مجله ایرانی آموزش در علوم پزشکی
سال چهاردهم شماره 4 (پیاپی 66، تیر 1393)

Active learning methods are becoming increasingly popular in midwifery students education. So the aim of this study was to determine the effect of education using demonstration on midwifery student's self-efficacy in delivery management. This quasi-experimental study was performed in 2013 in Isfahan University of Medical Sciences. Thirty midwifery students were selected through census and then they were randomly allocated into two groups (15 students in each group). Generalized Self Efficacy questionnaire (GSE10) was completed by both groups before and after the education (demonstration and ordinary). The collected data was analyzed using descriptive statistics, student t-test, and paired t-test. The significant level of less than 0.05 was considered. The findings of t-test did not show any significant difference between self efficacy scores of demonstration and control group before intervention while a statistically significant difference was observed between the scores of two groups after intervention (p=0.001, and t=-1.43). Paired t-test also showed a statistically significant difference in self efficacy scores after intervention between case and control group respectively (p=0.002, t=-1.30 and p=0.024, t=-5.12). Also the rate of self efficacy score increased in demonstration group by 89 percent while it was 23 percent in control group (p=0.014). Demonstration method can increase self efficacy levels among midwifery students in managing delivery phases. As a result, the use of this teaching method is recommended for effective learning.

Use of worked examples is one of the methods to decrease cognitive load and facilitate learning. There are different methods to provide worked examples. The aim of this study was to compare the effect of two teaching methods of complete and incomplete worked examples on students’ cognitive load in instruction of medical terminology. In a quasi-experimental study in 2013 in Semnan, 77 students who had chosen the course of medical terminology for the first time, were selected and randomly allocated in two groups, one trained through complete examples and the other through incomplete (completion) examples. Students’ cognitive loads were measured using a subjective cognitive load scale during study and examination. Findings were analyzed using parametric statistical tests. The findings of this study showed that mean of cognitive load of students in complete example group was 16.83±6.58 during study and 26.59±5.98 during examination out of a total of 36 points. Students’ mean score of cognitive load in incomplete example group was 17.33±5.79 during study and 26.55±5.15 during examination. Statistical analysis did not show any significant difference between cognitive loads of two groups during study and examinations. However, during the study, the cognitive load of students of emergency medicine in associate degree (21.21±5.24), emergency medicine in bachelor degree (15.63±5.64), and operating room in bachelor degree (13.9±5.05) was significantly higher compared to students of other disciplines (P=0.001). The findings showed that there was a relationship between cognitive load during study and during examination (P=0.01). Although cognitive load in complete example group and incomplete example group did not show a significant difference in this study, worked example could be used as a teaching method. Further studies are needed with emphasis on the structure of examples, involving students in working examples and use of these examples.

Patients are cornerstone of ambulatory teaching of medical students in clinics worldwide. Patient’s attitude and feeling towards the service they receive grounds for an increase in patients’ collaboration and consequently the quality of students’ clinical education. The aim of this study is to assess patient’s attitude and feeling toward the presence of medical students in educational clinics of Shahid Mostsfa Khomeini hospital. This descriptive cross-sectional study was performed on 502 patients who visited 8 educational clinics of Shahid Mostafa Khomeini hospital in year 2013 who were selected through convenience sampling. Data was gathered using a researcher-made questionnaire. Face and content validity of the questionnaire as well as its reliability were confirmed using Chronbach’s Alpha (α=0.75). Statistical data analysis was performed using t-test and ANOVA. Mean score of patients’ feeling toward presence of medical students was 3.46±1 out of 5 total scores. In overall, 71.8% of patients were relaxed during history taking and examination by students. There was a significant statistical difference between mean and standard deviation of the feelings of patients informed about presence of students (3.81±0.73) and those non-informed (3.13±1.1) patients about negotiation (p=0.001, t=7.95). A significant difference was also observed between mean and standard deviation of the feelings of the patients toward examination and history taking by physicians of opposite gender (3.76±1) or the same gender (3.25±0.93) (p=0.001). In general, patient’s felt comfortable about presence of medical students during history taking and examination. But in case of being further informed about presence of students and emphasis on their role on students’ training as well as being guaranteed about their privacy, this feeling will be increased among patients.

Electronic technology has been developed in health system like other areas. Application of electronic software for nursing process can facilitate this service. Foreign software cannot be an appropriate one for domestic use in terms of its language, clinical situations, cultural factors, and social variables. As a result, the aim of this study is to design and assess the local nursing process computerized software. This study was conducted in two phases of software design and assessment. The first phase was implemented in 4 stages of “developing the steps of nursing process in accordance software”, “algorithm design”, “test” and “final revision”. The second phase included a pilot study with participation of 20 students and nurses performed in ICU ward of Ghaem hospital in Mashhad. These individuals performed nursing process on three clients using the newly designed software. Then their opinions were taken using a validated and reliable researcher-made questionnaire for assessing the software. Data was analyzed using descriptive statistics and mann withney. First phase of the study encompassed designing the software; software menus included data base menu, patient's background information, registration of nursing process, setting, alarm, and help. In second phase, the results of pilot study showed that 81.3% of participants rated software as good or very good. The main advantages of the software, according to 90% of nurses, related to accuracy and preciseness of data compared to handwritten documents and facilitating the arrangement of client’s problems and according to 100% of the students, simplicity, sharing the labor, assessing the warning signs, and avoiding errors. The average of software evaluation scores by students was (84.3±5.83) out of 100 which is significantly higher than that of nurses (73.2±1.13, p =0.02). Development of the local nursing software in accordance with our health system was feasible and associated with satisfaction among nurses and students. Application of this software leads to increased accuracy, decreased error, and shared labor that are counted as factors promoting patient care services.

Nursing concepts has been developed and made in academic education. Nursing education in Iran has experienced many ups and downs by far. Once viewed as a technical discipline, nursing has changed to the paradigm of nursing as a science and as an art. It has become a university discipline in Iran also but the quality of nursing care and clinical knowledge transfer faced serious challenges. In this study we explore the challenges in four areas of teacher, student, lesson plans, and teaching environment. This review article was developed through searching scientific databases and literature published during 1995-2013 on academic education of nursing discipline in Iran. Search engines and databases used in this study were Elsevier, Wiley Blackwell, PubMed, Iran Medex, SID, and Medlib. Totally 60 articles in this field were retrieved and according to their appropriateness with challenges in academic nursing education, 19 articles were used in the study. The most important challenges in nursing education were as follows: there are no fundamental concepts of nursing in lesson plans in bachelors’ level and the dominant biomedical paradigm in lessons, moves students toward becoming a physician assistant. Professional attitude of nursing teachers are far different from ideal conditions expected in nursing and the academic image provided by teachers is not identical to a clinical nursing image. Nursing students also do not have an appropriate attitude toward their own profession to the extent that they know nursing as a job, and not as an evolutionary specific profession. Academic environment also, not only doesn’t develop critical thinking but also suppresses this ability. The consequences of ineffective academic education in Iran are: lack of applicable knowledge for dealing with real clinical situation, students confusion about university education; inconsistency of the academic staff with clinical staff, and failure to view the proper image of nursing by clients and community. With regard to the before mentioned challenges, it seems necessary to invest on academic nursing education in order to solve these problems.

Patient education is considered as a standard in quality of nursing care. It is counted as an accrediting criterion for the organizations that provide health services. Meanwhile, there are evidences indicating the failure in this area. As a result, this study aimed to determine barriers to patient education in managerial, individual care-giving, as well as patients and caregivers dimensions from nurses’ viewpoints. This descriptive cross-sectional study was conducted on a census sample of nurses working in hospitals affiliated to Jahrom University of Medical Sciences in year 2013 (n=271). Data gathering tool was a researcher-made questionnaire about three categories of barriers to patient education, including “managerial”, “individual care-giving” and “patients and caregivers” obstacles. The validity and reliability of the questionnaire was confirmed. Data was analyzed by calculating frequency of responses to items, and weighted frequencies in each category. Most responders agreed to the barrier role of managerial (88.9%), individual care-giving (52%) and patients and caregivers (76.8%) items in patient education program. The most important barriers were lack of time due to workload (87.1%) regarding management area, lack of patient education planning for nurses in their daily work as a duty (64.2%) regarding individual care-giving area, and the unknown role of the nurses as a teacher to patients and the community (72.3%) regarding patients and caregivers. Management agents were the most important barriers of patient education. Therefore it is recommended that managers make actions such as taking a sufficient number of personnel, prioritize education by nurses in their daily tasks, and introduce patients with education to make them eager to admit this education and consequently encourage nurses.

Assessing the attitude of medical students who has passed basic sciences, toward research and research activities in basic sciences, can provide a powerful basis for future interventions and improvement in their attitudes. In this study in Isfahan Medical School, the attitude of newcomer medical students toward research and specially research in basic sciences has been investigated at the completion of physiopathology courses. This is a descriptive cross-sectional study performed on all newcomer medical ‎students in physiopathology course after basic science courses in Isfahan ‎University of Medical Sciences in year 2010 (n=65). The instrument was a researcher made ‎questionnaire including 33 questions. The questionnaire was validated through face and content validity and its reliability was confirmed based on Cronbach’s Alpha (0.85). We used student T-test, Spearman and Pearson correlation coefficient for statistical analysis. The mean of research understanding was 5.9± 1.49 out of eight. There was a significant positive relationship between previous research activities and the score of research understanding. There was also a significant relationship between interest toward research and doing research in clinical fields among students interested in research activities. Students showed a positive attitude toward research. However, they were more interested in clinical research rather than basic research and most students interested in research activities preferred clinical studies as their future activities. Offering MD-PhD dual degree training programs and recruiting physician scientist in them could introduce some career opportunities in this field and also train the demanding researchers for research centers in Iran medical research centers.

An effective factor in any individual’s efficacy in educational, occupational, and domestic areas, is having self-regulation skills. The aim of this study was to review the association between attribution styles and self-regulation among students of School of Nursing and Midwifery in Mashhad University of Medical Sciences. This descriptive correlation study was performed on all female and male students of School of Nursing and Midwifery of Mashhad University of Medical Sciences during 2011-2012 academic years. Using Morgan’s table and single-stage cluster sampling, 200 samples were selected. Data was collected using Seligman’ and Sink’s attribution styles questionnaire as well as Miller’ and Brown’s general self-regulation questionnaire. Data was analzed using descriptive statistics and multiple regression and analysis of variance tests. Among the three internal, stable, and generally attributional styles, only internal attribution style could predict performing and planning domains of self-regulation (p<0.01). None of attribution styles could predict investigating and evaluation domains of self-regulation (p>0/05). The results showed that there was a significant difference between male and female students considering three internal (F(1,139)=0.41, p<0.01), stable (F(1,139)=0.12, p<0.001), and generally (F(1,139)=0.006, p<0.001) attributional styles. One of the essential needs of medical community is to have responsible, committed, and self-regulated nurses and midwives having internal attribution style. Therefore, it seems necessary to provide educational environment in which nursing and midwifery students could be guided toward forming attribution styles to promote effective self-regulation.