of the two models, abstract norms (β=0.313) and cue to action (β=0.210) had more direct effects. Seat belt use among the subjects was in an average level. According to the high mortality due to transporation vehicles in country and the effective preventive role of seat belt, the use of this device should be enhanced. As a theoretical framework in instructional programs which are intended to propound seat belt use, TPB could be applied better than HBM to predict the intention of seat belt use.

The present research compares curricula for undergraduate medical education(UME) in Iran and in selected medical schools in terms of general structure, program length, mission and objectives, content, number and type of study stages, and finally, the extent of implementing quality improvement strategies.

This is a descriptive-comparative study on the important components of UME curricula in Iran and some renowned or innovative medical schools, selected purposefully from all continents. The study had two stages: first, finding medical schools offering high standard education from all continents; second, identifying and studying the different aspects of curricula in those schools as well as Iranian medical schools’ curriculum, based on Ludvigsson’s indicators.

The results show that considering available standards in an effective educational curriculum (Ludvigsson’s indicators), medical schools of Australia, North America, Europe, Asia and Africa rank from the highest to lowest. The study reflects that UME curriculum in Iran does not fulfill the necessary standards.

There is a great gap between the quality of UME curriculum of Iran and that of other universities in terms of implementing effective educational standards, which suggests that UME program in Iran needs to be revisited and revised.

Whilst there is an extensive descriptive literature on the effective lecturing, there are few studies on student's perspective toward the attributes of effective lecture sessions. The aim of this study is to explore student's viewpoints on factors affecting the quality of lecture sessions.

This was a two-stage descriptive study in which 25 dentistry students at clinical stage, studying at Tehran University of Medical Sciences attended a focus group session and represented their viewpoints about weaknesses and strengths of lecture sessions of theory courses. A questionnaire was developed according to the students’ statements. Features of an effective lecture session were categorized into 4 groups of factors related to the lecturer, content, physical facilities available in class, and educational management. Reliability was assessed through Spearman correlation analysis. This questionnaire including 45 items was distributed among 130 students studying at fourth to sixth-year, in the School of Dentistry. Students’ agreement with each item in questionnaire was measured using 5-point Likert scale.

Ninety seven questionnaires were collected. Items of factors related to the lecturer mostly regarded by students, among them were “oral presentation techniques” (mean score of 4.64), “presenting case to demonstrate the association between theory and practice” (4.63), and “the lecturer’s ability to associate the content” (4.55) which received the highest scores.

Dentistry students at clinical stage thought that the role of lecture in theoretical courses is very important. They believed that the ability of lecturer in organizing and explanation of the content plays the most important role in giving an effective lecture.

Using standard authoring tools is essential to promote E-Learning in teaching-learning process. Learning content in medical sciences often consists of multimedia elements. On the other hand, it is frequently required to revise and update the medical content. Hence, access to the authoring tools that can encompass multimedia elements and allow easy content revision is helpful in e-learning promotion in medical sciences. In this paper, a standard interactive multimedia content authoring tool, developed by the authors after many investigations is introduced. Current authoring tools do not meet all the content qualifications and few of them are available as open source. Therefore, we aimed to produce an interactive multimedia content authoring tool that could be open source, feasible, and able to be updated or modified. In addition to providing the standard content, this engine allows knowledge management that could be enriched as technology progresses. To develop this engine, characteristics such as “component based architecture”, “exploiting the SCORM and IMS standards”, and providing the content both in online and offline modes were considered. Some parts of the learning content created in medical sciences have been provided as a sample.