70 1608-9359 Medical Education Development Center, Isfahan University of Medical Sciences 2875 Teaching Methods Rhetoric in teaching: A Neglected element (letter to editor) Behnamfar Reza 1 10 2013 13 7 623 625 31 08 2013 02 10 2013 No abstract
2565 Program Evaluation The Status of Observing Patient Rights Charter in Outpatient Clinics of Tabriz University of Medical Sciences: Perspectives of Health Service Clients Amini Abolghasem Tabrizi Jafar Sadegh Shaghaghi Abdolreza Narimani Mohammad reza 1 10 2013 13 7 611 622 14 02 2013 08 07 2013 Introduction: Patient Rights Charter consists of a series of patients' legal rights that health care providers must observe and carry out but available evidences show that these are not fully practiced in some outpatient centers. This study aimed to investigate the status of observing patient rights from the perspective of clients in outpatient clinics affiliated to Tabriz University of Medical Sciences. Methods: This cross-sectional survey study was conducted on patients admitted to outpatient centers of Tabriz University of Medical Sciences within December 2011 (N=382). These people were chosen through simple random sampling based on Cochran formula. Data collection instrument was a researcher-made questionnaire derived from Iranian Patient rights charter, which its validity and reliability was approved. Data was analyzed using t-test and ANOVA. Results: Mean and standard deviation of total score for observing all essentials of patients’ rights charter in outpatient centers of the university was at a moderate and reasonable level (42.18±15.15) from the viewpoint of patients. The area of “providing health services based on respecting patient’s privacy and observing the essentials of secrecy and confidentiality” enjoying the highest mean score (66.12±24.39), was at a desirable level compared to other areas. The area of “having access to effective complaint management system” showed the lowest mean score (23.85±23.07) from the participants’ perspective proving a poor level. Ninety three (24.17%) of health service receivers believed that almost all areas of Patient Right Charter were observed totally in outpatient centers of the university. This is while 96 people(25.17%) believed that patients’ right chart has never been practiced in outpatient centers of Tabriz University of Medical Sciences. Conclusions: The general satisfaction with observation of patients’ right charter in outpatient centers of Tabriz University of Medical Sciences is at a moderate level and considered to be acceptable. Only in area of “providing health services based on respecting patient’s privacy and observing the essentials of secrecy and confidentiality”, the satisfaction level is higher than norms. Therefore, study of factors affecting patients’ satisfaction is among research priorities for responding about the current satisfaction status and the manner of providing health services. 2490 Teaching Methods Team-Based Learning A New Strategy in Integrated Medical Curriculum: The experience of School of Medicine, Tehran University of Medical Sciences Hassanzadeh GHolamreza Abolhasani Farid Mirzazadeh Azim Alizadeh Maryam 1 10 2013 13 7 601 610 26 12 2012 01 10 2013 Introduction: Revising medical curricula & establishing reformed programs result in refined educational methods which are accompanied by development of active & student-based teaching methods such as Team Based Learning (TBL). This paper describes an experience of implementation and evaluation findings of TBL according to medical students’ viewpoints. Methods: This action research was planned for a census sample (n=187) basic science students of Tehran University of Medical Sciences with the new curriculum. After briefing the students about TBL and forming teams we did TBL in the following steps: Individual Readiness Assurance Test (IRAT), Team Readiness Assurance Test(TRAT), appeal, Team Application(TAP), and peer assessment in 15% of each program block. Data gathered by observation recording sheets, and a researcher-made questionnaire, and analyzed using descriptive statistics. Results: A major part of the students (63.8% ) have admitted TBL as a deep learning approach. Students believed that TRATs were useful (46.2%), team application was a learning facilitator in TBL classes (51.7%) and the class management was suitable (60.5%). The observational data showed that the students changed their seats in order to take part in group discussions. They were listening carefully, asking questions and giving reference to support their claims. Some were against this method because it increased their study workload. Conclusion: It seems TBL has a positive effect on deep learning and facilitates learning. The results indicate that TBL results in cooperative & active learning, and it improves class activity and may be, because of the developed interaction between students, it can promote communication skills. We recommend the use of TBL as a teaching method, beside other teaching methods, in medical sciences education. 2538 Teaching Methods The Effect of Preceptorship Program on Clinical Skills of Undergraduate Nursing Students Heydari Abbas Alizadeh Batul Mazloum SeyedReza 1 10 2013 13 7 588 600 22 01 2013 15 10 2013 Introduction: Several programs have been introduced to improve clinical skills of nursing students. Meanwhile, taking benefit of expert clinical nurses (preceptors) for educating nursing students is a new groove to clinical learning. Regarding the limited number of studies on this subject in Iran, current study aimed to determine the effect of preceptorship program on nursing students’ clinical skills. Methods: This experimental study of pre and post-test with two groups design was conducted on 64 BSc nursing students passing their clinical course in the burning-care ward of Imam-Reza hospital of Mashhad. Students were randomly assigned into two groups of control and intervention. In the intervention group, every student was supervised and trained by an expert nurse (preceptor). Control group were trained through the routine teaching method by the clinical instructor. The students’ clinical skills were measures and compared before and after clinical course in the two groups, using t-test, paired t-test Mann Whitney and covariance analysis Results: The students’ clinical skills were improved in both groups. According to the findings of independent t-test and Mann Whitney, the score increments in preceptorship program were significantly more than in the routine method (p≤0/002). Conclusion: Implementation of preceptorship program is helpful and effective for improving clinical skills of nursing students. Thus, it is recommended that educational centers and hospitals try to employ this educational method. On the other hand, the results of this study revealed the necessity of collaboration between academic members and health care providers. 2518 Teaching Methods The Effect of Using Feedback Strategies with an Emphasis on Pharmaceutical Care standards on Nursing Students’ Knowledge and their Medication Errors Purfarzad Zahra Farmahini Farahani Moloud Ghamari zare Zohreh Ghorbani Mojtaba 1 10 2013 13 7 577 587 15 01 2013 01 10 2013 Introduction: Medication administration process is a critical aspect of professional nursing care. Prevention from medical errors needs awareness and appropriate decision-making and performance. The aim of this study is to evaluate the effect of using feedback strategies with an emphasis on medication care standards on knowledge of nursing students and their medication errors. Methods: During two semesters of 2011-2012 academic year, a quasi-experimental study was conducted on 59 nursing students of Arak nursing school, who were passing training course in cardiopulmonary ward. Students were divided into 2 groups of intervention and control. Data-gathering tool was a researcher-made observation checklist about the types and frequency of medication errors which was completed by an observer. In order to evaluate pharmaceutical knowledge, a questionnaire of 26 items was developed by the researcher. The data was analyzed using descriptive statistics (mean and standard deviation) and Wilcoxon and Mann Whitney statistical tests. Results: There was a significant difference between mean scores of medication errors in both groups before and after intervention. After intervention, the mean score of knowledge was higher in intervention group (19.86±2.43) compared to that of control group (13.70±2.92). In addition, a statistically significant difference was observed in mean of medication errors between experiment (0.48±0.63) and control group (1.23±1.04) after intervention (P=0.001 and Z=3.20). Conclusion: There was an enhancement in the students’ awareness of medication care and a reduction in their medication errors. This reveals the positive outcome of giving feedback along with an emphasis on medication care standards and its helpful effects on students’ knowledge and their failures. Therefore, in order to enhance the efficacy of education and to reduce medication errors as well, clinical instructors can enrich the clinical training practices by choosing proper programs designed in accordance with objectives and educational contents. 2328 Teaching Methods Comparison of Video-Based Instruction and Instructor Demonstration on Learning of Practical Skills in Nursing Students Nourozi Heji Mohammad Rokhi Farkhondeh Karimi Moonaghi Hossein 1 10 2013 13 7 571 576 13 09 2012 01 10 2013 Introduction: Since technology has an important role in the improvement of educational quality, finding better methods of teaching and learning and improving equipment and teaching materials is emphasized. Regarding this, two educational methods- presentation by the instructor and video presentation, were offered and their effectiveness on nursing students’ learning skills was compared. Methods: This quasi-experimental study was carried on 48 nursing students of Mashhad nursing and midwifery school. One group received training through video film and the other were taught by instructor demonstration. Both had opportunity for practical exercise. The students’ learning was assessed via questionnaires and checklists in OSCE. To compare the scores of the two groups, the independent T-test and Mann Whitney U test were used. Results: The results indicated that the average grade for insertion and remove of NG tube, putting on and taking off the gloves in a non-surgical way in the instructor-led demonstration group was more than the video-presentation group (p<0.020). But in the case of hand scrub in a non-surgical way, the results did not indicate a significant difference (p<0.077). Conclusion: Video presentation showed to be less effective. This research confirms the superiority of instructor-led training for practical skills. Of course, in cases where live presentation- due to lack of instructors or equipment- is not possible, video-presentation as an alternative or as a complementary method could be used. 2443 Communication Skills Education The Time Allowed to Patients to Explain Their Problem in Outpatient Clinics of Mashhad University of Medical Sciences Hospitals Movaffaghi Zahra Makarem Abbas Beyraghi Narges Hosseini Fakhrossadat Farsi Mohammad 1 10 2013 13 7 561 570 30 11 2012 28 09 2013 Introduction: Listening to patients is essential for medical practice and patient care. This study was conducted to determine the time given to patients to explain their problem before being interrupted and redirected by clinical faculties in outpatient clinics of Mashhad University of Medical Sciences. Methods: The cross-sectional observational descriptive study was carried out in year 2011-2012, by observing and audio recording 330 clinical consultations from 30 faculty member physicians. The sample size was determined by doing a pilot study and the faculties were selected randomly using stratified sampling. The time initially given to patients to explain their problem before being interrupted and redirected by physicians was measured in seconds using a chronometer. An MP3 recorder was used for audio recording. Data were collected by non-participatory observation method. Descriptive statistics was used along with ANOVA, t test, correlation and regression for data analysis. Results: Participation rate in patients and physicians were 93% and 46%, respectively. The physicians had a mean age of 47, included both male(70% ) and female(30%), and were mainly assistant professors(67%). Data from 320 observations were analyzed. The average time given to the patients to explain their problems was 9.5±0.55 seconds. The given times were negatively correlated with number of booked appointments(r= -0.15, p≤0.007) and positively correlated with total consultation time(r=0.21, p≤0.0001). Conclusion: The findings show that the clinical faculties are giving relatively less time to their patients compared with the similar studies. Poor performance of faculties as the role models of future doctors leads to students’ cynicism for professional medical standards. Future projects are recommended in order to set standards for medical practice and maximum workload of physicians. 2350 Teaching Methods Quality of Residents’ Promotion Exams before & after Educational Intervention in 2010-2011 Taheri Mahdokht khoshrang Hossien Asadi louyeh Ataollah Hidarzadeh Abtin 1 10 2013 13 7 551 560 06 10 2012 28 09 2013 Introduction: Resident promotion exams are considered one of the most important summative exams in residency period that allow residents to proceed to a higher grade. Multiple choice questions are the most common and objective test in medical science education. Therefore, finding methods to improve quality of exams, particularly in specialty programs, is important. The aim of this study is to determine effectiveness of training workshops on improving quality of residency promotion exams in medical school of Guilan University of Medical Sciences (GUMS). Methods: In this Quasi-experimental study (before & after), all questions of resident promotion exams of GUMS for 12 specialty programs in year 2010 (150 questions for each specialty-1800 questions in total) were structurally and taxonomically evaluated using a valid and reliable checklist based on Millman principles. After12 one–day educational workshops (one for each department) on multiple choice questions), questions of residents’ promotion exam in year 2011 were evaluated. Data related to questions designed by faculties who had participated in the interventional workshop were analyzed using statistical Wilcoxon signed-rank test. Results: Taxonomy of questions of written promotion exam in years 2010 and 2011 were as follows: 1204(%66.09) questions were of first level taxonomy, 565 (%31.4) of 2nd level, and 31(% 1.7) of 3rd level in the 2010 exam, and 867 questions (%48.2) were of first level taxonomy, 741 (%41.2) of 2nd level, and 192 (%10.6) of 3rd level in the 2011. Findings showed significant differences between taxonomy of questions of different programs in 2010 and 2011 (p=0.0001, Z=23.83). Also, according to Millman’s structural principles, the rate of questions with no structural problem was %66.77 in the year 2010 and %75.22 in 2011. There is a statistically significant difference based on Millman principles between 2010 and 2011 (p=0.0001, Z=16.703). Conclusion: Current study showed that training workshops are effective in improving the rate of questions targeted at higher levels of knowledge (Taxonomies 2 & 3) in residency promotion exams. 2515 other Attitudes of Environmental Health and Occupational Health Students Toward Their Discipline and Future Career in Qazvin University of Medical Sciences in 2012. Jamali Hamzah Ali Ghalenoei Mehran 1 10 2013 13 7 541 550 13 01 2013 01 10 2013 Introduction: The raise of environmental and occupational health graduates followed by scarce employment has developed a concern about these disciplines and future career among students. This study was performed with the aim of determining environmental health and occupational health students' attitude toward their disciplines and future career in Qazvin University of Medical Sciences in 2012. Methods: All environmental and occupational health freshmen of Qazvin University of Medical Sciences studying for a segregated or integrated Bachelor’s Degree in 2012-2013 participated in this descriptive cross-sectional study through census (n=156). The data gathering tool was Minnesota University questionnaire including 17 questions, using a Likert scale. Data were analyzed using t-test and chi-square test. Results: The mean and standard deviation of environmental students' attitude toward their future career was 50.7±9.7 (out of 85). Also mean and standard deviation of occupational students' attitude was 53.3±6.9. Mean and standard deviation of environmental health students' attitude in men was 58±8.4, But these parameters in women were 49.7±9.7. On the other hand, mean and standard deviation of occupational health students' attitude toward their future career was 53.3±7.6 in men and 53.2± 6.7 in women. Conclusion: The mean score for attitude of environmental health under investigation toward their discipline and future career was lower than acceptable level which demonstrates lack of desirable attitude toward future career among students. The authorities should pay special attention to creating jobs for these students. Curriculum improvement should also be seriously considered in order to increase the students’ competence. Also, informing students about university disciplines before they take the entrance examination, and supporting the students financially may prove helpful in improving their attitudes.